[Episodes of nontyphoidal salmonellosis in adult patients of the Valladolid West Area in 2017: Evaluation of the suitability of the microbiological culture request and the prescribed treatment]. / Episodios de salmonelosis no tifoidea en pacientes adultos del Área Valladolid Oeste en 2017: Evaluación de la idoneidad de la petición del cultivo microbiológico y del tratamiento pautado.

OBJECTIVE: Gastroenteritic salmonellosis is still the second cause diagnosed of infectious diarrhea, most of these clinical pictures are mild and self-limited and therefore the use of antibiotics is limited to few cases. The aim of the study was to describe the episodes of diarrhea caused by Salmonella enterica subsp. enterica, assessing the suitability of the request and the use of antibiotics according to the criteria included in the methodology. METHODS: A retrospective, descriptive, observational study was conducted, collecting data from the clinical history. RESULTS: A total of 122 episodes were included. The reason for consultation was diarrhea, which generated a greater demand in the Hospital Emergency Services (42.6%). The most frequent serotypes isolated were Enteritidis (53.3%), and Typhimurium (40.2%). The adequate request of the stool was 90.2%. Antibiotic was prescribed in 64.6% (79) of the episodes, most patients under 65 years (58 episodes), the average age was 48.43 years. They were treated mainly with ciprofloxacin and azithromycin, in 57 and 14 episodes, respectively. The average duration of antibiotic treatment was 6 days. There was an adequate use of antibiotics in 49.1% of episodes. When the origin of the request was the Hospital Emergency Service, it was inadequate in 63.5% (33) of them. It was inadequate in 60.0% (39) of episodes when ser. Enteritidis was isolated. Almost half, 48.85% (42) of the 58 episodes in which antibiotics were prescribed among those under 65 (86), were treated without being indicated. CONCLUSIONS: Training actions should be implemented focused on optimizing the management of antibiotics in this entity.

[A descriptive study of Hafnia alvei isolated from stool samples: an approach to its clinical assessment]. / Descriptivo de Hafnia alvei aisladas en coprocultivo: aproximación a su valoración en clínica.

OBJECTIVE: The importance in human diarrhoeal disease of Hafnia alvei is unclear. The objective of the study was to describe the population which was isolated H. alvei in stool cultures and the therapeutic management of these cases in our Health Area. METHODS: A descriptive retrospective study was carried out in 2014 and 2015. Epidemiological, clinical, treatment and evolution variables were collected in the computerized clinical history. RESULTS: A collection of 7,290 stool specimens were processed, 3,321 in 2014 and 3,969 in 2015, of which 58 (1.7%) and 53 (1.3%) were positive for H. alvei, respectively. A 60.4% of samples were isolated in women. The mean age was 38.68 years. A 68.5% of samples were from primary care. In 71.2% there was related clinic, diarrhoea in 57.7%. In 75.7% of the cases there was not associated underlying disease. A 43.2% of the cases received treatment. A 66.7% of treated patients came from Primary Care. The mean duration of treatment was 8 days. The evolution was favourable in 85.4% of the cases treated. All strains were susceptible to ciprofloxacin and trimethoprim/sulfamethoxazole. CONCLUSIONS: More evidence is needed to support H. alvei as a cause of gastroenteritis.

Exposure assessment of a cyclist to particles and chemical elements.

Cycle paths can be used as a route for active transportation or simply to cycle for physical activity and leisure. However, exposure to air pollutants can be boosted while cycling, in urban environments, due to the proximity to vehicular emissions and elevated breathing rates. The objective of this work was to assess the exposure of a cyclist to particles and to chemical elements by combining real-time aerosol mass concentration reading equipment and biomonitoring techniques. PM10 and PM2.5 were measured on three cycle paths located in Lisbon, during weekdays and weekends and during rush hours and off-peak hours resulting in a total of 60 campaigns. Lichens were exposed along cycle paths for 3 months, and their element contents were measured by instrumental neutron activation analysis using the k 0 methodology (k 0-INAA). Using a bicycle commute route of lower traffic intensity and avoiding rush hours or other times with elevated vehicular congestion facilitate a reduction in exposure to pollutants. The implementation of cycle paths in cities is important to stimulate physical activity and active transportation; however, it is essential to consider ambient air and pollutant sources to create safer infrastructures.

Influence of Spanish TV commercials on child obesity.

OBJECTIVES: To examine the strategies used in food advertising campaigns on Spanish television and their breach of the Self-Regulation Code on Food Advertising aimed at Preventing Obesity and Promoting Healthy Habits in Children, as such breach advocates the consumption of products that fail to meet the nutritional requirements. STUDY DESIGN: Observational descriptive study. METHODS: Viewing and content analysis of 52 food commercials on the children's television channels 'Disney Channel' and 'Boing' on Saturday and Sunday (9:00-12:00) and general channels 'Telecinco' and 'Antena 3' on Monday to Friday (8:00-9:00 and 17:00-20:00), from March to May 2013; subsequent analysis of the nutrition labelling of the advertised products. RESULTS: There are different ways of bypassing the advertising agreement. Strategies are used which hide or distort the facts about the product in favour of the advertiser. 18 advertisements refer to website or Facebook pages, thus facilitating feedback, and 11 advertisements refer to the Plan for Promoting Healthy Lifestyles in the Spanish Population. With regard to nutritional quality, the composition of the products analysed is high in sugars and saturated fats with average levels of fat and salt. A comparison of the broadcast time of the commercials shows that the figures for fat and saturated fat are similar in food advertised in the morning and in the afternoon, but products that are high in sugar and salt are advertised more in the morning. If the overall figures are compared, they are higher in foods advertised in the morning. DISCUSSION: The Self-Regulation Code is insufficient. There is an obvious risk of trivialising the messages of the health promotion plan. The regulation of advertising is complex and if the nutritional composition of the foods advertised is likely to lead to child obesity, it is essential to reflect on the consequences deriving from the advertising of these products.

Quantitative coronary arterial stenosis assessment by multidetector CT and invasive coronary angiography for identifying patients with myocardial perfusion abnormalities.

BACKGROUND: Semi-quantitative stenosis assessment by coronary CT angiography only modestly predicts stress-induced myocardial perfusion abnormalities. The performance of quantitative CT angiography (QCTA) for identifying patients with myocardial perfusion defects remains unclear. METHODS: CorE-64 is a multicenter, international study to assess the accuracy of 64-slice QCTA for detecting ≥50% coronary arterial stenoses by quantitative coronary angiography (QCA). Patients referred for cardiac catheterization with suspected or known coronary artery disease were enrolled. Area under the receiver-operating-characteristic curve (AUC) was used to evaluate the diagnostic accuracy of the most severe coronary artery stenosis in a subset of 63 patients assessed by QCTA and QCA for detecting myocardial perfusion abnormalities on exercise or pharmacologic stress SPECT. RESULTS: Diagnostic accuracy of QCTA for identifying patients with myocardial perfusion abnormalities by SPECT revealed an AUC of 0.71, compared to 0.72 by QCA (P = .75). AUC did not improve after excluding studies with fixed myocardial perfusion abnormalities and total coronary arterial occlusions. Optimal stenosis threshold for QCTA was 43% yielding a sensitivity of 0.81 and specificity of 0.50, respectively, compared to 0.75 and 0.69 by QCA at a threshold of 59%. Sensitivity and specificity of QCTA to identify patients with both obstructive lesions and myocardial perfusion defects were 0.94 and 0.77, respectively. CONCLUSIONS: Coronary artery stenosis assessment by QCTA or QCA only modestly predicts the presence and the absence of myocardial perfusion abnormalities by SPECT. Confounding variables affecting the relationship between coronary anatomy and myocardial perfusion likely account for some of the observed discrepancies between coronary angiography and SPECT results.

[Improving communication between levels of health care: direct referral of patients to a one-stop service for major outpatient surgery]. / Mejora de la comunicación entre niveles asistenciales: derivación directa de pacientes a una consulta de alta resolución de cirugía mayor ambulatoria.

OBJECTIVE: To analyze the results obtained with a "one-stop" specialty service designed as part of a collaborative program involving primary and specialized care in order to improve communication between levels of care and reduce the delay in referral and surgical treatment for patients eligible for outpatient surgery. DESIGN: Prospective, descriptive, longitudinal study. SETTING: Major Outpatient Surgery Unit of the Hospital Clinico San Carlos and health centers serving Health Area 7 in Madrid, central Spain. PARTICIPANTS: Patients more than 14 years of age with a surgical condition involving the abdominal wall, pilonidal sinus, soft-tissue tumor, or proctological disease. INTERVENTION: Direct referral, with completed preoperative work-up, of patients from health centers to the Major Outpatient Surgery Unit of the Hospital Clinico San Carlos according to a protocol developed by consensus. The patient is seen on the same day for surgical work-up and anesthesia work-up, and is given preoperative information. Patients then make only one further visit to the hospital to undergo surgery. MAIN MEASURES: Number of patients with each diagnosis referred, diagnostic concordance between the health center and hospital, delay from referral to surgical treatment, number of trips made for different appointments, and referral rate. RESULTS: A total of 188 patients were referred. More than two thirds (68.7%) had an abdominal wall condition eligible for direct referral. Diagnostic concordance was 96%. The delay from referral until surgery was reduced by 60%, and the number of trips for appointments was reduced by 66.6%. The overall referral rate was 12.6%. CONCLUSIONS: Because of its feasibility, acceptability, and cost-efficiency, the direct referral system has the potential to improve relations between primary and specialized care and enhance the quality of care by shortening the delay to treatment.

Evaluación del Sequential Organ Failure Assessmente (SOFA) score para predecir mortalidad en los pacientes críticos, y comparación con los scores APACHE II Y SAPS II / Sequential Organ Failure Assessment Assessed (SOFA) score to predict mortality in critically ill patients, and comparison with APACHE II scores and SAPS II

Objetivos: 1) Determinar la utilidad del SOFA score y sus variables derivadas como predictores de mortalidad 2) correlacionar la mortalidad estmada por el SOFA score y derivadas, con la predicha por APACHE II y SAPS II. Materiales y métodos: Diseño: cohorte prospectiva. Lugar UTI polivalente de un hospital escuela. Pacientes: los ingresados desde el 1/5/01 al 14/4/03. Al ingreso se calcularon los scores pronósticos APACHE II y SAPS II y SOFA inicial, y diariamente (hasta 30 días de internación), el score SOFA con los peores valores del día anterior. Adicionalmente se calcularon las siguintes variables derivadas: SOFA medio: valor promedio de la internación; SOFA total: suma de todos los valores diarios; delta SOFA 48hs: diferencia entre el SOFA inicial y a las 48 hs del ingreso; y SOFA máximo: el valor más alto registrado. Análisis estadístico: primeramente, se calculó el área bajo la curva ROCd (AUC) correspondiente a las 5 variables citadas, a APACHE IIy a SAPS II, y luego se compararon con refencia a la que presentó mayor AUC en el procedimeinto anterior...

[Transbronchial needle aspiration in bronchogenic carcinoma with visible lesions: diagnostic yield and cost]. / Punción transbronquial en el carcinoma broncogénico con lesión visible: rendimiento y coste económico.

BACKGROUND: Transbronchial needle aspiration (TBNA) is a bronchoscopic technique whose usefulness in diagnosing endobronchial lesions has not yet been clearly established. OBJECTIVE: We aimed to determine whether the diagnostic yield of fiberoptic bronchoscopy could be increased, without a negative impact on diagnostic costs, if TBNA were used in combination with conventional diagnostic techniques (bronchial washings and bronchial brushings and forceps biopsy). PATIENTS AND METHODS: The cases of 130 patients diagnosed with bronchogenic carcinoma with endoscopically visible lesions were analyzed retrospectively. All had undergone conventional diagnostic procedures; TBNA was also performed if the bronchoscopist considered it was indicated. The final cost was calculated in euros for each diagnosis as the sum of the cost of the procedures needed to reach the diagnosis, including both endoscopic procedures and others (transthoracic needle aspiration, lymph node biopsy). Diagnostic yield and costs in cases diagnosed using only conventional techniques were compared to the yield and costs in cases in which both conventional techniques and TBNA were used. RESULTS: TBNA was performed in 49 patients and provided the diagnosis in 85.7%. Conventional techniques led to cytological and histological diagnosis in 80.2% of the cases, and the combination of conventional techniques and TBNA gave a diagnosis in 89.7% (P=.01). Significant differences were observed in extrinsic compression (conventional 37.5%; conventional+TBNA 100%; P=.01), submucosal infiltration (conventional 54.6%; conventional+TBNA 85%; P=.03), and exophytic mass with necrosis (conventional 80%; conventional+TBNA 100%; P=.01). The mean (SD) cost of diagnosis was euros 381.60 (euros 156.53) using conventional techniques and euros 413.25 (euros 112.91) for conventional techniques in combination with TBNA. By adding TBNA, costs decreased for diagnoses of submucosal infiltration, exophytic mass with necrosis and extrinsic compression, although the saving was significant only for extrinsic compression. CONCLUSION: The diagnostic yield of TBNA is high for endoscopically visible bronchial anomalies suggesting neoplasm, particularly when the lesion is due to extrinsic compression, submucosal infiltration, or exophytic mass with necrosis.

A system dynamic model for the assessment of different exposure routes in aquatic ecosystems.

With the exception of a limited number of highly persistent lipophilic pollutants, waterborne exposure is considered the most relevant exposure route for aquatic organisms, and even the only relevant exposure route in lower tier assessment, while the potential for bioaccumulation is only evaluated as secondary poisoning for birds and mammals. In addition, some evaluations consider that only the dissolved fraction is bioavailable for pelagic organisms. The lack of easy and cost-effective assessment methods is probably the main reason to disregard the contribution of other routes. This paper presents a system dynamics model that estimates the time-dependent accumulation of toxic chemicals through the food chain, and has also the potential to include the exposure from sediment. The generic ecosystem includes a primary producer and three levels of consumers, represented by unicellular algae, cladoceran invertebrates, cladoceran-eating fish and fish-eating fish, respectively. Nevertheless, the model, built using Microsoft Excel software, allows any number of levels and ecological-exposure relationships. The results obtained for four illustrative pollutants demonstrate that factors such as the binding to algae and other edible particles or food chain exposure for lipophilic non-persistent chemicals may constitute significant exposure routes. The current low tier European ecological risk assessment guidelines do not cover these aspects, and therefore may under estimate the real risk for both aquatic organisms and their predators. The model includes a simplified worst-case alternative that normally can be calculated using the existing information. Under a tiered approach, the simplified alternative is proposed to trigger the need of the toxicokinetics assays required to perform the complete time-dependent calculation.

Rapid and cost-effective multiparameter toxicity tests for soil microorganisms.

Three biochemical parameters, DNA quantification in soil samples and two enzymatic activities, beta-galactosidase and dehydrogenase have been assessed as potential end-points for the use in cost-effective toxicity tests on soil microorganisms. The assessment included the development of a classical dose-response 24-h assay and the incorporation of measurements of the effects on microbial activities in soil column leaching studies and multispecies miniaturised terrestrial systems (MTS). Four different chemicals, copper, a new herbicide, thiabendazole and fenthion were studied. A rapid fluorescence DNA quantification technique did not produce adequate responses. The efforts to quantify DNA after extraction and clean-up procedures failed due to the presence of humic acids. From the protocol of the technique one could see that the technical procedure is time-consuming and expensive and, for this reason, not suitable for use as a parameter in rapid and cost-effective tests. However, the enzymatic activities showed their potential as toxicity end-points. Copper produced a concentration/response inhibition of beta-galactosidase and dehydrogenase with EC50 values of 78.39 and 24.77 mg Cu/kg soil, respectively. In the soil column study, these endpoints allowed the measurement of the microbial activities through the column. The effects of the new herbicide on beta-galactosidase and dehydrogenase activities were statistically significant for the highest application dose (40 g/ha). Thiabendazole affected the microbial activity when mixed within the soil, but no effects were observed when this fungicide was applied on the soil surface. Fenthion produced effects when applied either in the soil or on the soil surface. These results can be explained by the low mobility of thiabendazole. The results show the capabilities of these biochemical parameters to be included as endpoints in cost-effective bioassays.

Assessing the potential hazard of chemical substances for the terrestrial environment. Development of hazard classification criteria and quantitative environmental indicators.

Hazard assessment constitutes an essential tool in order to evaluate the potential effects of chemical substances on organisms and ecosystems. It includes as a first step, hazard identification, which must detect the potential dangers of the substance (i.e. the kind of effects that the substance may produce), and a second step to quantify each danger and to set the expected dose/response relationships. Hazard assessment plays a key role in the regulation of chemical substances, including pollution control and sustainable development. However, the aquatic environment has largely received more attention than terrestrial ecosystems. This paper presents the extrapolation of several basic concepts from the aquatic to the terrestrial compartment, and suggests possibilities for their regulatory use. Two specific proposals are discussed. The first focuses on the scientific basis of the hazard identification-classification criteria included in the EU regulations and their extrapolation to the terrestrial environment. The second focuses on the OECD programme for environmental indicators and the development of a soil pollution pressure indicator to quantify the potential hazards for the soil compartment and its associated terrestrial ecosystem related to the toxic chemicals applied deliberately (i.e. pesticides) or not (i.e. heavy metals in sludge-based fertilisers; industrial spills) to the soil.

Ecological risk assessment of pesticides in the Mediterranean region. The need for crop-specific scenarios

The risk assessment procedures of pesticides in the European Union are mostly based on worst-case scenarios developed for central and northern European conditions. From the point of view of Mediterranean conditions, these assessment procedures are not always appropriate, and therefore the development of specific scenarios is required. There are differences not only in meteorological data (temperature, solar irradiation, or rainfall volume and annual distribution) between these countries, but also in farm distribution, crop characteristics, soil or sediment properties and surface or groundwater characteristics. These differences are more evident for the typical crops of the southern countries, such as olive groves, vineyards, citrus or rice fields, and in these cases more realistic estimates of exposure are required. Our proposal includes the development of new criteria to improve the ecological risk assessment process for the conditions of the Mediterranean region, and the justification of this need.

Prenatal diagnosis in Spain.

An overview of the national organisation of prenatal diagnosis (PND) in Spain is presented. Although PND is technically well developed and the number of prenatal services seems to be adequate, the uneven distribution between regions is reflected in a different prevalence reduction of chromosomal disorders and congenital malformations. Only about 41% or pregnant women use PND, with a wide range (14-64%) between regions. There is no national policy in PND or maternal serum screening for Down's syndrome, but local policies. As clinical genetics is not an officially recognised speciality, there is a shortage of clinical geneticists and it is difficult to organise PND activities and regulate them by law.

Occupational asthma caused by Papaver somniferum.

Twenty eight workers of a pharmaceutical factory were studied. The company produced morphine and other alkaloids extracting the active principles from shells of Papaver somniferum. Six of the exposed subjects had clinical symptoms of sensitization to this allergen and positive skin tests. A bronchial provocation test was found to be positive on 4 workers and specific IgE could be found on the 6 sensitized patients by an ELISA and a RAST test using an aqueous extract of P. somniferum. A histamine release using the same antigen was also positive in the 4 samples from sensitized patients available. An SDS-PAGE of the extract revealed a major protein band with an estimated mol wt of 52,000 d. This band had the highest IgE-binding capacity as shown by immunoblotting. All these facts suggest that P. somniferum allergy is mediated by an IgE mediated mechanism and not by a pharmacological or toxic effect of the alkaloids or polyphenols.

Valoración de los criterios electrocardiográficos de infarto agudo del miocardio en presencia del bloqueo completo de la rama izquierda del haz de His / Evaluation of electrocardiographic criteria of acute myocardial infraction in the presence of complete blockade of the left branch of the his bundle

Se evaluaron los criterio electrocardiográficos de infarto agudo del miocardio (IAM) en presencia de bloqueo completo de la rama izquierda del haz de His (MCRIHH). De un total de 720 pacientes ingresados a la Unidad Coronaria del Hospital de Especialidades del Centro Médico Nacional. La Raza IMSS, cerca del 2 por ciento de los pacientes presentaron IAM+BXRIHH, que corresponden a un total de 12 pacientes. En ellos se evaluaron 15 criterios electrocardiográficos. El diagnóstico de infarto agudo del miocardio (IAM) se confirmó mediante electrocardiografía seriada cada ocho horas por espacio de 72 horas, determinación enzimática y por estudio de medicina nuclear, además de ecocardiografía bidimensional. En el presente estudio se encontró una utilidad significativa del uso del electrocardiograma en presencia de ambas patologías, tomando en cuenta los siguientes criterios en orden de importancia decreciente: a) cambios progresivos en el conplejo QRS en el segmento ST; b) onda Q patológica según la localización del infarto; c) empastamiento ascedente de la S en V3 y V4. La combinación de estos criterios incrementa el valor del diagnóstico, especialmente en aquellos infartos con localización anteroseptal

[Acute cholecystitis: an evaluation of the factors that determine the start of surgical treatment]. / Colecistitis aguda: valoración de los factores que condicionan el inicio del tratamiento quirúrgico.

The authors studied 100 acute cholecystitis treated between 1984 and 1990. In 71.4% of the cases it was associated with gallstones and 28.6% were primary acalculous cholecystitis. Two percent were postoperative. 77 patients underwent surgery. 14.3% needed an emergency operation due to acute abdominal syndrome and sepsis. In the remaining patients, the surgical procedure was performed days or weeks later according to the course of the disease, the surgeons criteria, and family and social-labour conditions. Based on these criteria, 31.7% had surgery during the first week, 23.8% in the second and 44.5% in the third or later. Cholecystectomy was the surgical procedure performed in 98.7% of the cases. Morbidity rate was 11.6% and mortality 3.9%. Analysis of morpho-clinical grades has been done in relation with the type of cholecystitis, the clinical symptoms and the course of the disease. Finally the different factors used to argue for an early or delayed surgical treatment are discussed.

[Determination of basal and stimulated blood gastrin in duodenal ulcer]. / Valoración de la gastrinemia basal y estimulada en la úlcera duodenal.

Serum gastrin levels were measured under basal conditions and after hyperproteic meal stimulation in 24 patients with non-stenotic duodenal ulcer, 78% of them were males with a mean age of 36.4 years. Results were compared with those obtained in 20 volunteers. Basal gastrin levels in patients with duodenal ulcer 46.2 +/- 17.5 pg/ml did not show any significant statistical differences when compared with those in the control group (51.01 +/- 28.1 pg/ml). After meal stimulation gastrin levels at different time intervals, were similar in patients with duodenal ulcer and in the control group. We conclude that serum gastrin does not seem to play a relevant pathogenic role in the development of duodenal ulcer; its measurement is of no value as a biological marker of duodenal ulcer disease.

[Cessation of breast feeding: mothers exposed to the above-mentioned risk]. / Supresión de la lactancia materna: madres expuestas a dicho riesgo.

We have investigated the incidence of breast-feeding and factors that concerns it, in 135 mothers who gave birth from January to July 1986 in our hospital. 97% of mothers began breast-feeding, but only 42% went on with it at third month of infant's life, and only 9.75% of them at sixth month. The most common reason for breast feeding failure is the "cry baby". The mother's age, the socioeconomic level, the mother-newborn bonding after delivery are related with lengthy breast feeding. In conclusion, the lower social levels are the target for the information in order to promote the breast-feeding.