[Study of incidence of COVID-19 in Spain and its relationship to geographical province distribution]. / Estudio de la incidencia de COVID-19 en España y su relación geográfica provincial.

BACKGROUND: The aim of this study was to determine incidence of COVID-19 in relationship to geographical distribution among Spain. METHOD: Cluster analysis taking into consideration the incidence of COVID-19 in the provinces and autonomous cities of Spain in each of the first six waves of the pandemic. RESULTS: All the provinces of the Canary Islands, Catalonia and Andalusia form independent clusters. In Comunidad Valenciana, Galicia, País Vasco and Aragón two out of three provinces (three out of four in Galicia) were in the same cluster, with no other provinces. DISCUSSION: The incidence of COVID-19 in Spain in the first six waves forms clusters that reproduce the territorial division of Spain into autonomous communities. Although this could be explained by greater mobility within a community, it cannot be ruled out that this distribution is due to differences in screening, diagnosis, registration or reporting of COVID-19 cases.

Changes in volatile fatty acid production and microbiome during fermentation of food waste from hospitality sector.

Due to the increasing demand for low carbon-footprint bioproducts in the markets, innovative processes technologies and products are needed. The objective of this study was to assess the quality and potential of food waste (FW) from the hospitality sector to produce volatile fatty acids (VFAs). A batch type acid fermentation system was used to study VFA production in different process conditions (a decreased pH and increased organic loading rate). The evolution of VFAs and long-chain fatty acids was followed. Amplicon sequencing of the 16S rRNA gene was used to investigate the bacterial and archaeal community, and elucidate microbial communities in different FW and process conditions. The results show that high VFA concentrations (of up to 18 g/L) were achieved in overloaded conditions, which were also affected by the activity and composition of the inoculum. FW played an important role in modulating microbial composition, especially the bacterial communities belonging to the lactic acid bacteria group.

Development of an Anti-Acinetobacter baumannii Biofilm Phage Cocktail: Genomic Adaptation to the Host.

The need for alternatives to antibiotic therapy due to the emergence of multidrug resistant bacteria (MDR), such as the nosocomial pathogen Acinetobacter baumannii, has led to the recovery of phage therapy. In addition, phages can be combined in cocktails to increase the host range. In this study, the evolutionary mechanism of adaptation was utilized in order to develop a phage adapted to A. baumannii, named phage Ab105-2phiΔCI404ad, from a mutant lytic phage, Ab105-2phiΔCI, previously developed by our group. The whole genome sequence of phage Ab105-2phiΔCI404ad was determined, showing that four genomic rearrangements events occurred in the tail morphogenesis module affecting the ORFs encoding the host receptor binding sites. As a consequence of the genomic rearrangements, 10 ORFs were lost and four new ORFs were obtained, all encoding tail proteins; two inverted regions were also derived from these events. The adaptation process increased the host range of the adapted phage by almost 3-fold. In addition, a depolymerase-expressing phenotype, indicated by formation of a halo, which was not observed in the ancestral phage, was obtained in 81% of the infected strains. A phage cocktail was formed by combining this phage with the A. baumannii phage vB_AbaP_B3, known to express a depolymerase. Both the individual phages and the phage cocktail showed strong antimicrobial activity against 5 clinical strains and 1 reference strain of A. baumannii tested. However, in all cases resistance to the bacterial strains was also observed. The antibiofilm activity of the individual phages and the cocktail was assayed. The phage cocktail displayed strong antibiofilm activity.

Bio-based Algae Oil: an oxidation and structural analysis.

OBJECTIVE: In search of natural components, vegetal oils are increasingly becoming more popular in cosmetics. However, high oxidation instability, presence of potential allergens and synthetic anti-oxidants have limited their applications so far. Therefore, a need exists for a natural emollient with high oxidation stability. In this work, we report on a novel sustainably produced triglyceride containing primarily three monounsaturated oleic acid chains, dubbed 'Bio-Based Algae Oil' hereafter, as a natural emollient for cosmetic formulations. To produce Bio-Based Algae Oil, simple sugars are converted into triglyceride oils using microalgae fermentation with minimal environmental impact. METHODS: Bio-Based Algae Oil was compared to other commonly used triglyceride-based emollients in the skincare industry in terms of thermal/oxidation stability, composition and moisturizing properties. Oxidation stability of emollients was compared using Rancimat and pressurized differential scanning calorimetry (PDSC) techniques. Fatty acid composition of each oil was analysed using proton nuclear magnetic resonance (1 H-NMR) and gas chromatography (GC) techniques to correlate unsaturation level of each oil to its oxidation stability. We also conducted an in vivo moisturizing study in which skin hydration level of human subjects was compared before and after application of emollient up to 24 h. RESULTS: Results showed that Bio-Based Algae Oil was the most stable emollient in thermal and oxidation stability studies given its low unsaturation and high anti-oxidant content determined by 1 H-NMR and GC techniques. It also provided the highest skin hydration level when applied on skin demonstrating its efficacy as a moisturizing emollient in cosmetic formulations. CONCLUSIONS: Compositional analysis of Bio-Based Algae revealed that it is a triglyceride containing primarily three monounsaturated oleic acid chains with very low polyunsaturated fatty acid content resulting in high oxidation stability and consequently prolonged shelf-life. Given its sustainability, high oxidation stability and skin health benefits such as moisturization demonstrated during an in vivo study, we envision to utilize Bio-Based Algae Oil in many cosmetic formulations across skincare, suncare and bath and shower markets.

OBJECTIF: Dans la quête de composants naturels, les huiles végétales deviennent de plus en plus prisées en cosmétique. Toutefois, la forte instabilité à l'oxydation, la présence d'allergènes potentiels et d'antioxydants synthétiques ont contribué à la réduction de leurs demandes jusqu'ici. Par conséquent, il existe un besoin en émollient naturel doté d'une stabilité à l'oxydation élevée. Dans le cadre de ces travaux, nous présentons un nouveau triglycéride produit de manière durable contenant principalement trois chaînes d'acide oléique mono-insaturées, appelé « Huile d'algues d'origine biologique ¼ comme étant un émollient naturel pour les produits cosmétiques. Pour obtenir de l'Huile d'algues d'origine biologique, des sucres rapides sont transformés en huiles triglycérides par fermentation de microalgues avec un impact environnemental minimal. MÉTHODES: L'huile d'algues d'origine biologique a été comparée à d'autres émollients à base de triglycérides fréquemment utilisés dans l'industrie des soins de la peau en matière de stabilité thermique ou d'oxydation, de composition et de propriétés hydratantes. Stabilité thermique ou oxydation, composition et propriétés hydratantes. La stabilité à l'oxydation des émollients a été comparée grâce au Rancimat et à des techniques de calorimétrie différentielle à balayage haute pression (PDSC). La composition des acides gras de chaque huile a été analysée grâce aux techniques de résonance magnétique nucléaire du proton (1 H-NMR) et de chromatographie en phase gazeuse (CPG) afin de créer une corrélation entre le taux d'insaturation de chaque huile et sa stabilité à l'oxydation. Nous avons également procédé à une étude in vivo de l'hydratation au cours de laquelle le niveau d'hydratation de la peau des patients humains a été comparé avant et après l'utilisation de l'émollient sur une période allant jusqu'à 24 h. RÉSULTATS: Les résultats ont démontré que l'huile d'algues d'origine biologique était l'émollient le plus stable lors des études sur la stabilité thermique et la stabilité à l'oxydation, en raison de sa faible insaturation et de sa teneur élevée en antioxydants déterminés par les techniques 1 H-NMR et GC. Elle a également produit le taux d'hydratation de la peau le plus élévé, lorsqu'appliqué à la peau, ce qui démontre son efficacité comme émollient hydratant dans les produits cosmétiques. CONCLUSIONS: L'analyse de la composition de l'huile d'algues d'origine biologique a révélé qu'il s'agit d'un triglycéride contenant principalement trois chaînes d'acide oléique mono-insaturées avec une très faible teneur en acides gras polyinsaturés, ce qui entraîne une stabilité à l'oxydation élevée et par conséquent une durée de vie prolongée. Compte tenu de sa durabilité, sa stabilité à l'oxydation élevée et ses bienfaits pour la santé de la peau, notamment l'hydratation démontrée au cours d'une étude in vivo, nous envisageons d'utiliser l'huile d'algues d'origine biologique dans de nombreuses formulations cosmétiques présentes sur le marché des soins de la peau, des produits solaires et des bains et douches.

Mechanisms of Bacterial Tolerance and Persistence in the Gastrointestinal and Respiratory Environments.

Pathogens that infect the gastrointestinal and respiratory tracts are subjected to intense pressure due to the environmental conditions of the surroundings. This pressure has led to the development of mechanisms of bacterial tolerance or persistence which enable microorganisms to survive in these locations. In this review, we analyze the general stress response (RpoS mediated), reactive oxygen species (ROS) tolerance, energy metabolism, drug efflux pumps, SOS response, quorum sensing (QS) bacterial communication, (p)ppGpp signaling, and toxin-antitoxin (TA) systems of pathogens, such as Escherichia coli, Salmonella spp., Vibrio spp., Helicobacter spp., Campylobacter jejuni, Enterococcus spp., Shigella spp., Yersinia spp., and Clostridium difficile, all of which inhabit the gastrointestinal tract. The following respiratory tract pathogens are also considered: Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Burkholderia cenocepacia, and Mycobacterium tuberculosis Knowledge of the molecular mechanisms regulating the bacterial tolerance and persistence phenotypes is essential in the fight against multiresistant pathogens, as it will enable the identification of new targets for developing innovative anti-infective treatments.

Evolution of the Quorum network and the mobilome (plasmids and bacteriophages) in clinical strains of Acinetobacter baumannii during a decade.

In this study, we compared eighteen clinical strains of A. baumannii belonging to the ST-2 clone and isolated from patients in the same intensive care unit (ICU) in 2000 (9 strains referred to collectively as Ab_GEIH-2000) and 2010 (9 strains referred to collectively as Ab_GEIH-2010), during the GEIH-REIPI project (Umbrella BioProject PRJNA422585). We observed two main molecular differences between the Ab_GEIH-2010 and the Ab_GEIH-2000 collections, acquired over the course of the decade long sampling interval and involving the mobilome: i) a plasmid harbouring genes for blaOXA 24/40 ß-lactamase and abKA/abkB proteins of a toxin-antitoxin system; and ii) two temperate bacteriophages, Ab105-1ϕ (63 proteins) and Ab105-2ϕ (93 proteins), containing important viral defence proteins. Moreover, all Ab_GEIH-2010 strains contained a Quorum functional network of Quorum Sensing (QS) and Quorum Quenching (QQ) mechanisms, including a new QQ enzyme, AidA, which acts as a bacterial defence mechanism against the exogenous 3-oxo-C12-HSL. Interestingly, the infective capacity of the bacteriophages isolated in this study (Ab105-1ϕ and Ab105-2ϕ) was higher in the Ab_GEIH-2010 strains (carrying a functional Quorum network) than in the Ab_GEIH-2000 strains (carrying a deficient Quorum network), in which the bacteriophages showed little or no infectivity. This is the first study about the evolution of the Quorum network and the mobilome in clinical strains of Acinetobacter baumannii during a decade.

[Venous thromboembolic disease: Comparison of management practices in France, Italy and Spain]. / Comparaison en France, en Italie et en Espagne des modalités de prise en charge de la maladie thromboembolique veineuse.

BACKGROUND: Many national and international guidelines have been established for venous thromboembolic disease (VTE). Homogeneous management practices could be expected in the different European countries. To verify this hypothesis, we compared practices in France, Italy and Spain. METHOD: We used data from the international RIETE registry to compare VTE management between France, Italy and Spain. RESULTS: From 2001 January to 2011 January, patients were consecutively included in France (n=1548), Italy (n=2083) and Spain (29,824). All patients received anticoagulant treatment. Low molecular-weight heparin (LMWH) was the most frequently used drug as initial therapy in all three countries, but unfractionated heparin (UFH) was more frequently used in France and Italy than in Spain. In France, the proportion of patients receiving LMWH was lower than the proportion of patients with active cancer (cancer 22.5 %, long-term treatment with LMWH 17.4 %). A vena cava filter was significantly more frequently used in France (5.5 % in France, 3.2 % in Italy and 2 % in Spain, P<0.0001). High bleeding risk because of surgery with recent thromboembolic disease was the most frequent indication in France and Italy for vena cava filter placement (36.4 %, and 31.3 %, respectively). CONCLUSION: Despite the publication of national and international guidelines, VTE management differs among the three major European countries included in the RIETE registry, France, Italy and Spain.

Genomic Evolution of Two Acinetobacter baumannii Clinical Strains from ST-2 Clones Isolated in 2000 and 2010 (ST-2_clon_2000 and ST-2_clon_2010).

Acinetobacter baumannii is a successful nosocomial pathogen due to its ability to persist in hospital environments by acquiring mobile elements such as transposons, plasmids, and phages. In this study, we compared two genomes of A. baumannii clinical strains isolated in 2000 (ST-2_clon_2000) and 2010 (ST-2_clon_2010) from GenBank project PRJNA308422.

Genome Sequence of a Clinical Strain of Acinetobacter baumannii Belonging to the ST79/PFGE-HUI-1 Clone Lacking the AdeABC (Resistance-Nodulation-Cell Division-Type) Efflux Pump.

Increased expression of chromosomal genes for resistance-nodulation-cell division-type efflux systems plays a major role in the multidrug resistance of Acinetobacter baumannii Little is known about the genetic characteristics of clinical strains of Acinetobacter baumannii lacking the AdeABC pump. In this study, we sequenced the genome of clinical strain Ab421 GEIH-2010 (belonging to clone ST79/PFGE-HUI-1 from the GEIH-REIPI Ab. 2010 project) which lacks this efflux pump.

[Analysis of the medical prescription in institutionalised patients]. / Analisis de la prescripción farmacológica en pacientes institucionalizados.

OBJECTIVES: To evaluate/assess the therapeutic concordance/agreement with prescribed medication in patients institutionalized diagnoses in two periods of time as well as the characteristics of this prescription. MATERIAL AND METHODS: Observational and descriptive study. Prescribing and clinical diagnoses of institutionalized patients were analyzed. These patients were treated by the same physicians during the period of time with a one-year interval (2010-2011), offering prescribing information in this period. RESULTS: A total of 81 patients (78% women), mean age 84±7 years, and 5±2 diagnoses per patient. The number of drugs per patient was more than 8 in the 2 periods, being higher in 2011 compared to 2010. From all the prescription, we found that 8.88% in 2010 and 9.3% in 2011 are included as "limited clinical value" drugs. In 2010, it sees a concordance of 86.71±13.75 against 87.17±14.58 in 2011, it means, 87% of patients are treated with drugs in agreement with their diagnoses, representing an increase of 0.47 in 2011 regarding 2010. No statistically significant differences between the 2 years. CONCLUSIONS: The prescriptions in institutionalized patients are very high and the number of drugs per patient increased after information. When we analyzed prescriptions we underline a high percentage of drugs included in the group of limited clinical value (citicoline). A significant percentage of prescriptions don't correspond with diagnoses avaiable in their clinical history.

[Haemorrhage and morbidity associated with the use of tranexamic acid in cardiac surgery: a retrospective, multicentre cohort study]. / Hemorragia y morbilidad asociada al uso de ácido tranexámico en cirugía cardiaca. Estudio multicéntrico de cohortes retrospectivo.

INTRODUCTION: Postoperative bleeding is common complication, affecting up to 20% of patients, after cardiac bypass surgery. Fibrinolysis is one of the causes of this excessive bleeding, and for this reason the use of tranexamic acid is recommended. The problem with using this is that there are numerous guidelines and differences in the dose to be administered. Our aim was to evaluate whether there were any differences in postoperative bleeding and morbidity after cardiac surgery with the administering of different tranexamic acid doses in three university hospitals. MATERIAL AND METHODS: A retrospective, multicentre cohort study was conducted. A total of 146 patients who were subjected to elective cardiac bypass surgery according to the anaesthetic-surgical protocol of each hospital were included in the study. The clinical histories were reviewed, and they were divided into two groups according to the tranexamic acid dose: Group A (high doses), initial dose of 20mg/kg and continuous infusion of 4 mg/kg/hour until closure of the sternotomy. A further 100mg was added to prime the bypass machine. Group B (low doses), initial dose of 10mg/kg followed by a continuous infusion of 2mg/kg/hour until closure of the sternotomy. A further 50mg was added to prime the bypass machine. Variables, such as age, sex, weight, height, type of surgical procedure (valvular, coronary or mixed), haematocrit, INR, and preoperative platelet count, time and temperature of the bypass machine, and haematocrit on sternum closure, were recorded. Among the post-operative variables collected were: debit due to drainage at 6, 12 and 24 hours after surgery, number and type of blood products transfused in the first 24 hours, need for further surgery due to haemorrhage, CVA, TIA, or a new acute myocardial infarction, convulsions, and mortality. RESULTS: The incidence of increased bleeding (patients in the 90 percentile) was higher in Group B at all the study evaluation times (P<.05). The incidence of further surgery due to bleeding, and the need for transfusion of ≥ 3 units of packed red cells was lower in Group A (5.56%) than in Group B (13.89%). There were no significant differences in the requirements for blood products transfusions between the groups. As regards associated morbidity, there was one isolated case of convulsion and a perioperative AMI in another case in Group A, and three cases of perioperative AMI in Group B. CONCLUSIONS: Elevated doses of tranexamic acid in cardiac bypass surgery appear to significantly reduce bleeding in the first hours after surgery compared to low doses. However, this decrease did not lead to a reduction in the needs for blood products.

Reprocessed polylactide: studies of thermo-oxidative decomposition.

The combustion process of virgin and reprocessed polylactide (PLA) was simulated by multi-rate linear non-isothermal thermogravimetric experiments under O(2). A complete methodology that accounted on the thermal stability and emission of gases was thoroughly developed. A new model, Thermal Decomposition Behavior, and novel parameters, the Zero-Decomposition Temperatures, were used to test the thermal stability of the materials under any linear heating rate. The release of gases was monitored by Evolved Gas Analysis with in-line FT-IR analysis. In addition, a kinetic analysis methodology that accounted for variable activation parameters showed that the decomposition process could be driven by the formation of bubbles in the melt. It was found that the combustion technologies for virgin PLA could be transferred for the energetic valorization of its recyclates. Combustion was pointed out as appropriate for the energetic valorization of PLA submitted to more than three successive reprocessing cycles.

A methodology to assess the energetic valorization of bio-based polymers from the packaging industry: pyrolysis of reprocessed polylactide.

The energetic valorization process of bio-based polymers is addressed in this study, taking polylactide (PLA) as model. The pyrolysis of virgin and multiple-injected PLA was simulated by means of multi-rate linear-non-isothermal thermogravimetric experiments. A complete methodology, involving control of gases, thermal stability and thermal decomposition kinetics was proposed. The release of gases was monitored by Evolved Gas Analysis of the fumes of pyrolysis, by in-line FT-IR, with the aid of 2D-correlation IR characterization. A novel model to establish the thermal stability of PLAs under any linear heating profile was proposed. A kinetic strategy was methodically applied to assess the thermal decomposition in terms of activation energy and kinetic model. It was found that the pyrolysis technologies for virgin PLA could be straightforwardly transferred for the valorization of its recyclates.

[Patients' perception on attention received from Health Centres non-sanitary staff]. / Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud.

AIMS: To know patients' perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. MATERIAL AND METHODS: Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by χ(2) test. Open-ended questions were grouped in categories in a process involving three researchers independently. RESULTS: Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. CONCLUSIONS: Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres.

[Cecal volvulus: imaging features]. / Vólvulo cecal: características en imagen.

OBJECTIVE: To determine the sensitivity of plain-film radiography and computed tomography (CT) in the diagnosis of cecal volvulus. MATERIAL AND METHODS: We reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. Two radiologists working in consensus analyzed the findings at plain-film radiography and at CT and calculated the sensitivities. The plain-film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall suffering at CT were compared to the histologic findings. RESULTS: The most sensitive findings at plain-film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel occlusion (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the "coffee bean" sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86%. Retrospectively, 36% of the plain-film studies and 86% of the CT studies were classified as certain for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables. CONCLUSIONS: The plain-film signs reported for cecal volvulus enable a certain diagnosis in a third of all cases; the CT signs enable a certain diagnosis in most cases. The evaluation of additional findings increases the chances of reaching the correct diagnosis.

Two cases of cyclic vomiting syndrome in systemic autoimmune conditions: SLE and autoimmune hepatitis.

Vomiting directly attributable to SLE occurs in approximately 8% of patients, and its causes are sometimes obscure when common conditions are ruled out. Cyclic vomiting syndrome is a common functional disorder which usually starts from childhood. We report the first two cases of patients affected by systemic autoimmune conditions associated to cyclic vomiting syndrome. Identification and proper treatment may guide to diagnosis and alleviate neglected manifestations of autoimmune patients.