[Sociodemographic characteristics and risk factors associated to significative bacteriuria in a Spanish health area]. / Características sociodemográficas y factores de riesgo asociados a las bacteriurias significativas en un área de salud del sudeste español.

OBJECTIVE: To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship with sociodemographic factors and to analyze risk factors in inpatients. METHODS: Cross-sectional descriptive study carried out on urine culture samples received between 2016-2020 in the Microbiology laboratory, differentiating between minors and adults. The dependent variable was the presence of SB and the independent variables were age, sex, year, type of sample and source of the sample. In urine cultures of inpatients, risk factors were evaluated from the Minimum Basic Data Set. RESULTS: A total of 68,587 valid records (96.3% of the total) were analyzed. 40.8% (95% CI: 40.4%-41.2%) of urine cultures in adults and 33.8% (95% CI: 32.9%-34.7%) in children were positive, with an incidence that ranged in adults between 18.2 cases/1,000 inhabitants in 2016 and 14.6 cases/1,000 inhabitants in 2020 and 21.1 and 8.4 cases/1,000 inhabitants respectively in minors. Positive urine cultures were more frequent in children from urban areas compared to rural areas (OR=1.37; p<0.01). In hospitalized adults, for each year of age the risk of SB increased by 2%, it was 36% higher in women, 18% higher in obese patients and 17% more frequent in patients with kidney disease, (p<0.01). No relationship was observed between SB and diagnosis of COVID-19. CONCLUSIONS: The sociodemographic characteristics of the population with SB in our health area are similar to those found in other geographical areas worldwide, observing a decreasing trend in incidence in the years studied. The frequency of SB in children is higher in urban areas.

Schwannoma de plexo braquial y toxina botulínica: a propósito de un caso / Brachial plexus schwannoma and botulinum toxin: a case report

Los schwannomas de plexo braquial son tumoraciones desarrolladas a partir de las vainas neurales de rara presentación, pero evolución benigna. Pueden ocasionar clínica, generalmente de tipo neuropático, por crecimiento local con el consiguiente efecto compresivo de estructuras neurales nobles como las raíces del plexo braquial. La toxina botulínica es una neurotoxina sintetizada por la bacteria clostridium botulinum. Su mecanismo de acción consiste en bloquear selectivamente los receptores colinérgicos de la unión neuromuscular, produciendo una parálisis neuromuscular temporal y reversible, recuperando la función en aproximadamente tres a seis meses. Presentamos el caso de un paciente diagnosticado de schwannoma de plexo braquial con efecto compresivo creciente, a quien se le plantea tratamiento con toxina botulínica en los músculos escalenos.(AU)

Brachial plexus schwannomas are tumors developed from the neural sheaths of rare presentation, but benign evolution. They can cause symptoms, generally of the neuropathic type, due to local growth with the consequent compressive effect of noble neural structures such as the roots of the brachial plexus. Botulinum toxin is a neurotoxin synthesized by the bacterium Clostridium Botulinum. Its mechanism of action consists of selectively blocking the cholinergic receptors of the neuromuscular junction, producing a temporary and reversible neuromuscular paralysis, recovering function in approximately three to six months. We present the case of a patient diagnosed with brachial plexus schwannoma with increasing compre­ssive effect who was treated with botulinum toxin in the scalene muscles.(AU)

Evolución de la resistencia a antibióticos de microorganismos causantes de infecciones del tracto urinario: un estudio de vigilancia epidemiológica de 4 años en población hospitalaria / Evolution of the antibiotic-resistance of microorganisms causing urinary tract infections: A 4-year epidemiological surveillance study in a hospital population

Antecedentes: La infección del tracto urinario (ITU) es la primera causa de infección en pacientes con ingreso hospitalario. En este trabajo describimos los patógenos más frecuentemente implicados en el desarrollo de ITU en pacientes hospitalizados, su perfil de sensibilidad antibiótica y la evolución de la actividad de los antibióticos de uso habitual en el tratamiento de estas infecciones. Métodos: Se evaluaron retrospectivamente los resultados de los cultivos y antibiogramas de las muestras de orina procedentes de pacientes adultos ingresados en el Complejo Hospitalario Virgen de las Nieves (Granada, España) con confirmación microbiológica de ITU entre enero de 2013 y diciembre de 2016. Resultados: Se identificaron 4.347 microorganismos (3.969 bacterias y 378 levaduras). Durante los 4años de estudio, y en ambos sexos, Escherichia coli fue la especie más frecuentemente aislada; sin embargo, el 62,9% de las ITU estuvieron causadas por microorganismos diferentes a este. La presencia de microorganismos multirresistentes como Acinetobacterspp. (1,2%) y de enterobacterias productoras de betalactamasas de espectro extendido (10,0%) y de carbapenemasas (0,3%) fueron también hallazgos relevantes. Imipenem, piperacilina-tazobactam y fosfomicina presentaron tasas de actividad por encima del 80%, considerando todos los microorganismos causantes de ITU, mientras que el resto de antibióticos ensayados presentaron porcentajes de actividad inferiores al 70%. Conclusión: Imipenem y piperacilina-tazobactam fueron los antibióticos de uso hospitalario más activos, lo que los convierte en antibióticos de primera línea en el tratamiento empírico de la ITU en este ámbito sanitario. El uso de otros antibióticos debería estar limitado a situaciones de sensibilidad demostrada o muy probable

Background: Urinary tract infections (UTIs) are the leading cause of infection in hospitalised patients. In this study, we describe the most common pathogens involved in the development of UTIs in hospitalised patients, their antibiotic-sensitivity profile and the activity evolution of antibiotics in standard use for treating these infections. Methods: We retrospectively assessed the results of cultures and antibiograms from urine samples from adult patients hospitalised in the Hospital Complex Virgen de la Nieves (Granada, Spain) with a microbiological confirmation of UTI between January 2013 and December 2016. Results: We identified 4,347 microorganisms (3,969 bacteria and 378 yeasts). During the 4years of the study, Escherichia coli was the most common species isolated in both sexes; however, 62.9% of the UTIs were caused by other microorganisms. The presence of multiresistant microorganisms such as Acinetobacterspp. (1.2%) and extended-spectrum beta-lactamase-producing enterobacteria (10.0%) and carbapenemase-producing enterobacteria (0.3%) were also relevant findings. Imipenem, piperacillin-tazobactam and fosfomycin presented activity rates above 80%, considering all causal microorganisms of UTI, while the other tested antibiotics presented activity rates below 70%. Conclusion: Imipenem and piperacillin-tazobactam were the most active antibiotics in hospital use, which makes them first-line antibiotics in the empiric treatment of UTIs in this healthcare setting. The use of other antibiotics should be limited to conditions of demonstrated or highly probable sensitivity

Tratamiento anticoagulante en pacientes médicos con situaciones clínicas complejas / Anticoagulant treatment of medical patients with complex clinical conditions

La información disponible sobre el tratamiento o profilaxis con fármacos anticoagulantes en pacientes ambulatorios con enfermedades médicas y situaciones clínicas complejas es escasa, y no existen guías de práctica clínica y/o recomendaciones específicas para este subgrupo de sujetos, quienes son frecuentemente atendidos por los internistas. Entendemos por situaciones clínicas complejas aquellas en que por la comorbilidad, edad, pronóstico vital o tratamiento múltiple con fármacos de los pacientes, se configura una situación clínica de interacciones enfermedad-enfermedad; enfermedad-fármaco o fármaco-fármaco que no se incluye dentro de los escenarios sobre los que habitualmente se generan las evidencias científicas. El objetivo de esta revisión narrativa es recopilar y adaptar las recomendaciones de guías clínicas y revisiones sistemáticas a situaciones clínicas complejas, donde puede ser conflictivo la aplicación directa de recomendaciones basadas en estudios que no incorporan a pacientes con dicha complejidad y comorbilidad

There is scarce available information on the treatment or prophylaxis with anticoagulant drugs of outpatients with medical diseases and complex clinical conditions. There are no clinical practice guidelines and/or specific recommendations for this patient subgroup, which are frequently treated by internists. Complex clinical conditions are those in which, due to comorbidity, age, vital prognosis or multiple treatment with drugs, a clinical situation arises of disease-disease, disease-drug or drug-drug interactions that is not included within the scenarios that commonly generate the scientific evidence. The objective of this narrative review is collecting and adapting of the clinical guidelines recommendations and systematic reviews to complex clinical conditions, in which the direct application of recommendations based on studies that do not include patients with this complexity and comorbidity could be problematic

Synergy between pyroelectric and photovoltaic effects for optoelectronic nanoparticle manipulation.

The combined action of the pyroelectric (PY) and photovoltaic (PV) effects, exhibited by z-cut LiNbO3:Fe substrates, has been investigated for particle trapping and patterning applications. The novel hybrid procedure provides new possibilities and versatility to optoelectronic manipulation on LiNbO3 substrates. It has allowed obtaining periodic and arbitrary 2D patterns whose particle density distribution is correlated with the light intensity profile but can be tuned through ΔT according to the relative strength of the PV and PY effects. A relevant result is that the PY and PV contributions compete for a ΔT range of 1-20 °C, very accessible for experiments. Moreover, the synergy of the PY and PV has provided two additional remarkable applications: i) A method to measure the PV field, key magnitude for photovoltaic optoelectronic tweezers. Using this method, the minimum field needed to obtain a particle pattern has been determined, resulting relatively high, E~60 kV/cm, and so, requiring highly doped crystals when only using the PV effect. ii) An strategy combining the PY and PV to get particle patterning in samples inactive for PV trapping when the PV field value is under that threshold.

Anticoagulant treatment of medical patients with complex clinical conditions. / Tratamiento anticoagulante en pacientes médicos con situaciones clínicas complejas.

There is scarce available information on the treatment or prophylaxis with anticoagulant drugs of outpatients with medical diseases and complex clinical conditions. There are no clinical practice guidelines and/or specific recommendations for this patient subgroup, which are frequently treated by internists. Complex clinical conditions are those in which, due to comorbidity, age, vital prognosis or multiple treatment with drugs, a clinical situation arises of disease-disease, disease-drug or drug-drug interactions that is not included within the scenarios that commonly generate the scientific evidence. The objective of this narrative review is collecting and adapting of the clinical guidelines recommendations and systematic reviews to complex clinical conditions, in which the direct application of recommendations based on studies that do not include patients with this complexity and comorbidity could be problematic.

Evolution of the antibiotic-resistance of microorganisms causing urinary tract infections: A 4-year epidemiological surveillance study in a hospital population. / Evolución de la resistencia a antibióticos de microorganismos causantes de infecciones del tracto urinario: un estudio de vigilancia epidemiológica de 4 años en población hospitalaria.

BACKGROUND: Urinary tract infections (UTIs) are the leading cause of infection in hospitalised patients. In this study, we describe the most common pathogens involved in the development of UTIs in hospitalised patients, their antibiotic-sensitivity profile and the activity evolution of antibiotics in standard use for treating these infections. METHODS: We retrospectively assessed the results of cultures and antibiograms from urine samples from adult patients hospitalised in the Hospital Complex Virgen de la Nieves (Granada, Spain) with a microbiological confirmation of UTI between January 2013 and December 2016. RESULTS: We identified 4,347 microorganisms (3,969 bacteria and 378 yeasts). During the 4years of the study, Escherichia coli was the most common species isolated in both sexes; however, 62.9% of the UTIs were caused by other microorganisms. The presence of multiresistant microorganisms such as Acinetobacterspp. (1.2%) and extended-spectrum beta-lactamase-producing enterobacteria (10.0%) and carbapenemase-producing enterobacteria (0.3%) were also relevant findings. Imipenem, piperacillin-tazobactam and fosfomycin presented activity rates above 80%, considering all causal microorganisms of UTI, while the other tested antibiotics presented activity rates below 70%. CONCLUSION: Imipenem and piperacillin-tazobactam were the most active antibiotics in hospital use, which makes them first-line antibiotics in the empiric treatment of UTIs in this healthcare setting. The use of other antibiotics should be limited to conditions of demonstrated or highly probable sensitivity.

Uso de bloqueo genitofemoral en combinación con bloqueo ilioinguinal e iliohipogástrico para orquiectomía en paciente postrasplantado pulmonar. A propósito de un caso / Use of genitofemoral and ilioinguinal and iliohypogastric nerve block during orchiectomy in a post-lung transplant patient. A case report

Presentamos el caso de un paciente postrasplantado pulmonar, ASA III, propuesto para orquiectomía por neoplasia testicular. La técnica anestésica era la combinación de bloqueo iliohipogástrico (ILH), ilioinguinal (ILI) y genitofemoral (GF) con sedación. El área inguinal recibe inervación sensitiva principalmente de los nervios ILI, ILH y GF, la rama genital de este último inerva piel de la porción anterosuperior del escroto. Al realizar el bloqueo ecoguiado del nervio GF, es necesario identificar el cordón espermático y administrar anestésico local por dentro y por fuera para cubrir variaciones anatómicas del nervio. Los bloqueos periféricos son una opción factible para pacientes complejos. Su principal ventaja es la anestesia y analgesia del área sin la inestabilidad hemodinámica asociada a la anestesia general y neuroaxial. El bloqueo del nervio GF aporta anestesia hemiescrotal, lo que permite la manipulación e intervención sobre esta área, complementando la anestesia aportada por el bloqueo de los nervios ILI e ILH

The case is presented of a post-lung transplant patient, ASA III, proposed for orchiectomy due to testicular cancer. A combination of iliohypogastric (ILH), ilioinguinal (ILI) and genitofemoral (GF) nerve block together with sedation was used as anaesthetic technique. The inguinal area received sensory innervation mainly from ILI, ILH and GF nerves. The genital branch of the GF nerve supplies innervation to skin of the anterosuperior portion of the scrotum. When performing the echo-guided block of GF nerve, it is necessary to identify the spermatic cord, and administer the local anaesthetic on the inside and periphery of the cord. Peripheral nerve blocks are a valid option for complex patients. Its main advantage is the anaesthesia and analgesia level that it provides without the haemodynamic instability associated with general or neuraxial anaesthesia. GF nerve block provides hemi-scrotal anaesthesia, allowing manipulation and intervention in the inguinal-scrotal area, complementing the anaesthesia provided by ILI and ILH nerve blocks

[Inpatient candiduria: etiology, susceptibility to antifungal drugs and risk factors]. / Candiduria en pacientes hospitalizados: etiología, sensibilidad a los fármacos antifúngicos y factores de riesgo.

OBJECTIVE: Candida could become the second most frequent cause of nosocomial urinary tract infection. Although Candida albicans is the most important species, others have arisen as emerging pathogens. The aim of this study was to analyze the presence of candiduria in inpatients. METHODS: We performed a retrospective study of Candida isolates from adult inpatient urocultures over five years, gathering and tabulating data on: the species; susceptibility to fluconazole, amphotericin B, and voriconazole (Vitek2, BioMerieux); presence of catheter; hospital department of origin; and patient age and sex. RESULTS: We detected 289 yeast episodes, observing an annual increase: 134 (46.4%) were non-C. albicans yeasts, with 57 (19.7%) being Candida glabrata, 37 (12.8%) Candida tropicalis, 25 (8.6%) Candida parapsilosis, and 10 (3.5%) Candida lusitaniae. Most isolates derived from catheterized (240, 83.0%) and Internal Medicine Department (118, 40.8%) patients, observing an annual increase; 152 (52.6%) isolates were from males, and the mean age was >65 years. Susceptibility to antifungals was >85%. CONCLUSIONS: Inpatient urocultures should include data on the presence of Candida, which is more prevalent in Internal Medicine Department inpatients, in those with urinary catheter, and in over 65-year-olds. Almost half of the isolates were non-C. albicans yeasts, and we recommend complete identification of the species involved.

Historical bibliometric analysis of the top cited articles on vesicoureteral reflux 1950-2016, and incorporation of a novel impact index.

INTRODUCTION AND OBJECTIVES: Vesicoureteral reflux (VUR) has been one of the defining conditions unique to pediatric urology since its inception. The clinical implications of this disease process depend on intrinsic patient factors such as age, genetics, epigenetics, voiding habits, anatomic anomalies, and extrinsic factors such as the pathogenicity of infectious agents. Knowledge about its natural history, the implications of conservative and surgical management, and their associated outcomes have evolved dramatically over time. This study aimed to use bibliometric analyses to summarize the evolution of VUR management over time. In order to accomplish this, the most referenced articles for VUR since 1950 were identified, and a comprehensive analysis of their impact on the management and understanding of VUR was performed by creating a novel impact index. METHODS: A reference search was carried out for indexed citations through the portal 'Science Citation Index' in the subsection 'Web of Science Core Collection' using 'vesicoureteral reflux' as a MeSH term. References were analyzed and subcategorized according to various subtopics. A unique impact index was developed to adjust the number of publications for the time since publication, in order to define the impact of the paper amongst the most frequently cited papers. Articles were analyzed and data were tabulated according to the number of citations, country and institute of origin, journal of publication, impact factor, and first authorship. RESULTS: Citation counts ranged from 43 to 510, and the mean number of citations per publication was 101.43. The most discussed topic was 'treatment'. The impact index showed that more recent publications have a higher impact. The author with the highest index impact had 271 citations in a period of 5 years. The top 150 articles were published across 23 countries, the majority being from the USA (Summary fig.). The most frequently cited institution had 12 publications. The journal with the highest publication referencing rate was the Journal of Urology. CONCLUSION: The most cited articles were valuable sources of information to describe the historical evolution of the pathophysiology and management of VUR. After adjusting for time since publication, the most recent publications (i.e. those published after 1990) had a higher impact index. Combining traditional bibliometric analysis with this novel impact index may allow researchers to optimize future literature analyses, while also assisting clinicians in understanding best practices for patient management based on the available literature.

Use of genitofemoral and ilioinguinal and iliohypogastric nerve block during orchiectomy in a post-lung transplant patient. A case report. / Uso de bloqueo genitofemoral en combinación con bloqueo ilioinguinal e iliohipogástrico para orquiectomía en paciente postrasplantado pulmonar. A propósito de un caso.

The case is presented of a post-lung transplant patient, ASA III, proposed for orchiectomy due to testicular cancer. A combination of iliohypogastric (ILH), ilioinguinal (ILI) and genitofemoral (GF) nerve block together with sedation was used as anaesthetic technique. The inguinal area received sensory innervation mainly from ILI, ILH and GF nerves. The genital branch of the GF nerve supplies innervation to skin of the anterosuperior portion of the scrotum. When performing the echo-guided block of GF nerve, it is necessary to identify the spermatic cord, and administer the local anaesthetic on the inside and periphery of the cord. Peripheral nerve blocks are a valid option for complex patients. Its main advantage is the anaesthesia and analgesia level that it provides without the haemodynamic instability associated with general or neuraxial anaesthesia. GF nerve block provides hemi-scrotal anaesthesia, allowing manipulation and intervention in the inguinal-scrotal area, complementing the anaesthesia provided by ILI and ILH nerve blocks.

[Assessment of adherence to antibiotic treatment in Primary Care by determining levels of the drug using a liquid chromatography technique]. / Valoración de la adherencia al tratamiento antibiótico en Atención Primaria mediante la determinación de niveles del fármaco utilizando una técnica de cromatografía líquida.

OBJECTIVE: The lack of adherence to antibiotic treatments is a matter of special interest, which has important clinical implications, as it is associated with therapeutic failure and increased bacterial resistance causing a high sani-tary cost. The objective of our study was to assess the degree of adherence to prescribed antibiotic treatment in outpatients through the detection of these in blood, urine or sputum. METHODS: Concentrations of antibiotics prescribed in 39 patients (34 with clinical suspicion of urinary tract infection and 5 with clinical suspicion of low respiratory tract infection) treated in Primary Care consultations of the Sanitary District of Almería (Spain) were determined by ultra-high performance liquid chromatography coupled to tandem mass spectrometry. RESULTS: A 48.7% of the patients did not comply correctly with the indicated treatment due to the complete or partial omission in taking the prescribed antibiotics. This lack of adherence was independent of the age and sex of the patients, the number of daily doses of the antibiotic, and whether or not they were receiving another medication. CONCLUSIONS: Precise analytical techniques such as liquid chromatography can be useful to detect inadequate or incomplete treatments as well as the degree of adherence of outpatients. Thus, adequate measures could be established that affect the control of therapeutic compliance.

Colágenas Recombinantes para Andamios de Ingeniería de Tejidos / Recombinant Collagens for Tissue Engineering Scaffolds

Resumen: Las colágenas son cada día más atractivas en la fabricación de andamios para Ingeniería de Tejidos, por su biocompatibilidad, manejo y capacidad de producirlas industrialmente. El objetivo del presente artículo fue presentar un análisis sobre el avance en la investigación, el desarrollo y producción de colágenas recombinantes de humano, los sistemas de producción y sus usos en Ingeniería de Tejidos. Se realizó una revisión de la literatura científica internacional arbitrada en bases de datos como Scopus, PubMed y Google Académico y se empleó aquella relevante a nuestro objetivo. Se encontró que el desarrollo de colágenas recombinantes de humano muestra un avance significativo y en la actualidad los sistemas de expresión, como bacterias y plantas, presentan ventajas sobre la calidad de la estructura y la biocompatibilidad, aunque con rendimientos todavía bajos. Mientras que existe escasa información sobre sus aplicaciones en Ingeniería de Tejidos, principalmente cartílago y hueso, en modelos animales y estudios clínicos. En las fuentes de información no se incluyeron patentes, por lo que nuestros hallazgos están limitados a publicaciones científicas. El presente trabajo, presenta los avances más recientes sobre la ingeniería de colágenas recombinantes y sus aplicaciones biomédicas en fabricación de tejidos con potencial uso clínico. Por lo que su factibilidad en la medicina regenerativa es prometedor y se requiere mayor investigación que permita su aplicación en un futuro cercano.

Abstract: Due to its biocompatibility, handling and industrial production capacity, collagens have been increasingly attractive in the manufacture of scaffolds for Tissue Engineering. The aim of the present work was to present an analysis on the progress in research, development and production of human recombinant collagens, expression systems and their uses in Tissue Engineering. A review of the international scientific peer-reviewed literature in databases such as Scopus, PubMed and Google Scholar was done and that relevant to our objective was employed. The development of human recombinant collagens was found to be significant, and currently the expression systems, like bacteria and plants, show advantages over structure quality and biocompatibility, albeit with still restricted yields. However, there is narrow information about its applications in Tissue Engineering, mostly studied for cartilage and bone, in animal models and clinical studies. We did not include patents in the study, thus our findings are limited to scholar data. The present work presents the most recent advances in the engineering of recombinant collagens and their biomedical applications in the manufacture of tissues with potential clinical applications. The potential of recombinant collagens in regenerative medicine is promising and more research is needed that might allow a broad application in the near future.

[Multilocus Sequence Typing analysis of human Campylobacter coli in Granada (Spain)].

OBJECTIVE: Different subtypes of Campylobacter spp. have been associated with diarrhoea and a Multilocus Sequence Typing (MLST) method has been performed for subtyping. In the present work, MLST was used to analyse the genetic diversity of eight strains of Campylobacter coli. METHODS: Nineteen genetic markers were amplified for MLST analysis: AnsB, DmsA, ggt, Cj1585c, CJJ81176-1367/1371, Tlp7, cj1321-cj1326, fucP, cj0178, cj0755/cfrA, ceuE, pldA, cstII, cstIII. After comparing the obtained sequences with the Campylobacter MLST database, the allele numbers, sequence types (STs) and clonal complexes (CCs) were assigned. RESULTS: The 8 C. coli isolates yielded 4 different STs belonging to 2 CCs. Seven isolates belong to ST-828 clonal complex and only one isolate belong to ST-21. Two samples came from the same patient, but were isolated in two different periods of time. CONCLUSIONS: MLST can be useful for taxonomic characterization of C. coli isolates.

A new case report of urinary tract infection due to KPC-3-producing klebsiella pneumoniae (ST258) in Spain. / A propósito de un nuevo caso de infección del tracto urinario por klebsiella pneumoniae (ST258) productor de KPC-3 en España.

OBJECTIVE: We describe the characterization of a new isolated in Spain of Klebsiella pneumoniae ST258 producing KPC-3, carbapenems non-susceptible, recovered from a sample of urine from a patient with urinary tract infection and no history of carbapenems exposure. METHODS: After the isolation, identification of K. pneumoniae was performed by biochemical tests and mass spectrometry. The carbapenems susceptibility testing was performed by microdilution and E-test in cation-adjusted Mueller-Hinton. The study was completed by Rapidec® Carba NP. In order to determine the genetic basis of resistance to carbapenems we used Xpert® Carba-R for carbapenemase type and subtype was subsequently analyzed by amplification by PCR and sequencing. RESULT: We demonstrated by MLST that the strain belonged to the clone of high-risk ST258. CONCLUSIONS: This is the first characterization, in our media, of a clinical isolated of K. pneumoniae ST258 producing KPC-3 and no history of carbapenems exposure.

A propósito de un nuevo caso de infección del tracto urinario por klebsiella pneumoniae (ST258) productor de KPC-3 en España / A new case report of urinary tract infection due to KPC-3-producing klebsiella pneumoniae (ST258) in Spain

OBJETIVO: Presentamos la caracterización de un nuevo aislado en España de Klebsiella pneumoniae ST258 productor de KPC-3, no sensible a carbapenémicos, recuperado de una muestra de orina de una paciente con infección del tracto urinario y sin antecedentes de exposición previa a carbapenémicos. MÉTODOS: Tras el aislamiento, la identificación de K. pneumoniae fue realizada mediante pruebas bioquímicas y espectrometría de masas y la prueba de sensibilidad a carbapenémicos se realizó mediante microdilución y E-test en Mueller-Hinton ajustado para cationes. El estudio se completó mediante Rapidec® Carba NP. Con el fin de determinar las bases genéticas de la resistencia a carbapenémicos se analizó el tipo de carbapenemasa mediante Xpert® Carba-R, posteriormente se subtipo mediante amplificación por PCR y secuenciación. RESULTADO: Mediante MLST, se demostró que la cepa pertenecía al clon de alto riesgo ST258. CONCLUSIONES: Esta es la primera caracterización en nuestro medio de un aislado clínico de K. pneumoniae ST258 productor de KPC-3, sin antecedentes de exposición previa a carbapenémicos

OBJECTIVE: We describe the characterization of a new isolated in Spain of Klebsiella pneumoniae ST258 producing KPC-3, carbapenems non-susceptible, recovered from a sample of urine from a patient with urinary tract infection and no history of carbapenems exposure. METHODS: After the isolation, identification of K. pneumoniae was performed by biochemical tests and mass spectrometry. The carbapenems susceptibility testing was performed by microdilution and E-test in cation-adjusted Mueller-Hinton. The study was completed by Rapidec® Carba NP. In order to determine the genetic basis of resistance to carbapenems we used Xpert® Carba-R for carbapenemase type and subtype was subsequently analyzed by amplification by PCR and sequencing. RESULT: We demonstrated by MLST that the strain belonged to the clone of high-risk ST258. CONCLUSIONS: This is the first characterization, in our media, of a clinical isolated of K. pneumoniae ST258 producing KPC-3 and no history of carbapenems exposure

Changes in D1 but not D2 dopamine or mu-opioid receptor expression in limbic and motor structures after lateral hypothalamus electrical self-stimulation: A quantitative autoradiographic study.

Intracranial self-stimulation (ICSS) of the lateral hypothalamus (LH) is involved in the activation of neuroanatomical systems that are also associated with the processing of natural and other artificial rewarding stimuli. Specific components of this behavior (hedonic impact, learning, and motor behavior) may involve changes in different neurotransmitters, such as dopamine and opioids. In this study, quantitative autoradiography was used to examine changes in mu-opioid and D1/D2-dopamine receptor expression in various anatomical regions related to the motor and mesolimbic reward systems after intracranial self-stimulation of the LH. Results of the behavioral procedure and subsequent radiochemical assays show selective changes in D1 but not D2 or mu receptors in Accumbens-Shell, Ventral Pallidum, Caudate-Putamen, and Medial Globus Pallidus. These findings are discussed in relation to the different psychobiological components of the appetitive motivational system, identifying some dissociation among them, particularly with respect to the involvement of the D1-dopamine subsystem (but not D2 or mu receptors) in goal-directed behaviors.

Differential lasting inhibitory effects of oxytocin and food-deprivation on mediobasal hypothalamic polydipsia.

This study analyzed the effects of systemic oxytocin (OT) administration and 48-h food deprivation on the polydipsia, hyperphagia, and polyuria produced by electrolytic lesions of the mediobasal hypothalamus (MBH). In a first experiment, food deprivation transiently decreased the polydipsic response, whereas food deprivation plus OT administration reduced the water intake and urine excretion of polydipsic animals but not their subsequent food intake. These results were replicated in a second experiment (20 days), which also showed that OT potentiates sodium excretion, reducing the estimated plasma sodium levels in food-deprived MBH-lesioned animals. Administration of OT on day 21 to food-deprived (from day 20 to 22) animals (second period of the experiment 2) blocked the differences in water intake and urine excretion volumes between MBH and control animals on days 21 and 22. Subsequently, this 48-h food deprivation induced an additional and lasting (days 23-40) reduction in the intake of water and food of MBH animals. According to these findings, OT administration and/or food deprivation may potentially exert enduring reducing effects on the polydipsia, polyuria, and hyperphagia of MBH syndrome.