Extended-spectrum and AmpC ß-lactamases screening and antibiotic resistance profile of Escherichia coli isolated from urine / Análisis de las ß-lactamasas de espectro extendido y tipo AmpC y el perfil de resistencia a antibióticos de Escherichia coli aisladas de orina

Introduction: Antimicrobial resistance is a global concern since infections by resistant pathogens are associated with higher mortality and morbidity. Objective: To assess the prevalence of Escherichia coli isolates producing extended-spectrum and AmpC beta-lactamase (ESBL) in urine samples from patients at the Hospital Metropolitano de Santiago in Dominican Republic. Methods: Pathogen identification and antibiogram were carried out by the automated systems BD Phoenix or Microscan®. General information and past medical history were gathered from patients with a positive urine culture for E. coli. Manual ESBL/AmpC screening was performed with the commercial ESBL+AmpC screen disc kit from Liofilchem Laboratory, Italy. Results: One or both of the studied phenotypes were present in 36% of the analyzed isolates. Among the risk factors for the detection of E. coli producing ESBL and/or AmpC in urine were male gender, advanced age, placement of urinary catheter, arterial hypertension, neoplasms, and coexistence of two or more comorbidities. Apart from cephalosporins resistance, isolates producing ESBL and/or AmpC also showed higher resistance to other antibiotics, such as gentamicin (66.7%), ciprofloxacin and levofloxacin (83.3%), and ampicillin (91.7%). Furthermore, 85% of the ESBL/AmpC producing samples were multidrug resistant (resistant to 1 or more drugs in at least 3 different antibiotic categories). Conclusions: The high prevalence of antimicrobial resistance found in this study highlights the importance of implementing national and global measures to tackle the problem, especially in developing countries such as the Dominican Republic, where resources are scarce.

Introducción: La resistencia antimicrobiana es un grave problema global, pues las infecciones causadas por patógenos resistentes están asociadas con una mayor mortalidad y morbilidad. Objetivos: Analizar la prevalencia de aislados de Escherichia coli productores de β-lactamasas de espectro extendido (BLEE) y tipo AmpC procedentes de muestras de orina de pacientes del Hospital Metropolitano de Santiago en la República Dominicana. Métodos: La identificación del patógeno y el antibiograma fueron llevados a cabo mediante los sistemas automáticos BD Phoenix o Microscan®. Se recolectó información general y la historia médica de pacientes con un cultivo de orina positivo para E. coli. La detección de BLEE/AmpC se realizó de manera manual con el estuche comercial ESBL+AmpC de Liofilchem Laboratory, de Italia. Resultados: Un 36 % de las muestras analizadas mostraron uno o ambos fenotipos estudiados. Como factores de riesgo para la detección en orina de E. coli productoras de BLEE o AmpC se encontraron: sexo masculino, edad avanzada, colocación de un catéter urinario, hipertensión, neoplasmas y coexistencia de comorbilidades. Además de resistencia a las cefalosporinas, los aislados productores de BLEE y AmpC revelaron también elevada resistencia a otros antibióticos como gentamicina (66,7 %), ciprofloxacina y levofloxacina (83,3 %), y ampicilina (91,7 %). Un 85,0 % de las muestras productoras de BLEE/AmpC fueron multidrogorresistentes. Conclusiones: La elevada prevalencia de resistencia antimicrobiana encontrada en este estudio refleja la importancia de tomar medidas nacionales y globales para contener el problema, especialmente en países en desarrollo como República Dominicana, donde los recursos son escasos.

Efficacy and safety of trabectedin in metastatic uterine leiomyosarcoma: A retrospective multicenter study of the Spanish ovarian cancer research group (GEICO).

OBJECTIVE: We assessed trabectedin in patients with advanced uterine leiomyosarcoma (uLMS) in real-life clinical practice given according to the marketing authorization. METHODS: Thirty-six women from 11 tertiary hospitals across Spain who received trabectedin after anthracycline-containing regimen/s were retrospectively analyzed. The primary endpoint was progression-free survival (PFS). RESULTS: Median PFS and overall survival (OS) since starting trabectedin treatment were 5.4 (95%CI: 3.5-7.3) and 18.5 months (95%CI: 11.5-25.6), respectively. Median OS was significantly higher (P = 0.028) in patients receiving trabectedin in ≤ 2nd line (25.3 months) than in ≥ 3rd (15.1 months) and with ECOG performance status ≤ 1 at trabectedin start (19.8 months) than ECOG 2-3 (6.0 months, P = 0.013). When calculating OS since diagnosis, patients had longer OS with localized disease at diagnosis (87.4 months) vs. locally advanced (30.0 months) or metastatic (44.0 months, P = 0.041); and patients who received adjuvant therapy (87.4 months) compared with those who did not (30.0 months, P = 0.003), especially when receiving radiochemotherapy (106.7 months, P = 0.027). One patient (2.8%) had a complete response (CR) and nine patients (25.0%) achieved a partial response (PR) for an objective response rate of 27.8% with median response duration of 11 months (range: 4-93). Eighteen patients (50.0%) had disease stabilization for a disease control rate (DCR) of 77.8%. More patients receiving trabectedin in 1st-line of advanced disease achieved CR (16.7%) and PR (50.0%) than those in ≥ 2nd line/s (0.0% and 20.0%), whereas the DCR was similar across treatment lines. Reversible neutropenia was the most common grade 3/4 laboratory abnormality (19.4%). CONCLUSIONS: Trabectedin confers clinical benefit in patients with recurrent/metastatic uLMS, given after failure to an anthracycline-based regimen being comparable to those reported in clinical trials and with a manageable safety profile.

Mathematical skills in children with pilocytic astrocytoma.

BACKGROUND: Pediatric patients with circumscribed cerebellar pilocytic astrocytoma (PA) tumors generally perform within the normal range on neuropsychological tests after a complete tumor resection. The outcome in academically relevant abilities such as mathematics, which in adults involve some cerebellar functions, is however much less understood. The aim of this study is to retrospectively investigate the neuroplasticity of mathematical skills and associated cognitive functions following cerebellar resection of PA in pediatric patients. METHODS: Twenty-two children (mean age = 11.2 + 1.8), including 11 PA patients (females = 6) and 11 healthy controls (females = 6), were administered a battery of mathematical (MaT) and neuropsychological tests. Single-case statistical analyses were carried out (Crawford's t) as well as between-group comparisons (Wilcoxon test). Spearman correlations between MaT and neuropsychological tests were calculated. RESULTS: Thirty-six percent of the patients showed difficulties in some mathematical tasks, 50% of them within a broader cognitive deficit. Verbal working memory was associated with MaT performance both in patients and controls while, crucially, visuospatial memory, and visual-motor integration were associated with MaT in patients only. Among patients, MaT correlated negatively with tumor size and positively with the interval surgery test. CONCLUSIONS: The results evince an overall recovery of mathematical abilities despite PA in the majority of patients. This functional reestablishment is supported by visuospatial and visuomotor integration functions that contribute to set up emerging mathematical skills in these patients. Higher levels of compensation are found in more developed tumors as compared to smaller ones.

Gemcitabine and capecitabine as third- or later-line therapy for refractory advanced colorectal cancer: a retrospective study.

AIM: To evaluate gemcitabine plus capecitabine as third-line or later-line therapy in patients with refractory advanced colorectal cancer (CRC) who maintain a good performance status (PS). PATIENTS AND METHODS: We retrospectively evaluated patients who had failed at least two lines of therapy or had contraindication to standard therapy and received gemcitabine (1,000 mg/m(2), d1 biweekly) plus capecitabine (1,700 mg/m(2)/day, d1-7 every two weeks) in a compassionate use program. RESULTS: Thirty-nine patients were enrolled. The majority (85%) had ECOG PS 1. Gemcitabine plus capecitabine was administered as third- and fourth-line in 49% and 23% of patients, respectively; and as fifth-line or later-line in 28%. A clinical benefit of 21% was found. The median progression-free survival and overall survival were 3.0 and 7.3 months, respectively. Toxicity was mild to moderate, with no reported grade 4 toxicities. CONCLUSION: Gemcitabine plus capecitabine was safe and well-tolerated. While the efficacy of this regimen was modest in terms of response, the survival data were acceptable and consistent with previous publications on this setting.

Validity of a combined fibromyalgia (FM) questionnaires to asses physical activity levels in Spanish elderly women: an experimental approach.

Questionnaires designed to assess the level of physical activity among elderly Spanish speaking women usually have problems of reproducibility and are difficult to administer. This study aims to validate a Spanish combined version of two questionnaires originally designed to assess physical activity levels in fibromyalgia women. The leisure time physical activity instrument (LTPAI) and the physical activity at home and work instrument (PAHWI). Both questionnaires were translated to Spanish using translation/back translation methodology, and then were administered to 44 women aged 60-80 twice, with an interval of 2 weeks. During the first administration, participants answered the Yale physical activity questionnaires (YPAS) and performed the 6-min walking test (6MWT). Although the Spanish version of the LTPAI and the PAWHI showed poor test-retest reliability and poor construct validity, the sum of the two questionnaires showed much better associations. The results suggest that the Spanish combined version of LTPAI and PAHWI would seem to be useful tools for assessing the level of physical activity among elderly Spanish speaking women. Nevertheless, such considerations as the cultural adaptation of their content or the link between the intensity of physical activity as perceived and that actually done must be adjusted for greater efficiency.

Un método simple para la recolección, extracción y medición de catecolaminas en orina de adultos mayores / A simple method to collect, extract and measure urinary catecholamines in elderly people

La medición de catecolaminas en orina ha sido utilizada tanto para diagnóstico como para la investigación. Este trabajo propone algunas modificaciones y condiciones estandarizadas para llevar a cabo la recolección de muestras de orina y la extracción y cuantificación de las catecolaminas utilizando cromatografía líquida de alto desempeño con detección electroquímica (HPLC-EC). Se probaron distintos métodos de preservación de la muestra durante la recolección, y se encontró que no es necesario utilizar ningún preservante o refrigerante para mantenerla estable. Se utilizó también la extracción en fase sólida (EFS) en la que, al modificar variables como la velocidad de elusión y la cantidad del eluyente final, se obtuvieron porcentajes de recuperación de 85,8% para dopamina, 88% para epinefrina y 96,9% para norepinefrina. En la medición por cromatografía, los coeficientes de variación fueron menores al 10% en la evaluación entre días y entre corridas; el error fue 2,5% en todos los casos. Se probó, además, que el método es lineal (r²Z0,9882; a<0,001) y que los valores obtenidos son comparables con resultados reportados previamente para adultos mayores, aunque el método y los cambios propuestos podrían ser utilizados también en otros grupos etarios.

Catecholamines in plasma and urine have been widely used for clinical diagnosis and research. The present paper proposes simple changes to collect, extract and quantify catecholamines among elderly people, and to obtain more accurate results using HPLC-EC. Refrigeration and acid were tested as preserving methods during urine collection. A pre-treatment with SPE was used to clean samples, and some variables were changed in order to improve recovery previous to chromatography analysis. No significant differences were found in sample catecholamines concentration using different preservation methods, or even in samples without refrigeration or acid during collection. Recovery obtained after changing some variables in SPE was 88.0% in epinephrine, 85.8% in dopamine and 96.9% in norepinephrine. VC was less than 10% between-days and between-run evaluation in all catecholamines, and error was 2.5%. Calibration curves were linear (r²Z0.9882; a<0.001) in matrixes employed. Values obtained in test samples were comparable with previous results reported in elderly people. The method and the changes proposed are useful to measure urinary catecholamines in elderly people. However, it is proposed that they could also be useful for other age groups, and not only for research but also for clinical purposes.