First Spanish case of nocardiosis caused by Nocardia takedensis.

Nocardia takedensis is a recently described species isolated from soil. The first clinical isolate in Japan has recently been reported. This report describes the first clinical isolate of N. takedensis in Spain from a respiratory specimen.

Spatial-temporal survey of Microcystis oligopeptide chemotypes in reservoirs with dissimilar waterbody features and their relation to genetic variation.

The ability of cyanobacteria to produce toxins and other secondary metabolites is patchily distributed in natural populations, enabling the use of cellular oligopeptide compositions as markers to classify strains into ecologically-relevant chemotypical subpopulations. The composition and spatiotemporal distribution of Microcystis chemotypes within and among waterbodies was studied at different time scales by analyzing (i) Microcystis strains isolated between 1998 and 2007 from different Spanish reservoirs and (ii) individual Microcystis aeruginosa colonies collected from pelagic and littoral habitats in Valmayor reservoir (Spain) during a bloom. No agreement between chemotypes and both morphotypes and genotypes (based on cpcBA-IGS, 16S-23S rRNA ITS and mcyB genes) was found, suggesting that oligopeptide profiles in individual strains evolve independently across morphospecies and phylogenetic genotypes, and that the diversity of microcystin variants produced cannot be explained by mcyB gene variations alone. The presence of identical chemotypes in spatially-distant reservoirs with dissimilar trophic state, lithology or depth indicate that waterbody characteristics and geographical boundaries weakly affect chemotype composition and distribution. At smaller spatiotemporal scales (i.e. during bloom), M. aeruginosa populations showed high number of chemotypes, as well as marked differences in chemotype composition and relative abundance among the littoral and pelagic habitats. This indicates that the factors influencing chemotype composition, relative abundance and dynamics operate at short spatial and temporal scales, and supports emerging hypotheses about interactions with antagonistic microorganisms as possible drivers for widespread chemical polymorphisms in cyanobacteria.

LAM study: Effects of lacosamide on behaviour and quality of life in patients with epilepsy. / Estudio LAM: conducta y calidad de vida en pacientes diagnosticados de epilepsia tratados con lacosamida.

INTRODUCTION: Psychiatric comorbidities are common in epileptic patients, and evaluating the impact of antiepileptic drugs on patients' moods is therefore essential. The aim of this study is to assess the effects of lacosamide on behaviour and quality of life in people with epilepsy. METHODS: We conducted a multicentre prospective observational study of poorly-controlled epileptic patients who received lacosamide as an adjuvant treatment. Patients were evaluated on 4 occasions during a 12-month period. The impact of lacosamide on patients' mood and quality of life was assessed with the Quality of Life in Epilepsy Inventory-10 (QOLIE-10), the Hospital Anxiety and Depression Scale (HADS), and the Barratt Impulsiveness Scale (BIS-11). As a secondary objective, we evaluated the effectiveness and safety of lacosamide. RESULTS: We included 55 patients with a mean age of 47.1±18.4 years. At baseline, 34.5% of the patients had psychiatric comorbidities; the mean number of crises in the previous month was 3.6±4.3. The QOLIE-10 and HADS scales revealed statistically significant improvements in patients with a poor baseline condition (anxiety, depression, and/or poor quality of life). The BIS-11 scale detected no impulsive behaviour during follow-up. After 12 months of treatment, 51.9% of the patients were seizure-free and 77.8% experienced a reduction of at least 50% in seizure frequency. Adverse effects were mild in most cases; lacosamide was discontinued in 10 patients (18.2%). CONCLUSIONS: Lacosamide is a safe and effective treatment option for patients with epilepsy and psychiatric comorbidities.

Genotyping of Mycobacterium tuberculosis over two periods: a changing scenario for tuberculosis transmission.

OBJECTIVE: To evaluate changes in the molecular epidemiology of tuberculosis (TB) in Zaragoza, Spain, over a decade that has seen large social and health changes, including the attenuation of the human immunodeficiency virus (HIV) epidemic and increased immigration. DESIGN: A population-based molecular study was conducted using standard restriction fragment length polymorphism IS6110 typing that included all patients with bacteriologically confirmed TB living in the Zaragoza area from 2001 to 2004. The current situation was compared with that described in a previous study from 1993 to 1995. RESULTS: A total of 454 Mycobacterium tuberculosis isolates were genotyped; 239 (52.6%) were grouped in 45 clusters composed of 2 to 85 isolates. Independent risk factors for clustering were identified. The main differences with the previous study were the increase of TB cases among immigrants, a decrease in HIV-TB co-infected patients and the occurrence of a large TB outbreak involving 85 patients (M. tuberculosis Zaragoza [MTZ] strain). CONCLUSION: A change in the epidemiological pattern of TB has been observed in the last years. TB transmission is more common among the Spanish-born population, while foreign birth is significantly less associated with clustering. A single epidemic strain caused 18.7% of all TB cases.

Liberación del ion flúor de un cemento de ionómero vítreo modificado con extracto etanólico de propóleo / Liberation of the fluoride ion from a vitreous ion cement modified with ethanol extract of propolis

Objetivo. El objetivo de este estudio fue cuantificar la liberación de flavonoides y flúor en probetas de ionómero vítreo convencional tipo II modificado con extracto de propóleo. Métodos. Fueron utilizadas 60 unidades de análisis. El extracto etanólico de propóleo al 2% fue incorporado a un ionómero vítreo tipo II. Para la determinación de la liberación de flavonoides el laboratorio analizó la concentración de quercetina por ml de solución, sea agua destilada o solución fisiológica durante un periodo de 5 días. Resultados. Hubo liberación inicial de 0,40 mg/ml de flúor en solución fisiológica y de 0,35 mg/ml de flúor en agua destilada, y una liberación final de 0 mg/ml de flavonoides y de flúor en solución fisiológica y de 0,18 mg/ml de flúor en solución de agua destilada. Conclusiones. La liberación de flúor y flavonoides se produce en mayor concentración en las primeras horas, decreciendo a medida que pasan las horas.

Objective. The objective of this study was to quantify the release of flavonoids and fluoride in test tubes of conventional type II vitreous ionomer modified with propolis extract. Methods. Sixty units of analysis were used. The 2% propolis ethanolic extract was incor- porated into a type II glass ionomer. To determine the release of flavonoids, the laboratory analyzed the concentration of quercetin per ml of solution, either distilled water or physiological solution, during a period of 5 days. Results. There was an initial release of 0.40 mg/ml of fluorine in physiological solution and 0.35 mg / ml of fluorine in distilled water, and a final release of 0 mg/ml of flavonoids and fluorine in physiological solution and of 0,18 mg/ml of fluorine in distilled water solution. Conclusions. The release of fluoride and flavonoids occurs in greater concentration in the first hours, decreasing as the hours go by.

The molecular epidemiology of tuberculosis in Zaragoza, Spain: a retrospective epidemiological study in 1993.

SETTING: The incidence of tuberculosis (TB) in Spain is one of the highest in Europe. In Zaragoza region the incidence rate of tuberculosis and the acquired immune deficiency syndrome (AIDS) are close to the national average. OBJECTIVE: To better define the molecular epidemiology of tuberculosis in an area of Europe where this has not been previously studied. DESIGN: A retrospective epidemiological study on tuberculosis was conducted in Zaragoza, a region of Spain, in 1993. The study population consisted of 226 patients from whom positive culture and complete clinical and demographic data were available. Mycobacterium tuberculosis strains were typed by standard restriction fragment length polymorphism (RFLP). A cluster was defined as two or more isolates with identical RFLP patterns when five or more copies of IS6110 are present. The 137 non-clustered patients were compared with the 89 clustered patients and studied by using univariate analysis. RESULTS: Thirty-nine percent of the patients were clustered, suggesting possible recent transmission. Infection with drug-resistant M. tuberculosis was associated with a decreased risk of being in a cluster. The strains isolated from human immunodeficiency virus (HIV)-positive patients were not associated with clustering. We found that immigration was not a major determinant in the total number of TB cases. CONCLUSION: Immigration, HIV and drug resistance were not associated with recent transmission. More than 50% of the clusters contained two or three patients, indicating that small outbreaks were responsible for most of the tuberculosis cases. Our RFLP typing results indicate that a TB control programme should be implemented in Spain in order to lower transmission of TB.

[The inappropriate antidiuretic hormone secretion syndrome associated with cryptococcal meningitis in a patient with the acquired immunodeficiency syndrome]. / Síndrome de secreción inadecuada de hormona antidiurética asociado a meningitis criptocócica en un paciente con síndrome de inmunodeficiencia adquirida.

Meningitis and other infectious diseases of the central nervous system are predisposing causes of the inadequate secretion syndrome of the antidiuretic hormone (ISADH). The association between the acquired immunodeficiency syndrome (AIDS) and ISADH is recognized but little studied. In AIDS patients hyponatremia is a frequent finding and it is responsible for ISADH in most cases. However, there is little reference material concerning the incidence of presentation and the type of osmoregulation anomaly this entity presents in these patients. A case in which ISADH is associated to cryptococcal meningitis and AIDS is described with an evaluation of the hormonal response to the test of hypertonic saline serum infusion corresponding to a release of ADH.

[Resistance of Mycobacterium tuberculosis in Zaragoza, Spain (1993-1997) and related factors]. / Resistencia de Mycobacterium tuberculosis en Zaragoza (1993-1997) y factores asociados.

BACKGROUND: To know the frequency of resistance of Mycobacterium tuberculosis in a general hospital and the related factors. PATIENTS AND METHOD: Transversal study of the sensitivity of Mycobacterium tuberculosis in the Hospital Miguel Servet (Zaragoza, Spain) between 1993-1997; the proportions method was used to study the susceptibility. Statistical analysis of conventional tests and significance level at p < 0.05 were performed. RESULTS: Four hundred and twenty height patients with culture-positive to Mycobacterium tuberculosis were studied; 136 (31.8%) were HIV+, 121 (28.3%) were HIV and in 171 (39.9%) this situation was unknown. In 47 patients (10.9%) the strains isolated were resistant at least to one drug. Primary resistance was 5.9% (22 patients) and acquired resistance was 42.4% (25 patients). Primary resistance in HIV+ patients was 9. 2% and in HIV patients was 7.5%; acquired resistance in HIV+ patients was greater than in HIV patients (51.8% vs 42.8%). When we compared the resistances between both HIV+ and HIV patients we did not find significant differences. Twenty isolates (4.7%) were resistant to more than one drug and 10 (2.3%) were resistant to at least isoniazid and rifampin. The risk factors for acquired resistance were alcohol (odds ratio [OR] = 2.65; 95% CI, 1.24-5.65), drugs users (OR = 2.33; 95% CI, 1.05-5.17), previous episodes of tuberculosis (OR = 109.40; 95% CI, 15.02-796.43) and homeless (OR = 3.75; 95% CI, 1.26-11.17); we did not find significant differences between the different risk factors according to primary resistance. CONCLUSIONS: On one study, the resistance of M. tuberculosis is similar to other described in Spain. We haven't found significant differences between both seropositive and seronegative patients. The risk factors for acquired resistance were alcoholism, drug users, previous episodes of tuberculosis and homeless.

[Pulmonary cryptosporidiosis and AIDS. Presentation of a case and review of the literature]. / Criptosporidiasis pulmonar y SIDA. Presentación de un caso y revisiónde la literatura.

Pulmonary cryptosporidiasis is a rare disease. However, following the advent of the acquired immunodeficiency syndrome (AIDS), this rare pathology infection by Cryptosporidium and we conduct a literature review. The Cryptosporidium can be detected with the routine technique used for the identification of mycobacterias in sputum: Zichl-Neelsen, auramine O, Kinyoun, etc. The most frequent sympthomatology includes chronic cough (91%), fever (59%) and dyspnea (64%). In 78% of cases, several respiratory infectious agents coexist, mainly P. carinii (47%) and Cytomegalovirus (41%). In 76% of cases, the infection is followed by diarrhea, detecting Cryptosporidium in the feces of 80% of these patients. The most frequent cause of death is respiratory failure. The radiologic evidences are not specific. The OKT4+/OKT8+ ratio has an average value of 0.3 (0.05-0.9). There is not any treatment truly effective.

Telangiectasia macularis eruptiva perstans: A report of five cases / A propósito de cinco casos / Macularis eruptive telangiectasia perstans

Se comunican cinco pacientes con mastocitosis cutánea, en la forma clínica de "telangiectasia macularis eruptiva perstans" (TMEP), con hallazgos clínicos asociados. En la mayoría de los pacientes, la enfermedad se presenta en adultos con manifestaciones clínicas limitadas a la piel, con buen pronóstico. Destacamos la importancia de su conocimiento por el dermatólogo, la necesidad de su estudio y seguimiento multidisciplinario.

Five patients with cutaneous mastocytosis are presented with the clinical variant of "macularis eruptive telangiectasia perstans" (METP), with associated clinical findings. In most cases the disease occurs in adults with clinical manifestations limited to the skin with a good prognosis. We emphasize the importance of studying by a dermatologist and the necessity of interdisciplinary consideration and a proper follow-up.

Temporary loss of plasma membrane integrity in orthodontic tooth movement.

In these studies, a rat model of orthodontic tooth movement was used to support the premise that periodontal ligament (PDL) cells experience plasma membrane disruption and resealing events upon application of mechanical stress. Immunoelectron microscopy, showed albumin in the cytoplasm of PDL and bone lining cells in the tension side of moved molars. The intracellular localization of this large molecule (60 KDa) suggests that these cells have undergone plasma membrane disruption and resealing. To further assess these and previous findings, fluorescent dyes (FITC-dextran and rhodamine-dextran) were delivered into the vascular system followed by application of 50 g of static load. These large dextran molecules (10 KDa) were preferentially taken up by PDL cells of the buccal (tension side) of moved molars. These cells were determined to be viable since dead cells do not retain these diffusible tracers. These studies provide evidence of a novel cellular mechanism for uptake and release of molecules and suggest a potential role for plasma membrane disruption in the mechanotransduction of orthodontic tooth movement.

Systematic molecular characterization of multidrug-resistant Mycobacterium tuberculosis complex isolates from Spain.

We used spoligotyping and restriction fragment length polymorphism (RFLP) of the IS6110-insertion sequence to study the molecular epidemiology of multidrug-resistant (MDR) tuberculosis in Spain. We analyzed 180 Mycobacterium tuberculosis complex isolates collected between January 1998 and December 2000. Consecutive isolates from the same patients (n = 23) always had identical genotypes, meaning that no cases of reinfection occurred. A total of 105 isolates (58.3%) had unique RFLP patterns, whereas 75 isolates (41.7%) were in 20 different RFLP clusters. Characterization of the katG and rpoB genes showed that 14 strains included in the RFLP clusters did not actually cluster. Only 33.8% of the strains isolated were suggestive of MDR transmission, a frequency lower than that for susceptible strains in Spain (46.6%). We found that the Beijing/W genotype, which is prevalent worldwide, was significantly associated with immigrants. The 22 isolates in the largest cluster corresponded to the Mycobacterium bovis strain responsible for two nosocomial MDR outbreaks in Spain.

[Computerized simulations in nursing education. Faculty of Medical Sciences of Pinar del Rio, 1982-1995]. / Las simulaciones computarizadas en la enseñanza de enfermería. Facultad de ciencias médicas De pinar del Río. 1992-1995.

This study is based on a pedagogical experience obtained with the use of computerized simulations in the baccalaureate degree program. It consists in preparing under certain technical norms a situation reflecting a real event the student will face in the future. It is aimed at showing the level of effectiveness attained by automated simulations in Nursing education, comparing it with the traditional methods (seminars). Two groups were organized to this end: a case base study with simulations, and a control group with the traditional method. 38 4th-year nursing students who were passing through the Community Health Nursing rotation took part in this study. On analyzing the results by frequent evaluations and final tests, it was proved that it is easier for students to get 5 at traditional seminars, which may be caused by the rigorousness of simulations, since they measure all the students' decisions individually. Students using simulations obtained better qualitative results in the final evaluation. The time used for the development of simulations was no langer than 15 minutes. Students consider the method as useful, since it allows them, to get closer to computers, to prepare for the future and to develop creativity. It is concluded that simulations should be used as an evaluation system.

[Pneumonia diagnosed with bronchoscopy in HIV-positive patients]. / Neumonías diagnosticadas por broncoscopia en pacientes HIV-positivos.

BACKGROUND: The object of our research is to analyse the microbiological results of the samples which have been obtained by means of fibronchoscopy (FB) from HIV positive patients from 1991 until 1993. METHODS: Sixty fibrobronchoscopies were carried out on fifty-seven HIV positive patients. In every case, samples of bronchoaspirate (BAS), bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) were cultured; the last two in a quantitative way. Pneumocystis carinii was investigated in BAL by means of immunofluorescence with monoclonal antibodies. RESULTS: Some microorganisms were isolated in forty-seven bronchoscopies. Thirteen episodes resulted negative. The most frequent etiologic agent was Pneumocystis carinii (seventeen cases). The etiology of fifteen episodes was polymicrobial. The intersticial radiological pattern was the predominant one. It was observed in twenty-seven cases. With regard to immunity, 91% of the patients showed CD4 < 200. CONCLUSIONS: In our research work, the samples that have been obtained by means of FB showed a high percentage of diagnoses; that is the reason why we regard this technique as very useful for the diagnosis of pneumonia in patients with AIDS. Due to the large number of bacterian pneumonia, we consider necessary not only the use of BAL, but also that of TPC in these processes.

Mycobacterium malmoense lymphadenitis in Spain: first two cases in immunocompetent patients.

Reported here are two cases of Mycobacterium malmoense lymphadenitis that occurred in two immunocompetent children in Spain. To the best of our knowledge, these are the first documented cases of extrapulmonary infection by M. malmoense in Spain. This report serves to draw attention to this emerging nontuberculous mycobacterium that is gaining increasing recognition as a pulmonary and extrapulmonary pathogen in different countries.