Rapid Isolation of Staphylococcus aureus Pathogens from Infected Clinical Samples Using Magnetic Beads Coated with Fc-Mannose Binding Lectin.

Here we describe how Staphylococcus aureus bacteria can be rapidly isolated from clinical samples of articular fluid and synovial tissue using magnetic beads coated with the engineered chimeric human opsonin protein, Fc-mannose-binding lectin (FcMBL). The FcMBL-beads were used to capture and magnetically remove bacteria from purified cultures of 12 S. aureus strains, and from 8 articular fluid samples and 4 synovial tissue samples collected from patients with osteoarthritis or periprosthetic infections previously documented by positive S. aureus cultures. While the capture efficiency was high (85%) with purified S. aureus strains grown in vitro, direct FcMBL-bead capture from the clinical samples was initially disappointing (< 5% efficiency). Further analysis revealed that inhibition of FcMBL binding was due to coating of the bacteria by immunoglobulins and immune cells that masked FcMBL binding sites, and to the high viscosity of these complex biological samples. Importantly, capture of pathogens using the FcMBL-beads was increased to 76% efficiency by pretreating clinical specimens with hypotonic washes, hyaluronidase and a protease cocktail. Using this approach, S. aureus bacteria could be isolated from infected osteoarthritic tissues within 2 hours after sample collection. This FcMBL-enabled magnetic method for rapid capture and concentration of pathogens from clinical samples could be integrated upstream of current processes used in clinical microbiology laboratories to identify pathogens and perform antibiotic sensitivity testing when bacterial culture is not possible or before colonies can be detected.

Chemical partitioning in lightweight aggregates manufactured from washing aggregate sludge, fly ash and used motor oil.

The optimized BCR sequential extraction procedure was applied to washing aggregate sludge and fly ash, the raw materials used to produce artificial lightweight aggregates (LWAs) in a previous study. The mixtures of the raw materials and the two types of LWAs obtained have also undergone this procedure. As a result, it has been possible to evaluate the effects of the heating process on the extraction behaviour of twenty-eight elements. The thermal process reduces the availability of all the studied heavy metals, with the exception of Mo. The availability of the other elements is also reduced, with the exceptions of As and Sb, which increase in the non-residual fractions.

Utilización de levetiracetam intravenoso en un hospital general / The Use of intravenous levetiracetam in a general hospital

Introducción y objetivos. Aunque la vía oral es la forma habitual de administración de los fármacos antiepilépticos, en ciertas ocasiones se requiere la vía parenteral. El levetiracetam es el único de los nuevos fármacos antiepilépticos con posibilidad de administración por vía intravenosa. Se presenta un estudio de utilización de levetiracetam intravenoso en un hospital general, con evaluación de su eficacia y seguridad. Pacientes y métodos. Se analizaron de forma retrospectiva las historias clínicas de todos los pacientes ingresados en el hospital que fueron tratados con levetiracetam intravenoso durante el período de tiempo comprendido entre julio de 2007 y mayo de 2008. Resultados. Un total de 53 pacientes fue tratado con levetiracetam intravenoso. Aproximadamente la mitad de los pacientes (47%) había estado ingresada a cargo del servicio de neurología, seguido del servicio de neurocirugía (21%) y oncología (9%). La edad media fue de 52,2 años (rango: 9-87 años) y el 40% eran mujeres. Las crisis fueron sintomáticas en el 81%, y las etiologías más frecuentes fueron los ictus (40%) y los tumores cerebrales (33%). La presentación clínica más frecuente fueron las crisis epilépticas repetidas (47,2%) y el estado epiléptico (26,4%). Globalmente, el control de las crisis se consiguió en el 87% de los pacientes. No se detectaron efectos adversos graves atribuibles al tratamiento con levetiracetam. Conclusiones. El levetiracetam intravenoso parece ser un fármaco antiepiléptico eficaz y seguro en pacientes hospitalizados, especialmente en aquéllos que presentan comorbilidad asociada y/o plurimedicación (AU)

Introduction and aims. Although antiepileptic drugs are usually administered orally, sometimes they must be given intravenously. Levetiracetam is the only one of the new antiepileptic drugs that can be administered intravenously. In this study we report on the use of intravenous levetiracetam in a general hospital, while also evaluating its effectiveness and safety. Patients and methods. A retrospective analysis was conducted of the medical records of all hospital admissions that were treated with intravenous levetiracetam between July 2007 and May 2008. Results. A total of 53 patients were treated with intravenous levetiracetam. Approximately half the patients (47%) had been admitted to neurology, followed by neurosurgery (21%) and oncology (9%). The mean age was 52.2 years (range: 9-87 years) and 40% were females. Seizures were symptomatic in 81% of cases and the most common aetiologies were strokes (40%) and brain tumours (33%). The most frequent presenting symptoms were repeated epileptic seizures (47.2%) and epileptic status (26.4%). Overall, control of seizures was achieved in 87% of patients. No severe side-effects that could be attributed to levetiracetam therapy were detected. Conclusions. Intravenous levetiracetam seems to be an effective, safe antiepileptic drug in hospitalised patients, and especially so in those who present an associated comorbidity and/or who are on multiple drug therapy (AU)

[The use of intravenous levetiracetam in a general hospital]. / Utilización de levetiracetam intravenoso en un hospital general.

INTRODUCTION AND AIMS: Although antiepileptic drugs are usually administered orally, sometimes they must be given intravenously. Levetiracetam is the only one of the new antiepileptic drugs that can be administered intravenously. In this study we report on the use of intravenous levetiracetam in a general hospital, while also evaluating its effectiveness and safety. PATIENTS AND METHODS: A retrospective analysis was conducted of the medical records of all hospital admissions that were treated with intravenous levetiracetam between July 2007 and May 2008. RESULTS: A total of 53 patients were treated with intravenous levetiracetam. Approximately half the patients (47%) had been admitted to neurology, followed by neurosurgery (21%) and oncology (9%). The mean age was 52.2 years (range: 9-87 years) and 40% were females. Seizures were symptomatic in 81% of cases and the most common aetiologies were strokes (40%) and brain tumours (33%). The most frequent presenting symptoms were repeated epileptic seizures (47.2%) and epileptic status (26.4%). Overall, control of seizures was achieved in 87% of patients. No severe side-effects that could be attributed to levetiracetam therapy were detected. CONCLUSIONS: Intravenous levetiracetam seems to be an effective, safe antiepileptic drug in hospitalised patients, and especially so in those who present an associated comorbidity and/or who are on multiple drug therapy.

Production of lightweight aggregates from mining and industrial wastes.

Washing aggregate sludge from a gravel pit, sewage sludge from a wastewater treatment plant (WWTP) and a clay-rich sediment have been physically, chemically and mineralogically characterized. They were mixed, milled and formed into pellets, pre-heated for 5 min and sintered in a rotary kiln at 1150 degrees C, 1175 degrees C, 1200 degrees C and 1225 degrees C for 10 and 15 min at each temperature. The effects of the raw material characteristics, heating temperatures and dwell times on the loss on ignition (LOI), bloating index (BI), bulk density (rho(b)), apparent and dry particle densities (rho(a), rho(d)), voids (H), water absorption (WA(24h)) and compressive strength (S) were determined. All the mixtures presented a bloating potential taking into consideration the gases released at high temperatures. The products obtained were lightweight aggregates (LWAs) in accordance with Standard UNE-EN-13055-1 (rho(b)0) and showed the lowest apparent particle density, the lowest water absorption and the highest compressive strength. It was possible to establish three groups of LWAs on the basis of their properties in comparison to Arlita G3, F3 and F5, commercially available lightweight aggregates manufactured in Spain. Our LWAs may have the same or similar applications as these commercial products, such as horticulture, prefabricated lightweight structures and building structures.

Trastorno del sueño asociado al tratamiento con rimonabant / Sleep disorders associated with treatment with rimonabant

No disponible

[Preadmission statins treatment in stroke patients: opportunity to treat high vascular risk patients]. / Antecedente del uso de estatinas en el ictus: oportunidad de mejora en el paciente con alto riesgo vascular por aterotrombosis.

AIM: To describe the use of preadmission statins in patients with cerebrovascular accident and the possible predictive factors. PATIENTS AND METHODS: Cross-sectional observational study of 795 consecutive patients with acute cerebrovascular accident. We assessed the differences among patients who were on preadmission statins (161) and those who were not (634), regarding vascular risk factors and clinical and neurosonological atherothrombotic disease markers. For univariate analysis, we used squared chi test, and for multivariate analysis, logistic regression analysis. RESULTS: Preadmission statins were 20.3%. In high vascular risk patients defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), this reached 28% and it might be 72%. Predictive factors for preadmission statins use were, in a positive sense, the antecedent of hypercholesterolemia diagnosis (OR = 189; 95% CI = 58-615; p < or = 0.001) and stroke (OR = 2.1; 95% CI = 1.2-3.6; p < or = 0.01), and in a negative sense, smoking (OR = 0.38; 95% CI = 0.18-0.81; p = 0.012). CONCLUSIONS: In our population of patients with stroke, the predictive factors of preadmission statins did not adjust to the current therapeutic NCEP-ATP III recommendations; treatment with statins in high vascular risk population was way below the indications, it was 28% and it might be 72%.

[Lumbar puncture: its indications, contraindications, complications and technique]. / Punción lumbar: indicaciones, contraindicaciones, complicaciones y técnica de realización.

INTRODUCTION: Although first described over 100 years ago, lumbar puncture is still an important tool in the diagnosis of neurological diseases. In this article we review its indications, contraindications, the technique for carrying it out, the analysis of the cerebrospinal fluid and possible complications. DEVELOPMENT: The lumbar puncture has diagnostic and therapeutic indications. The chief diagnostic indications include infectious, inflammatory and neoplastic diseases affecting the central nervous system. Complications are infrequent, except for headaches and low back pain, but can be severe. Analysis of the cerebrospinal fluid must include a cell count and determination of the glucose and protein concentrations. The other analytical studies of cerebrospinal fluid must be conducted according to the diagnostic suspicion. CONCLUSION: The lumbar puncture in expert hands is a safe test. The health professional should be suitably familiar with its contraindications, the regional anatomy and the technique used to perform it.

Punción lumbar: indicaciones, contraindicaciones, complicaciones y técnica de realización / Lumbar puncture: Its indications, conraindications, complications and technique

Aunque se describió hace más de 100 años, la punción lumbar continúa siendo una importante herramientadiagnóstica en las enfermedades neurológicas. En este artículo se revisan sus indicaciones, contraindicaciones, técnica de realización, análisis del líquido cefalorraquídeo y posibles complicaciones. Desarrollo. La punción lumbar tiene indicacionesdiagnósticas y terapéuticas. Las principales indicaciones diagnósticas incluyen enfermedades infecciosas, inflamatorias y neoplásicas que afectan al sistema nervioso central. Las complicaciones, con la excepción de la cefalea y la lumbalgia, son infrecuentespero pueden ser graves. El análisis del líquido cefalorraquídeo debe incluir un conteo celular y la determinación de la concentración de glucosa y proteínas. El resto de los estudios analíticos en el líquido cefalorraquídeo debe realizarse en funciónde la sospecha diagnóstica. Conclusión. La punción lumbar en manos expertas es una prueba segura. Es necesario conocer adecuadamente sus contraindicaciones, la anatomía regional y su técnica de realización

Although first described over 100 years ago, lumbar puncture is still an important tool in thediagnosis of neurological diseases. In this article we review its indications, contraindications, the technique for carrying it out, the analysis of the cerebrospinal fluid and possible complications. Development. The lumbar puncture has diagnostic andtherapeutic indications. The chief diagnostic indications include infectious, inflammatory and neoplastic diseases affecting the central nervous system. Complications are infrequent, except for headaches and low back pain, but can be severe. Analysisof the cerebrospinal fluid must include a cell count and determination of the glucose and protein concentrations. The other analytical studies of cerebrospinal fluid must be conducted according to the diagnostic suspicion. Conclusion. The lumbar puncture in expert hands is a safe test. The health professional should be suitably familiar with its contraindications, the regional anatomy and the technique used to perform it

Enfermedad tromboembólica venosa: análisis de 239 casos / Thromboembolic diseases: analysis of 239 cases

Objetivo: Conocer el número de pacientes que ingresan o que desarrollan durante su ingreso en un hospital ETEV, analizar el manejo de esta enfermedad y sentar las bases para un estudio prospectivo de dicha enfermedad. Métodos: Se trata de un estudio descriptivo retrospectivo de pacientes diagnosticados de ETEV durante su ingreso en el Hospital Clínico San Carlos de Madrid en un período de 6 meses. Se recogen los datos relacionados con antecedentes epidemiológicos, diagnóstico, tratamiento y complicaciones de los pacientes con trombosis venosa profunda (TVP), tromboembolismo pulmonar (TEP) o ambas (TVP + TEP). Resultados: Del 1 de octubre de 2003 al 31 de marzo de 2004, 239 pacientes fueron diagnosticados de ETEV (64 TVP, 125 TEP y 51 TVP + TEP) al alta en nuestro hospital con una edad media de 73,2 años (desviación estándar 13,64). Como factores de riesgo con diferencias estadísticamente significativas detectamos la quimioterapia, el infarto agudo de miocardio y la obesidad. No se ha observado relación entre el tipo de tratamiento utilizado y la aparición de hemorragia. Los pacientes con episodios previos de ETEV presentaron hemorragias más frecuentemente que aquellos sin dichos antecedentes. La hipocinesia de ventrículo derecho en el ecocardiograma fue un factor de mal pronóstico para la muerte por ETEV así como la aparición de TVP + TEP. Conclusión: En más del 50% de los pacientes la ETEV era TEP y más del 60% eran mujeres. Es importante disponer de información sobre estos pacientes, ya que 2/3 ingresan en medicina interna. La quimioterapia, el IAM y la obesidad fueron factores que se asociaron a TVP, TEP y TVP + TEP de forma significativa, respectivamente. La hipocinesia de ventrículo derecho en el ecocardiograma fue un factor de mal pronóstico para la muerte por ETEV así como la coincidencia de TVP + TEP

Aim: To know the number of patients that are admitted in the hospital with TED or those who have developed it during their stay, analyzing how to manage this disease and make a basis for a prospective study of this disease. Methods: It is a descriptive and retrospective study of TED diagnosed patients during their stay at the Hospital Clínico San Carlos of Madrid for a 6 month period. Data related with epidemiologic records, diagnosis, treatment and complications of patients with Deep-Vein Thrombosis (DVT), Pulmonary Thromboembolism (PTE) or both (DVT+PTE) are collected. Results: From October 1st of 2003 to March 31st of 2004, 239 patients were diagnosed with TED (64 DVT, 125 PTE y 51 DVT + PTE) when they were discharged from our hospital, with an average age of 73.2 years (standar desviation 13.64). We classify as risky factors with significative statistical diferences chemotherapy, acute myocardium infarction and obesity. It has not been found any relation between the treatment used and the development of hemorrage. Patients with previous episodies of TED had more frequent hemorragies than those without such records. Hypokinesia in the right ventricle shown on the echocardiogram supposed a gloomy prognosis of the death for TED as well as the development of DVT + PTE. Conlusion: In more than a 50% of patients, TED was PTE and more than a 60% were women. It is important to obtain information about these patients because 2/3 of them are admitted to internal medicine. Chemotherapy, AIM and obesity were factors significatively associated to DVT, PTE and DVT + PTE. Hypokinesia in the right ventricle shown on the echocardiogram supposed a gloomy prognosis for TED as well as the development of DVT + PTE

[Thromboembolic disease: analysis of 239 cases]. / Enfermedad tromboembólica venosa: análisis de 239 casos.

AIM: To know the number of patients that are admitted in the hospital with TED or those who have developed it during their stay, analyzing how to manage this disease and make a basis for a prospective study of this disease. METHODS: It is a descriptive and retrospective study of TED diagnosed patients during their stay at the Hospital Clínico San Carlos of Madrid for a 6 month period. Data related with epidemiologic records, diagnosis, treatment and complications of patients with Deep-Vein Thrombosis (DVT), Pulmonary Thromboembolism (PTE) or both (DVT+PTE) are collected. RESULTS: From October 1st of 2003 to March 31st of 2004, 239 patients were diagnosed with TED (64 DVT, 125 PTE y 51 DVT + PTE) when they were discharged from our hospital, with an average age of 73.2 years (standard desviation 13.64). We classify as risky factors with significative statistical differences chemotherapy, acute myocardium infarction and obesity. It has not been found any relation between the treatment used and the development of hemorrhage. Patients with previous episodes of TED had more frequent hemorrhagies than those without such records. Hypokinesia in the right ventricle shown on the echocardiogram supposed a gloomy prognosis of the death for TED as well as the development of DVT + PTE. CONCLUSION: In more than a 50% of patients, TED was PTE and more than a 60% were women. It is important to obtain information about these patients because 2/3 of them are admitted to internal medicine. Chemotherapy, AIM and obesity were factors significatively associated to DVT, PTE and DVT + PTE. Hypokinesia in the right ventricle shown on the echocardiogram supposed a gloomy prognosis for TED as well as the development of DVT + PTE.

Variation in patient management and outcomes for acute coronary syndromes in Latin America and North America: results from the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial.

BACKGROUND: Although more than 9500 patients have been enrolled in major clinical trials in Latin America, practice patterns in this region have rarely been examined. We sought to compare characteristics, resource utilization, and outcomes of patients treated for acute coronary syndromes in Latin America with those in North America. METHODS: The Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Theraphy Trial (PURSUIT) enrolled 10,948 patients with non-ST-segment elevation acute coronary syndromes, including 585 in Latin America and 4358 in North America. We analyzed regional differences in patient groups, treatment patterns, and outcomes and used logistic regression analysis to identify association of enrollment region and survival. RESULTS: For patients in Latin America, the length of hospital stay was significantly longer (10 [7, 15] days vs 6 [4, 9], P <.001). Angiograms, angioplasty, and bypass surgery were significantly less common in Latin America (46.2%, 17.6%, and 11.3% vs 79.4%, 33.6%, and 19.4%, P <.001). Thirty-day death/myocardial infarction was not significantly higher, although mortality alone was significantly higher (6.8% vs 3.1%, P <.001). After adjustment for baseline characteristics, enrollment in Latin America remained an independent predictor for death at 30 days (odds ratio [OR] [95% confidence interval (CI)] 2.42 [1.60-3.67]) and persisted at 6 months (OR [95% CI] 2.5 [1.8-3.4]). CONCLUSIONS: Latin American patients treated for acute coronary syndromes were managed less invasively and were twice as likely as their North American counterparts to die within 6 months. This mortality difference was not explained by imbalances in baseline risk.

[Left ventricular function in pure mitral stenosis. Hemodynamic echocardiographic study]. / La función ventricular izquierda en la estenosis mitral pura. Estudio ecocardiográfico hemodinámico.

We studied the left ventricular performance in 40 patients with pure mitral stenosis, using a M Mode Echocardiographic study. In 19% of the group the left ventricular function was abnormal, however, we were able to distinguish three subsets: small left ventricular dimension, normaland dilated. In the first two subsets, the cardiac performance was normal in almost all the patients (85%). In 15%, the left ventricular function was depressed, probably due to a restricting flow into the cavity, segmental atrophy and fibrosis caused by chronic mitral obstruction. In the last group (dilated left ventricle), the end-systolic dimension was abnormal in 71,4% of the patients. Our study suggests that the increased dimension of the left ventricle is accompanied by poor ventricular performance and represents an intrinsic trace of damage of the myocardium by the previous rheumatic carditis. The importance of detecting this last subset is emphasized due to the high incidence of impairment in left ventricular function. This detection could in some cases prevent the surgical treatment when this function is severely depressed.

[Echocardiographic diagnosis of atrial thrombosis]. / Diagnóstico ecocardiográfico de la trombosis auricular.

Seventy patients with rheumatic mitral disease were studied by M-Mode and 2D echocardiography in order to detect left atrial thrombosis before surgery. Thrombosis were suspected by the observation of abnormal echoes in the left atrium. During surgery 17 (24%) patients had atrial thrombosis. It had been suspected by echocardiography in 12 (sensitivity 70%). In 53 patients thrombosis were not found during surgery; in 46 the echo had been also negative (specificity 86%). There was a false positive detection of thrombosis by echo in 7 patients (14%) and false negativity in 5 (30%). Patients with atrial thrombosis had atrial fibrilation in 91% of cases; and the most frequent valvular disease was mitral stenosis. There was not a direct relationship among existence of left atrial thrombosis and the anteroposterior diameter of the left atrium as measured by echo. We conclude that echocardiography has good specificity to rule out atrial thrombosis and moderate sensitivity to detect it in rheumatic mitral disease.

Diagnostico ecocardiografico de la trombosis auricular. / Echocardiography of atrial thrombosis

Se estudiaron 70 pacientes con valvulopatia mitral reumatica con ecocardiografia modo M y bidimensional, para detectar trombos en la auricula izquierda, previamente a la cirugia. La trombosis se sospecho por la observacion de ecos anormales en el interior auricular. Durante la correccion quirurgica se encontraron trombos auriculares en 17 (24%). De ellos, la trombosis se sospecho por ecocardiografia en 12 (o sea, sensibilidad de 70%). No se encontraron trombos durante la cirugia en 53 pacientes; en 46 de ellos el eco tampoco la sugirio (especificidad 86%). El eco mostro falsa positividad en 7 pacientes (14%) y falsa negatividad en 5 (30%). En el 91% de los pacientes con trombosis auricular existia fibrilacion auricular y la lesion valvular mas frecuentemente encontrada fue la estenosis mitral. No se encontro relacion directa entre la existencia de trombosis auricular y el diametro anteroposterior de dicha cavidad medido por ecocardiografia. Por los resultados obtenidos podemos concluir que la ecocardiografia tiene buena especificidad para descartar trombosis auricular y moderada sensibilidad para detectarla en la valvulopatia mitral