Test-retest reliability of the isometric contraction test (IC test) of the masticatory muscles in subjects with and without temporomandibular muscle disorders.

OBJECTIVE: Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. This study aimed to determine the test-retest reliability of the IC test. METHODS: A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen's kappa (k), PABAK, and percent agreement (PA) between days were estimated. RESULTS: The IC test showed good to excellent test-retest reliability values (k>0.77; PABAK>0.90), both globally and individually for the muscles evaluated, and PA>90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values. CONCLUSION: The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain.

Test-retest reliability of the isometric contraction test (IC test) of the masticatory muscles in subjects with and without temporomandibular muscle disorders

Abstract Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. Objective This study aimed to determine the test-retest reliability of the IC test. Methods A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen's kappa (k), PABAK, and percent agreement (PA) between days were estimated. Results The IC test showed good to excellent test-retest reliability values (k>0.77; PABAK>0.90), both globally and individually for the muscles evaluated, and PA>90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values. Conclusion The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain.

Imported Dengue Infection in a Spanish Hospital with a High Proportion of Travelers from Africa: A 9-Year Retrospective Study.

Epidemiological data on dengue in Africa are still scarce. We investigated imported dengue infection among travelers with a high proportion of subjects from Africa over a 9-year period. From January 2005 to December 2013, blood samples from travelers with clinical suspicion of dengue were analyzed. Dengue was diagnosed using serological, antigen detection, and molecular methods. Subjects were classified according to birthplace (Europeans versus non-Europeans) and last country visited. Overall, 10,307 serum samples corresponding to 8,295 patients were studied; 62% were European travelers, most of them from Spain, and 35.9% were non-Europeans, the majority of whom were born in Africa (mainly Equatorial Guinea) and Latin America (mainly Bolivia, Ecuador, and Colombia). A total of 492 cases of dengue were identified, the highest number of cases corresponding to subjects who had traveled from Africa (N = 189), followed by Latin America (N = 174) and Asia (N = 113). The rate of cases for Africa (4.5%) was inferior to Asia (9%) and Latin America (6.1%). Three peaks of dengue were found (2007, 2010, and 2013) which correlated with African cases. A total of 2,157 of past dengue infections were diagnosed. Non-Europeans who had traveled from Africa had the highest rate of past infection (67.8%), compared with non-Europeans traveling from Latin America (38.7%) or Asia (35%). Dengue infection in certain regions of Africa is underreported and the burden of the disease may have a magnitude similar to endemic countries in Latin America. It is necessary to consider dengue in the differential diagnosis of other febrile diseases in Africa.

Evidence of exposure to cytostatic drugs in healthcare staff: a review of recent literature / Evidencia de la exposición a fármacos citostáticos del personal sanitario: revisión de la literatura reciente

Objective: Provide updated evidence and learn about the actions that must be implemented in order to prevent the occupational exposure to cytostatic drugs. Method: A bibliographic search was carried out on the MEDLINE, COCHRANE PLUS and WEB OF SCIENCE databases, with the terms ‘surface contamination’, ‘cytostatic drug’, ‘drug preparation’, ‘occupational exposure’, ‘safe handling’ and ‘closed-system transfer device’, within the 2010-2015 period. Results: Thirteen articles were selected for review. These articles are from hospitals in U.S.A., Canada, Japan, Australia, Spain, Portugal and Germany. In all of them, surface contamination by cytostatic agents was found in over 15 different surfaces, with concentrations ranging from 1.69 ng/cm2 to 4-784 µg/cm2 . The specific drugs were cyclophosphamide, ifosfamide, 5-fluorouracil, methotrexate, paclitaxel, cisplatin, gemcitabine, and docetaxel. Closed-system transfer devices can reduce the contamination in work surfaces significantly, but do not eliminate it. Conclusions: Presence of contamination by cytostatic drugs was confirmed in many hospitals across all 5 continents. In all cases, contamination was found in the cabinet, on the floor in front of the cabinet, and in other places of the Hospital Pharmacy. The drug most frequently found was cyclophosphamide. The most effective action used to reduce contamination was the closed-system transfer devices (CSTDs) (AU)

Objetivo: Disponer de la evidencia más actual y conocer las medidas a aplicar para evitar la exposición laboral a citostáticos. Método: Se realizó una búsqueda bibliográfica en las bases de datos MEDLINE, COCHRANE PLUS y WEB OF SCIENCE con los términos ‘surface contamination’, ‘antineoplastic drug’, ‘drug preparation’, ‘occupational exposure’, ‘safe handling’ y ‘closed-system transfer device’ para el periodo 2010- 2015. Resultados: Se seleccionaron 13 artículos para la revisión. Estos artículos corresponden a hospitales de USA, Canadá, Japón, Australia, España, Portugal y Alemania. En todos ellos se ha encontrado contaminación por fármacos citostáticos en más de 15 superficies distintas con concentraciones que van desde los 1,69 ng/cm2 hasta 4,784 µg/cm2 . Los fármacos determinados han sido ciclofosfamida, ifosfamida, 5-fluorouracilo, metotrexato, paclitaxel, cisplatino, gemcitabina y docetaxel. El sistema cerrado reduce la contaminación de las superficies de trabajo significativamente, pero no la elimina. Conclusiones: Se verifica la presencia de contaminación por fármacos citostáticos en numerosos hospitales de los 5 continentes. En todos los casos se ha encontrado contaminación en la cabina, en el suelo frente a la cabina y en otros lugares de la farmacia. El fármaco más frecuentemente encontrado es la ciclofosfamida. El sistema empleado más eficaz para reducir la contaminación es el uso de dispositivos cerrados de transferencia (CSTD-closed system transfer device) (AU)

Evidence of exposure to cytostatic drugs in healthcare staff: a review of recent literature.

OBJECTIVE: Provide updated evidence and learn about the actions that must be implemented in order to prevent the occupational exposure to cytostatic drugs. METHOD: A bibliographic search was carried out on the MEDLINE, COCHRANE PLUS and WEB OF SCIENCE databases, with the terms "surface contamination", "cytostatic drug", "drug preparation", "occupational exposure", "safe handling" and "closed-system transfer device", within the 2010-2015 period. RESULTS: Thirteen articles were selected for review. These articles are from hospitals in U.S.A., Canada, Japan, Australia, Spain, Portugal and Germany. In all of them, surface contamination by cytostatic agents was found in over 15 different surfaces, with concentrations ranging from 1.69 ng/cm2 to 4-784 µg/cm2. The specific drugs were cyclophosphamide, ifosfamide, 5-fluorouracil, methotrexate, paclitaxel, cisplatin, gemcitabine, and docetaxel. Closed-system transfer devices can reduce the contamination in work surfaces significantly, but do not eliminate it. CONCLUSIONS: Presence of contamination by cytostatic drugs was confirmed in many hospitals across all 5 continents. In all cases, contamination was found in the cabinet, on the floor in front of the cabinet, and in other places of the Hospital Pharmacy. The drug most frequently found was cyclophosphamide. The most effective action used to reduce contamination was the closed-system transfer devices (CSTDs).

Objetivo: Disponer de la evidencia mas actual y conocer las medidas a aplicar para evitar la exposicion laboral a citostaticos. Método: Se realizo una busqueda bibliografica en las bases de datos MEDLINE, COCHRANE PLUS y WEB OF SCIENCE con los terminos "surface contamination", "antineoplastic drug", "drug preparation", "occupational exposure", "safe handling" y "closed-system transfer device" para el periodo 2010- 2015. Resultados: Se seleccionaron 13 articulos para la revision. Estos articulos corresponden a hospitales de USA, Canada, Japon, Australia, Espana, Portugal y Alemania. En todos ellos se ha encontrado contaminacion por farmacos citostaticos en mas de 15 superficies distintas con concentraciones que van desde los 1,69 ng/cm2 hasta 4,784 µg/cm2. Los farmacos determinados han sido ciclofosfamida, ifosfamida, 5-fluorouracilo, metotrexato, paclitaxel, cisplatino, gemcitabina y docetaxel. El sistema cerrado reduce la contaminacion de las superficies de trabajo significativamente, pero no la elimina. Conclusiones: Se verifica la presencia de contaminacion por farmacos citostaticos en numerosos hospitales de los 5 continentes. En todos los casos se ha encontrado contaminacion en la cabina, en el suelo frente a la cabina y en otros lugares de la farmacia. El farmaco mas frecuentemente encontrado es la ciclofosfamida. El sistema empleado mas eficaz para reducir la contaminacion es el uso de dispositivos cerrados de transferencia (CSTD-closed system transfer device).

Nivel de satisfacción de un grupo de ancianos de Madrid con los cuidados enfermeros recibidos en urgencias / Level of satisfaction of a group of elderly people from Madrid with the nursing care received at the emergency centre

La población actual está envejeciendo debido a que las personas cada vez son más longevas. Este hecho, unido a las pluripatologías de los ancianos y a los frecuentes casos de polimedicación, hace de este grupo de edad un grupo con características especiales. El objetivo de este artículo es conocer el nivel de satisfacción que los ancianos tienen sobre los cuidados enfermeros recibidos en un servicio de urgencias. Se trata de un estudio descriptivo transversal sobre 200 personas mayores de 65 años que acudieron al servicio de urgencias de un hospital público, mediante un cuestionario validado al español y ya utilizado en estudios previos. La media de edad fue de 77,5 años; la valoración media de los hombres fue de 56,42 sobre 75 puntos, mientras que la de las mujeres fue de 54,9. Los ítems mejor valorados fueron los referidos a la comprensión y al conocimiento de la enfermedad por parte de la enfermera. Se puede afirmar que existen factores muy positivamente valorados, como el conocimiento de la enfermedad por parte de los profesionales y el nivel de comprensión; sin embargo, aspectos como la atención personal o el tiempo dedicado a los pacientes son aspectos que, según los ancianos, pueden ser mejorables para que el nivel de satisfacción de este tipo de pacientes sea mayor

The current population is aging because people are increasingly living longer. This fact, coupled with multiple pathologies of the elderly and the frequent occurrence of polypharmacy, makes this age group a group with special characteristics. That is why the aim of this article is to know the level of satisfaction that the elderly have about nursing care received in an emergency. It is a cross-sectional study on 200 people over 65 who came to the emergency department of a public hospital, using a validated Spanish and already used in previous studies questionnaire. The mean age was 77.5 years; the average score of males was 56.42 on 75 points, while that of women was 54.9. The most valued items were those related to the understanding and awareness of the disease by the nurse. We can say that there are factors positively valued as knowledge of the disease by professionals and the level of understanding; However, aspects such as personal attention and time spent on patients are issues that, according to the elderly, can be upgradable to the level of satisfaction of these patients is greater

Shigellosis in Subjects with Traveler's Diarrhea Versus Domestically Acquired Diarrhea: Implications for Antimicrobial Therapy and Human Immunodeficiency Virus Surveillance.

An increase of sexually transmitted shigellosis is currently being reported in developed countries. In addition, travel-related shigellosis can introduce resistant strains that could be disseminated within this new scenario. Epidemiological features and antimicrobial susceptibility of shigellosis depending on where infection was acquired were investigated. From 2008 to 2013, subjects with shigellosis were studied. Patients were classified according to acquisition of Shigella as traveler's diarrhea (TD) or domestically acquired diarrhea (DAD). Ninety cases of shigellosis were identified: 76 corresponding to the TD group and 14 to the DAD group. In the DAD group, most of patients were human immunodeficiency virus (HIV)-positive men who have sex with men (MSM), being shigellosis associated to male sex (P = 0.007) and HIV infection (P < 0.0001). S. sonnei (47.8%) and S. flexneri (42.2%) were the predominant species. The highest resistance was detected for trimethoprim/sulfamethoxazole (SXT) (81.8%), followed by ampicillin (AMP) (37.8%) and ciprofloxacin (CIP) (23.3%). Resistant Shigella strains were more frequent in subjects with TD than those with DAD, although only for CIP the difference was significant (P = 0.034). Continuous monitoring of patients with shigellosis is necessary to control the spread of resistant Shigella strains and for effective therapy. Men with shigellosis who have not traveled to an endemic area should be screened for HIV infection.

Performance of a new gelled nested PCR test for the diagnosis of imported malaria: comparison with microscopy, rapid diagnostic test, and real-time PCR.

Microscopy and rapid diagnostic tests (RDTs) are the techniques commonly used for malaria diagnosis but they are usually insensitive at very low levels of parasitemia. Nested PCR is commonly used as a reference technique in the diagnosis of malaria due to its high sensitivity and specificity. However, it is a cumbersome assay only available in reference centers. We evaluated a new nested PCR-based assay, BIOMALAR kit (Biotools B&M Labs, Madrid, Spain) which employs ready-to-use gelled reagents and allows the identification of the main four species of Plasmodium. Blood samples were obtained from patients with clinical suspicion of malaria. A total of 94 subjects were studied. Fifty-two (55.3%) of them were malaria-infected subjects corresponding to 48 cases of Plasmodium falciparum, 1 Plasmodium malariae, 2 Plasmodium vivax, and 1 Plasmodium ovale. The performance of the BIOMALAR test was compared with microscopy, rapid diagnostic test (RDT) (BinaxNOW® Malaria) and real-time quantitative PCR (qPCR). The BIOMALAR test showed a sensitivity of 98.1% (95% confidence interval [CI], 89.7-100), superior to microscopy (82.7% [95% CI, 69.7-91.8]) and RDT (94.2% [95% CI, 84.1-98.8]) and similar to qPCR (100% [95% CI, 93.2-100]). In terms of specificity, the BIOMALAR assay showed the same value as microscopy and qPCR (100% [95% CI, 93.2-100]). Nine subjects were submicroscopic carriers of malaria. The BIOMALAR test identified almost all of them (8/9) in comparison with RDT (6/9) and microscopy (0/9). In conclusion, the BIOMALAR is a PCR-based assay easy to use with an excellent performance and especially useful for diagnosis submicroscopic malaria.

Colonial architecture and growth dynamics of Staphylococcus aureus resistant to methicillin

El objetivo del estudio fue observar la estructura colonialy la dinámica del crecimiento de Staphylococcus aureusresistente a meticilina (SARM) empleando cortes semifinosvisualizados al microscopio óptico. Se estudiaron unacepa de S. aureus sensible a meticilina (SASM) y un SARM.Después de cada periodo de incubación (24 y 48 h) a 37ºClas colonias fueron incluidas en una resina epoxi. Cortessemifinos de 0.5 μm fueron teñidos con azul de toluidina yvisualizados al microscopio. Desde el punto de vista microscópico,no se observaron diferencias estructurales entrelas colonias de SASM y SARM. Si se observaron diferenciasen ambas cepas entre las colonias de 24 y 48 h de incubación.En las colonias de 24 h se observaron 2 capasclaramente diferenciadas: (A) una capa basal con alta densidadde población en contacto con el medio de cultivo y(B) una capa superficial con menor densidad de población.En las colonias de 48 h se observaron cuatro capas: (A)una capa basal con alta densidad de población; (B) una capaclara constituida por restos bacterianos muy degradadosen cuyo seno se observan muy escasos y dispersos cocosque conservan sus propiedades tintoriales; (C) una capamixta, constituida por una mezcla de bacterias vivas y restosbacterianos muy groseros y poco degradados y (D) unacapa superficial con menor densidad de población que lacapa basal. Las colonias forman estructuras altamente organizadasoriginadas por la disponibilidad de nutrientes ymecanismos de comunicación intercelular. La arquitecturacolonial es un proceso complejo y tiempo dependiente(AU)

The aim of the study was to explore the structure andgrowth dynamics of Staphylococcus aureus resistant to methicillin(MRSA) colonies using semithin sections visualizedby light microscope. One S. aureus susceptible to methicillin(MSSA) and one MRSA clinical strains were studied. Coloniesin agar plates were embedded in epoxy resin after each incubationperiod (24 h and 48 h) at 37ºC. Semithin sections of0.5 μm were stained with toluidine blue and visualized by lightmicroscope. Microscopically, no structural differences wereobserved between SASM and SARM colonies but differenceswere observed in both strains between 24 and 48 h incubationperiods. Colonies showed two layers clearly differentiated at24 h independently of the resistance to methicillin: (A) onebasal layer with high density of population in contact withculture media, and (B) one superficial layer with a lower densityof population. Colonies showed four layers at 48 h: (A) onebasal layer with high density of population; (B) one clear layerconstituted by very degraded bacterial remains in which canbe observed cocci dispersed with their dyeing properties; (C)one mixed layer constituted by viable bacteria and little degradedbacterial remains (D) one superficial layer with a lowerdensity of population than basal layer. Colonial architecture isa complex and time-dependent process(AU)

Colonial architecture and growth dynamics of Staphylococcus aureus resistant to methicillin.

The aim of the study was to explore the structure and growth dynamics of Staphylococcus aureus resistant to methicillin (MRSA) colonies using semithin sections visualized by light microscope. One S. aureus susceptible to methicillin (MSSA) and one MRSA clinical strains were studied. Colonies in agar plates were embedded in epoxy resin after each incubation period (24 h and 48 h) at 37 degrees . Semithin sections of 0.5 µm were stained with toluidine blue and visualized by light microscope. Microscopically, no structural differences were observed between SASM and SARM colonies but differences were observed in both strains between 24 and 48 h incubation periods. Colonies showed two layers clearly differentiated at 24 h independently of the resistance to methicillin: (A) one basal layer with high density of population in contact with culture media, and (B) one superficial layer with a lower density of population. Colonies showed four layers at 48 h: (A) one basal layer with high density of population; (B) one clear layer constituted by very degraded bacterial remains in which can be observed cocci dispersed with their dyeing properties; (C) one mixed layer constituted by viable bacteria and little degraded bacterial remains (D) one superficial layer with a lower density of population than basal layer. Colonial architecture is a complex and time-dependent process.