Language abnormality in deaf people with schizophrenia: a problem with classifiers.

INTRODUCTION: Although there is evidence for language abnormality in schizophrenia, few studies have examined sign language in deaf patients with the disorder. This is of potential interest because a hallmark of sign languages is their use of classifiers (semantic or entity classifiers), a reference-tracking device with few if any parallels in spoken languages. This study aimed to examine classifier production and comprehension in deaf signing adults with schizophrenia. METHOD: Fourteen profoundly deaf signing adults with schizophrenia and 35 age- and IQ-matched deaf healthy controls completed a battery of tests assessing classifier and noun comprehension and production. RESULTS: The patients showed poorer performance than the healthy controls on comprehension and production of both nouns and entity classifiers, with the deficit being most marked in the production of classifiers. Classifier production errors affected handshape rather than other parameters such as movement and location. CONCLUSIONS: The findings suggest that schizophrenia affects language production in deaf patients with schizophrenia in a unique way not seen in hearing patients.

[Secondary chondrosarcoma: radiopathological correlation]. / Condrosarcoma secundario: correlación radiopatológica.

Chondrosarcomas are malignant bone tumors originating in cartilage. Chondrosarcoma is the third most common malignant bone tumor after multiple myeloma and osteosarcoma. About 75% of chondrosarcomas are primary lesions. The remaining 25% belong to special categories such as histologic variants and secondary forms. A secondary chondrosarcoma is one that appears in a pre-existing benign chondral lesion; the different types of secondary chondrosarcomas include solitary osteochondroma, multiple osteochondromatosis, enchondroma, the different types of enchondromatosis, and primary synovial chondromatosis. The incidence of this malignant transformation varies widely in function of the type of lesion. In this article, we discuss and illustrate the different types of secondary chondrosarcomas, placing special emphasis on the imaging findings that should alert to these lesions and give radiologists a key role in the diagnosis, management, and follow-up of these patients.

Early evolutionary colocalization of the nuclear ribosomal 5S and 45S gene families in seed plants: evidence from the living fossil gymnosperm Ginkgo biloba.

In seed plants, the colocalization of the 5S loci within the intergenic spacer (IGS) of the nuclear 45S tandem units is restricted to the phylogenetically derived Asteraceae family. However, fluorescent in situ hybridization (FISH) colocalization of both multigene families has also been observed in other unrelated seed plant lineages. Previous work has identified colocalization of 45S and 5S loci in Ginkgo biloba using FISH, but these observations have not been confirmed recently by sequencing a 1.8 kb IGS. In this work, we report the presence of the 45S-5S linkage in G. biloba, suggesting that in seed plants the molecular events leading to the restructuring of the ribosomal loci are much older than estimated previously. We obtained a 6.0 kb IGS fragment showing structural features of functional sequences, and a single copy of the 5S gene was inserted in the same direction of transcription as the ribosomal RNA genes. We also obtained a 1.8 kb IGS that was a truncate variant of the 6.0 kb IGS lacking the 5S gene. Several lines of evidence strongly suggest that the 1.8 kb variants are pseudogenes that are present exclusively on the satellite chromosomes bearing the 45S-5S genes. The presence of ribosomal IGS pseudogenes best reconciles contradictory results concerning the presence or absence of the 45S-5S linkage in Ginkgo. Our finding that both ribosomal gene families have been unified to a single 45S-5S unit in Ginkgo indicates that an accurate reassessment of the organization of rDNA genes in basal seed plants is necessary.

Pump-probe X-ray holographic imaging of laser-induced cavitation bubbles with femtosecond FEL pulses.

Cavitation bubbles can be seeded from a plasma following optical breakdown, by focusing an intense laser in water. The fast dynamics are associated with extreme states of gas and liquid, especially in the nascent state. This offers a unique setting to probe water and water vapor far-from equilibrium. However, current optical techniques cannot quantify these early states due to contrast and resolution limitations. X-ray holography with single X-ray free-electron laser pulses has now enabled a quasi-instantaneous high resolution structural probe with contrast proportional to the electron density of the object. In this work, we demonstrate cone-beam holographic flash imaging of laser-induced cavitation bubbles in water with nanofocused X-ray free-electron laser pulses. We quantify the spatial and temporal pressure distribution of the shockwave surrounding the expanding cavitation bubble at time delays shortly after seeding and compare the results to numerical simulations.

[Prevalence of nosocomial infections in 27 hospitals in the Mediterranean region]. / Prévalence des infections nosocomiales dans 27 hôpitaux de la région Méditerranéenne.

A multicentre study was conducted in 27 hospitals in Algeria, Egypt, Italy, Morocco and Tunisia to evaluate the prevalence and characteristics of the nosocomial infections. The study population (4634 patients) was relatively young, mean age 41.1 (standard deviation 23.4) years. The prevalence of nosocomial infections was 10.5%; this was higher in non-teaching centres and moderate-sized hospitals. Overall, urinary tract infections were the most common. Paediatric departments rated particularly high (11.3%). The most commonly isolated organisms were: Escherichia coli (17.2%), Staphylococcus aureus (12.5%), Pseudomonas aeruginosa and Klebsiella pneumoniae (9.2% each). On the day of the study, 40.7% of the patients were under treatment with antibiotics, with nearly half for an empirical indication. Nosocomial infection was significantly associated with mechanical ventilation, hospitalization > or = 8 days, presence of a central or peripheral catheter), urinary catheter, diabetes and age.

Long-acting opioid-agonists in the treatment of heroin addiction: why should we call them "substitution"?

Many studies have documented the safety, efficacy, and effectiveness of long-acting opioids (L-AOs), such as methadone and buprenorphine, in the treatment of heroin addiction. This article reviews the pharmacological differences between L-AO medications and short-acting opioids (heroin) in terms of reinforcing properties, pharmacokinetics, effects on the endocrine and immune systems. Given their specific pharmacological profile, L-AOs contribute to control addictive behavior, reduce craving, and restore the balance of disrupted endocrine function. The use of the term "substitution," referring to the fact that methadone or buprenorphine replace heroin in binding to brain opioid receptors, has been generalized to consider L-AOs as simple replacement of street drugs, thus contributing to the widespread misunderstanding of this treatment approach.

[Oral nutritional supplementation in hematologic patients]. / Suplementación oral nutricional en pacientes hematológicos.

RATIONALE: Hematological patients often present anorexia which along with other secondary effects from the chemotherapy and/or radiotherapy treatments compromise their nutritional status. Oral supplementation can aid to fulfill the energy and protein requirements of these patients. Nevertheless, the use of commercial nutritional supplements normally available, is limited by its poor intake. OBJECTIVE: To evaluate the degree of fulfillment of the prescribed supplements and fulfillment of energy requirements, as well as the development of nutritional status in hematological patients hospitalized for treatment with chemotherapy and/or radiotherapy. METHODS: Prospective, randomized and open study of inpatients at the hematological ward. Patients were randomized sequentially and they were assigned into 3 different nutritional interventions providing: Group 1 (G1), a flavored supplement; Group 2 (G2): a non flavored (neutral) supplement and Group 3 (G3): "kitchen" foods as supplements. Need and amount of nutritional supplements were provided according to the oral intake previously analyzed. Nutritional assessment (at admission and discharge) was based in the Subjective Global Assessment test (SGA), Risk Nutritional Index (RNI) and percentage of lost weight. Both fulfillment of supplement intake and achievement of energetic requirements were analyzed. RESULTS: 125 patients of 51.3 +/- 16.8 years; 45% men and 55% women. DIAGNOSIS: 54% lymphoma, 33% leukemia, 8% myeloma and others 4%. Length of stay (LOS): 7.0 +/- 3.6 d. The nutritional assessment done by SGA showed significant negative changes in G2 and G3 (G1: 30% developed malnutrition and 28% improved their nutritional status, p = NS; G2: 50% developed malnutrition against 7% whom improved their nutritional status, p = 0.002; y G3: 37% developed malnutrition against 21% whom improved their nutritional status, p = 0.02). According to RNI, patients evolved negatively from their nutritional state but no significant differences were found within groups (G1, from 81% of malnutrition to 90%; G2, from 77% to 91%, and G3 from 71% to 85%). Globally, during hospitalization patients lost weight significantly (2.3 +/- 2.2 kg, p < 0.001), but within groups weight loss differences were not significant (G1, 1.16 kg; G2, 1.75 kg, y G3, 1.17 kg). All three groups required intake of supplements (G1, 47%; G2, 30%, and G3, 47%). The percentage of fulfillment of oral intake was similar in both commercial supplemented groups (G1, 47% and G2, 58%) although it was significantly greater in those receiving kitchen supplements (G3, 100%, p < 0.001). The fulfillment of energy requirements at admission and discharge did not showed significant changes (G1, from 53% to 46%; G2, from 67% to 52% and G3 from 49% to 55%). CONCLUSION: Our results suggest that hematological patients admitted to hospital for treatment with chemotherapy and/or radiotherapy loose weight during their hospitalization and present intakes below their energy requirements so they need supplementation. Kitchen supplements are better accepted than commercial ones although that does not result in an increased total energy intake. The group which received commercial flavored supplements was the only one which did not showed negative significant changes in the nutritional status evaluated by SGA.

Dissimilar molecular and morphological patterns in an introgressed peripheral population of a sand dune species (Armeria pungens, Plumbaginaceae).

Introgression is a poorly understood evolutionary outcome of hybridisation because it may remain largely undetected whenever it involves the transfer of small parts of the genome from one species to another. Aiming to understand the early stages of this process, a putative case from the southernmost border of the Armeria pungens range from its congener A. macrophylla is revisited following the discovery of a subpopulation that does not show phenotypic signs of introgression and resembles typical A. pungens. We analysed morphometrics, nuclear ribosomal DNA ITS and plastid DNA (trnL-trnF) sequences, genome size, 45S and 5S rDNA loci-FISH data and nrDNA IGS sequences. Within the study site, most individuals match morphologies of either of the two hybridising species, particularly the new subpopulation, with intermediate phenotypes being scarce. This pattern does not fully fit molecular evidence revealing two ITS ribotypes co-occurring intragenomically in most plants from the study site and one single plastid haplotype. Genome size and structural features of the IGS sequences both indicate that A. pungens from the study site is genetically more similar to its sympatric congener than to the remainder of its conspecifics. Introgression of A. macrophylla into A. pungens and plastid capture explain all the evidence analysed. However, important features to understand the origin and fate of the introgressed population, such as the degree and direction of introgression, which are important for understanding early stages of hybridisation in plants with low reproductive barriers, should be addressed with new data.

Sarcomatoid urothelial bladder carcinoma in adults: Histology, symptomatology, treatments and survival. / Carcinoma urotelial sarcomatoide de vejiga en el adulto: histología, sintomatología, tratamientos y supervivencia.

OBJECTIVE: Sarcomatoid urothelial bladder carcinoma comprises 3% of the tumours of the bladder and is considered one of the most aggressive tumours of the urinary tract. Our aim is to analyse the characteristics of sarcomatoid urothelial bladder carcinoma in adults, its treatments and survival. METHOD: A retrospective study performed between 2000 and 2017 of all the patients with a sarcomatoid urothelial bladder carcinoma in a single centre. We studied the anatomopathological characteristics, symptoms at time of diagnosis, treatment given and survival according to the treatment given. RESULTS: Sixteen patients were diagnosed with sarcomatoid carcinoma, 11 with no heterologous component, one with rhabdomyosarcomatous components, 2 with chondrosarcomatous components and 2 with osteosarcomatous components. The mean age was 74 years (±20) and 88% were smokers. The primary symptom was haematuria, and the least well-tolerated was dysuria together with hypogastric pain. Ninety-four percent of the patients had muscle layer infiltration and 18% had metastases at the time of diagnosis. Thirty-seven percent of the patients were treated by radical cystectomy, thirteen percent by radical cystectomy plus adjuvant chemotherapy, and 50% were treated by palliative transurethral resection to control their symptoms. A survival curve was made with the different treatments given, which showed a mean global survival of 7 months and no statistically significant differences in terms of survival according to the treatment given. CONCLUSIONS: Sarcomatoid urothelial carcinoma is an aggressive disease, of rapid and torpid onset which occurs in patients of advanced age and smokers. There are no established treatment guidelines, and it appears that no treatment influences increased survival. Cystectomy should be evaluated as a treatment alternative for patients whose symptoms are difficult to control. The various heterologous components do not appear to influence the progression of the disease or patient survival.

A Stochastic Spiking Neural Network for Virtual Screening.

Virtual screening (VS) has become a key computational tool in early drug design and screening performance is of high relevance due to the large volume of data that must be processed to identify molecules with the sought activity-related pattern. At the same time, the hardware implementations of spiking neural networks (SNNs) arise as an emerging computing technique that can be applied to parallelize processes that normally present a high cost in terms of computing time and power. Consequently, SNN represents an attractive alternative to perform time-consuming processing tasks, such as VS. In this brief, we present a smart stochastic spiking neural architecture that implements the ultrafast shape recognition (USR) algorithm achieving two order of magnitude of speed improvement with respect to USR software implementations. The neural system is implemented in hardware using field-programmable gate arrays allowing a highly parallelized USR implementation. The results show that, due to the high parallelization of the system, millions of compounds can be checked in reasonable times. From these results, we can state that the proposed architecture arises as a feasible methodology to efficiently enhance time-consuming data-mining processes such as 3-D molecular similarity search.

[Polyarthritis secondary to intravesical BCG instillation, a case report]. / Poliartritis secundaria a instilaciones intravesicales de BCG, a propósito de un caso.

Immunotherapy with intravesical instillation of Bacillus Calmette is the best complementary after TUR treatment against T1 grade 2- 3 and CIS bladder cancer. However, this therapy is associated with several side- effects, incluiding joint symptoms. In this article we describe a case of polyarthritis associated with intravesical instillation, a rare complication. We review the clinical features, the pathogenic mechanisms and treatments described previously in the medical literature. Finally, we expose our brief experience and our final result.

Nosocomial and community-acquired meticillin-resistant Staphylococcus aureus infections in hospitalized patients (Spain, 1993-2003).

A series of annual surveys on the prevalence of infections in hospitalized patients in Spain was undertaken from 1993 to 2003 to describe clinical and demographic characteristics, trends and geographical variations in the proportion of meticillin-resistant Staphylococcus aureus (MRSA). A total of 8312 S. aureus infections in patients from 296 acute care hospitals pertaining to 17 regions in Spain were observed during the study period. Overall, 23.8% of these organisms were reported as meticillin resistant. The proportion of MRSA varied widely across regions and during the study period. Patients with nosocomial infections (NIs) had a two-fold higher prevalence of MRSA (31%) than patients with community-acquired infections (CAIs) (14%; P<0.001). Nevertheless, there was an increasing trend in the prevalence of MRSA isolates, both in patients with NI (from 22% to 41%; P<0.001) and with CAI (from 7% to 28%; P<0.001) throughout the 11-year period. Geographical variations over the last three years (2001-2003) show a centripetal gradient, with the lowest MRSA prevalence in south-west Spain and the highest MRSA prevalence in the central regions. Almost five-fold differences in MRSA proportions were seen between regions (range 10.3-54.5%). Compared with bloodstream infections, infections in other sites were more likely to be caused by MRSA (adjusted odds ratios for surgical site, urinary tract, skin and respiratory infections of 1.2, 1.2, 1.5 and 2.1, respectively).

Positional stability and radial dynamics of sonoluminescent bubbles under bi-harmonic driving: Effect of the high-frequency component and its relative phase.

The use of bi-frequency driving in sonoluminescence has proved to be an effective way to avoid the spatial instability (pseudo-orbits) developed by bubbles in systems with high viscous liquids like sulfuric or phosphoric acids. In this work, we present extensive experimental and numerical evidence in order to assess the effect of the high frequency component (PAc(HF)) of a bi-harmonic acoustic pressure field on the dynamic of sonoluminescent bubbles in an aqueous solution of sulfuric acid. The present study is mainly focused on the role of the harmonic frequency (Nf0) and the relative phase between the two frequency components (φb) of the acoustic field on the spatial, positional and diffusive stability of the bubbles. The results presented in this work were analyzed by means of three different approaches. First, we discussed some qualitative considerations about the changes observed in the radial dynamics, and the stability of similar bubbles under distinct bi-harmonic drivings. Later, we have investigated, through a series of numerical simulations, how the use of high frequency harmonic components of different order N, affects the positional stability of the SL bubbles. Furthermore, the influence of φb in their radius temporal evolution is systematically explored for harmonics ranging from the second to the fifteenth harmonic (N=2-15). Finally, a multivariate analysis based on the covariance method is performed to study the dependences among the parameters characterizing the SL bubble. Both experimental and numerical results indicate that the impact of PAc(HF) on the positional instability and the radial dynamics turns to be progressively negligible as the order of the high frequency harmonic component grows (i.e. N ≫ 1), however its effectiveness on the reduction of the spatial instability remains unaltered or even improved.

Strategies for prognostic assessment of uncomplicated first myocardial infarction: 5-year follow-up study.

OBJECTIVES: Our aim was to use noninvasive studies early after infarction to assess medium-term prognosis in patients with a first uncomplicated myocardial infarction. BACKGROUND: Although the use of early postinfarction assessment to gauge short-term prognosis in myocardial infarction is well established, there have been few comprehensive evaluations of noninvasive methods for assessing medium- and long-term prognosis. METHODS: We prospectively studied 115 consecutive patients < 65 years old with a first acute uncomplicated myocardial infarction to evaluate the prognostic role of predischarge cardiac studies. These included submaximal exercise testing, thallium-201 scintigraphy, radionuclide exercise ventriculography, two-dimensional echocardiography, ambulatory electrocardiographic (Holter) monitoring and cardiac catheterization. All patients without complications were followed up > or = 5 years. RESULTS: During the follow-up period, 78 patients (68%) developed complications, which were severe in 37 (32%). Exercise thallium-201 scintigraphy yielded the highest percentage (77%) for correctly classified patients. It also had the highest predictive value for complications (97%) and severe complications (92%) when it was used in association with exercise testing and radionuclide ventriculography. The addition of cardiac catheterization did not improve on the predictive power of noninvasive studies. Four decision trees (exercise testing + echocardiography, exercise testing + radionuclide ventriculography, thallium-201 + echocardiography, thallium-201 + radionuclide ventriculography) allowed stratification of all patients in a high, intermediate or low risk category. The combination of thallium-201 scintigraphy and radionuclide ventriculography yielded the best results (90% predictive value for complications if the outcome of both tests was positive), but there were no significant differences with the other models. CONCLUSIONS: Any combination of a test detecting residual ischemia or functional capacity, or both (exercise testing or thallium-201 scintigraphy), and a test assessing ventricular function (echocardiography or radionuclide ventriculography) results in useful prognostic information in patients with an uncomplicated first acute myocardial infarction.

Uncomplicated first myocardial infarction: strategy for comprehensive prognostic studies.

To evaluate the prognostic role of combined cardiac studies (submaximal exercise test, thallium-201 scintigraphy, radionuclide exercise ventriculography, two-dimensional echocardiography, Holter monitoring and cardiac catheterization) in patients with a first acute myocardial infarction without complications during hospital admission, 115 consecutive patients aged less than 65 years were prospectively evaluated. The studies were carried out before hospital discharge and the patients were then clinically followed up for 12 months. During the follow-up period, 69 patients (60%) developed complications, which were severe in 23 (20%). Half of all complications and 70% of severe complications developed during the 1st follow-up month. Logistic regression analysis disclosed that the combination of studies with the highest predictive power for complications (probability of complications 99%) and severe complications (probability of severe complications 95%) was the association of exercise test + thallium-201 + echocardiogram. Four decision models (exercise test + echocardiography, exercise test + radionuclide ventriculography, thallium-201 scintigraphy + echocardiography, thallium-201 scintigraphy + radionuclide ventriculography) allowed the stratification of all patients in a particular risk category (high, intermediate or low). The best decision model was the association of thallium-201 scintigraphy + radionuclide ventriculography (probability of complications if both tests were positive 84%; probability of absence of severe complications if both tests were negative 88%), but there were no significant differences with the other models. Any association of a test detecting residual ischemia or functional capacity, or both (exercise test or thallium-201) and a test assessing ventricular function (echocardiography or radionuclide ventriculography) results in significant prognostic information in patients with an uncomplicated first acute myocardial infarction. Additional cardiac catheterization does not improve the predictive power of noninvasive studies, which should ideally be performed before hospital discharge because most complications develop during the 1st follow-up month.

Stable tridimensional bubble clusters in multi-bubble sonoluminescence (MBSL).

In the present work, stable clusters made of multiple sonoluminescent bubbles are experimentally and theoretically studied. Argon bubbles were acoustically generated and trapped using bi-frequency driving within a cylindrical chamber filled with a sulfuric acid aqueous solution (SA85w/w). The intensity of the acoustic pressure field was strong enough to sustain, during several minutes, a large number of positionally and spatially fixed (without pseudo-orbits) sonoluminescent bubbles over an ellipsoidally-shaped tridimensional array. The dimensions of the ellipsoids were studied as a function of the amplitude of the applied low-frequency acoustic pressure (PAc(LF)) and the static pressure in the fluid (P0). In order to explain the size and shape of the bubble clusters, we performed a series of numerical simulations of the hydrodynamic forces acting over the bubbles. In both cases the observed experimental behavior was in excellent agreement with the numerical results. The simulations revealed that the positionally stable region, mainly determined by the null primary Bjerknes force (F→Bj), is defined as the outer perimeter of an axisymmetric ellipsoidal cluster centered in the acoustic field antinode. The role of the high-frequency component of the pressure field and the influence of the secondary Bjerknes force are discussed. We also investigate the effect of a change in the concentration of dissolved gas on the positional and spatial instabilities through the cluster dimensions. The experimental and numerical results presented in this paper are potentially useful for further understanding and modeling numerous current research topics regarding multi-bubble phenomena, e.g. forces acting on the bubbles in multi-frequency acoustic fields, transient acoustic cavitation, bubble interactions, structure formation processes, atomic and molecular emissions of equal bubbles and nonlinear or unsteady acoustic pressure fields in bubbly media.

Cigarette smoking and male lung cancer risk with special regard to type of tobacco.

BACKGROUND: The mortality rate from lung cancer (LC) increased sharply in Spain between 1957 and 1986. This increase has been related to a previous increase in cigarette smoking. Certain features of cigarette smoking which were frequent among Spanish smokers (use of black tobacco and use of cigarettes without filter) have been related to a higher risk of LC. METHODS: A hospital-based case-control study was conducted between December 1986 and June 1990. The 325 male patients with lung cancer included in the study (cases) were compared with 325 age-matched male controls without LC. Occupation and lifetime tobacco consumption were requested using a structured questionnaire. The LC odds ratios (OR) and 95% CI were estimated with multiple logistic regression. RESULTS: Lung cancer risk increased with cigarette consumption and duration of the habit. After adjusting for lifetime cigarette consumption and for socioeconomic level, LC risk was greater among black tobacco smokers than among exclusive blond tobacco smokers (OR = 5.0, 95% CI: 2.0-12.7); LC risk among long-term (> or =20 years) filter-tipped cigarette users was lower compared to all other smokers (OR = 0.4, 95% CI: 0.2-0.7). CONCLUSIONS: The main results of the study (a higher LC risk among black tobacco users than in exclusive blond tobacco users, and a lower LC risk among long-term filter-tipped cigarette smokers than all other smokers) have been consistent with previous case-control studies and with ecologic studies which took into account past exposure levels.

Nosocomial infections in Spain: results of five nationwide serial prevalence surveys (EPINE Project, 1990 to 1994). Nosocomial Infections Prevalence Study in Spain.

OBJECTIVE: To determine trends in rates of nosocomial infections in Spanish hospitals. DESIGN: Prospective prevalence studies, performed yearly from 1990 through 1994. SETTING: A convenience sample of acute-care Spanish hospitals. PARTICIPANTS AND PATIENTS: The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately. RESULTS: The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P = .0001). Patients admitted to intensive-care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis. CONCLUSIONS: The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicated that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.

Nosocomial infections in pediatric patients: a prevalence study in Spanish hospitals. EPINE Working Group.

BACKGROUND: The magnitude of the problem of nosocomial infection in children has never been studied in Spain. METHODS: In 1990, a nationwide cross-sectional study was conducted to determine the prevalence of nosocomial infection and associated risk factors. RESULTS: Among 38,489 patients surveyed, 4081 were pediatric patients. Three hundred forty-five patients (8.4%) had active nosocomial infection at the time of the survey. Pediatric intensive care units (29.7%), hematology (23%), and special units (22%) showed the highest rates. Infections were most common in patients younger than 1 year (prevalence, 12.3%). Frequencies of nosocomial infection by site were as follows: bloodstream, 22.1%; urinary tract, 13.1%; lower respiratory tract, 12.3%; postoperative wound, 8%; gastrointestinal tract, 7.6%; skin, 6.5%; eye, 5.8%; and others 24.6%. The factors most closely associated with a higher prevalence of nosocomial infection in pediatrics were as follows: age younger than 1 year, surgery, moderate and severe baseline risk, number of diagnoses, and all categories of extrinsic risk factors. The most frequent etiologic agents were gram-positive bacteria (45.8%). CONCLUSIONS: Although the overall prevalence is at an acceptable level, future efforts should be focused on developing more effective prevention strategies in specific areas.