Prevalencia e importancia de micobacterias no tuberculosas en pacientes adultos con fibrosis quística en un hospital de Madrid / Prevalence and importance of non-tuberculous mycobacteria in adult patients with cystic fibrosis in a hospital in Madrid

INTRODUCCIÓN: El papel de las micobacterias no tuberculosas (MNT) en los pacientes con fibrosis quística (FQ) está, en ocasiones, en controversia. El objetivo del trabajo es evaluar la prevalencia y las características clínicas/microbiológicas de pacientes adultos con FQ colonizados con MNT, destacando Mycobacterium abscessus (M. abscessus). MÉTODOS: Se ha realizado un estudio retrospectivo en 92 pacientes adultos con FQ en el que se diferenció: grupo control, 64 pacientes no colonizados por MNT, y grupo a estudio, 28 pacientes colonizados por MNT. Se han analizado variables como la edad, mutación F508del, función pulmonar, afectación pancreática, tinción de auramina y recolonizaciones entre ambos grupos. RESULTADOS: La prevalencia de MNT encontrada ha sido 30,4%. La MNT más prevalente fue Mycobacterium avium complex seguida por M. abscessus. Para M. abscessus, en el estudio comparativo con pacientes colonizados por otras MNT, se obtuvieron diferencias estadísticamente significativas en las variables de edad. DISCUSIÓN: Hemos encontrado alta prevalencia de MNT en pacientes adultos con FQ y relacionamos la aparición de M. asbcessus con edades inferiores a 30 años y F508del. Con el fin de conocer mejor el papel patógeno de las MNT, especialmente de M. asbcessus, se requieren estudios multicéntricos en población con FQ

INTRODUCTION: The role of non-tuberculous mycobacteria (NTM) among cystic fibrosis (CF) patients, on occasion, remains unknown. The aim of our study is to evaluate the prevalence and clinical/microbiological characteristics of CF adult patients colonized by NTM, highlighting Mycobacterium abscessus (M. abscessus). METHODS: A retrospective study was conducted with 92 CF adult patients: including a control group of 64 patients, not colonized by NTM, and a study group of 28 patients, colonized by NTM. We have analyzed variables such as age, F508del mutation, lung function, pancreatic involvement, auramine staining and co-colonizations between both groups. RESULTS: The prevalence of NTM found was 30.4%. The most prevalent was Mycobacterium avium complex followed by M. abscessus. For M. abscessus, in the comparative study with patients colonized by other NTM, significant results were obtained for variables age. DISCUSSION: We have found a high prevalence of NTM among adult patients with CF, and we associated the presence of M. asbcessus with ages less than 30 years and F508del. Due to the pathogenic role of NTM, especially M. asbcessus, multicenter studies are required within the population suffering from CF

Nutrition Risk in Hospitalized Pediatric Patients: Higher Complication Rate and Higher Costs Related to Malnutrition.

BACKGROUND: Hospitalized children present higher rates of undernutrition. Malnutrition can lead to a more complex hospitalization process with an increased length of stay and higher costs. Our aim was to analyze nutrition risk in hospitalized children and its relationship with clinical outcomes in a tertiary level hospital. METHODS: This is a single institution prospective observational study. The research involved 282 consecutive children admitted along 3 months. Anthropometric measurements and nutrition risk by means of the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) tool were performed at admission. The incidence of infectious complications, length of hospital stay, weight loss, hospital expenses, and need of nutrition support were recorded. RESULTS: The percentage of children with high, moderate, and low nutrition risk was 12.8%, 45%, and 42%, respectively. The prevalence of acute and chronic malnutrition was 13.7% and 7.4%. STRONGkids score correlated with clinical outcomes: longer stay, higher hospital expenses, and need of nutrition support were observed in children with high nutrition risk scores compared with the other groups (P < 0.001). The overall incidence of infectious complications was low (3.5%); a higher STRONGkids score did not predict a higher rate. CONCLUSION: Hospitalized children exposed to high nutrition risk have poorer clinical outcomes: longer stay, higher hospital expenses, and need of nutrition support. More studies are required to assess if applying STRONGkids and starting a nutrition intervention would result in lower costs and a shorter length of stay.

Prevalence and importance of non-tuberculous mycobacteria in adult patients with cystic fibrosis in a hospital in Madrid. / Prevalencia e importancia de micobacterias no tuberculosas en pacientes adultos con fibrosis quística en un hospital de Madrid.

INTRODUCTION: The role of non-tuberculous mycobacteria (NTM) among cystic fibrosis (CF) patients, on occasion, remains unknown. The aim of our study is to evaluate the prevalence and clinical/microbiological characteristics of CF adult patients colonized by NTM, highlighting Mycobacterium abscessus (M. abscessus). METHODS: A retrospective study was conducted with 92 CF adult patients: including a control group of 64 patients, not colonized by NTM, and a study group of 28 patients, colonized by NTM. We have analyzed variables such as age, F508del mutation, lung function, pancreatic involvement, auramine staining and co-colonizations between both groups. RESULTS: The prevalence of NTM found was 30.4%. The most prevalent was Mycobacterium avium complex followed by M. abscessus. For M. abscessus, in the comparative study with patients colonized by other NTM, significant results were obtained for variables age. DISCUSSION: We have found a high prevalence of NTM among adult patients with CF, and we associated the presence of M. asbcessus with ages less than 30 years and F508del. Due to the pathogenic role of NTM, especially M. asbcessus, multicenter studies are required within the population suffering from CF.

[Physicians' geographical distribution in Spain and its evolution during the period 1998-2007]. / Distribución geográfica de los médicos en España y su evolución temporal durante el período 1998-2007.

BACKGROUND: Population accessibility to health care depends on the geographical distribution of health care professionals. The aim of this study is to analyse the provincial distribution of Spanish physicians, its recent evolution and the factors related with it. METHODS: Observational, cross-sectional, ecological, descriptive and analytical study on data from public official data sources (Statistics National Institute, Health and Consume Ministry). We obtained, on a provincial basis, variables related with physicians' distribution, socioeconomic conditions, health care resources and medical training capacity. We built some variability indicators for physicians' distribution, and we analysed the bivariated and multivariated correlations between provincial physicians' rate and the other variables. RESULTS: The ratio between the upper and lower values of the population based physicians' provincial ratio is 2,109 (2,158 in 1998), the variation coefficient is 0,19 (0,185 in 1998), and the Gini index is 0,103 (0,097 in 1998). There is a strong correlation between physicians' distribution and the specialist training capacity of each province in bivariated (r=0,87) and multivariated analysis (where socioeconomic and health care structure indicators and postgraduate training capacity explain 83,3% of physicians' distribution variance). CONCLUSIONS: The variability of physicians' distribution in Spain has been almost steady in the last decade, and its level is similar to that in other European countries. The provincial training capacity seems to play a fundamental role in physicians' distribution.