Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia.

Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.

Muscle Pathology in Free-Ranging Stranded Cetaceans.

Despite the profound impact that skeletal muscle disorders may pose for the daily activities of wild terrestrial and marine mammals, such conditions have been rarely described in cetaceans. In this study, the authors aimed to determine the nature and prevalence of skeletal muscle lesions in small and large odontocetes and mysticetes ( n = 153) from 19 different species. A macroscopic evaluation of the epaxial muscle mass and a histologic examination of the longissimus dorsi muscle were performed in all cases. The only macroscopically evident change was variable degrees of atrophy of the epaxial muscles ( longissimus dorsi, multifidus, spinalis) in emaciated specimens. The histopathological study revealed single or combined morphological changes in 91.5% of the cases. These changes included the following: degenerative lesions (75.2%), muscle atrophy (37.9%), chronic myopathic changes (25.5%), parasitic infestation (9.2%), and myositis (1.9%). The skeletal muscle is easily sampled during a necropsy and provides essential microscopic information that reflects both local and systemic conditions. Thus, skeletal muscle should be systematically sampled, processed, and examined in all stranded cetaceans.

[Sociodemographic characteristics and risk factors associated to significative bacteriuria in a Spanish health area]. / Características sociodemográficas y factores de riesgo asociados a las bacteriurias significativas en un área de salud del sudeste español.

OBJECTIVE: To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship with sociodemographic factors and to analyze risk factors in inpatients. METHODS: Cross-sectional descriptive study carried out on urine culture samples received between 2016-2020 in the Microbiology laboratory, differentiating between minors and adults. The dependent variable was the presence of SB and the independent variables were age, sex, year, type of sample and source of the sample. In urine cultures of inpatients, risk factors were evaluated from the Minimum Basic Data Set. RESULTS: A total of 68,587 valid records (96.3% of the total) were analyzed. 40.8% (95% CI: 40.4%-41.2%) of urine cultures in adults and 33.8% (95% CI: 32.9%-34.7%) in children were positive, with an incidence that ranged in adults between 18.2 cases/1,000 inhabitants in 2016 and 14.6 cases/1,000 inhabitants in 2020 and 21.1 and 8.4 cases/1,000 inhabitants respectively in minors. Positive urine cultures were more frequent in children from urban areas compared to rural areas (OR=1.37; p<0.01). In hospitalized adults, for each year of age the risk of SB increased by 2%, it was 36% higher in women, 18% higher in obese patients and 17% more frequent in patients with kidney disease, (p<0.01). No relationship was observed between SB and diagnosis of COVID-19. CONCLUSIONS: The sociodemographic characteristics of the population with SB in our health area are similar to those found in other geographical areas worldwide, observing a decreasing trend in incidence in the years studied. The frequency of SB in children is higher in urban areas.

Evolution of caries and fluorosis in schoolchildren of the Canary Islands (Spain): 1991, 1998, 2006.

The aim of this work is to assess the evolution of caries and fluorosis prevalence and indices at 7 and 12 years of age in the Canary Islands through three cross epidemiological studies conducted in 1991, 1998 and 2006. The three studies followed a similar methodology, using the WHO diagnosis criteria and indications, except for the assessment of fluorosis, which was measured with the "Thylstrup and Fejerskov" index. The examining dentists were trained and calibrated in an area with high endemic fluorosis. The three studies took a sample of 1000 students for each age group. At 7 years of age, the decayed, and filled teeth (dft) varied from 1.42 in 1991 to 1.14 in 1998 and 1.37 in 2006. At 12 years of age, the Decayed, Missing, and Filled Teeth (DMFT) went from 1.86 to 1.21 and 1.51 in the three studies respectively and the significant caries index (SiC) went from 4.28 to 3.15 and 3.72. At this age, the Filled Rate rose from 24.05% in 1991 to 30.43% in 1998 and to 37.20% in 2006. In relation to fluorosis, at 12 years of age the percentage of healthy or fluorosis-free schoolchildren in the Canary Islands between the first and the second studies went down from 73% to 61.3% and went up to 78.5% in 2006, with a noticeable fall in the prevalence of children with severe and moderate fluorosis. Despite the fluctuations of caries shown in the three studies, at 12 years of age the Canary Islands have remained in the low level of caries of the WHO classification from 1991 up to now. The evolution in the prevalence of dental fluorosis shows the effect of the measures taken, 10 years after they were started.

Psychological Interventions for Parents of Children with Cancer: A Systematic Review and Meta-analysis

This study provides a systematic review and meta-analysis of randomized controlled trials that analyzed the efficacy of psychological interventions for parents of children with cancer. The search was conducted in the databases PsycInfo, Medline, PsycArticles, and PsycTests. Fourteen studies met the inclusion criteria. Two independent researchers extracted relevant data, and the studies were assessed for methodological quality. The standardized mean difference (d) was used as the effect size index. The meta-analyses, which applied random and mixed-effects models, showed that weighted effect sizes were statistically significant for depression at posttreatment (d= 1.19). However, the methodological quality moderated the depression estimate. The weighted effect sizes for the remaining variables were not statistically significant: stress/burnout (d= 0.90), quality of life (d= 1.26), anxiety (d= 0.21), posttraumatic stress (d= 0.05), and general indicator of emotional symptoms (d= 0.33). This review also highlights several methodological limitations of the studies. Future directions for research that examines interventions targeting primary caregivers of children with cancer are discussed. In conclusion, more high-quality research is needed to establish the efficacy of psychological interventions for parents of children with cancer (AU)

Morphology and changes in Clara cells in the foetal bronchioles of Swiss mice.

In this work we have studied the morphology and evolution of Clara cells in the bronchiolar mucosa of lungs from 63 Swiss mice foetuses that were classified into three groups according to age (14, 16 and 18 days). A control group composed of 21 15-day-old Swiss mice was also studied. The most salient feature of the Clara cells observed was the occurrence of two types of secretory granules and a large smooth endoplasmic reticulum. On the other hand, the Clara cells of the control group had a single secretory granule. Clara cells thus seem to take part in bronchiolar metabolism, as they were quite abundant in the early foetal groups and diminished as birth approached. This cell decrease was confirmed by the control group (15-day-old mice), the bronchioles of which contained scant cells and numerous ciliated cells.

Apoptosis of thymocytes in experimental African Swine Fever virus infection.

This paper report on the lesions occurred in the thymus in experimental acute African swine fever (ASF). Twenty-one pigs were inoculated with the highly virulent ASF virus (ASFV) isolate Spain-70. Animals were slaughtered from 1 to 7 days post infection (dpi). Three animals with similar features were used as controls. Thymus samples were fixed in 10% buffered formalin solution for histological and immunohistochemical study and in 2.5% glutaraldehyde for ultrastructural examination. For immunohistochemical study, the avidin-biotin-peroxidase complex (ABC) technique was used to demonstrate viral protein 73 and porcine myeloid-histiocyte antigen SWC3 using specific monoclonal antibodies. Cell apoptosis was evaluated by the TUNEL assay. Blood samples were taken daily from all pigs and were used for leukocyte counts. The results of this study show a severe thymocyte apoptosis not related to the direct action of ASFV on these cells, but probably to a quantitative increase in macrophages in the thymus and their activation. A decrease in the percentage of blood lymphocytes was observed at the same time No significant vascular changes were observed in the study. With these results we suggest that ASFV infection of the thymus does not seem to play a critical role in the acute disease. Although severe apoptosis was observed, animals died because of the severe lesions found in the other organs.

Ultrastructural pathology of the bone marrow in pigs inoculated with a moderately virulent strain (DR'78) of African swine fever virus.

Interpretation of changes in bone marrow during infectious processes is quite complex. This paper reports bone marrow lesions observed in pigs inoculated with a moderately virulent ASF virus strain and studies their relationship to the pathogenesis of the disease. In this work, we have carried out the structural and ultrastructural study of the bone marrow of 14 Large White x Landrace pigs that were inoculated by the intramuscular route with 10(5) 50% hemodsorbing doses (HAD50) of the Dominican Republic'78 ASF virus strain. The inoculated pigs were killed at 3, 5, 7, 9, 11, 13, 15 and 17 days postinjection. Analysis of cells and structures belonging to the two main bone-marrow compartments, the hematopoietic cells and the hematopoietic micro-environment, showed that after inoculation with a moderately virulent strain, the most significant changes occurred in macrophages and megakaryocytes, consisting in virus replication in these cell populations and apoptosis of megakaryocytes, related with the sudden and transitory thrombocytopenia detected in the subacute ASF.

Electrospray mass spectra of group 6 (Fischer) carbenes in the presence of electron-donor compounds.

Fischer carbene complexes 1-7 are not ionized under standard electrospray ionization (ESI) conditions. We report here that unsaturated chromium and tungsten (Fischer) carbene complexes can be ionized in an electrospray ion source in the presence of electron-donor compounds such as hydroquinone (HQ) or tetrathiafulvalene (TTF). The addition of these compounds, which seem to act as electron transfer agents, permits the recording and study of their ESI mass spectra in the negative mode of detection. Both chromium and tungsten(0) carbene complexes undergo in the first fragmentation stage a double simultaneous decarbonylation process.

Focal mesangial-sclerosing glomerulonephritis and acute-spontaneous infectious canine hepatitis: structural, immunohistochemical and subcellular studies.

The glomerular alterations observed in a dog with acute spontaneous infectious canine hepatitis (ICH) are described. Histologic changes of the glomeruli were enlargement of the mesangium with presence of intranuclear inclusion bodies and without proliferation of mesangial cells. Electron microscopy revealed adenovirus replication sites in glomerular mesangial cells and in endothelial cells of glomerular capillaries, as well as a focal mesangial-sclerosing glomerulonephritis associated with electron dense deposits which were closely related with extracellular ICH viral particles and immunohistochemically reactive for immunoglobulin (Ig) G, IgA, IgM and C3c complement components.

Immunohistochemical detection of Brucella abortus antigens in tissues from aborted bovine fetuses using a commercially available polyclonal antibody.

A commercially available polyclonal antibody and an avidin-biotin-peroxidase immunohistochemical technique were used to detect Brucella abortus antigens in formalin-fixed, paraffin-embedded tissues of lung and liver from 20 aborted bovine fetuses. Thirteen fetuses were obtained from farms with a previous history of brucellosis, and 7 were collected from farms without a history of brucellosis. Among the 13 aborted bovine fetuses obtained from farms with a history of brucellosis, immunoreactivity to B. abortus was detected in lung (9 fetuses) and in liver (1 fetus), whereas Brucella was cultured from abomasal contents in 9 fetuses (8 were immunohistochemically positive). In addition, 11 dams of these 13 aborted bovine fetuses had antibodies to Brucella. Brucella abortus was not detected by immunohistochemistry in the 7 aborted bovine fetuses collected from farms without a history of brucellosis. Bacteriologic culture and serologic tests were also negative for Brucella. The results of this study revealed that the immunohistochemical technique was sufficiently sensitive for detecting B. abortus antigens in formalin-fixed lung tissues from naturally aborted bovine fetuses. Although additional studies are necessary to rule out cross-reaction of the polyclonal antibody with other microorganisms that cause bovine abortion, this immunohistochemical technique could be a complementary tool to serology and bacteriology for the diagnosis of brucellosis.

Immunohistochemical detection of hog cholera viral glycoprotein 55 in paraffin-embedded tissues.

Formalin-fixed, paraffin embedded tissues obtained from 40 pigs inoculated with a field isolate of hog cholera virus were examined for the presence of Gp55, a major structural protein of the virus envelope, using a monoclonal antibody-based immunohistochemical test with the avidin-biotin-peroxidase complex method. Immunoreactivity was detected in hog cholera virus-infected tissues but not in control pigs tissues, African swine fever virus-infected tissues, or bovine viral diarrhea virus-infected porcine or bovine tissues. The first positive reactions were seen in lymphatic tissues, digestive tract and skin on postinoculation day (pid) 4, respiratory and urinary tissues on pid 5, nervous tissues on pid 6, and endocrine tissues on pid 7. These staining reactions persisted until the last observation on pid 18. Hog cholera virus antigen was not detected in heart tissue at any time. The highest levels of antigen detection were found in tonsils, spleen, and pancreas, although the esophageal mucosa and skin epithelial cells were also intensely and widely stained. The cellular staining pattern of Gp55 had a ubiquitous distribution. It was found in epithelial cells, macrophages and circulating monocytes, endothelial cells, lymphoid cells, and glial cells. The results showed a high specificity and high sensitivity for detecting hog cholera Gp55 in formalin-fixed, paraffin embedded tissue samples. This method allows precise association of Gp55 with specific cells, tissues, and histologic lesions, making the technique suitable for use in routine diagnosis of hog cholera.

Cryptosporidiosis in chickens from southern Spain.

Cryptosporidiosis in chickens from southern Spain is reported. Cryptosporidia were found in the trachea, esophagus, and epithelium of the bursa of Fabricius in chickens from different regions. In one flock, cryptosporidiosis was associated with respiratory problems and high mortality. In another flock, it was associated with low mortality and weight loss.

Hemorrhagic enteritis by adenovirus-like particles in turkeys: a possible pathogenic mechanism.

This paper describes an outbreak of hemorrhagic enteritis due to adenovirus in turkeys in Spain. Diagnosis of the disease was confirmed by histopathological examination and the observation of adenovirus in spleen mononuclear cells and intestinal infiltrate. Evidence was also found of intravascular coagulation, which may give rise to the bleeding considered characteristic of this disease.

Localization of African swine fever viral antigen, swine IgM, IgG and C1q in lung and liver tissues of experimentally infected pigs.

An immunohistological study was carried out on lungs and livers of pigs experimentally infected with two different African swine fever virus (ASFV) isolates. ASFV antigen, swine immunoglobulins (IgM and IgG) and (Clq) complement were demonstrated in both organs at different stages of infection. The ASFV antigen was mainly found in mononuclear phagocytic system (MPS) cells. Immunoglobulins and complement were observed in plasma, infected and non-infected phagocytic cells and cell debris. These findings suggest the presence, in acute infection, of immune complexes which may be involved in immunopathogenic mechanisms.

Caprine peripheral neuroblastomas: structural and ultrastructural features, intermediate filaments profile and neuro-endocrine characterization.

In this report the morphological and immunohistochemical features with respect to intermediate filament proteins and the neuroendocrine nature of bilateral neuroblastomas possibly originating from the adrenal medulla in a goat kid are presented. Histologically, the tumours were composed of small, round, blue cells organized in highly cellular nests and sheets separated by fibrovascular septa. Isolated cells mimicking the morphological features of neurones were observed in both tumours. Ultrastructurally, dense-core neurosecretory granules, about 100 nm in diameter, and irregularly organized neurotubular networks were seen. The small tumour cells were only labelled by vimentin, while the neurone-like cells were labelled by both neurone-specific enolase and synaptophysin. The lack of staining of the tumour cells by the neurofilament proteins antiserum, which was also observed in a human neuroblastoma (used as positive control) has been previously reported and is probably the result of the tissue processing and/or the poor differentiation stage of the tumours. The vimentin labelling of tumour cells could be explained by the poor differentiation stage of the tumours, since vimentin is the only intermediate filament protein in presumptive neuroblasts, being replaced by neurofilament proteins in later stages of neurogenesis.

Pathological changes in the renal interstitial capillaries of pigs inoculated with two different strains of African swine fever virus.

African swine fever is a viral disease of pigs characterized predominantly by haemorrhagic lesions. This paper reports the lesions observed in the renal interstitial capillaries of pigs inoculated with African swine fever virus strains of differing virulence: the Malawi'83 strain (haemadsorbent and highly virulent) and the Dominican Republic'78 strain (haemadsorbent and moderately virulent). In pigs infected with the Malawi'83 strain, petechial haemorrhages and microhaemorrhages were observed 5 days after inoculation and lesions were evident in the renal capillaries. Signs of phagocyte activation were noticeable in endothelial cells, with enlarged fenestrations and even loss of endothelium, leaving the basement membrane of the vessels exposed. Platelet plugs and microthrombi were also observed in these vessels. At 7 days after inoculation these lesions had intensified, and were accompanied by virus replication in the endothelial cells. In pigs infected with the Dominican Republic'78 strain, haemorrhages were more abundant and more extensive, and although no endothelial cell lesions were observed, there was intense vasodilation with diapedesis of erythrocytes.

Structural and ultrastructural study of glomerular changes in African swine fever.

The pathological effect of haemorrhagic fever viruses on the kidney have not been clearly documented. This study reports glomerular lesions in African swine fever. In the acute form of the disease there was an acute diffuse proliferative glomerulonephritis, which was believed to be related to virus replication in circulating monocytes and glomerular mesangial cells, and to the presence of abundant circulating cell debris resulting from viral replication at other sites. In the subacute form, the proliferative mesangial glomerulonephritis observed may have been associated with systemic immune-mediated phenomena, and with subendothelial and mesangial deposits of immunoglobulins and complement components.

Pathogenesis of classical swine fever: renal haemorrhages and erythrodiapedesis.

Thirty pigs were inoculated with a virulent isolate (Quillota strain) of classical swine fever (hog cholera) virus to establish the chronological occurrence of lesions in the kidney and to determine the mechanism responsible for renal haemorrhages. The study included the use of histopathological, ultrastructural, immunohistochemical (detection of viral antigen gp55, MAC387, lambda chains, CD3 and C1q) and morphometrical techniques (vascular area). Renal interstitial oedema and haemorrhages were detected from 7 days post-inoculation (dpi), associated with a slight interstitial mononuclear infiltrate and evidence of viral infection in macrophages and fibroblasts, and in a small proportion of lymphocytes. Viral infection was not detected in capillary endothelial cells. An intense mononuclear infiltrate, with B cells, T cells and small numbers of macrophages, was detected from 10 dpi. In the final phase of the experiment (14 dpi), slight proliferation and degranulation of mast cells were observed. Increased expression of the C1q component of complement was also detected. A significant increase in vascular area was observed from 7 dpi. These results suggest that haemorrhages observed in the kidneys of pigs inoculated with the Quillota strain resulted from erythrodiapedesis and increased vascular permeability, probably aggravated by mast cell degranulation in the final stage of the experiment. The results suggested that mast cell degranulation was linked to activation of the complement system.

Thrombocytopenia associated with apoptotic megakaryocytes in a viral haemorrhagic syndrome induced by a moderately virulent strain of African swine fever virus.

A viral haemorrhagic syndrome was induced in 14 pigs by inoculation with an African swine fever (ASF) virus strain of moderate virulence, to determine changes in megakaryocyte (MK) numbers and morphology and thus to assess the role of these cells in the thrombocytopenia characteristic of subacute ASF. The strain tested induced changes in the proportion of different types of MK (typical nucleated MKs, apoptotic MKs and immature MKs); it also caused subcellular lesions over the first 7 days post-inoculation (dpi). At 7 dpi, severe thrombocytopenia was observed. There was a statistically significant increase in apoptotic MK numbers. The MKs showed three stages in the course of the disease: a compensatory stage, represented by cytoplasmic projections, a hypermaturity stage, represented by apoptotic MKs, and a regenerative stage, represented by clusters of immature MKs. These changes, especially the presence of numerous apoptotic MKs, may explain the early and transitory thrombocytopenia detected in subacute ASF. The large number of apoptotic MKs observed may be associated with the accelerated maturation of these cells, resulting from the action of cytokines, or peripheral platelet consumption, or both.