Hostelería hospitalaria del Complejo Hospitalario Universitario de Santiago (CHUS) / The hospital catering service of the Complejo Hospitalario Universitario de Santiago (CHUS)

Los requerimientos de eficiencia en la gestión hospitalaria se basan en las necesidades logísticas en función de las características estructurales del hospital, para concluir con éxito el servicio prestado a los pacientes. Este artículo resume la evaluación desarrollada en el CHUS del servicio prestado en función de la cantidad y calidad ofrecida, así como el grado de fiabilidad y compromiso de la sección de Hostelería Hospitalaria del centro (AU)

The efficiency requirements in hospital management are based on the logistics needs according to the structural characteristics of the hospital, in order to successfully perform the service given to patients. This article summarises the assessment, developed in the CHUS, of the service provided according to the quantity and quality offered, as well as the degree of reliability and commitment in the Hospital Catering section of the centre (AU)

Characterization of a Mycobacterium intracellulare variant strain by molecular techniques.

This paper describes a Mycobacterium intracellulare variant strain causing an unusual infection. Several isolates obtained from an immunocompromised patient were identified as members of the Mycobacterium avium complex (MAC) by the commercial AccuProbe system and biochemical standard identification. Further molecular approaches were undertaken for a more accurate characterization of the bacteria. Up to seven different genomic sequences were analyzed, ranging from conserved mycobacterial genes such as 16S ribosomal DNA to MAC-specific genes such as mig (macrophage-induced gene). The results obtained identify the isolates as a variant of M. intracellulare, an example of the internal variability described for members of the MAC, particularly within that species. The application of other molecular approaches is recommended for more accurate identification of bacteria described as MAC members.

Mutations in the rpoB gene of rifampin-resistant Mycobacterium tuberculosis isolates in Spain and their rapid detection by PCR-enzyme-linked immunosorbent assay.

Genetic alterations in the rpoB gene were characterized in 50 rifampin-resistant (Rif(r)) clinical isolates of Mycobacterium tuberculosis complex from Spain. A rapid PCR-enzyme-linked immunosorbent assay (ELISA) technique for the identification of rpoB mutations was evaluated with isolates of the M. tuberculosis complex and clinical specimens from tuberculosis patients that were positive for acid-fast bacilli (AFB). Sequence analysis demonstrated 11 different rpoB mutations among the Rif(r) isolates in the study. The most frequent mutations were those associated with codon 531 (24 of 50; 48%) and codon 526 (11 of 50; 22%). Although the PCR-ELISA does not permit characterization of the specific Rif(r) allele within each strain, 10 of the 11 Rif(r) genotypes were correctly identified by this method. We used the PCR-ELISA to predict the rifampin susceptibility of M. tuberculosis complex organisms from 30 AFB-positive sputum specimens. For 28 samples, of which 9 contained Rif(r) organisms and 19 contained susceptible strains, results were concordant with those based on culture-based drug susceptibility testing and sequencing. Results from the remaining two samples could not be interpreted because of low bacillary load (microscopy score of 1+ for 1 to 9 microorganisms/100 fields). Our results suggest that the PCR-ELISA is an easy technique to implement and could be used as a rapid procedure for detecting rifampin resistance to complement conventional culture-based methods.

rpoB mutations as an epidemiologic marker in rifampin-resistant Mycobacterium tuberculosis.

SETTING: Cases of rifampin-resistant Mycobacterium tuberculosis from the prison population in Madrid and from the general population in Spain. OBJECTIVE: To identify the rpoB mutations associated with resistance to rifampin and to investigate rpoB genotyping as an epidemiological marker in rifampin-resistant M. tuberculosis. DESIGN: Twenty-nine rifampin-resistant clinical isolates of M. tuberculosis, 15 obtained from the prison population in Madrid and 14 from the general population in Spain, were characterized by sequence analysis of the 81-bp core region of the rpoB gene and IS6110 DNA fingerprinting. RESULTS: All the isolates had mutations in rpoB, with those in codon 531 accounting for 41% of the total. Twenty-three (79%) isolates were highly resistant to rifampin (minimum inhibitory concentration > or = 64 mg/L). Nineteen different IS6110 fingerprints were observed: one was shared by seven isolates, one by three, two by two, and 15 were unique. Two IS6110 clusters could be divided into subclusters on the basis of rpoB analysis. Epidemiologic links were identified among patients whose isolates had identical IS6110 patterns and rpoB genotypes, but not between those with identical IS6110 patterns and different rpoB genotypes. CONCLUSION: Characterization of rpoB mutations can provide information about susceptibility to rifampin and be a useful epidemiological tool for discrimination of rifampin-resistant strains of M. tuberculosis with identical IS6110 fingerprints.

[Total gastrectomy in newborn infant]. / Gastrectomía total en lactante.

Total gastrectomy is rarely indicated in childhood and when necessary it involves multiple ulterior therapeutic problems, mainly nutritional, which need a meticulous physiological approach to avoid further complications, as illustrated by the following patient who, at age 15 months, was submitted to total gastric resection, Y en Roux esophagojejunal anastomosis and splenectomy, because of peritonitis secondary to dehiscence of a recent esophagogastric anastomosis for partial gastric resection due to gastric volvulus and necrosis, which in turn were associated to diaphragmatic relaxation. The patient was admitted to our hospital one month later with signs of acute calorie-protein malnutrition (W/A 60% and W/H 68%, NCHS standards) requiring combined parenteral and enteral nutritional support (via central venous catheter and jejunostomy tube for 15 and 35 days respectively) together with intramuscular vitamin B 12, oral iron and oral vitamin supplements before it became possible to fed him only by mouth. Prophylaxis against Streptococcus pneumonia infections with monthly benzatin penicillin was also instituted. Mean daily weight increases of 16 g, W/A 68% and W/H 74% were thus achieved before hospital discharge, without evidence of dumping syndrome nor alkaline reflux.

[Modular diet and parenteral support in persistent diarrhea]. / Dieta modular y apoyo parenteral en diarrea persistente.

Eleven infants with protracted diarrhea were treated with modular diet and short-term parenteral nutrition. Mean age at admission was 3.7 months with males predominating. Enteropathogenic E. coli, classic serotypes, were isolated from 7 patients and rotavirus from one. A child with combined, severe immunodeficiency died. Milk protein intolerance was diagnosed in another patient. Balance studies and peroral biopsies were performed. Malnutrition was more frequent and hospital stay was longer in those infants who developed nosocomial infections. Even though this treatment shortened the duration of the hospitalization, the negative nutritional impact persisted: Weight/Age (NCHS) decreased from 84% to 61%, with rapid recovery after discharge. Fecal lactic acid excretion was increased on admission to 1,296 mg x day and disaccharidase activity was decreased. The modular diet decreased both fecal volume and lactic acid excretion.