Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain.

A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a "nosocomiun", i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

Management of the oral hemangiomas in infants and children: Scoping review.

BACKGROUND: Pediatric oral hemangiomas are benign vascular tumors that can be seen from birth, particularly in females. Hemangiomas are most frequent located in the lips and usually regress spontaneously, thus they do not require any type of treatment in most cases. The present scoping review pretended to synthesize the most relevant and currently available information from the international dental literature published in the last 25 years, regarding the management of pediatric oral hemangiomas. MATERIAL AND METHODS: An exhaustive literature search was performed in four electronic databases (PubMed, Embase, Google Scholar, and Cochrane). Initially, 241 related titles and abstracts were found. After the duplication removal, screening, and assessment processes, 37 records were included for full-text reading. Finally, 20 articles in the English language were included in the scoping review for data extraction and assessment. RESULTS: We identified and subsequently discussed three fundamental issues associated to the management of pediatric oral hemangiomas: (i) clinical characteristics, differential diagnosis, and histopathological findings; (ii) evolution and complications; and (iii) current available treatment modalities. CONCLUSIONS: Although these like-tumor lesions are uncommon, pediatric dentistry practitioners must be familiar with the inherent clinical characteristics, diagnosis approaches, and currently available treatment options. Nowadays, surgical removal and non-invasive medical/pharmacologic therapies are the best management modalities for pediatric oral hemangiomas.

Alcohol-based mouthwash as a risk factor of oral cancer: A systematic review

BACKGROUND: Oral and pharynx cancer represent a serious global problem, reaching an incidence of half a million cases annually. The role of tobacco and alcohol have been studied and proven to be one of its risk factors. We also know that mouthwashes contain a variable percentage of alcohol, so there is a reasonable concern about their role in carcinogenesis. MATERIALS AND METHODS: To answer the PICOS (Population; Intervention; Comparison; Outcomes; Study) question: "Do patients (Population) who use alcohol-based mouthwashes (Intervention) compared to those who do not use them (Comparison) have higher acetaldehyde levels in saliva or higher risk of oral cancer development? (Out-comes)" Meta-analyses, systematic reviews, randomized and non-randomized clinical trials, case-control stud-ies, and prospective and retrospective cohort studies were included (Study). Two independent authors conducted literature screening through MEDLINE, Scopus and the Cochrane Library, and they also conducted article and data extraction to undertake quality analyses. The main outcome measures were salivary acetaldehyde levels or the risk of oral cancer development. The most relevant data was extracted and the risk of bias from the studies included was also evaluated RESULTS: Out of 497 potentially eligible papers, 8 studies were included in the qualitative analysis which include a total of 43,499 subjects: two meta-analyses, a clinical trial, three case-control studies and two cohort studies. One study (n = 3,926) found a relationship between alcohol mouthwash and oral cancer, two studies (n = 25,033) found this relationship when a high frequency of mouthwash was present, three studies (n = 14,482) failed to find this relationship and 2 studies (n = 58) found a temporary increase of acetaldehyde levels in saliva after alcohol mouthwash. CONCLUSIONS: It cannot be guaranteed that the use of mouthwash represents an independent risk factor for the develop-ment of head and neck cancer. However, the risk does increase when it occurs in association with other carcinogenic risk factors

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Alcohol-based mouthwash as a risk factor of oral cancer: A systematic review.

BACKGROUND: Oral and pharynx cancer represent a serious global problem, reaching an incidence of half a million cases annually. The role of tobacco and alcohol have been studied and proven to be one of its risk factors. We also know that mouthwashes contain a variable percentage of alcohol, so there is a reasonable concern about their role in carcinogenesis. MATERIALS AND METHODS: To answer the PICOS (Population; Intervention; Comparison; Outcomes; Study) question: Do patients (Population) who use alcohol-based mouthwashes (Intervention) compared to those who do not use them (Comparison) have higher acetaldehyde levels in saliva or higher risk of oral cancer development? (Outcomes) Meta-analyses, systematic reviews, randomized and non-randomized clinical trials, case-control studies, and prospective and retrospective cohort studies were included (Study). Two independent authors conducted literature screening through MEDLINE, Scopus and the Cochrane Library, and they also conducted article and data extraction to undertake quality analyses. The main outcome measures were salivary acetaldehyde levels or the risk of oral cancer development. The most relevant data was extracted and the risk of bias from the studies included was also evaluated. RESULTS: Out of 497 potentially eligible papers, 8 studies were included in the qualitative analysis which include a total of 43,499 subjects: two meta-analyses, a clinical trial, three case-control studies and two cohort studies. One study (n = 3,926) found a relationship between alcohol mouthwash and oral cancer, two studies (n = 25,033) found this relationship when a high frequency of mouthwash was present, three studies (n = 14,482) failed to find this relationship and 2 studies (n = 58) found a temporary increase of acetaldehyde levels in saliva after alcohol mouthwash. CONCLUSIONS: It cannot be guaranteed that the use of mouthwash represents an independent risk factor for the development of head and neck cancer. However, the risk does increase when it occurs in association with other carcinogenic risk factors.

Rationalizing the relative abundances of trimetallic nitride template-based endohedral metallofullerenes from aromaticity measures.

The synthesis of endohedral metallofullerenes (EMFs) from a carbon soot sample of an arc discharge leads to a variety of EMFs that are obtained in different relative abundances. In the present work, we show that these abundances can be predicted from aromaticity calculations. In particular, we use the normalized Additive Local Aromaticity (ALAN) index. Our results show that the most abundant Sc3N-based and Y3N-based EMFs in fullerene soot are the most aromatic. This study reinforces the idea that aromaticity plays a key role in determining the stability of EMFs.

Investigation of cyano-bridged coordination nanoparticles Gd(3+)/[Fe(CN)6](3-)/D-mannitol as T1-weighted MRI contrast agents.

Cyano-bridged Gd(3+)/[Fe(CN)6](3-) coordination polymer nanoparticles of 3-4 nm stabilized with D-mannitol presenting a high r1 relaxivity value of 11.4 mM(-1) s(-1) were investigated in vivo as contrast agents (CA) for Magnetic Resonance Imaging (MRI). They allow an increase of the MR image contrast and can act as an efficient intravascular T1 CA with a relatively long blood-circulation lifetime (60 min) without specific toxicity.

Effect of pretreatments and air-frying, a novel technology, on acrylamide generation in fried potatoes.

This paper investigated the effect of air-frying technology, in combination with a pretreatment based of soaking the samples in different chemical agent solutions (citric acid, glycine, calcium lactate, sodium chloride, or nicotinic acid [vitamin B3]), on the generation of acrylamide in fried potatoes. The influence of reducing sugars on the development of surface's color was also analyzed. The experiments were conducted at 180 °C by means of air-frying and deep-oil-frying, as a reference technology. Based on the evolution of color crust with frying time, it could be concluded that the rate of Maillard reaction decreased as the initial reducing sugars content increased in the raw material, and was also lower for deep-oil-frying than for air-frying regardless of pretreatments applied. Air-frying reduced acrylamide content by about 90% compared with conventional deep-oil-frying without being necessary the application of a pretreatment. However, deep-oil fried potatoes pretreated with solutions of nicotinic acid, citric acid, glycine at 1%, and NaCl at 2% presented much lower acrylamide levels (up to 80% to 90% reduction) than nonpretreated samples.

Los métodos alternativos en el estudio de la seguridad de cosméticos / Alternative methods in the study of the safety of cosmetics

El Reglamento 1223/2009 establece las normas que deben cumplir todos los productos cosméticos comercializados en Europa, con objeto de velar por el funcionamiento del mercado interior y lograr un elevado nivel de protección de la salud humana garantizando el uso de métodos alternativos que no impliquen la utilización de animales. El Laboratorio Europeo de Referencia para las Alternativas a la Experimentación con Animales (EURL-EURL- ECVAM) es el laboratorio de referencia en Europa encargado de validar los métodos alternativos. Posteriormente pueden ser homologados por la Organización de Cooperación y Desarrollo Económico (OCDE). Por otro lado, el Comité Científico de Seguridad de los Consumidores (SCCS) asesora a la Comisión sobre todos los temas relacionados con la seguridad de los cosméticos. En esta revisión se detalla una relación de métodos alternativos necesarios para evaluar la seguridad de los ingredientes cosméticos así como los métodos usados y sus limitaciones (AU)

Regulation 1223/2009 apply to all cosmetic products marketed in Europe in order to ensure the internal market and achieve a high level of protection of human health by ensuring the use of alternative methods not involving the use of animals. The European Reference Laboratory for Alternatives to Animal Testing (EURL- EURL-ECVAM) is the European reference laboratory responsible for validating alternative methods. They can also be approved by the Organization for Economic Cooperation and Development (OECD). In addition, the Scientific Committee on Consumer Safety (SCCS) advises the EU Commission on all issues related to cosmetic safety. In this review, alternative methods needed to assess the safety of cosmetic ingredients and the methods used and their limitations are outlined (AU)

²°¹Tl⁺-labelled Prussian blue nanoparticles as contrast agents for SPECT scintigraphy.

Prussian blue (PB) and its analogues on the nanometric scale are exciting nano-objects that combine the advantages of molecular-based materials and nanochemistry. Herein, we demonstrate that ultra-small PB nanoparticles of 2-3 nm can be easily labelled with radioactive (201)Tl(+) to obtain new nanoprobes as radiotracers for 201-thallium-based imaging.

Flake size-dependent cyto and genotoxic evaluation of graphene oxide on in vitro A549, CaCo2 and vero cell lines.

This study was carried out by varying both graphene oxide (GO) concentration (10 μg/mL, 50 μg/mL, 100 μg/mL) and flakes sizes of 1320 nm and 130 nm. Characterization by scanning electron microscopy and Raman spectroscopy demonstrate that the area of GO flakes varies of one order of magnitude but their chemical structure remains unmodified. A 24-h cytotoxicity test showed, for A549, a loss in the viability, while the test exhibits overall a positive increase in the viability for CaCo2 and Vero. A 24-h comet assay shows a marked GO genotoxicity: for micrometer-sized GO flakes the genotoxicity is in positive correlation with the concentration, while for nanometer-sized GO flakes there was a high degree of genotoxicity at the lowest concentration tested.

Diseño y validación de un mapa de riesgos para la mejora de la seguridad del paciente en los servicios de urgencias hospitalarios / Design and validation of a risk map for improving safety patient in emergency departments

Objetivo: Diseño y validación de un mapa de riesgos de la atención urgente (MR) aplicable para todos los servicios de urgencias (SU) hospitalarios españoles. Material y métodos: Diseño de un MR utilizando la metodología del Análisis Modal de Fallos y Efectos (AMFE). El trabajo constó de cuatro fases: diseño, consenso (rondas de consultores mediante técnica Delphi), validación y diseño definitivo. Resultados: El MR definitivo recogió, tras su validación, 13 procesos, 118 subprocesos, 271 fallos posibles y 1.368 riesgos. Atendiendo a las puntuaciones de mediana del índice de probabilidad de riesgos (IPR), se elaboraron dos versiones reducidas: MR Recomendado, con los riesgos por encima de la mediana global de cada proceso, formado por 13 procesos, 108 subprocesos, 217 fallos posibles y 748 riesgos; y MR Imprescindible (con los riesgos >280 puntos de IPR), formado por 10 procesos, 54 subprocesos, 79 fallos posibles y 180 riesgos. Conclusión: El MR obtenido es una herramienta proactiva homogénea y validada, que analiza todos los procesos asistenciales urgentes y que permite la gestión de riesgos en cualquier SU (AU)

Objective: To design and validate an emergency care risk map (RM) which can be used in all the Spanish emergency departments (ED). Material and methods: To design a RM using the Failures Modes and Effects Analysis method (FMEA). The study has four phases: Design, consensus (using Delphi technique), validation and final design. Results: The final RM collected, after validation, a total of 13 processes, 118 subprocesses, 271 possible failures and 1,368 risks. Based on median scores risk odds ratio (IPR), we obtained two smaller versions: Recommended MR, with the risks above the overall median for each process, consists of 13 processes, 108 subprocesses, 217 possible failures and 748 risks; and Essential RM (with the risk >280 points IPR), consisting of a total of 10 processes, 54 subprocesses, 79 and 180 potential risks. Conclusion: The RM obtained is a proactive, homogeneous and validated tool, which analyzes all the emergency cares processes, and which allows risk management in every ED (AU)

Validation of receptor-binding assays to detect antibiotics in goat's milk.

The suitability of different receptor-binding assays to detect antibiotics in raw goat's milk was investigated. Detection capability of most ß-lactams and tetracyclines assessed applying the Betastar Combo, the SNAP Betalactam, the SNAP Tetracycline, and the Twinsensor tests was at or below maximum residue limits established by European legislation. Regarding test specificity, cross-reactions with antibiotics other than ß-lactams and tetracyclines were not found, and no false-positive results were obtained for the Betastar Combo and the SNAP tests when bulk samples of goat's milk were analyzed. For the Twinsensor test, the false-positive rate was 1%. The performance of the Betastar Combo and the SNAP tests was practically unaffected by the milk quality parameters using individual samples of goat's milk collected at points throughout the entire lactation period (false-positive rate, ≤5%). However, a larger number of positive results were obtained by the Twinsensor test in this type of milk sample (>10%), especially in the last weeks of lactation. Interferences related to the use of the preservative azidiol were not observed in any case. Neither were any significant differences found in relation to the interpretation method (visual versus instrumental) applied. In general, the response of the Betastar Combo, SNAP, and Twinsensor tests was optimal for the analysis of bulk caprine milk; thus, they may be used to monitor milk for the presence of ß-lactam and tetracycline residues in quality control programs.

Brote comunitario de foliculitis por Pseudomonas aeruginosa asociado a un spa / Community outbreak of Pseudomonas aeruginosa folliculitis associated with a spa

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Ecotoxicological impact of MSW landfills: assessment of teratogenic effects by means of an adapted FETAX assay.

The introduction of chemical products into the environment can cause long-term effects on the ecosystems. Increasing efforts are being made to determine the extent of contamination in particularly affected areas using diverse methods to assess the ecotoxicological impact. We used a modified Frog Embrio Toxicity Assay-Xenopus method to determine the extent of toxicological load in different sample soils obtained near three municipal solid waste landfills in Catalonia (Spain). The results show that the Garraf landfill facility produces more embryotoxic damage to the surroundings, than the others ones: Can Mata landfill and Montferrer-Castellbó landfill. The aim of this work is to demonstrate how different management of complex sources of contamination as the controlled dumping sites can modulate the presence of toxics in the environment and their effects and through this, help determine the safer way to treat these wastes. To this effect some conceptual modifications have been made on the established American Society for Testing and Materials protocol. The validity of the new model, both as to model of calculation as to protocol, has been demonstrated in three different sites with complex sources of contamination.

Human infection by a "fish tapeworm", Diphyllobothrium latum, in a non-endemic country.

We document a case of locally acquired "broad- or fish-tapeworm" infection caused by Diphyllobothrium latum in a 27-year-old Spanish man, confirmed by molecular analysis (COI gene). The patient had naturally expelled a worm of 110 cm in length, but the physical examination did not yield any remarkable findings, and the patient did not suffer from any particular symptoms. Laboratory test results were normal except for a remarkable increase in the red blood cell count, and an evident decrease in the mean corpuscular volume and mean corpuscular hemoglobin. Vitamin B12 and folic acid values were in the normal range without signs of anemia. It was suggested that these anomalies in erythrocyte formation might not be related to the parasite, and analysis of the patient's anamnestic data revealed that the infection could only have been caused by the ingestion of imported fish, although no light could be shed on the specific source of infection. From a public health viewpoint, this human case of fish-borne zoonosis is exemplary, suggesting that not only is control of fish and fish product quality essential, but also increased awareness of the general population with regard to changes in culinary habits.