[Evaluation of the validity of Ag PANBIO-COVID19 in the diagnosis of SARS-CoV-2 infection in asymptomatic or mildly infected patients]. / Evaluación de la validez del Ag PANBIO-COVID19 de Abbott en el diagnóstico de la infección por SARS-CoV-2 en pacientes asintomáticos o con infección leve.

OBJECTIVE: To assess the validity of SARS-CoV-2 Antigen (Ag) detection for the diagnosis of SARS-CoV-2 infection in mildly infected or asymptomatic patients. METHODS: Observational study to evaluate diagnostic tests. Non-hospitalized patients with indication for diagnostic testing for SARS-CoV-2 infection were included. The diagnostic test to be evaluated was the determination of Ag and as a reference standard to determine the presence of viral RNA the RT-PCR was used. RESULTS: A total of 494 patients were included. Of these 71.5% (353/494) had symptoms and 28.5% (141/494) were asymptomatic (presurgery screening (35/494) and confirmed case-contact (106/494). The overall sensitivity of the Ag test was 61.1% and the specificity was 99.7%. The sensitivity and specificity in the asymptomatic group were 40% and 100% respectively, and in the symptomatic group 63.5% and 99.6% respectively. In turn, the sensitivity and specificity in the group of symptomatic patients varied according to the time of symptom evolution: in patients with recent symptoms, they were 71.4% and 99.6% respectively, while in patients with symptoms of more than 5 days of evolution, they were 26.7% and 100% respectively. In all groups studied, the presence of antigen is associated with a high viral load (Ct<30 cycles). CONCLUSIONS: The use of Ag detection test is not indicated for the diagnosis of SARS-CoV-2 infection in asymptomatic patients or with symptoms of more than 5 days of evolution, but it could be useful in patients with symptoms of 1-5 days of evolution.

Hormona paratiroidea, calcidiol, calcitriol y riesgo de eventos adversos en pacientes con síndrome coronario agudo / Parathyroid hormone, calcidiol, calcitriol and adverse events in the acute coronary syndrome

Objetivo: Conocer el perfil clínico, así como el significado pronóstico, de la presencia de niveles elevados de hormona paratiroidea (PTH) en pacientes ingresados por síndrome coronario agudo (SCA). Diseño y ámbito: Estudio observacional y prospectivo de pacientes ingresados por SCA en un único centro español durante un periodo de 6meses. Intervención y variables de interés: Se determinaron las concentraciones de PTH, calcidiol, calcitriol, NT-proBNP, proteína Creactiva, cistatinaC y fibrinógeno circulantes en las primeras 48h del ingreso y se realizaron modelos ajustados para predecir muerte o reingreso por SCA tras el alta. Resultados: Se reclutaron 161 pacientes (edad 67±14años; 75,2% varones) de los cuales 41 (25,5%) presentaron valores elevados de PTH. Se registraron 50 eventos adversos durante un seguimiento de 275 personas-año. Los pacientes con niveles elevados de PTH fueron en mayor proporción mujeres (21,2 vs. 39,0%) y de mayor edad (63,3 vs. 77,8años, ambos p<0,05). Asimismo, presentaron mayor riesgo cardiovascular y una peor evolución en el seguimiento (razón de tasas de incidencia: 2,64; IC 95%: 1,5-4,6). Sin embargo, en un modelo ajustado por la escala GRACE, los niveles de PTH no se mostraron como un factor de riesgo independiente (hazard ratio=1,1; IC 95%: 0,6-2,2); tampoco el resto de componentes del panel. Conclusiones: La proporción de pacientes con niveles elevados de PTH ingresados por SCA es elevada. Su presencia se asoció con un perfil clínico más adverso y peor evolución durante el seguimiento, aunque no resultó ser un predictor independiente de mal pronóstico (AU)

Objective: To know the clinical profile as well as the prognostic significance of elevated levels of parathyroid hormone (PTH) in patients admitted for acute coronary syndrome (ACS). Design and setting: Observational and prospective study of patients admitted for ACS in a single Spanish center during a period of six months. Intervention and variables of interest: The circulating concentrations of PTH, calcidiol, calcitriol, NT-proBNP, C-reactive protein, cystatinC and fibrinogen were determined within the first 48h at admission. We performed adjusted models to predict death or re-entry for ACS after hospital discharge. Results: A total of 161 patients were recruited (age 67±14 years, 75.2% were men). Forty-one (25.5%) patients had elevated PTH values. During follow-up for a period of 275 person-years, 50 adverse events were recorded. Patients with elevated PTH levels were proportionally more women (21.2 vs. 39.0%) and older (63.3 vs. 77.8 years, both P<.05). Likewise, they presented significantly more cardiovascular risk and a worse prognosis during follow-up (incidence rate ratio 2.64 CI 95%: 1.5-4.6). However, in an adjusted model by the GRACE score, PTH levels were not shown to be an independent risk factor (hazard ratio=1.1; 95% CI: 0.6-2.2), neither other components of the panel. Conclusions: The proportion of patients with elevated levels of PTH admitted for ACS was high. The presence of high PTH levels was associated with an unfavorable clinical profile and a worse outcome during the follow-up, although it was not an independent predictor of poor prognosis (AU)

Parathyroid hormone, calcidiol, calcitriol and adverse events in the acute coronary syndrome. / Hormona paratiroidea, calcidiol, calcitriol y riesgo de eventos adversos en pacientes con síndrome coronario agudo.

OBJECTIVE: To know the clinical profile as well as the prognostic significance of elevated levels of parathyroid hormone (PTH) in patients admitted for acute coronary syndrome (ACS). DESIGN AND SETTING: Observational and prospective study of patients admitted for ACS in a single Spanish center during a period of six months. INTERVENTION AND VARIABLES OF INTEREST: The circulating concentrations of PTH, calcidiol, calcitriol, NT-proBNP, C-reactive protein, cystatinC and fibrinogen were determined within the first 48h at admission. We performed adjusted models to predict death or re-entry for ACS after hospital discharge. RESULTS: A total of 161 patients were recruited (age 67±14 years, 75.2% were men). Forty-one (25.5%) patients had elevated PTH values. During follow-up for a period of 275 person-years, 50 adverse events were recorded. Patients with elevated PTH levels were proportionally more women (21.2 vs. 39.0%) and older (63.3 vs. 77.8 years, both P<.05). Likewise, they presented significantly more cardiovascular risk and a worse prognosis during follow-up (incidence rate ratio 2.64 CI 95%: 1.5-4.6). However, in an adjusted model by the GRACE score, PTH levels were not shown to be an independent risk factor (hazard ratio=1.1; 95% CI: 0.6-2.2), neither other components of the panel. CONCLUSIONS: The proportion of patients with elevated levels of PTH admitted for ACS was high. The presence of high PTH levels was associated with an unfavorable clinical profile and a worse outcome during the follow-up, although it was not an independent predictor of poor prognosis.

Variabilidad en el registro de alergias por profesionales sanitarios en un hospital de tercer nivel / Variability in allergies registration done by healthcare professionals in a third level hospital

Introducción: El objetivo del estudio es cuantificar el grado de coincidencia en las alergias registradas en las distintas aplicaciones informáticas disponibles para cada profesional sanitario (médicos, personal de enfermería y farmacéuticos). Métodos: Estudio observacional descriptivo retrospectivo de 3 meses de duración en el que participaron todas las Unidades Clínicas con Sistema de Distribución de Medicamentos en Dosis Unitarias. Se incluyeron a todos los pacientes ingresados con al menos una alergia registrada en cualquiera de las tres aplicaciones informáticas utilizadas por los distintos profesionales sanitarios. Se cuantificaron el porcentaje de alergias registradas en una, dos o tres aplicaciones disponibles. Resultados: Se incluyeron 767 pacientes en los que se registraron 1.257 alergias. La mediana de edad fue 59 años y el 60,76% eran mujeres. El 70,09% de las alergias registradas fueron farmacológicas. El registro de alergias únicamente a través de la aplicación de enfermería fue el más frecuente (36,67%). El porcentaje de alergias registradas por los tres profesionales sanitarios fue el 7,88%. Haciendo distinción en el tipo de alergia, solamente el 0,80% de las alergias no farmacológicas fueron registradas simultáneamente por los tres profesionales sanitarios frente al 10,90% de las farmacológicas. El personal médico contribuyó al registro del 59,29% de las alergias farmacológicas y del 10,65% de las no farmacológicas. Discusión: Existe una gran variabilidad en el registro de alergias por parte del personal sanitario y escasa concordancia en las registradas por cada tipo de profesionales. El personal médico únicamente registró una décima parte de las alergias no farmacológicas

Introduction: The purpose of the study is to quantify the degree of coincidence in the allergies registered in the different computer applications available to each healthcare professional (doctors, nursing staff and pharmacists). Methods: It was conducted a three- month retrospective descriptive and observational study which included the participation of all Clinical Units with Medication Dispensing System in Single Doses. All in-patients with, at least, one allergy registered in any of the three computer applications used by the different healthcare professionals were included in the study. The percentage of allergies registered in one, two or three of the available applications was quantified. Results: 767 patients were included, among whom 1,257 allergies were recorded. The average age was 59 years and 60.76% were women. 70.09% of the recorded allergies were drug-related. The majority of allergies were just registered through the nursing application (36.67%). The percentage of allergies recorded by the three kinds of healthcare professionals was 7.88%. Differentiating the type of allergy, only 0.80% of non drug-related allergies were registered simultaneously by all three healthcare professionals in comparison with 10.90% of drug-related allergies. Medical staff recorded 59.29% of drug-related allergies and 10.65% of non drug-related allergies. Discussion: There is a high variability in the recording of allergies by the healthcare professionals and also a lack of concordance in those recorded by each type of professional. Medical staff only recorded 10% of non drug-related allergies

Real-time PCR with internal amplification control for detecting tuberculosis: method design and validation.

Real-time PCR has been a major development in the diagnosis of tuberculosis. However, most tests do not include an internal amplification control (IAC), which therefore limits it clinical application. In this study a new, easy to perform real-time PCR test with IAC was designed and validated in clinical samples. The primers amplified a 163-bp fragment of IS6110 of Mycobacterium tuberculosis and the IAC was designed with a fragment of a different microorganism (Chlamydia trachomatis). The interassay and intraassay variation of this test were very low (0.45-1.65% and 0.18-1.80%, respectively). The detection accuracy was validated in 50 samples (25 urine, 25 sputum) with different concentrations of M. tuberculosis, 18 clinical isolates of non-tuberculous mycobacteria and 148 samples with clinical suspicion of pulmonary tuberculosis. The specificity was 100%. The detection limit of this PCR test without IAC was approximately 15 bacteria and with IAC approximately 32 bacteria. This real-time PCR with IAC assay can improve the detection of M. tuberculosis and contribute to standardization of this diagnostic technique.

Screening for sterilizing activity of antibiotic combinations in an acid model of rapidly growing mycobacteria during the stationary phase of growth.

BACKGROUND: In view of the problems of correlation between the data provided by classical microbiological studies and clinical response, we designed an in vitro method to screen for the sterilizing activity of various antibiotics, individually or in combinations, against clinical isolates of various rapidly growing mycobacteria in the stationary phase. MATERIAL AND METHODS: We screened a large number of antibiotic combinations (4-16 microg/ml) for their sterilizing capacity in 26 Mycobacterium fortuitum clinical isolates, 7 Mycobacterium chelonae and 2 Mycobacterium abscessus clinical isolates (10(5) CFU). RESULTS: The best results against M. fortuitum were obtained with moxifloxacin, both on its own (13/26 strains) and in combination. This drug is also very active against M. chelonae (3/7 strains), and in combination with clarithromycin and amikacin exhibits sterilizing activity against all the strains studied. Combinations of clarithromycin with moxifloxacin or linezolid at high doses (16 microg/ml) exhibit activity against M. abscessus. CONCLUSIONS: The most relevant finding of our study is the good activity of moxifloxacin against these microorganisms in the stationary phase. This indicates the need to confirm these data in animal models or clinical trials in order to determine their true clinical importance.

Incidence of Beijing genotype of Mycobacterium tuberculosis in Elche, Spain: a 13-year surveillance study.

Strains of the Beijing genotype family of Mycobacterium tuberculosis have been associated with outbreaks and multidrug resistance. We performed a retrospective thirteen-year surveillance study (1993 - 2005) on the occurrence of this strain in Elche, Spain. Only one of the available isolates from 332 cases of tuberculosis tested positive for Beijing strain. The case, detected in 2001, was that of an immigrant patient from Senegal with pulmonary tuberculosis. The strain was not drug resistant and besides six close contact persons that were infected no secondary cases of this strain were detected. In the Elche area, the incidence of Beijing strains is very low and there is no evidence of transmission or higher virulence.

Importance of the efflux pump systems in the resistance of Mycobacterium tuberculosis to fluoroquinolones and linezolid.

OBJECTIVE: Our aim was to study the influence of efflux pump systems in the resistance of Mycobacterium tuberculosis to fluoroquinolones and linezolid. METHODS: We studied the mutations in gyrA and gyrB genes and the influence of efflux pump systems with 2 inhibitors (reserpine and MC 207.110). RESULTS: The effect of the active efflux system on the decrease in sensitivity to ciprofloxacin, moxifloxacin, levofloxacin, ofloxacin, gatifloxacin and linezolid was studied by investigating the variation in the in vitro activity of these compounds when assayed in association with reserpine and MC 207.110. These inhibitors exhibit activity both in strains that are resistant and in strains that are susceptible to these antibiotics. However, they are seen to be most active in resistant strains, since the minimum inhibitory concentration of the antibiotics studied in these strains was reduced between 2- and 6-fold. CONCLUSIONS: Therefore, these mechanisms are involved in the resistance to both compounds. It would be of interest to carry out further studies to determine to what extent these active efflux systems influence resistance to the different groups of drugs used in the treatment of tuberculosis, with a view to the possibility of using the inhibitors of these systems in future therapeutic applications.

Disminución de la actividad bactericida del ciprofloxacino en mutantes de Salmonella generados tras exposición repetida a diversas fluoroquinolonas / Decrease in bactericidal activity of ciprofloxacin in Salmonella mutants generated following repeated exposure to various fluorquinolones

Después de generar in vitro mutantes de Salmonella spp. con sensibilidad disminuida a las fluoroquinolonas tras su exposición repetida a concentraciones subinhibitorias de estos fármacos y caracterizar las alteraciones del gen gyrA, hemos determinado la modificación de la actividad bactericida que presenta el ciprofloxacino sobre los mutantes obtenidos. La pérdida de la actividad bactericida del ciprofloxacino se detecta en todos los mutantes, pero es mayor en los provenientes de cepas resistentes al ácido nalidíxico. Esto puede ayudar a explicar los fracasos terapéuticos observados con algunos tratamientos con fluoroquinolonas frente a este tipo de cepas. Además, nuestro modelo evalúa las primeras interacciones que se producen entre el microorganismo y los antibióticos, y pone de manifiesto que la pérdida de actividad bactericida del ciprofloxacino es un proceso que se produce tras la exposición a cualquiera de las fluoroquinolonas probadas

Salmonella mutants with reduced fluoroquinolone susceptibility were generated in vitro following repeated exposure to subinhibitory concentrations of the drugs and the alterations in the gyrA gene were characterized. Afterwards, the change in bactericidal activity exhibited by ciprofloxacin against the resulting mutants was determined. A decrease in the bactericidal activity of ciprofloxacin was found in all the mutants, but was more pronounced in mutants of nalidixic acid-resistant strains. This may help to explain the therapeutic failures sometimes described when fluoroquinolones are used in the treatment of these strains. In addition, our model evaluates the first interactions produced between the microorganism and the antibiotics, and demonstrates that the loss of bactericidal activity of ciprofloxacin occurs following exposure to all of the fluoroquinolones tested

Alterations in the gyrA and parC genes in Salmonella spp. following in vitro exposure to fluoroquinolones.

We characterize alterations in the QRDR fragment of gyrA and parC in Salmonella spp. following repeated exposure to different quinolones in two in vitro models. Mutations in QRDR of gyrA were found in only 25% of the mutants. The most frequent mutations were Asp87(R)Asn and Asp87(R)Tyr. Strains with the former mutation had a higher ciprofloxacin MIC than those with the latter. We did not find mutations in parC. Our data confirm that mutation in the QRDR fragment of gyrA is the mechanism that produces the greatest decrease in fluoroquinolone susceptibility. There is a greater reduction in the ciprofloxacin susceptibility of strains that were originally nalidixic acid-resistant than in that of strains that were originally susceptible, and this confirms that there is a greater likelihood of therapeutic failures with such strains.

[Decrease in bactericidal activity of ciprofloxacin in Salmonella mutants generated following repeated exposure to various fluorquinolones]. / Disminución de la actividad bactericida del ciprofloxacino en mutantes de Salmonella generados tras exposición repetida a diversas fluoroquinolonas.

Salmonella mutants with reduced fluoroquinolone susceptibility were generated in vitro following repeated exposure to subinhibitory concentrations of the drugs and the alterations in the gyrA gene were characterized. Afterwards, the change in bactericidal activity exhibited by ciprofloxacin against the resulting mutants was determined. A decrease in the bactericidal activity of ciprofloxacin was found in all the mutants, but was more pronounced in mutants of nalidixic acid-resistant strains. This may help to explain the therapeutic failures sometimes described when fluoroquinolones are used in the treatment of these strains. In addition, our model evaluates the first interactions produced between the microorganism and the antibiotics, and demonstrates that the loss of bactericidal activity of ciprofloxacin occurs following exposure to all of the fluoroquinolones tested.

Utilidad de medios de cultivo con sangre de carnero en el aislamiento de Mycobacterium tuberculosis / Usefulness of culture media with ram’s blood in the isolation of Mycobacterium tuberculosis

Introducción:Conocer la utilidad de varios medios en el aislamiento deMycobacterium tuberculosis.Material y metodos:97 cepas de M. tuberculosis se cultivaron en: Agar Columbia,agar tripticasa soja, GC agar y agar infusión corazón-cerebro.Todos tenían 10% de sangre de carnero como suplemento.Resultados:Más del 95% de las cepas crecen, no encontrando diferenciasestadísticamente significativas. La mayoría de las cepascrecen a la tercera semana de incubación.Conclusiones:El crecimiento de M. tuberculosis en medios con agar suplementadoscon sangre de carnero tras incubación prolongadadebe ser tenido en cuenta para mejorar el diagnóstico de estemicroorganismo en muestras escasas o en las que no se sospechóinicialmente la posible implicación de este patógeno. Además,el crecimiento de M. tuberculosis en medios con base deagar debe tenerse en cuenta a la hora de mantener las medidasde seguridad adecuadas en el manejo de estos cultivos

Introduction:To determine the usefulness of various media in the isolationof Mycobacterium tuberculosisMaterial and methods:Ninety seven M. tuberculosis strains were cultured in:Columbia agar, soya-tripticase agar, GC agar and heart braininfusion agar. All are suplemented with 10% ram’s blood.Results:Over 95% of the strains grew, and no statistically significantdifferences were found. Most strains grew during the thirdweek of incubation.Conclusions:The growth of M. tuberculosis in agar media suplementedwith ram’s blood after prolonged incubation should be taken intoaccount in order to improve the diagnosis of this microorganismin small samples or in those in which involvement of thispathogen was not initially suspected. In addition, the growth ofM. tuberculosis in agar base media should be borne in mindwhen maintaining the appropriate safety measures during handlingof these cultures

Influence of various criteria for elimination of duplicates when calculating the prevalence and antibiotic susceptibility of microorganisms associated with urinary infections.

The effect of applying various criteria for elimination of repeated isolates in the same patient on the prevalence and antibiotic susceptibility of microorganisms frequently associated with urinary infections were analyzed. When time criteria were applied, there was a decrease in the number of isolates of 13.4-27.5%, whereas when variations in antibiotic susceptibility were considered, between 4.3 and 20.3% of the isolates were eliminated. The absolute number of isolates varied considerably depending on which of these two criteria were used, but neither criterion was seen to modify significantly the antibiotic susceptibility of these microorganisms and this confirms the recommendations of the NCCLS for this group of pathogens.

Usefulness of different techniques in the study of the epidemiology of salmonellosis.

Our objective was to evaluate the usefulness of serotyping, phagotyping, antibiotyping and RAPD (random amplified polymorphic DNA) in the study of the epidemiology of salmonellosis in Elche (Spain). We examined 1232 clinical isolates of non-typhoid Salmonella serotypes. Serotyping adequately differentiates 12.3% of the isolates and phagotyping raises this percentage to 37%. Antibiotyping is a suitable complement in certain circumstances, such as in the case of specific outbreaks. RAPD is a fast and simple technique which is within the reach of most laboratories, complementing the results obtained by antibiotyping and serotyping, in order to be able to control outbreaks of salmonellosis in everyday practice.

Utilización y eficacia de la vacunación antigripal en la prevención de ingresos hospitalarios por descompensación cardiorrespiratoria en pacientes de alto riesgo en Cáceres / Utilization and effectiveness of the flu vaccination in the prevention of the hospitalization induced by cardiorespiratory decompensation in high-risk patients in Cáceres

Introducción. A pesar de las recomendaciones de vacunar anualmente contra la gripe a todos los ancianos y personas con diversas enfermedades crónicas, éstas no se cumplen. Hemos analizado el grado de utilización de la vacunación antigripal en la temporada 2000/2001 en pacientes mayores de 65 años con patologías crónicas de alto riesgo y su eficacia en cuanto a evitar ingresos hospitalarios por descompensación cardiorrespiratoria, reducir el número de consultas a su médico de Atención Primaria y días e ingreso hospitalario en un estudio casos/control en el servicio de Medicina Interna del Hospital de Cáceres. Pacientes y métodos. Se estudiaron 227 pacientes mayores de 65 años con enfermedad cardiorrespiratoria crónica, diabetes, insuficiencia renal crónica, hepatopatía, neumonía previa u otras causas de inmunosupresión. De ellos, 116 ingresaron por descompensación cardíaca o respiratoria (casos) y 99 pacientes seguidos en consultas externas que no ingresaron este año (controles), con características clínicas similares. A todos se les realizó un cuestionario que incluía características demográficas y de su enfermedad de base, se agruparon según el número de enfermedades subyacentes (una, dos o más), si había recibido la vacunación antigripal correcta, número de consultas a su médico de familia ese año por infecciones respiratorias, ingresos el año anterior y, en caso de ingreso, días que permaneció ingresado. Resultados. La edad media fue de 71 años, el 63 por ciento había ingresado el año anterior. El porcentaje de vacunados fue del 60 por ciento, la vacunación fue más empleada en los mayores de 75 años (p < 0,001), con enfermedad pulmonar obstructiva crónica (EPOC) (p < 0,005) e insuficiencia cardíaca (p < 0,01) y enfermos con dos o más factores de riesgo (p < 0,001). No encontramos diferencias entre casos y controles en cuanto a la edad, número de enfermos con insuficiencia cardíaca congestiva (ICC), diabetes mellitus (DM) ni padecer dos o más factores de riesgo, pero los que ingresaron padecían más de EPOC (OR: 3,6; IC: 2,01-6,45) y tenían más antecedentes de neumonía (OR: 5,24; IC: 2,4-11,14). Los factores que más influyeron en la posibilidad de ingreso fueron: EPOC (OR: 3,67; IC: 1,90-7,13) y antecedente de neumonía previa (OR: 3,88; IC: 1,69-8,95). La estimación de ingresos evitados por la vacunación fue del 59 por ciento (OR: 0,41; IC: 0,22-0,79), aunque no disminuyó el número de consultas a su médico ni los días de ingreso. Conclusiones. La vacunación antigripal parece infrautilizada en pacientes mayores de 65 años con pluripatología en el medio hospitalario. La vacunación parece ser eficaz en cuanto a que disminuye el número de ingresos por descompensación cardiorrespiratoria, incluso en estaciones no epidémicas. Deberíamos insistir en el empleo de la vacunación antigripal en estos pacientes de alto riesgo (AU)

[Utilization and effectiveness of the flu vaccination in the prevention of the hospitalization induced by cardiorespiratory decompensation in high-risk patients in Cáceres]. / Utilización y eficacia de la vacunación antigripal en la prevención de ingresos hospitalarios por descompensación cardiorrespiratoria en pacientes de alto riesgo en Cáceres.

INTRODUCTION: Despite the recommendations to vaccinate annually against the flu to all the elderly and people with various chronic diseases, these recommendations are not comon to fulfill. In this case-control study performed in the service of Internal Medicine of the Hospital of Cáceres we have analyzed the degree of utilization of the flu vaccination in the season 2000/2001 in patients over 65 years of age with high-risk chronic diseases, as well as the effectiveness of this vaccination to avoid the hospitalization induced by cardiorespiratory decompensation, in order to reduce the number of consultations to the primary care physician and in order to reduce the issue of days of hospitalization. PATIENTS OF METHOD: 227 patients over 65 years of age with chronic cardiorespiratory disease, diabetes, chronic renal insufficiency, hepatopathy, previous pneumonia, or other causes of immunosuppression were studied. Of them, 116 were admitted because of cadiac or respiratory decompensation (cases); the control group was made up of 99 patients who went to outpatient consultations, with clinical manifestations similar to the cases and they were not hospitalized during the year of study. All the participants filled a questionnaire that included demographic characteristics and data about the underlying disease; the participants were grouped according to the number of underlying disease (one, two or more), according to if had received correctly the flu vaccination, according to the number of consultations to its Family doctor during the year of the study because of respiratory infections, according to the hospitalizations during the previous year and in the patients that were hospitalized acording to the number of days of the hospitalization. RESULTS: The average age was 71 years and 63% patients had been hospitalized the previous year. The percentage of vaccinated was of 60% and the vaccination was applied most frequently to the patients older than 75 years (p < 0.001), with EPOC (p < 0.005), and with cardiac insufficiency (p < 0.01), as well as to the patients with 2 or more risk factors (p < 0.001). Differences were not observed among the cases and the controls with regard to the age, to the incidence of ICC, to the incidence of DM, nor to the presence of 2 or more risk factors; however, the patients who were hospitalized presented a greater incidence of chronic obstructive pulmonary disease (COPD) (OR: 3.6; IC: 2.01-6.45) and of previous pneumonía (OR: 5.24: CI: 2.4-11-14): The factors most influencing the possibility of hospitalization were: EPOC (OR: 3.67; CI: 1.90-7.13); previous pneumonía (OR: 3.88: CI: 1.69-8.95). The estimate of hospitalizations avoided by the vaccination was of 59 (OR: 0.41; IC: 0.22-0.79). The vaccination did not decrease the number of consultations to the physician nor the days of the hospitalization. CONCLUSIONS: The flu vaccination looks underused in patients over 65 years of age with multiple diseases in the hospital environment. The vaccination seems to be effective in order to diminish the number of hospital admissions because of cardiorespiratory decompensation, even in non-epidemic seasons. We should insist on the use of the flu vaccination in these high-risk patients.

Application of molecular biology techniques to the diagnosis of nontuberculous mycobacterial infections.

A total of 19,723 clinical samples were cultivated for the detection of mycobacteria from January 1995 to March 2001. The 203 strains of nontuberculous mycobacteria isolated were identified with the use of molecular techniques in combination with traditional biochemical tests. The molecular methods applied were PCR-restriction fragment length polymorphism analysis (PRA) alone or in combination with 16S rRNA and 16S-23S spacer sequencing. The patient records of those with specimens positive for mycobacteria were analysed to evaluate the clinical significance of the culture results. Twenty-five of the 124 patients analysed (20%) were regarded as having clinical mycobacteriosis. The main species associated with mycobacteriosis were: Mycobacterium avium (13 cases), M. intracellulare (2 cases), M. kansasii (5 cases), M. chelonae (2 cases), M. malmoense (1 case), M. scrofulaceum (1 case) and M. marinum (1 case). The use of PRA alone or in combination with gene sequencing provided valuable help in discerning mycobacteria at both the intra- and interspecies level, thus contributing to a faster and more efficient diagnosis and epidemiological follow-up.