[Episodes of nontyphoidal salmonellosis in adult patients of the Valladolid West Area in 2017: Evaluation of the suitability of the microbiological culture request and the prescribed treatment]. / Episodios de salmonelosis no tifoidea en pacientes adultos del Área Valladolid Oeste en 2017: Evaluación de la idoneidad de la petición del cultivo microbiológico y del tratamiento pautado.

OBJECTIVE: Gastroenteritic salmonellosis is still the second cause diagnosed of infectious diarrhea, most of these clinical pictures are mild and self-limited and therefore the use of antibiotics is limited to few cases. The aim of the study was to describe the episodes of diarrhea caused by Salmonella enterica subsp. enterica, assessing the suitability of the request and the use of antibiotics according to the criteria included in the methodology. METHODS: A retrospective, descriptive, observational study was conducted, collecting data from the clinical history. RESULTS: A total of 122 episodes were included. The reason for consultation was diarrhea, which generated a greater demand in the Hospital Emergency Services (42.6%). The most frequent serotypes isolated were Enteritidis (53.3%), and Typhimurium (40.2%). The adequate request of the stool was 90.2%. Antibiotic was prescribed in 64.6% (79) of the episodes, most patients under 65 years (58 episodes), the average age was 48.43 years. They were treated mainly with ciprofloxacin and azithromycin, in 57 and 14 episodes, respectively. The average duration of antibiotic treatment was 6 days. There was an adequate use of antibiotics in 49.1% of episodes. When the origin of the request was the Hospital Emergency Service, it was inadequate in 63.5% (33) of them. It was inadequate in 60.0% (39) of episodes when ser. Enteritidis was isolated. Almost half, 48.85% (42) of the 58 episodes in which antibiotics were prescribed among those under 65 (86), were treated without being indicated. CONCLUSIONS: Training actions should be implemented focused on optimizing the management of antibiotics in this entity.

[Turicella otitidis, contributions to its role in the etiology of ear infections]. / Turicella otitidis, aportaciones a su posible papel en la etiología de la patología infecciosa del oído.

OBJECTIVE: Turicella otitidis is a gram-positive bacillus coryneforme described, after 16S RNA sequencing, in 1994 by Funke et al as a microorganism involved in otitis media, and it is in health conditions a habitual colonizer of the external auditory canal. Since its description, more than twenty years ago, few cases of otitis related to or directly attributed to this microorganism have been published. METHODS: Description of a case of mastoiditis that required surgery and other cases of otic pathology in which T. otitidis was isolated, in the second semester of 2017 in our institution. They were reported only when they grew in pure culture. The identification was made by mass spectrophotometry and an antibiogram was performed. RESULTS: In our institution in the second half of 2017, 5 cases of otitis media were documented, some of them complicated, in which T. otitidis was isolated. The most of patients were children with recurrent otic pathology, and in some cases the sample was taken before the administration of antibiotics. CONCLUSIONS: Since the inclusion of new vaccines that protect against microorganisms typically causing otitis media, is possible there are a change in the etiology of this disease and that microorganisms anecdotally isolated until now have become protagonists. The improvement in the microbiological identification provided by tools such as mass spectrometry will help to clarify if there are or not a change in the etiology of these diseases.

[A descriptive study of Hafnia alvei isolated from stool samples: an approach to its clinical assessment]. / Descriptivo de Hafnia alvei aisladas en coprocultivo: aproximación a su valoración en clínica.

OBJECTIVE: The importance in human diarrhoeal disease of Hafnia alvei is unclear. The objective of the study was to describe the population which was isolated H. alvei in stool cultures and the therapeutic management of these cases in our Health Area. METHODS: A descriptive retrospective study was carried out in 2014 and 2015. Epidemiological, clinical, treatment and evolution variables were collected in the computerized clinical history. RESULTS: A collection of 7,290 stool specimens were processed, 3,321 in 2014 and 3,969 in 2015, of which 58 (1.7%) and 53 (1.3%) were positive for H. alvei, respectively. A 60.4% of samples were isolated in women. The mean age was 38.68 years. A 68.5% of samples were from primary care. In 71.2% there was related clinic, diarrhoea in 57.7%. In 75.7% of the cases there was not associated underlying disease. A 43.2% of the cases received treatment. A 66.7% of treated patients came from Primary Care. The mean duration of treatment was 8 days. The evolution was favourable in 85.4% of the cases treated. All strains were susceptible to ciprofloxacin and trimethoprim/sulfamethoxazole. CONCLUSIONS: More evidence is needed to support H. alvei as a cause of gastroenteritis.

Pleomorphic adenoma of the accessory parotid gland: case report and reappraisal of intraoral extracapsular dissection for management.

Pleomorphic adenoma is the most common tumor of the major and minor salivary glands. Rarely is it found evolving from an ectopic location of major salivary glandular tissue in the mid cheek. A healthy 56-year-old woman presented to our institution with a 20-year duration of a slowly growing right cheek soft tissue mass that was causing facial asymmetry. No significant functional or neurosensory dysfunction was appreciated. Radiologic examination showed a heterogeneous, hyperintense, well-delineated mass within the region of the right buccal fat pad. Fine-needle aspiration biopsy showed benign salivary gland elements consistent with pleomorphic adenoma. The decision was made to perform intraoral extracapsular dissection for removal. Discussion of the clinical assessment and magnetic resonance imaging evaluation with an emphasis on intraoral extracapsular dissection for definitive surgical therapy of longstanding benign salivary gland tumors is emphasized.

First metatarsophalangeal joint aspiration using a 29-gauge needle.

OBJECTIVES: To asses the clinical feasibility of aspirating symptomatic and asymptomatic first metatarsophalangeal (MTP) joints with a 29-gauge needle in order to obtain a synovial fluid (SF) sample. METHODS: All consecutive aspirations of first MTP joints performed within our department were prospectively recorded. The procedure was considered successful if SF volume was enough to perform a crystal search. Crystals were identified using a polarised light microscope (magnification x400) with a first order red compensator. Pain was recorded on a 10-cm visual analogue scale (VAS). RESULTS: Aspirations were attempted in 33 first MTP joints in 31 patients. SF was drawn from 30 of the joints (91%), with little difference between asymptomatic (89%) and inflamed joints (93%). The technique was well tolerated (mean VAS 1.74). Urate monosodium crystals were identified in 22 samples (73%) and another sample contained calcium pyrophosphate dihydrate crystals. CONCLUSIONS: A 29-gauge needle allows easy aspiration of the first MTP joint with only modest discomfort for the patients, and generally yields a SF sample of sufficient volume for crystal detection and identification.

Intervención grupal en los trastornos de ansiedad en Atención Primaria: técnicas de relajación y cognitivo-conductuales / Group intervention in anxiety disorders in Primary Health Care: relaxation and cognitive-behavioral techniques

INTRODUCCIÓN. Los trastornos de ansiedad son muy frecuentes en Atención Primaria. Su tratamiento incluye técnicas de relajación y respiración controlada y técnicas cognitivo-conductuales. Nuestro objetivo es valorar la eficacia del aprendizaje grupal de las técnicas mencionadas para reducir la ansiedad. MÉTODOS. El diseño es descriptivo longitudinal pre-post-intervención. Sujetos de estudio: pacientes que realizan los talleres de técnicas de relajación (18 grupos) en el centro de salud de octubre de 1997 a junio de 2004 (con asistencia al 80% de sesiones) (n = 117). Intervención: taller de 8 sesiones en 2 meses que incluye entrenamiento en respiración, técnicas de relajación (de Jacobson y entrenamiento autógeno de Schultz) y técnicas cognitivas (afrontamiento de estrés, resolución de problemas). Participan 10-12 personas por sesión semanal. Variables: sexo, edad, motivo para realizar el taller, tratamiento con psicofármacos. Se realiza escala de ansiedad-depresión de Goldberg (EADG)-18 ítems, antes y tras los talleres; se comparan puntuaciones pre-post-intervención (prueba de la t, intervalo de confianza al 95%). RESULTADOS. Realizan la EADG pre-post-intervención 95 pacientes, de los que el 93,7% son mujeres. La edad media es 46,8 años (desviación estándar 12,6). Los principales motivos para realizar el taller son: ansiedad el 51,6%, síntomas somáticos el 10,5% y el 9,5% son cuidadoras. El 47,4% toman tratamiento psicofarmacológico, sin diferencias en las puntuaciones de la EADG pre y post-intervención respecto al grupo sin tratamiento. El descenso medio de ansiedad pre-post-intervención en la EADG es de 3,2 puntos (2,7-3,6) (p < 0,0001) y de 1,9 (1,59-2,28) (p < 0,0001) en la subescala de depresión. CONCLUSIONES. Los talleres de técnicas de relajación pueden ser útiles en la reducción de la ansiedad y la depresión en Atención Primaria

INTRODUCTION. Anxiety disorders are very frequent in Primary Health Care. Relaxation and controlled respiration techniques and cognitive-behavior techniques are included in its treatment. METHODS. The design is pre-post intervention longitudinal and descriptive. Study subjects: patients who did a relaxation technique workshop (18 groups) in the health care center from October 1997 to June 2004 (with attendance to 80% of the sessions) (n = 117). Intervention: workshop of 8 sessions in 2 months includes training in breathing, relaxation techniques (of Jacobson and autogenous training of Schultz) and cognitive techniques (confronting stress, problem solving). Ten to 12 persons participate per weekly session. Variables: gender, age, reason for doing the workshop, treatment with psychodrugs. Goldberg Anxiety-Depression Scale (GADS)-18 items was applied before and after the workshops. Pre-post intervention scores (T test, 95% confidence interval) were compared. RESULTS. Pre-post intervention GADS was done in 95 patients, 93.7% of whom were woman. Mean age was 46.8 years (standard deviation 12.6). The main reasons for taking the workshop were: anxiety 51.6%, somatic symptoms 10.5% and 9.5% are caretakers. A total of 47.4% were taking psychodrug treatment, without differences in the pre-post-intervention GADS scores regarding the group without treatment. The mean decrease in pre-post intervention anxiety in the GADS was 3.2 points (2.79-3.6) (p < 0.0001) and 1 (1.59-2.28) (p < 0.0001) on the depression subscale. CONCLUSIONS. Relaxation technique workshops may be useful in the reduction of anxiety and depression in Primary Health Care

Characteristics and scaling of tungsten-wire-array z -pinch implosion dynamics at 20 MA.

We present observations for 20-MA wire-array z pinches of an extended wire ablation period of 57%+/-3% of the stagnation time of the array and non-thin-shell implosion trajectories. These experiments were performed with 20-mm-diam wire arrays used for the double- z -pinch inertial confinement fusion experiments [M. E. Cuneo, Phys. Rev. Lett. 88, 215004 (2002)] on the Z accelerator [R. B. Spielman, Phys. Plasmas 5, 2105 (1998)]. This array has the smallest wire-wire gaps typically used at 20 MA (209 microm ). The extended ablation period for this array indicates that two-dimensional (r-z) thin-shell implosion models that implicitly assume wire ablation and wire-to-wire merger into a shell on a rapid time scale compared to wire acceleration are fundamentally incorrect or incomplete for high-wire-number, massive (>2 mg/cm) , single, tungsten wire arrays. In contrast to earlier work where the wire array accelerated from its initial position at approximately 80% of the stagnation time, our results show that very late acceleration is not a universal aspect of wire array implosions. We also varied the ablation period between 46%+/-2% and 71%+/-3% of the stagnation time, for the first time, by scaling the array diameter between 40 mm (at a wire-wire gap of 524 mum ) and 12 mm (at a wire-wire gap of 209 microm ), at a constant stagnation time of 100+/-6 ns . The deviation of the wire-array trajectory from that of a thin shell scales inversely with the ablation rate per unit mass: f(m) proportional[dm(ablate)/dt]/m(array). The convergence ratio of the effective position of the current at peak x-ray power is approximately 3.6+/-0.6:1 , much less than the > or = 10:1 typically inferred from x-ray pinhole camera measurements of the brightest emitting regions on axis, at peak x-ray power. The trailing mass at the array edge early in the implosion appears to produce wings on the pinch mass profile at stagnation that reduces the rate of compression of the pinch. The observation of precursor pinch formation, trailing mass, and trailing current indicates that all the mass and current do not assemble simultaneously on axis. Precursor and trailing implosions appear to impact the efficiency of the conversion of current (driver energy) to x rays. An instability with the character of an m = 0 sausage grows rapidly on axis at stagnation, during the rise time of pinch power. Just after peak power, a mild m = 1 kink instability of the pinch occurs which is correlated with the higher compression ratio of the pinch after peak power and the decrease of the power pulse. Understanding these three-dimensional, discrete-wire implosion characteristics is critical in order to efficiently scale wire arrays to higher currents and powers for fusion applications.

Demonstration of radiation symmetry control for inertial confinement fusion in double Z-pinch hohlraums.

Simulations of a double Z-pinch hohlraum, relevant to the high-yield inertial-confinement-fusion concept, predict that through geometry design the time-integrated P2 Legendre mode drive asymmetry can be systematically controlled from positive to negative coefficient values. Studying capsule elongation, recent experiments on Z confirm such control by varying the secondary hohlraum length. Since the experimental trend and optimum length are correctly modeled, confidence is gained in the simulation tools; the same tools predict capsule drive uniformity sufficient for high-yield fusion ignition.

Symmetric inertial-confinement-fusion-capsule implosions in a double-z-pinch-driven hohlraum.

An inertial-confinement-fusion (ICF) concept using two 60-MA Z pinches to drive a cylindrical hohlraum to 220 eV has been recently proposed. The first capsule implosions relevant to this concept have been performed at the same physical scale with a lower 20-MA current, yielding a 70+/-5 eV capsule drive. The capsule shell shape implies a polar radiation symmetry, the first high-accuracy measurement of this type in a pulsed-power-driven ICF configuration, within a factor of 1.6-4 of that required for scaling to ignition. The convergence ratio of 14-21 is to date the highest in any pulsed-power ICF system.

Antiprotozoal activities of Colombian plants.

In our search for therapeutical alternatives for antiprotozoal chemotherapy, we collected a selection of 44 plants from western Colombia upon ethnopharmacological and chemotaxonomic considerations. Polar and apolar extracts of these species were examined for antimalarial activity using in vitro tests with two clones of Plasmodium falciparum. Leishmanicidal and trypanocidal activity were determined in vitro using promastigote and amastigote forms of several strains of Leishmania sp. and epimastigotes of Trypanosoma cruzi. Among the selected plants, the 15 following species showed good or very good antiprotozoal activity in vitro: Aspidosperma megalocarpon, Campnosperma panamense, Conobea scoparioides, Guarea polymera, Guarea guidonia, Guatteria amplifolia, Huberodendron patinoi, Hygrophila guianensis, Jacaranda caucana, Marila laxiflora, Otoba novogranatensis, Otoba parviflora, Protium amplium, Swinglea glutinosa and Tabernaemontana obliqua. Cytotoxicity was assessed in U-937 cells and the ratio of cytotoxicity to antiprotozoal activity was determined for the active extracts. Ten extracts from eight species showed selectivity indexes > or = 10. Among the extracts that showed leishmanicidal activity, the methylene chloride extract of leaves from C. scoparioides showed a selectivity index in the same range that the one of the Glucantime control. Several of the active leishmanicidal plants are traditionally used against leishmaniasis by the population of the concerned area.

Triterpenoid saponins from Isertia pittieri.

Two new 27-nor-triterpenoid saponins, pyrocincholic acid 3 beta-O-beta-D-quinovopyranosyl-28-[beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranosyl] ester (1) and pyrocincholic acid 3 beta-O-beta-D-quinovopyranosyl(1-->6)-beta-D-glucopyranosyl-28-[beta-D-glucopyranosyl(1-->2)-beta-D-glucopyranosyl] ester (2) were isolated from the stem bark of Isertia pittieri, together with two known bidesmosidic quinovic acid glycosides. The structures of 1 and 2 were determined on the basis of spectroscopic studies.

Un paciente con crioglobulinemia

Las crioglobulinas son inmunoglobulinas que precipitan cuando el suero se incuba a una temperatura inferior a 37° C.La clasificación de las crioglobulinas se basa en la composición del crioprecipitado, compuesto por una única clase de inmunoglobulinas en la crioglobulinemia simple o tipo I, y por dos clases distintas (IgG e IgM) en la crioglobulinemia mixta (CM), que engloba los tipos II y III. La mayor parte de las CM se asocian a diversos procesos como infecciones, enfermedades autoinmunes o síndromes linfoproliferativos.El descubrimiento del virus de la hepatitis C (VHC) ha puesto de manifiesto que la mayoría de las anteriormente denominadas 'CM esenciales' están asociadas a la infección por dicho virus.La crioglobulinemia de tipo I se asocia fundamentalmente a discrasias de células plasmáticas y procesos linfoproliferativos.La existencia de crioglobulinas circulantes (crioglobulinemia) no siempre se asocia a la presencia de sintomatología y se utiliza el término 'síndrome crioglobulinémico' cuando los pacientes con crioglobulinemia presentan manifestaciones clínicas. En ellos se observa un proceso vasculítico sistémico que implica a vasos de pequeño y mediano calibre de diversos órganos, especialmente la piel, sistema nervioso periférico y riñón. A diferencia de lo que ocurre con el resto de las enfermedades autoinmunes sistémicas, en la crioglobulinemia aún no se han definido los criterios para su diagnóstico, y generalmente se llega a una sospecha clínica que se confirma con la determinación de las crioglobulinas (AU)

Identification of four variants in the tryptophan hydroxylase promoter and association to behavior.

One of the most replicated findings in biological psychiatry is the observation of lower 5-hydroxyindoleacetic acid concentrations, the major metabolite of serotonin, in the brain and cerebrospinal fluid of subjects with impulsive aggression. Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in the synthesis of serotonin, however functional variants have not been reported from the coding sequence of this gene. Therefore, we screened the human TPH promoter (TPH-P) for genetic variants which could modulate TPH gene transcription. The TPH-P (2093 nucleotides) was screened for sequence variation by SSCP analysis of 260 individuals from Finnish, Italian, American Caucasian, and American Indian populations. Four common polymorphisms were identified: -7180T>G, -7065C>T, -6526A>G, and -5806G>T (designated as nucleotides upstream of the translation start site). In the Finns, the four polymorphisms had a minor allele frequency of 0.40 and in this population linkage disequilibrium between the four loci was complete. In the other populations the minor allele frequencies ranged from 0.40 to 0.45. TPH -6526A>G genotype was determined in 167 unrelated Finnish offenders and 153 controls previously studied for the TPH IVS7+779C>A polymorphism. A significant association was observed between -6526A>G and suicidality in the offenders. TPH -6526A>G and the previously reported intron seven polymorphism, TPH IVS7+779C>A, exhibited a normalised linkage disequilibrium of 0.89 in Finns. Normalized linkage disequilibrium was reduced in other populations, being 0.49 and 0.21 in Italians and American Indians, respectively. In conclusion, four TPH-P variants were identified which can be used for haplotype-based analysis to localize functional TPH alleles influencing behavior.

Zinc-regulated biosynthesis of immunodominant antigens from Aspergillus spp.

ASPND1 and ASPF2 are immunodominant antigens from Aspergillus nidulans and A. fumigatus, respectively, that are readily synthesized in infections in the human host, as demonstrated by their reactivity with more than 80% of sera from patients with aspergilloma or allergic bronchopulmonary aspergillosis. We demonstrate here that both antigens are exclusively produced under situations of low bioavailability of free Zn2+. Addition of micromolar concentrations of Zn2+ to the culture medium strongly stimulated Aspergillus growth but totally inhibited ASPND1 or ASPF2 production. This effect was specific, since other divalent metals had no effect. Removal of endogenous Zn2+ by a chelator also stimulated ASPND1 production, and the effect was specifically reversed by Zn2+. These results suggest a possible role of these antigens in the survival of the fungus in the lungs.

Specific interactions of monotetrahydrofuranic annonaceous acetogenins as inhibitors of mitochondrial complex I.

Annonaceous acetogenins (ACG) are a wide group of cytotoxic compounds isolated from plants of the Annonaceae family. Some of them are promising candidates to be a future new generation of antitumor drugs due to the ability to inhibit the NADH:ubiquinone oxidoreductase of the respiratory chain (mitochondrial complex I), main gate of the energy production in the cell. ACG are currently being tested on standard antitumor trials although little is known about the structure activity relationship at the molecular level. On recent studies, the relevance of several parts of the molecule for the inhibitory potency has been evaluated. Due to the great diversity of skeletons included in this family of natural products, previous studies on the presence and distribution of oxygenated groups along the alkyl chain only covered the compounds with different bis-tetrahydrofuranic (bis-THF) relative configurations. Therefore, we have investigated the inhibitory action of all the mono-tetrahydrofuranic (mono-THF) acetogenins available, which differ in the oxygenated arrangements along the molecule. Our results show that the hydroxyl and carbonyl groups, placed in the aliphatic chain that links the initial gamma-lactone moiety with the dihydroxylated tetrahydrofuranic ring system, significantly contribute for modulating the inhibitory potency of the ACG through specific effects.

Serum immunoglobulin E levels in relation to adenoid surgery.

The adenoid tissue is an immunecompetent lymphoid organ, which has the capacity of reacting against numerous antigens. We have studied the influence that the elimination of the said tissue would have on the total IgE serum levels in 33 patients of an average age of 5 and criteria of adenoidectomy and in whom these levels were measured before and after surgery. We have not noticed any statistically significant differences in the IgE values after adenoidectomy with respect to those prior to surgery, which were normal. Adenoidectomy, like other authors have observed after tonsillectomy, does not alter the IgE serum values.

Dual origins of Finns revealed by Y chromosome haplotype variation.

The Finnish population has often been viewed as an isolate founded 2, 000 years ago via a route across the Gulf of Finland. The founding event has been characterized as involving a limited number of homogeneous founders, isolation, and subsequent rapid population growth. Despite the purported isolation of the population, levels of gene diversity for the Finns at autosomal and mitochondrial DNA loci are indistinguishable from those of other Europeans. Thus, mixed or dual origins for the Finns have been proposed. Here we present genetic evidence for the dual origins of Finns by evaluating the pattern of Y chromosome variation in 280 unrelated males from nine Finnish provinces. Phylogenetic analysis of 77 haplotype configurations revealed two major star-shaped clusters of Y haplotypes, indicative of a population expansion from two common Y haplotypes. Dramatic and quite significant differences in Y haplotype variation were observed between eastern and western regions of Finland, revealing contributions from different paternal types. The geographic distribution and time of expansion for the two common Y haplotypes correlate well with archeological evidence for two culturally and geographically distinct groups of settlers. Also, a northeastern to southwestern gradient of Y haplotype frequencies provides convincing evidence for recent male migration from rural areas into urban Finland.