[Lipid nutrition and the epidermal barrier: The connection between immune-mediated inflammatory diseases and peroxisome proliferator-activated receptors, a new therapeutic target in psoriasis and atopic dermatitis]. / Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis.

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms-namely, deficient expression of PPAR-#a and impaired production of interleukin-10 and interferon-γ-in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis.

Lipid Nutrition and the Epidermal Barrier: The Connection Between Immune-Mediated Inflammatory Diseases and Peroxisome Proliferator-Activated Receptors, a New Therapeutic Target in Psoriasis and Atopic Dermatitis. / Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis.

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms-namely, deficient expression of PPAR-#a and impaired production of interleukin-10 and interferon-γ-in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis.

[Enterococcal infective endocarditis: description of 12 cases]. / Endocarditis infecciosa por enterococo: descripción de 12 casos.

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve, and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them.

[Clinical and epidemiological study of disease caused by Mycobacterium kansasii in the metropolitan area of Bilbao, Spain]. / Estudio clinicoepidemiológico de la enfermedad por Mycobacterium kansasii en el área urbana de Bilbao.

OBJECTIVE: Epidemiological description of individuals from whom Mycobacterium kansasii isolates were obtained in respiratory samples, and analysis of the isolates using molecular biological techniques. MATERIAL AND METHODS: A descriptive retrospective/ prospective study was carried out from January 1994 to April 2002 in Basurto Hospital and Santa Marina Hospital and from January 2000 to April 2002 in Cruces Hospital, Galdakao Hospital, and San Eloy Hospital. Diagnosis of the disease was performed according to American Thoracic Society criteria; other definitions were also applied to allow inclusion of all cases. Disease caused by M. kansasii in patients who were not infected with the human immunodeficiency virus (HIV) was compared with disease caused by Mycobacterium tuberculosis in a control group. Polymerase chain reaction was applied with analysis of restriction fragment length polymorphisms to differentiate between species of mycobacteria and classify them into genotypes. Amplified fragment length polymorphisms were used to recognize clones within each genotype. RESULTS: The patient charts of 334 patients in which an isolate of M. kansasii had been recorded were reviewed. We considered 220 patients to be suffering from disease caused by M. kansasii (American Thoracic Society criteria along with probable disease according to established definitions). The disease was more frequent in male patients (n=185; 84.1%) and in individuals who were not HIV positive (n=184; 83.6%). The highest incidence of disease in the Bizkaia region was found in Margen Izquierda-Encartaciones, where the rate was 8.05 per 100 000 inhabitants. In the Bilbao area, the highest rate was found in the districts lying on the outskirts. The underlying diseases were tuberculosis (20.5%), chronic obstructive pulmonary disease (25.9%), pulmonary neoplasia (7.7%), silicosis (0.9%), chronic liver disease (11.4%), and duodenal ulcer (8.6%). The most frequent constitutional symptoms were fever (39.1%), loss of appetite (23.2%), and weight loss (33.3%). Among the respiratory symptoms, the most outstanding were cough (70.9%) and expectoration (62.3%). The most frequent radiographic patterns were cavitation and pulmonary infiltration. The most common treatment regimen was rifampicin, isoniazid, and ethambutol (43.4%), and the average duration was 12 months in patients who were HIV negative. Analysis of antibiotic sensitivity, performed on 56 strains, revealed that 100% were resistant to isoniazid, while none displayed rifampicin resistance. Thirty-four cases of disease caused by M. kansasii were compared with 68 cases of tuberculosis, all of them without HIV infection. The comparison revealed a predominance of smokers, respiratory symptoms, and cavitation in patients with disease caused by M. kansasii. The majority of the isolates (98.5%) corresponded to genotype I. A total of 8 clones were obtained; the clones designated 1 and 3 were more common in HIV-positive and HIV-negative individuals respectively. CONCLUSIONS: In recent years, there has been an increase in the number of patients with disease caused by M. kansasii in the province of Bizkaia. The disease is more frequent in male patients, individuals who are HIV negative, and in urban areas. In addition, more respiratory symptoms and a higher incidence of cavitation were found in patients with disease caused by M. kansasii than in those with tuberculosis. Genotype I is the most common isolate, and clones 1 and 3 affect 80% of patients suffering from the disease.

[Prevalence of hepatitis B infection in institutions for the mentally retarded. Epidemiologic characteristics in the province of Vizcaya]. / Prevalencia de infección por el virus de la hepatitis B en instituciones de deficientes mentales. Características epidemiológicas en la provincia de Vizcaya.

The prevalence of hepatitis B virus (HBV) infection was studied in 346 subjects (148 employees and 198 mentally retarded) in four institutions for the mentally subnormal in Vizcaya-Spain. The prevalence of markers in the overall group was 32.6%; 13.5% in the employees and 46.9% in the mentally retarded. Early age and institutionalization time increases the risk of infection in the mentally retarded group, but not in the employees group. 220 subjects (118 employees and 102 mentally retarded) had negative HBV markers and were vaccinated with recombinant-DNA hepatitis B vaccine. The immunogenicity was 80% and the weight-height index the only factor implicit in the group of subjects no seroconverters. The reactogenicity of vaccine was 6.7%.

[Bacteremia by Corynebacterium striatum and neutrocytic ascites. Presentation of a case and review of the literature]. / Bacteriemia por Corynebacterium striatum y ascitis neutrocítica. Presentación de un caso y revisión de la literatura.

Corynebacterium striatum is a Gram-positive pleomorphic bacillus that has been regarded as a saprophyte of mucous membranes and skin. There are certain difficulties in identifying the Corynebacteria species in the laboratory and it is often necessary to resort to techniques which are not available in all laboratories. Over recent years, C. striatum has shown itself to be a potential pathogen generally in weakened or immunodepressed individuals, in relation with intravenous catheters and in intensive care units. We report a case of bacteremia by C. striatum and neutrocytic ascites probably related to that microorganism, and, in view of the rarity of this isolement, we have reviewed the cases published on this subject.

[Deep cervical infection]. / Infección cervical profunda.

The authors present the evolutive course of three cases of deep cervical infection. A discussion about the influence of the surgical and antibiotical treatment is done.

[Bacteremia: a Spanish multicenter study with 5000 cases. The Hospital Infection Study Group (GEIH)]. / Bacteriemia: estudio multicéntrico español con 5.000 casos. Grupo de Estudio de Infección Hospitalaia (GEIH).

INTRODUCTION: Bacteremia is one of the most common nosocomial infections and is still a severe condition that frequently represents a life-threatening problem for the patient. MATERIAL AND METHODS: SEPSIS DATA is a software programme developed by the SEIMC (Spanish Society of Infectious Diseases and Clinical Microbiology) nosocomial infection study group, and it has been designed to collect under common criteria bacteremia cases from Spanish hospitals. In this study, we analyse the results from the first 5,000 cases prospectively collected from 34 hospitals with the following distribution by number of beds: 8 hospitals with less than 200, 15 between 200 and 499.6 between 500 and 999 and 5 with more than 1,000 beds. RESULTS: Male patients (60%), older than 61 years (52%) are the predominant group. Bacteremia acquisition was extra-hospital in 58% of the cases. Most frequent underlying disease was neoplasm (22%) and 9% of the patients had HIV infection. Most frequent bacteremia sources were urinary tract (19.6%), primary (16%) and respiratory tract (15%). Most commonly isolated micro-organisms were E. coli (23%). S. aureus (13%), coagulase-negative Staphylococci (12%) and S. pneumoniae (8%). Microorganisms average time to grow in laboratory was 1.95 days. Origin focus of bacteremia was reported in 30% of the cases. Antibiotic therapy used was active against pathogen isolate in 96% of the cases. Adequate treatment was started empirically from the first day in 76% of the cases. Third generation cephalosporines were the antibiotic group most used (28%). Among the observed complications, 7.68% of the episodes occurred with shock and 2.68% with septic metastasis. Crude mortality until the end of episode was 16.64%.

Prevalence of methicillin-resistant Staphylococcus aureus in a Spanish hospital.

Recent reports of the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Europe are infrequent compared with reports in the 1960s. Annual incidence of the isolation of MRSA was studied in a general hospital in Guipúzcoa (Basque country) over a 9-year period. Overall prevalence was 4.5%-12.93% in the first 3 years (coinciding with an epidemic phase) and later 0.29%, underlining the cyclic and epidemic nature of this infection.

["Tropical" imported diseases: experience of a specialized unit in a general hospital]. / Enfermedades importadas "tropicales": experiencia de una consulta especializada en un hospital general.

BACKGROUND: In the last few years a considerable increase in imported diseases has occurred as a result of an increase in the numbers of travellers, international collaborative organizations, and immigrants. Altogether, this has prompted the setting-up of specialized units. MATERIALS AND METHODS: A report is given of the characteristics of patients attended at the Tropical Diseases Unit in the Basurto Hospital, since its set-up in March 1996 to March 1999. RESULTS: A total of 171 patients were attended at this unit after staying in tropical areas. Patients were classified as tourists (72), ONG collaborators (50) and immigrants (49). The origin areas were Africa (84 cases), Central America (49 cases), South America (23 cases) and Asia (15 cases). The main complaints included fever (61 cases), digestive symptoms (40 cases), skin problems (31 cases). The most common diagnoses were malaria (34), self-limited fever (17), self-limited diarrhoea (16), amebiasis (8), giardiasis (6), scabies (7) and cutaneous larva migrans (5). CONCLUSIONS: Health care activities included preventive issues, but mainly diagnosis and treatment of imported diseases. Among the attended individuals, there were not only travellers but also a significant proportion of immigrants and ONG collaborators. The most common diseases were malaria and digestive and cutaneous conditions.

[Primary adrenal failure and AIDS: report of 11 cases and review of the literature]. / Insuficiencia suprarrenal primaria y SIDA: descripción de once casos y revisión de la literatura.

OBJECTIVE: To know the prevalence of adrenal insufficiency (AI) in our patients with acquired immunodeficiency syndrome (AIDS) and to compare the clinical manifestations with those reported in previous series in the literature. PATIENTS AND METHODS: Retrospective study with review of clinical records of patients with AIDS diagnosed of AI (plasma cortisol after synthetic ACTH < 18 micrograms/dl) in our hospital for a period of 6 and a half years. RESULTS: Eleven out of 65 patients (17%) with the hormonal study performed were diagnosed of AI. The prevalence of AI in our patients with AIDS was 1.66%. The response of plasma cortisol to synthetic ACTH was abnormal in the 11 patients (mean increase: 1.89 micrograms/dl). Nine out of the 11 patients had a decreased basal plasma cortisol level (mean: 4.75 micrograms/dl). Basal plasma ACTH levels were increased (mean: 638.9 pg/ml) in seven out of nine patients. Patients were severely immunosuppressed (mean CD4: 21/microliter). While the clinical course was subacute (mean: 5.1 weeks), nine out of the eleven patients developed an adrenal crisis which required emergency therapy. Ten patients had an opportunist infection--M. tuberculosis (3), M. avium-intracellulare (3), Cytomegalovirus (3), histoplasmosis (1)--which could involve the adrenal glands in ten patients. All patients responded to treatment but their mean survival was 5.6 weeks. CONCLUSIONS: Although the prevalence of AI in our patients with AIDS was low (1.66%), it is important to be aware of the disease and to order a basal plasma cortisol value after synthetic ACTH, as treatment improves the life quality of patients if AI is confirmed, despite a short survival time.