Combination of Soy Isoflavones, 8-Prenylnaringenin and Melatonin Improves Hot Flashes and Health-Related Quality of Life Outcomes in Postmenopausal Women: Flavie Study.

OBJECTIVES: This study aims to investigate the effects of a combination of soy isoflavones, 8-prenylnaringenin (8-PN), and melatonin in postmenopausal women suffering from moderate-to-severe hot flashes (HFs). METHODS: A multicenter, prospective, open-label study enrolled 44 postmenopausal women suffering from moderate-to-severe HFs (≥ 5 daily or ≥ 35 weekly) to receive 54.4 mg standardized soy isoflavones (including 24.5 mg genistein and 16.3 mg daidzein), 100 µg 8-PN, and 1 mg melatonin once daily for 12 weeks. The primary clinical outcomes included changes in health-related quality of life (HRQoL) scores (Menopause-Specific QoL questionnaire [MENQoL] and Cervantes Scale) and HFs following 4 and 12 weeks of treatment. Other analyses included treatment adherence, acceptability, tolerability, and safety. RESULTS: All of the four domains of MENQoL questionnaire significantly improved at 4 weeks (P < 0.05) and 12 weeks (P < 0.001), affecting significantly the vasomotor, psychosocial, and physical spheres (41.2%, 26.3%, and 25.0%; 12 weeks improvements, respectively). Similarly, in the menopause (39.3%) and psychic (51.7%) domains (both P < 0.05 at 12 weeks), the global score of the Cervantes Scale significantly increased at 4 weeks (18.6%) and 12 weeks (35.4%). Accordingly, moderate-to-severe HFs significantly decreased at 4 weeks compared to baseline (41.7% reduction) and further reduced at 12 weeks (76.5%), including the total number of episodes. CONCLUSIONS: Food supplements containing soy isoflavones, 8-PN, and melatonin showed an early and progressive benefit for reducing clinically significant HFs and for improving HRQoL across all domains, favorably affecting postmenopausal women's overall well-being.

Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa: Guidelines by the Spanish Society of Chemotherapy / Elección del tratamiento antibiótico en la infección invasiva aguda por Pseudomonas aeruginosa: Guía de la Sociedad Española de Quimioterapia

Pseudomonas aeruginosa is characterized by a notable intrinsic resistance to antibiotics, mainly mediated by the expression of inducible chromosomic β-lactamases and the production of constitutive or inducible efflux pumps. Apart from this intrinsic resistance, P. aeruginosa possess an extraordinary ability to develop resistance to nearly all available antimicrobials through selection of mutations. The progressive increase in resistance rates in P. aeruginosa has led to the emergence of strains which, based on their degree of resistance to common antibiotics, have been defined as multidrug resistant, extended-resistant and panresistant strains. These strains are increasingly disseminated worldwide, progressively complicating the treatment of P. aeruginosa infections. In this scenario, the objective of the present guidelines was to review and update published evidence for the treatment of patients with acute, invasive and severe infections caused by P. aeruginosa. To this end, mechanisms of intrinsic resistance, factors favoring development of resistance during antibiotic exposure, prevalence of resistance in Spain, classical and recently appeared new antibiotics active against P. aeruginosa, pharmacodynamic principles predicting efficacy, clinical experience with monotherapy and combination therapy, and principles for antibiotic treatment were reviewed to elaborate recommendations by the panel of experts for empirical and directed treatment of P. aeruginosa invasive infections (AU)

Pseudomonas aeruginosa se caracteriza por una notable resistencia intrínseca a los antibióticos mediada fundamentalmente por la expresión de β-lactamasas cromosómicas inducibles y la producción constitutiva o inducible de bombas de expulsión. Además de esta resistencia intrínseca, P. aeruginosa posee una extraordinaria capacidad para desarrollar resistencia a prácticamente todos los antimicrobianos disponibles a través de la selección de mutaciones. El aumento progresivo de la resistencia en P. aeruginosa ha llevado a la aparición de cepas que, de acuerdo con el grado de resistencia frente a los antibióticos habituales, se han definido como multirresistentes, extensamente resistentes y panresistentes. Estas cepas se están diseminando mundialmente, complicando progresivamente el tratamiento de las infecciones por P. aeruginosa. En este escenario, el objetivo de las presentes recomendaciones es la revisión y puesta al día de la evidencia publicada para el tratamiento de pacientes con infección aguda, invasiva y grave por P. aeruginosa. Con este fin, se han revisado los mecanismos de resistencia intrínseca, factores que favorecen el desarrollo de resistencia durante la exposición a antibióticos, prevalencia de la resistencia en España, antibióticos clásicos así como los de reciente introducción activos frente a P. aeruginosa, principios farmacodinámicos predictores de eficacia, experiencia clínica con tratamientos en monoterapia o terapia combinada y principios del tratamiento antibiótico para elaborar por un panel de xpertos recomendaciones para el tratamiento empírico o dirigido de infecciones invasivas por P. aeruginosa (AU)

[Study of a cohort of patients with Enterococcus spp. Bacteraemia. Risk factors associated to high-level resistance to aminoglycosides]. / Estudio de una cohorte de pacientes con bacteriemias por Enterococcus spp. Factores de riesgo para resistencia de alto nivel a aminoglicósidos.

OBJECTIVES: To analyze a cohort of patients with Enterococcus sp. bacteraemia. PATIENTS AND METHODS: Retrospective and observational study of a cohort of non-pediatric in-patients with Enterococcus spp. bacteraemia (June 2007-September 2009). Data collection from clinical records was done according to a standard protocol. We analyzed epidemiological, clinical and microbiological data. Treatment with glycopeptides in non allergic patients or in case of betalactam susceptibility (ampicillin) was considered "optimizable". RESULTS: Three were 106 cases of bacteraemia (2.2/1000 admitted patients; 84% E. faecalis); 83% had an underlying condition; 88% nosocomial or health related cases. Urinary infection was present in 20% and primary bacteraemia in 47%. High level resistance to gentamicin (HLRG) was present in 60%; there was no vancomycin or linezolid resistance. Most frequent empiric treatments were penicillin-betalactamase inhibitor (25%) and glycopeptides (22%). Most frequent definitive treatment was glycopeptides (34%), being "optimized" 21% and 44% of empiric and definitive treatments, respectively. Mortality was 23% (related, 14%). In the multivariate analysis, risk factors associated with HLRG were nosocomial acquired infection (OR 6.083; 95CI% 1.428-25.915) and no-abdominal origin (OR 6.006; 95CI%1.398-25.805). In multivariate analysis, independent risk factors for mortality were: Pitt > 3 (OR 14.405; 95CI%2.236-92.808) and active empiric treatment (OR 8.849; 95CI% 1.101-71.429). Incidence in previous cohort was similar but HLRG rate has increased. CONCLUSIONS: Risk factors associated with HLRG were nosocomial acquired infection and no-abdominal origin. Risk factors for mortality were initial clinical severity and having received active empiric treatment. HLRG rate has increased.

What is the impact of a rapid diagnostic E-test in the treatment of patients with Gram-negative bacteraemia?

OBJECTIVE: To evaluate the influence of a rapid diagnostic test (RDT) in antibiotic therapeutic decisions in non-paediatric patients with Gram-negative bacteraemia (GNB). PATIENTS AND METHODS: A RDT consisting of a direct antibiogram was used on blood isolates of GNB. GNB were also identified and sensitivity tests were performed according to standard criteria. Information on empirical treatment was registered (T1), as well as the antibiotic administered once the results of the RDT were available (T2). Finally, we noted the ideal antibiotic that the infectious diseases specialist (IDS) would have prescribed (T3). The decision regarding T2 was always taken by the patient's physician or the physician on duty. RESULTS: A RDT was performed for 248 patients. The most frequently isolated bacterium was Escherichia coli (13% producing extended-spectrum beta-lactamase). T1 was considered appropriate in 74% and appropriate but optimizable in 43%. T2 was considered appropriate in 95%, appropriate but optimizable in 36%, and inappropriate in 5%. The cost of the optimizable treatment (T2) was € 2210, while the cost of the ideal treatment would have been € 416; the saving in antibiotic cost of 1 day of treatment would have been € 1694. CONCLUSIONS: Treatment prescribed by a non-IDS after a RDT was inappropriate in 5% and optimizable in 36%. It is our recommendation that information provided by a RDT should be interpreted by an IDS to make the information more beneficial both economically and 'ecologically'.

Baja mortalidad en un brote de enfermedad del legionario: correlación con el estudio de citopatogenicidad / Low mortality rate in an outbreak of Legionnaires’ disease: Correlation with the cytopathogenity study

Fundamento y objetivo: En el año 2001 tuvo lugar en Murcia un brote de enfermedad del legionario (EL) con una de las tasas de mortalidad más bajas conocidas. Los objetivos de este estudio fueron describir la presentación clínica y los resultados de los estudios molecular y de virulencia de los aislamientos clínicos de Legionella para correlacionar la baja mortalidad de la serie con la virulencia de la cepa. Pacientes y método: Estudio prospectivo y descriptivo de un brote de EL en un subgrupo de 86 pacientes. Se analizan datos demográficos, factores de riesgo y evolución clínica. Se ha practicado subtipificación molecular mediante electroforesis en campo pulsátil y estudio de citopatogenicidad de los aislamientos clínicos y se han comparado con los de aislamientos procedentes de otros brotes. Resultados: La edad media fue de 58,2 años, con predominio del sexo masculino (77,9%). El tabaquismo fue el factor de riesgo más frecuente (71,7%). El 70,2% de los pacientes presentaba enfermedades de base. Las manifestaciones clínicas, los datos de laboratorio y la radiología fueron compatibles con un cuadro de neumonía atípica. La mortalidad fue del 3,2%. Todos los aislamientos clínicos de Legionella pneumophila mostraron el mismo subtipo molecular. En el estudio de citopatogenicidad, las cepas de Legionella procedentes del brote se incluyeron dentro del grupo de menor virulencia. Conclusiones: En este subgrupo de pacientes predominaron el sexo masculino, el tabaquismo, la presentación clínica compatible con neumonía atípica y la baja mortalidad. La baja virulencia de este genotipo molecular de L. pneumophila podría ser causante, en parte, de la baja mortalidad observada en el brote de Murcia (AU)

Background: In 2001 an outbreak of Legionnaires’ diseases occurred in Murcia, Spain, with one of the lowest known rates of associated mortality. We describe the clinical data of a subgroup of patients, and present the results from molecular and virulence studies to correlate the lower mortality of the overall series with the strain virulence. Patients and methods: A subgroup of 86 patients from the outbreak of Legionnaires’disease was prospectively included. Demographic, risk factors and clinical evolution data were obtained. Moreover, we performed a pulsed field gel electrophoresis and cytopathogenicity assay of the Murcia outbreak that were compared with other unrelated Legionella isolates. Results: Sixty-nine (77.9%) patients were males. The mean age of the patients was 58.2 years (range: 32–87). Smoking was the most frequent risk factor in 62 patients (71.7%) and 61 patients (70.2%) had underlying diseases. Clinical, laboratory and radiological manifestations were compatible with the atypical pneumonia syndrome. The mortality rate was 3.2%. All the clinical L. pneumophila isolates analyzed by PFGE showed the same subtype. When analyzing theses strains together with other Legionella strains, they were included in the group with lower virulence in the cytopathogenicity study. Conclusions: The most outstanding data in this subgroup of patients were: male-sex, smoking, atypical clinical manifestations and low mortality. The low virulence of this molecular genotype of L. pneumophila may be responsible, in part, for the low mortality observed in the outbreak in Murcia (AU)

Uso de prácticas clínicas durante el embarazo, parto, puerperio y recién nacido, en hospitales públicos de Manizales - Colombia, 2005 / Using guides for clinical practice during pregnancy, delivery and postpartum and for the newborn in public hospitals in Manizales, Colombia, 2005

Se evaluó la frecuencia de uso de prácticas comprobadas cientificamente como beneficiosas, inefectivas o perjudiciales, en el cuidado del embarazo, trabajo de parto, puerperio y periodo neonatal, en tres centros públicos de atención en salud de la ciudad de Manizales. Algunas prácticas clínicas que se han demostrado benéficas, aún no se han implementado o no se utilizan en forma rutinaria; tal es el caso del uso del carné materno perinatal, el tamizaje para sífilis durante la gestación, el diligenciamiento del programa, la terminación de la gestación luego de las 41 semanas para reducir la mortalidad perinatal, el apoyo continuo a la mujer durante el trabajo de parto y parto, el manejo activo del alumbramiento para prevenir la hemorragia postparto, la lactancia materna exclusiva y el pinzamiento del cordón umbilical después del primer minuto. De igual forma, otras prácticas que se han demostrado inefectivas e incluso perjudiciales, todavía se siguen utilizando, como es el caso del enema evacuante durante el trabajo de parto, la posición en decúbito dorsal (supino) en el periodo expulsivo del parto y la restricción del contacto madre-hijo en los recién nacidos sanos. Debe implementarse una política restrictiva de episiotomía, evitando realizarla de manera rutinaria en las primíparas.