[The postal code as a "bar code" of antimicrobial resistance]. / El código postal como "código de barras" de las resistencias antimicrobianas.

OBJECTIVE: The need to integrate local resistances into clinical practice is increasingly urgent, especially in Primary Care where empirical treatment is frequent. METHODS: A retrospective observational study of positive microbiological isolates of Neisseria gonorrhoeae from any location (urethral, cervical, pharyngeal, rectal or urine) was carried out in the health area of Alcalá de Henares. Sociodemographic characteristics and resistance to cephalosporins, azithromycin, penicillin and quinolones were analyzed. Each isolate was related to its postal code of origin. RESULTS: We analyzed 256 microbiological samples of N.gonorrhoeae, most of them male (92.9%) with a mean age of 33 years. Half of the samples (49.8%) were resistant to ciprofloxacin. Temporal and spatial evolution of antimicrobial resistance was integrated in heat maps. CONCLUSIONS: Knowing local resistances can help to prescribe more adequate empirical treatments, especially in Primary Care, avoiding inadequate antibiotics and decreasing resistance rates.

Estimation of missed bloodstream infections without the third blood culture set: a retrospective observational single-centre study.

OBJECTIVES: The question of whether to obtain two or three sets of blood cultures to assess the aetiology of bloodstream infections (BSIs) remains open to debate. Few studies have assessed the proportion of BSIs missed without the third blood culture set (BCS). The aim of our study was to determine the proportion of BSIs that would be missed without the third BCS in a hospital where obtaining three BCSs is the standard of care. METHODS: We performed a descriptive retrospective study in Hospital Gregorio Marañón (Madrid) from 2010 to 2013. We included all episodes of BSI in which three BCSs were systematically obtained. RESULTS: We included 4000 episodes of BSI between 2010 and 2013. Without the third BCS, we would have missed 298 (7.5%) episodes of BSI: 141 (47.3%) by gram-positive microorganisms, 147 (49.3%) by gram-negative microorganisms, and 10 (3.4%) by yeasts. In 132/298 (44.3%) of the episodes another clinical sample was obtained within a week of the BCS extraction; in 101/298 (33.9%), the same microorganism was present in a significant clinical sample other than blood. CONCLUSIONS: Our data suggest that performing a third BCS is useful, as not doing this could result in an unacceptable number of BSIs going undetected.

Diagnostic performance of Anyplex II MTB/MDR/XDR for detection of resistance to first and second line drugs in Mycobacterium tuberculosis.

PURPOSE: Genotypic methods have considerably improved the diagnosis of multidrug-resistant (MDR) tuberculosis. One of these tests is Anyplex II MTB/MDR/XDR (Anyplex). Our aim was to evaluate the diagnostic performance of this multiplex PCR. METHODS: We conducted our study on 47 MDR tuberculosis and 14 pan-susceptible strains. We evaluated the ability of Anyplex to detect resistance mutations in rpoB (rifampin [RIF]), katG and inhA (isoniazid [INH]), gyrA (fluoroquinolones [FLQ]), and rrs and eis (aminoglycosides [AMG]). We used the agar proportion method as gold standard. We also studied concordance with GenoType MTBDRplus (first line drugs) and MTBDRsl (second line drugs). DNA sequencing was applied to clarify discrepancies. RESULTS: All pan-susceptible strains were susceptible by Anyplex. Sensitivity and specificity of Anyplex for detection of resistance mutations were 97.9% and 100%, respectively, for RIF, 91.5% and 100% for INH, 80% and 100% for FLQ, and 50% and 99.7% for AMG. Concordance with GenoType was perfect for RIF, INH, and FLQ (kappa score, k=1.0) and moderate for AMG (k=0.48). Sensitivity and specificity for detection of MDR tuberculosis were 89.4% and 100%, respectively. DNA sequencing of the phenotypically resistant strains considered as susceptible by Anyplex, confirmed no mutations in the corresponding genes. CONCLUSIONS: Anyplex is a reliable assay for the detection of MDR tuberculosis and shows excellent concordance with GenoType. Anyplex reduces the time to diagnosis of MDR tuberculosis strains, as it is recommended by current guidelines on control of tuberculosis.

Serum levels of adipokines in patients with idiopathic inflammatory myopathies: a pilot study.

Adipokines are cytokines not only regulating metabolic and endocrine activities, but also modulating inflammatory and immune responses in several clinical settings, including autoimmunity. This study was aimed to evaluate whether serum adipokine levels may be useful as markers of disease activity in patients with idiopathic inflammatory myopathies (IIM). Adiponectin, leptin, chemokine C-C motif ligand-2 (CCL2), interleukin (IL)-6, and tumor necrosis factor (TNF) were measured in the serum of all participants. For each adipokine, we evaluate the area under the ROC curve (AUC) and its correlation with creatine kinase (CK) levels. Thirteen patients with IIM and 13 age- and gender-matched healthy individuals were studied. In patients, the levels of CK (273 ± 321 versus 54 ± 29 U/L; P < 0.0001), leptin (1994 ± 1355 versus 818 ± 738 pg/mL; P = 0.024), and IL-6 (32.4 ± 24.1 versus 13.9 ± 3.5 pg/mL; P = 0.003) were significantly higher than in controls. As a result, CK (AUC = 0.929, 0.833-1.00; P = 0.0002), leptin (AUC = 0.783, 0.588-0.977; P = 0.025), and IL-6 (AUC = 0.846, 0.680-1.00; P = 0.005) significantly discriminated between patients and controls. Neither CCL2 (3256 ± 4585 versus 1118 ± 399 pg/mL; P = 0.319) nor TNF (85.1 ± 83.3 versus 58.2 ± 16.8 pg/mL; P = 0.809) levels were different. Additionally, only serum levels of CCL2 were significantly correlated with CK titers (Spearman´s rho coefficient 0.620, 0.087-0.877; P = 0.023). The levels of CCL2 are in parallel with CK activity in the serum of patients with IIM, suggesting a potential utility as markers of disease activity. Elevated levels of leptin and IL-6 also support a role for adipokines in IIM.

Improved method for the detection of catheter colonization and catheter-related bacteremia in newborns.

Accurate diagnosis of catheter-related bloodstream infection (CRBSI) is mandatory for hospital infection control. Peripherally inserted central venous catheters (PICCs) are widely used in intensive care units, but studies about procedures for detection of colonization are scarce in neonates. We sequentially processed 372 PICCs by 2 methods, first by the standard roll-plate (RP) technique and then by rubbing catheters on a blood agar plate after being longitudinally split (LS). With both techniques, we detected 133 colonized PICCs. Ninety-four events of CRBSI were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value for detection of CRBSI were 58.5%, 92.8%, 73.3%, and 86.9%, respectively, for RP technique and 96.8%, 88.5%, 74.0%, and 98.8%, respectively, for LS technique. The LS technique increased the proportion of detected CRBSI by 38.3%. Neonatal PICC tips should be cultured after cutting them open. This technique is simple and sensitive to detect catheter colonization and also to diagnose CRBSI.

New direct-acting antivirals for patients with chronic HCV infection: can we monitor treatment using an HCV core antigen assay?

We evaluated the diagnostic usefulness of an HCV core antigen (HCV-Ag) assay in HCV-infected patients undergoing treatment with direct-acting antivirals. We analyzed 103 samples from 28 patients. Compared with RT-PCR, sensitivity was 96.2% and specificity was 100%. The correlation between techniques was excellent (Pearson coefficient: 0.871). HCV-Ag proved to be useful in patients with sustained viral response and in patients who experienced treatment failures.

Influenza A and B co-infection: a case-control study and review of the literature.

Influenza virus infection remains a major cause of morbidity and mortality during winter seasons. Bacterial and virus co-infection is a commonly described situation in these patients. However, data on co-infection by influenza A and B viruses are lacking. In this study, we present the cases of co-infection by influenza A and B viruses during the winter season of 2014-2015 in our institution. We analyzed 2759 samples from 2111 patients and found that 625 samples corresponding to 609 patients were positive for influenza A or B virus. A total of 371 patients had influenza A, 228 had influenza B, and 10 (1.6 %) had influenza A and B virus detection in the same sample. The median age of co-infected patients was 78.6 years, and only one of the co-infected patients died because of the infection. Comparison with a control group of mono-infected patients revealed that co-infection was significantly associated with nosocomial acquisition [odds ratio (OR) = 4.5, 95 % confidence interval (CI) = 1.05-19.25, p = 0.042]. However, co-infection was not associated with worse outcome, previous underlying condition, or vaccination status. Multivariate analysis revealed that co-infection was not an independent risk factor for death and that no single risk factor could predict co-infection.

Solid-contact Hg(II)-selective electrode based on a carbon-epoxy composite containing a new dithiophosphate-based ionophore.

The experimental results herein concern a novel ion-selective electrode manufactured with an inner solid contact based on a new ligand O,O'-(2,2'-biphenylene)dithiophosphate pentyl (PenDTF). This electrode displays high selectivity toward the Hg(II) ion even in the presence of different divalent ions. The electrode also exhibited a good Nernstian response to Hg(II) (33.7±1.0 mV decade(-1)) over an ample concentration range (5.3×10(-7)-1.0×10(-2) mol L(-1)), with a detection limit of (6.1±1.7)×10(-7) mol L(-1). As a result of design, the electrode can be used for many experiments, simply renewing its contact surface with emery paper, without giving rise to a significant response deviation, exhibiting a variation coefficient of 3%, capable of being tested within the 0-5 pH interval. The electrode was used satisfactorily as indicating electrode during the potentiometric titration of Hg(II) ions with EDTA.

[Regression of a choroidal metastasis from prostate adenocarcinoma after hormonal therapy]. / Regresión de una metástasis coroidea de adenocarcinoma de próstata con tratamiento hormonal.

CASE REPORT: We report a case of a patient diagnosed with prostatic adenocarcinoma with multiple bone metastases and a choroidal metastasis in his left eye. Hormonal therapy with an anti-androgen and a LH-RH agonist was followed by regression of the choroidal mass over a period of 2 months. No metastatic recurrence has been demonstrated after a follow-up period of 14 months. DISCUSSION: Complete resolution of choroidal metastases of prostatic adenocarcinoma with hormonal therapy is exceptional, but the effect of this treatment on such metastases should be observed before recommending radiation therapy.

Activity of taraxasteryl acetate on inflammation and heat shock protein synthesis.

Pluchea sagittalis whole plant dichloromethane extract showed inhibitory activity in several inflammatory models: rat hind paw-edema, mice ear edema, and air-pouch rat granuloma. The extract inhibited the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in stimulated human neutrophils. It also showed inhibitory effect on heat shock protein 72 (hsp72) synthesis in stimulated neutrophils, while it had opposite effects on unstimulated cells. The triterpene taraxasteryl acetate was obtained from the dichloromethane extract by bioassay directed isolation, being active against induced ROS and RNS production in human neutrophils. In mice ear edema (induced by phorbol-12-mirystate-13-acetate, croton oil and arachidonic acid), taraxasteryl acetate showed a topical anti-inflammatory activity similar to the extract, but at 1/20 of the dose. The same ratio was observed for the inhibition of hsp72 production in stimulated human neutrophils. In unstimulated monocytes and neutrophils, taraxasteryl acetate showed a higher stimulating activity of hsp72 production than the extract, involving different mechanisms in each cell type. To our knowledge, taraxasteryl acetate is the first natural product for which a dual effect on the hsp response is reported.

[Epithelioid hemangioendothelioma of penis]. / Hemangioendotelioma epitelioide de pene.

A case of EH of the penis in a sixtyfour-year-old patient is described. This is a rare--in this location--vascular tumor of borderline malignant potential between hemangioma and angiosarcoma. Local excision of the tumor with a cut-off of normal tissue and careful follow-up of the patient is the accepted procedure. Immunohistochemistry is essential for the diagnosis.

[Fibroepithelial polyp of the urethra in an adult]. / Pólipo fibroepitelial de uretra en un adulto.

We present the case of a fibroepithelial polyp of the prostatic urethra in a forty-five year old patient. This type of polyp is rare in the adult. The principal symptoms which the patient presented were haematuria and an intermittent reduction in micturitional flow. Endoscopic images of the tumour are shown and certain details of its histology; this is a polypoid lesion of loose connective tissue covered by typical urothelium, with occasional fascicles of smooth muscle, no prostatic-type glandular structures and no appreciable inflammatory component.

[Adrenal ectopy in epididymis]. / Ectopia adrenal en epidídimo.

OBJECTIVE: To report a case of ectopic adrenal in the epididymis. METHODS: A 17-year-old male consulted for a left varicocele and complaints referred to the right epididymis a year and a half after an episode of acute epididymitis. A nodule was excised from the epididymis. RESULTS: The pathological analysis showed an 0.4 cm nodule comprised of adrenocortical tissue. CONCLUSIONS: Ectopic adrenal cortical tissue is a benign lesion. Although routine search for this lesion is not indicated, it should be resected for histological analysis and differential diagnosis when it is found during a surgical procedure in this area.

Activity of plant extracts on the respiratory burst and the stress protein synthesis.

Aqueous, methanol and dichloromethane extracts from Artemisia copa, Baccharis grisebachii, Baccharis incarum, Baccharis latifolia, Mutisia kurtzii and Pluchea sagittalis, plants used in the Traditional Medicine of South America, are studied for activity on the respiratory burst and the inducible heat shock protein of 72 kD (hsp72) synthesis. Activity on the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS), as well as on hsp72 synthesis was measured by flow cytometry in human neutrophils. Cells were stimulated using hydrogen peroxide, phorbol-12-myristate-13-acetate (PMA) or formyl-methionyl-leucyl-phenylalanine (FMLP) for ROS generation, and sodium nitroprusside (SNP) or PMA in the presence of calmodulin inhibitor W-13 for RNS. The production of hsp72 was induced by heat, PMA, H2O2 and SNP. The best inhibitory activity was shown by the dichloromethane extracts of Baccharis grisebachii and Pluchea sagittalis that were active in all the assays. The aqueous extract of Pluchea sagittalis was also active in most assays. The aqueous extract from Mutisia kurtzii caused a clear increase of the hsp72 production and showed prooxidant activity.

Cryopreservation of lipid-rich seeds: effect of moisture content and cooling rate on germination.

The effect of fast and slow cooling on germination of seeds from two Brassicaceae species (Eruca vesicaria (L.) Cav., Brassica napus L. var. oleifera (Moench) DC cv. Bingo) and cypselas from three Compositae species (Onopordum nervosum Boiss., Onopordum acanthium L., Helianthus annuus L. cv. Viky) at different moisture contents was studied. Seed lipid content (dry weight basis) ranged from 15% (O. nervosum) to 41% (H. annuus). For each species, seeds with four moisture contents were cryopreserved either by direct immersion in liquid nitrogen or by previous cooling at 10 degrees C/min from room temperature to -50 degrees C. In three species (E. vesicaria, B. napus, and H. annuus) germination of air-dried (6.2-8.9% moisture content) seeds cooled by direct immersion in liquid nitrogen was not significantly different from germination of control seeds (air-dried, non-cooled). In the two Onorpordum species the best response among cooling treatments was observed when air-dried seeds were slowly cooled.

[Suprarenal hemorrhage as the first manifestation of a small cell pulmonary carcinoma. Presentation of a case]. / Hemorragia suprarrenal como primera manifestación de un carcinoma pulmonar de células pequeñas. Presentación de un caso.

OBJECTIVE: To report on a case of small cell lung carcinoma presenting as adrenal hemorrhage. METHODS: A case of small cell lung carcinoma presenting as adrenal hemorrhage in a 60-year-old male is presented. The most important features of this tumor type and the adrenal metastasis are described. RESULTS: Treatment with carboplatin and VP-16 was unsuccessful. A brain CT scan showed several space occupying parenchymal lesions. Palliative radiotherapy was administered. The patient's condition has progressively become worse. He is currently receiving only palliative treatment. CONCLUSIONS: The adrenal gland is a common site of metastasis. One of the tumor types that frequently metastasize to the adrenals is small cell lung carcinoma, which is characterized by early local and systemic dissemination, associated paraneoplastic syndromes and its sensitivity to cytostatic agents. Adrenal metastasis from lung carcinoma should be suspected in patients with a large, heterogeneous, bilateral lesion.

Hemorragia suprarrenal como primera manifestación de un carcinoma pulmonar de células pequeñas. Presentación de un caso / Small cell lung carcinoma presenting as adrenal hemorrhage: A case report

OBJETIVO: Presentar un caso de hemorragia retroperitoneal de origen suprarrenal, como la primera manifestación de un carcinoma pulmonar de células pequeñas. MÉTODO: Se describe un caso de hemorragia suprarrenal como primera manifestación de un carcinoma pulmonar de células pequeñas en un varón de 60 años y se expone las principales características de este tumor, así como de las metástasis suprarrenales. RESULTADOS: Se instauró tratamiento citostático complementario con carboplatino y VP-16 sin éxito. La T.A.C. craneal mostró varias lesiones ocupantes de espacio en parénquima cerebral en relación con metástasis. Se administró radioterapia craneal paliativa. El paciente experimentó empeoramiento progresivo, administrándole, en la actualidad, tratamiento paliativo únicamente. CONCLUSIONES: Las glándulas suprarrenales son un sitio habitual de metástasis. Uno de los tumores que, frecuentemente, las afecta es el carcinoma pulmonar de células pequeñas. Esta neoplasia se caracteriza por su extensión local y sistémica precoz, la asociación a síndromes paraneoplásicos y especial sensibilidad a determinados citostáticos. En masas suprarrenales, grandes, heterogéneas y bilaterales, se debe descartar metástasis como primera posibilidad (AU)

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[Survival in prostatic cancer, treated conservatively]. / Supervivencia del cáncer de próstata, tratado de forma conservadora.

OBJECTIVES: To analyse the survival rate among prostate cancer patients with conservative treatment. To compare survival between individuals with localised and invasive tumours, as well as between subjects below and above 70 years old at the time of diagnosis. METHODS: This study includes 80 patients diagnosed with prostate cancer between 1987 and 1988 at the Urology Service of the Central Hospital of Asturias (Spain). The cases were taken and followed retrospectively for 10 years. Kaplan Meter curves and Cox regression analyses were used for studying patients globally. Patients were categorised by tumour stage as well as by their age at the time of initial diagnosis. RESULTS: 10 patients remained living 5 years after diagnosis, corresponding to a 17% survival rate. However, 10 years after diagnosis, only 1 subject remained alive. Mean survival expressed in days was 677.28% of the cases died after the first year of diagnosis. Significant differences in survival rates were not found with regard to the age of patients ar the time of the diagnosis. However, survival is significantly higher among patients with localised tumours as opposed to invasive ones (p = 0.025; RR = 2.3). CONCLUSIONS: The survival rates is low in this study. The majority of tumours were at advanced stages when diagnosed and were mostly found in very old patients. Today, the use of PSA allows doctors to diagnose prostate cancer at earlier stages and in younger patients. This has lead to an increase in the frequency of radical prostatectomy. Future research should investigate whether this increase in radical prostatectomy has significantly changed the mortality rate of patients with prostate cancer.

[Determination of NMP-22 as recurrence marker in bladder cancer. Preliminary study]. / Determinación de NMP-22 como marcador de recidivas en el cáncer vesical. Estudio preliminar.

OBJECTIVES: The present study was conducted to determine the efficacy of NMP-22 as a diagnostic test for recurrence of bladder tumors and to compare its efficacy with urine cytology. METHODS: 30 patients (25 male, 5 female), aged 41-87 years (mean 73.4), with bladder tumor were evaluated by cytology, cystoscopy and determination of NMP-22 at 3 and 6 months post-TUR of the bladder. A positive test was defined as NMP-22 greater than 10 U/ml. RESULTS: 80.7% were T1, 15.3% T2-T3, 76.8% were grade I and II, and 23.2% were grade III. NMP-22 showed a sensitivity of 69%, a specificity of 64%, a positive predictive value of 52% and a negative predictive value of 78%, using tumor recurrence at 3 and 6 months as the unit of analysis, for a recurrence rate of 36%. Cytology showed a sensitivity of 44%, a specificity of 92%, a positive predictive value of 77% and a negative predictive value of 74%. When both tests were used, we obtained a sensitivity of 87.5%, a specificity of 64.2%, a positive predictive value of 58.3% and a negative predictive value of 90%. In grade I tumors, determination of NMP-22 had a sensitivity of 100%, a specificity of 77.7%, a positive predictive value of 60% and a negative predictive value of 69%. CONCLUSIONS: NMP-22 showed an acceptable sensitivity but a low positive predictive value, therefore control cystoscopic evaluation cannot be avoided. The sensitivity and negative predictive values increased when NMP-22 and cytology are used in combination. We found NMP-22 to be a very useful marker for recurrence of low grade tumors.

[Multiple urethral lithiasis. Report of a case]. / Litiasis uretral múltiple. A propósito de un caso.

OBJECTIVE: To report a case of multiple urethral calculi, an uncommon urological condition in our setting. The clinical, radiological and therapeutic aspects are discussed and the literature is briefly reviewed. METHODS/RESULTS: A 77-year-old male consulted at the emergency services of our hospital for dysuria, pollakiuria and difficulty in voiding. The patient also referred and indurated area in the penile ventral aspect. Radiological examination disclosed three calculi in the penile urethra with were successfully removed by meatotomty and urethrolithotomy. The patient is currently asymptomatic. CONCLUSIONS: Urethral calculus is uncommon in developed countries. "Milking" is not advocated due to the high incidence of urethral injury. Treatment is by simple urethrolithotomy in combination with other techniques (urethroplasty, diverticulectomy, etc.), if required.