[Nosocomial infections caused by multiresistant Pseudomonas aeruginosa (carbapenems included): predictive and prognostic factors. A prospective study (2016-2017))]. / Infecciones nosocomiales por Pseudomonas aeruginosa multiresistente incluido carbapenémicos: factores predictivos y pronósticos. Estudio prospectivo 2016-2017.

OBJECTIVE: Pseudomonas aeruginosa is one of the major pathogens causing hospital-acquired infections. In recent years, antimicrobial resistance is increasing and multidrug resistant (MDR) and extremely drug resistant (XDR) isolates have been associated with an increase of mortality. The aim of this study is to assess the clinical significance and analyze predictors and prognostic factors. METHODS: Prospective case-control non-paired study involving 64 patients with P. aeruginosa nosocomial infection, 32 caused by susceptible P. aeruginosa and 32 by MDR/XDR including to carbapenems (XDR-C) strains, admitted at a third level hospital. The follow-up period was till hospital discharge or death and at 30 days after discharge. For all patients, clinical epidemiology and microbiological data were analyzed. RESULTS: The incidence of MDR/XDR-C strains was 2.3 per 1000 admissions. Ten of which were VIM metallo-ß-lactamase-producing. Independent predictor factors associated with MDR/XDR-C infections were: previous ICU or Resuscitation unit admission (OR 14.01; IC 95% 2.105-93.297) appearance >20 days after admission (OR 29.826; IC 95% 4.783-185.997) and leukocytosis (OR 10.0190; IC 95% 1.842-56.369). However, there were not statistically significant differences in clinical severity or mortality between both groups. CONCLUSIONS: The major risk factors associated with MDR/XDR-C infections were previous ICU or Resuscitation unit admission, appearance >20 days after admission and leukocytosis. MDR/XDR-C infections were not associated to increased mortality.

[Epidemiology and risk factors of patients with intra-abdominal postsurgical infection treated with tigecycline: a cohort study]. / Estudio de una cohorte de pacientes tratados con tigeciclina por infección intraabdominal tras cirugía abdominal compleja: epidemiologia y factores pronósticos.

OBJECTIVE: To study a cohort of patients with intra-abdominal postsurgical infection treated with tigecycline to analyze its effectiveness and mortality related factors. METHODS: Prospective study of patients with intra-abdominal postsurgical infection with microbiological isolation and treated with tigecycline. RESULTS: Out of 103 patients only 61 full fit inclusion criteria. Mean age was 67 year-old and 72% were male. Charlson score was ≥ 3 in 65.5%, being diabetes and colon cancer the most prevalent diseases. Cancer surgery was the most frequent procedure (n=44, 72%) and previous antibiotic administration was present in 43 cases (69%). Pitt score was ≥ 3 in 69% and most prevalent bacteria were Escherichia coli (38 %), Enterococcus spp. (34%; mainly Enterococcus faecium) and Klebsiella pneumoniae together with Enterobacter cloacae (28%). Tigecycline was prescribed alone (17; 28%) or in combination with other antibiotics (44; 72%), mainly meropenem (25; 57%) or amikacin (19, 43%). 11 patients died (18%), all of which suffered extended cancer surgery and isolation of extended-spectrum betalactamase producing Enterobacteriaceae. Factors statistically associated to death in univariate analysis were Charlson score >3, pH <7.3 and leucocyte count >20.000 cells/mm3. CONCLUSIONS: As being a cohort of patients treated with tigecycline, E. faecium isolation was very frequent. Non-fatal evolution was achieved in 82% cases, being tigecycline a potentially good option in the empiric treatment of very severe infections.

Evening chronotype associates with obesity in severely obese subjects: interaction with CLOCK 3111T/C.

BACKGROUND: Chronotype has been related to obesity and metabolic disturbances. However, little is known about the relationship between circadian preferences and genetic background in CLOCK genes with obesity and weight loss among severely obese patients after bariatric surgery. OBJECTIVES: The research goals were (1) to examine whether evening chronotype is related to obesity and weight loss evolution in severely obese followed during 6 years after bariatric surgery and (2) to examine potential interactions between circadian preferences and CLOCK 3111T/C for obesity in this population. SUBJECTS/METHODS: Participants (n=252, 79% female; age (mean±s.d.): 52±11 years; body mass index (BMI): 46.4±6.0 kg m-2) were grouped into evening and morning types. Obesity and weight loss parameters, energy and macronutrients intake, energy expenditure, chronotype, meal timing, sleep duration and CLOCK genotype were studied. RESULTS: Evening-type subjects showed significantly higher initial body weight (P=0.015) and BMI (P=0.014) than morning types. Moreover, evening-type, when compared with morning types, lost less weight (percentage of excess weight loss) after bariatric surgery (P=0.015). Weight-loss progression between the two chronotype groups differed significantly from the fourth year after the bariatric surgery toward a higher weight regain among evening types (P<0.05). We also detected a significant interaction between CLOCK 3111T/C SNP and chronotype for body weight at baseline (P<0.001). Specifically, among carriers of the risk allele C, evening types showed higher body weight than morning types (P=0.012). In addition, CLOCK 3111T/C SNP significantly associated with obesity and sleep duration in the older subjects. CONCLUSIONS: Evening chronotype is associated with higher obesity in severely obese subjects and with lower weight loss effectiveness after bariatric surgery. In addition, circadian preferences interact with CLOCK 3111T/C for obesity. The circadian and genetic assessment could provide tailored weight loss recommendations in subjects who underwent bariatric surgery.

Changes in Testicular Interstitial Connective Tissue of Hamsters (Mesocricetus auratus) During Ageing and After Exposure to Short Photoperiod.

The testicular interstitium of Syrian hamster (Mesocricetus auratus) was studied during ageing and in testicular regression after exposure to a short photoperiod, in relation to the interstitial cells and their connective tissue. This tissue was assessed histochemically using Masson's trichrome technique and the expression of Heat Shock Protein 47 (HSP-47) and collagen IV (α5) was assessed in Leydig cells. Finally, an ultrastructural analysis of some cells of the testicular interstitium was made. Leydig cells were positive for HSP-47 and collagen IV (α5). Ageing did not change the parameters studied while the short photoperiod altered the synthetic activity of Leydig cells. The positivity index of these cells for HSP-47 was significantly higher in the regressed testis, but was lower for collagen IV (α5). During ageing no change were observed. Ultrastructural Leydig cells showed a discontinuous basal lamina that did not change during ageing. The basal lamina was not identified in Leydig cells regressed by exposure to a short photoperiod. In conclusion; the intertubular connective tissue suffers little change with age. By contrast, in the testis regressed after exposure to a short photoperiod the studied parameters related to the intertubular connective tissue were altered. These changes are probably related with the low synthetic activity of regressed Leydig cell.

DOSE REFERENCE LEVELS IN SPANISH INTRAORAL DENTAL RADIOLOGY: STABILISATION OF THE INCORPORATION OF DIGITAL SYSTEMS IN DENTAL CLINICAL PRACTICES.

A total of 34 044 official quality assurance reports in dental radiodiagnostic surgery from 16 regions of Spain, compiled from 2002 to 2014, were studied in order to determine the progress of diagnostic reference levels (DRLs) for obtaining diagnostic images under normal conditions for clinical practice in Spanish dental clinics. A DRL of 2.8 mGy was set in 2014, which represents a 41.7 % decrease compared with that of 2002 (4.8 mGy). Over the same time period, the mean dose fell by 55.2 %. However, over the last 3 y, the stabilisation of the mean dose administered to patients has been observed with only a 6.7 % reduction in DRLs, which corresponds to the stabilisation of dental radiodiagnostic surgery on replacing the use of radiographic film with digital imaging systems.

Cellular changes in the hamster testicular interstitium with ageing and after exposure to short photoperiod.

The aim of this study was to evaluate the cellular changes that occur in the hamster testicular interstitium in two very different physiological situations involving testicular involution: ageing and exposure to a short photoperiod. The animals were divided into an 'age group' with three subgroups - young, adult and old animals - and a 'regressed group' with animals subjected to a short photoperiod. The testicular interstitium was characterised by light and electron microscopy. Interstitial cells were studied histochemically with regard to their proliferation, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP in situ nick end labelling (TUNEL+) and testosterone synthetic activity. We identified two types of Leydig cell: Type A cells showed a normal morphology, while Type B cells appeared necrotic. With ageing, pericyte proliferation decreased but there was no variation in the index of TUNEL-positive Leydig cells. In the regressed group, pericyte proliferation was greater and TUNEL-positive cells were not observed in the interstitium. The testicular interstitium suffered few ultrastructural changes during ageing and necrotic Leydig cells were observed. In contrast, an ultrastructural involution of Leydig cells with no necrosis was observed in the regressed group. In conclusion, the testicular interstitium of Mesocricetus auratus showed different cellular changes in the two groups (age and regressed), probably due to the irreversible nature of ageing and the reversible character of changes induced by short photoperiod.

Testicular histomorphometry and the proliferative and apoptotic activities of the seminiferous epithelium in Syrian hamster (Mesocricetus auratus) during regression owing to short photoperiod.

During the non-breeding season some animals exhibit testicular atrophy, decreased testicular weight and reduced seminiferous tubule diameter accompanied by depletion of the seminiferous epithelium. Some cellular factors involved in this depletion are changes in germ cell proliferation and apoptosis. In the Syrian hamster this depletion has been studied histologically and in terms of the involvement of proliferation and apoptosis in the seminiferous epithelium of fully regressed testes. The objectives of this study included the histomorphometrical characterization of the testis and the determination of the proliferative and apoptotic activity of germ cells in the seminiferous epithelium during testicular regression owing to short photoperiod. The study was performed using conventional light microscopy (hematoxylin and eosin), proliferating cell nuclear antigen and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP in situ nick end labelling staining, image analysis software, and transmission electron microscopy in three established regression groups: mild regression (MR), strong regression (SR), and total regression (TR). Morphometrically a gradual decrease in total tubular area and in the testicular, tubular, and epithelial volumes was observed during testicular regression. Interstitial and luminal volumes decreased from the MR group onwards. The tubular length decreased from MR to SR. As regards spermatogonial proliferation, only an initial decrease in proliferative activity was observed, whereas apoptotic germ cell activity increased throughout regression. The number of germ cells studied decreased throughout the process of testicular regression. In conclusion, testicular regression in Syrian hamster comprises two histomorphometrical phases, the first involving a decrease in seminiferous tubular diameter and volume and the second involving shortening of the seminiferous tubule and a decrease in interstitial volume. At the cellular level, there is an initial decrease in proliferation and increase in apoptosis involving all germ cells. At the end of regression, the proliferative and apoptotic activities of the spermatogonia recover the values observed prior to regression in preparation for recrudescence.

Transcutaneous oxygen tension measurements following peripheral transluminal angioplasty procedure has more specificity and sensitivity than ankle brachial index.

OBJECTIVE: To evaluate the superiority of transcutaneous oxygen pressure (TcPO2) before, during and after peripheral transluminal angioplasty (PTA) in comparison with ankle brachial index (ABI) in patients with diabetes. METHODS: 40 consecutive patients with diabetes treated by PTA where included. This study shows results before, during and after PTA and their progression for 8 weeks. RESULTS: The TcPO2 increased from 28.11 ± 8.1 to 48.03 ± 8.4 mmHg, 8 weeks after PTA (p < 0.001). The ABI increased from 0.48 ± 0.38 to 0.77 ± 0.39 after PTA (p < 0.001). After PTA, the stenosis of the vessel decreased from 58.33 ± 20.07% to 21.87 ± 13.57% (p < 0.001). TcPO2 was determined in all the patients, but ABI could not be determined in all patients. Furthermore, we determined patients with "false negatives" with an improvement in ABI and "false positives" in 12.5% of patients. Additionally, in this study, we monitored TcPO2 while performing PTA, revealing variations in each phase of the radiological procedure. CONCLUSION: The increase in TcPO2 measurements following PTA procedure has more specificity and sensitivity than does ABI. The use of TcPO2 may represent a more accurate alternative than traditional methods (ABI) used in assessing PTA results. The TcPO2 also allows the radiologist to assess changes in tissue oxygenation during PTA, allowing changes to the procedure and subsequent treatment. ADVANCES IN KNOWLEDGE: This is the first time that a graph is shown with TcPO2 results during PTA performance in many patients.

Toward a chronobiological characterization of obesity and metabolic syndrome in clinical practice.

BACKGROUND & AIMS: To test several circadian rhythm variables in a female population to identify the best tool to assess chronodisruption in obesity and metabolic syndrome (MetS) to define a score to be used for chronodisruption characterization in clinical practice. METHODS: Anthropometric measurements and markers of circadian rhythms, such as sleep and feeding diary, Horne-Ostberg questionnaire, melatonin and cortisol measurements, and wrist temperature measurements, were determined. MetS variables were also analyzed. Study was conducted in 70 women. Data were subjected to factor analysis. Receiver operating characteristic curves were used as predictors of chronodisruption risk, and a score was calculated to classify the subjects of risk. RESULTS: Factor analysis showed that the first-factor grouped variables were related to the skin temperature measurement. Second factor consisted of variables related to salivary cortisol levels and obesity-related measurements. Third factor included variables related to sleep-wake cycle. Fourth factor referred to peripheral temperature variables and included the classification of subjects according to the Horne-Ostberg questionnaire. To obtain a final punctuation we performed the weighted mean of the first four factors. The final range was from 27 to 57, mean value of 42. Punctuation was defined as the "chronodisruption score." Women displaying higher chronodisruption scores had higher MetS risk. CONCLUSION: The study demonstrates that wrist temperature recordings, together with two questions of sleep onset and offset, and one morning salivary cortisol determination could be enough to characterize the chronobiology of obesity and MetS, a new chronodisruption score was developed.

Autovaloración sobre prescripción de antibióticos en un hospital universitario / Self-assessment of patterns of antibiotic use in a university hospital

INTRODUCCIÓN: Valorar el conocimiento, las actitudes y las prácticas sobre prescripción de antibiótico entre los médicos de un hospital universitario. MÉTODOS: Dicha valoración se ha estudiado mediante una encuesta anónima directa y personalmente distribuida por un miembro de la plantilla del Servicio de Infecciosas. RESULTADOS: Se obtuvieron 316 cuestionarios, con una tasa de respuestas del 100% de los encuestados; un 65, un 68 y un 45%, respectivamente, admitieron ajustar siempre dosis, vía de administración y duración del tratamiento según la localización y la enfermedad de base; un 20% admitió hacer «desescalamiento»; un 31 y un 10% consideraban las resistencias y el coste económico, respectivamente, al tomar decisiones terapéuticas; un 16% admitió prescribir a menudo antibióticos sin indicación clínica. No hubo diferencias significativas. No hubo grandes diferencias significativas entre el personal de staff o los médicos en formación, o entre los pertenecientes a áreas quirúrgicas o médicas. CONCLUSIONES: La autopercepción de facultativos y residentes de nuestro centro es que hacen un uso inadecuado de antimicrobianos

INTRODUCTION: A questionnaire was used to determine the knowledge, attitudes and practices of antibiotic prescribing among doctors at a university hospital. METHODS: An anonymous questionnaire was directly distributed by a staff member of the Infectious Diseases Department. RESULTS: A total of 316 questionnaires were distributed with 100% response rate; antibiotic dose, route of administration, and treatment duration were always adjusted according to site of infection and underlying conditions in 65, 68 and 45%, respectively. Antibiotic de-escalation was recognized as usual practice in 20%; 31 and 10% considered potential microbiological resistances and economical-cost when taking prescription decisions, respectively; 16% admitted often prescribing antibiotics with no clinical indication. There were no major significant differences between staff and training physicians, or between surgical or medical specialists. CONCLUSIONS: The self-perception of physicians and residents in our hospital is that they make improper use of antimicrobials

[Self-assessment of patterns of antibiotic use in a university hospital]. / Autovaloración sobre prescripción de antibióticos en un hospital universitario.

INTRODUCTION: A questionnaire was used to determine the knowledge, attitudes and practices of antibiotic prescribing among doctors at a university hospital. METHODS: An anonymous questionnaire was directly distributed by a staff member of the Infectious Diseases Department. RESULTS: A total of 316 questionnaires were distributed with 100% response rate; antibiotic dose, route of administration, and treatment duration were always adjusted according to site of infection and underlying conditions in 65, 68 and 45%, respectively. Antibiotic de-escalation was recognized as usual practice in 20%; 31 and 10% considered potential microbiological resistances and economical-cost when taking prescription decisions, respectively; 16% admitted often prescribing antibiotics with no clinical indication. There were no major significant differences between staff and training physicians, or between surgical or medical specialists. CONCLUSIONS: The self-perception of physicians and residents in our hospital is that they make improper use of antimicrobials.

Cell proliferation in the seminiferous and epididymal epithelia of Sus domesticus.

It is important to understand the proliferative activity of the different structures of the male reproductive apparatus in livestock species, such as Sus domesticus, to ensure reproductive efficiency. The main aims of this study were (a) to evaluate the proliferative activity of the spermatogonia in the different stages of the seminiferous cycle and (b) to study the cell proliferation in the epididymal epithelium in each region, identifying the different cells involved. For this, the testes and epididymis of three healthy, sexually mature Sus domesticus boars were used. The organs were processed for light microscopy, and immunohistochemical techniques were used to detect proliferating cell nuclear antigen. The cells immunostaining positively and negatively for proliferating cell nuclear antigen were counted and several parameters and indexes were calculated to evaluate the proliferation in both epithelia, taking into account the stage of the seminiferous epithelium cycle, and, in the case of the epididymal epithelium, the different regions and cells are the same. Finally, a contrast analysis of equality between pairs of means was carried out followed by a least significant differences test, in which differences were considered significant at P < 0.05. In the seminiferous epithelium, the greatest total number of spermatogonia and proliferating spermatogonia was observed in the postmeiotic stages (mainly VII and VIII). The proliferation index of the spermatogonia increased from the meiotic to postmeiotic stages. As regards the epididymal epithelium, the total proliferation index was higher in the caput. In each region, the clear and principal cells showed the highest proliferation index with respect to the total number of cells counted, whereas the proliferation index of each cell with respect to the same type was higher in the clear cells, followed by the narrow and principal cells. In conclusion, the proliferative activity of spermatogonia in the seminiferous epithelium of Sus domesticus is stage-dependent, and mainly occurs in the postmeiotic stages. In the epididymal epithelium, proliferative activity takes place in several cell types and is dependent on the anatomical region of the epididymis. We think that these results may be of importance for understanding the pathologic or reproductive processes in which cell proliferation is involved in the male reproductive system.

Influence of histological degree of seminiferous tubular degeneration and stage of seminiferous cycle on the proliferation of spermatogonia in aged Syrian hamster (Mesocricetus auratus).

The ageing testis is associated with germ loss in the seminiferous epithelium and a decrease in spermatogonia proliferation. In this work, we study whether the stages of the seminiferous epithelium cycle and/or the degree of histological tubular degeneration resulting from ageing is related with this decrease in spermatogonia proliferation. Eleven hamsters were used, five aged 6 months and six aged 24 months. In both groups, the proliferative activity was studied by BrdU immunostaining. The number of BrdU-positive and BrdU-negative cells was measured, providing the overall proliferation index in adult and aged testes. The mean number of BrdU-positive cells was also determined for each degree of histological degeneration of seminiferous epithelium, and a spermatogonia proliferation index was obtained for each stage of the seminiferous cycle. Ageing caused an overall decrease in the BrdU-positive cell percentage and a decrease in the number of BrdU-positive cells in the tubular sections with hypospermatogenesis, the sloughing of germ cells and maturation arrest, these changes being similar in both young and old animals. The spermatogonia proliferation index was only seen to be significantly lower in ageing hamster in stages VII-VIII of the seminiferous epithelium cycle. In conclusion, the overall decrease in proliferation observed in aged seminiferous epithelium is correlated with an increase in the number of degenerated sections of the seminiferous tubules, and this decrease is a phenomenon which occurs in specific stages of the seminiferous cycle.

Mejora del conocimiento sobre reacciones alérgicas cruzadas en dos grupos de medicamentos: beta-lactámicos y AINEs / Improvement of the knowledge on allergic cross-reactions between two drug groups: beta-lactams and NSAIDS

OBJETIVOS: Identificar oportunidades de mejora, sobre el conocimiento disponible del personal sanitario (en concreto a personal médico, farmacéutico y de enfermería), sobre reacciones alérgicas cruzadas (RAC) de penicilinas y AINEs. MÉTODO: Estudio prospectivo cuasiexperimental pre-exposición en un hospital de 412 camas. Se realizó una valoración del conocimiento sobre RAC de penicilinas y AINEs, a través de encuestas anónimas, antes (1a encuesta) y después (2a encuesta) de la implantación de una serie de medidas de mejora: protocolo "paciente alérgico a medicamentos", tarjeta de bolsillo, póster resumen de información y charlas divulgativas. Las propias encuestas sirvieron de hoja de recogida de datos y el análisis estadístico se llevó a cabo con el programa SPSS v18.0. RESULTADOS: La media de errores en las las encuestas sobre "RAC en paciente alérgico a penicilinas" y sobre "RAC en paciente alérgico a AINEs", fue de 20,53 y 27,62, respectivamente. La media de errores en las 2as encuestas sobre "RAC en paciente alérgico a penicilinas" y sobre "RAC en paciente alérgico a AINEs", fue de 2,27 y 7,26, respectivamente. Todos los resultados se consideraron significativos para un nivel 945;< 0,05. CONCLUSIONES: -No se dispone de un nivel adecuado de conocimiento sobre RAC de penicilinas y AINEs, lo que justifica la realización de un ciclo de mejora. -Tras la implantación de las medidas de mejora se aprecia un aumento en el nivel de conocimiento sobre RAC en penicilinas y AINEs, en los grupos de estudio

OBJECTIVES: To identify opportunities for improving the available knowledge of health care professionals (particularly, physicians, pharmacists, and nurses) on crossed allergic reactions (CAR) to penicillins and NSAIDs. METHOD: Quasi-experimental prospective pre-exposure study at a 412-beds hospital. An assessment of the knowledge on CAR to penicillins and NSAIDs was performed by means of anonymous questionnaires before (1st questionnaire) and after (2d questionnaire) the implementation of a series of improvement measures: protocol of "patient allergic to drugs", pocket card, poster with summarized information, and informative talks. The questionnaires served as the CRF and the statistical analysis was done with the SPSS v18.0 software. RESULTS: The mean number of errors in the first questionnaire on CARs of penicillin allergic patient and on CARs of NSAIDs allergic patients was 20.53 and 27.62, respectively. The mean number of errors in the second questionnaire on CARs of penicillin allergic patient and on CARs of NSAIDs allergic patients was 2.27 and 7.26, respectively. All the results were significant for a p level < 0.005. CONCLUSIONS: -There is insufficient knowledge on CARs to penicillins and NSAIDS, which justifies improvement measures. -After the implementation of improvement measures, there is an increased knowledge on CARs to penicillins and NSAIDs in the study groups

[Improvement of the knowledge on allergic cross-reactions between two drug groups: beta-lactams and NSAIDS]. / Mejora del conocimiento sobre reacciones alérgicas cruzadas en dos grupos de medicamentos: ß-lactámicos y AINEs.

OBJECTIVES: To identify opportunities for improving the available knowledge of health care professionals (particularly, physicians, pharmacists, and nurses) on crossed allergic reactions (CAR) to penicillins and NSAIDs. METHOD: Quasi-experimental prospective pre-exposure study at a 412-beds hospital. An assessment of the knowledge on CAR to penicillins and NSAIDs was performed by means of anonymous questionnaires before (1st questionnaire) and after (2d questionnaire) the implementation of a series of improvement measures: protocol of "patient allergic to drugs", pocket card, poster with summarized information, and informative talks. The questionnaires served as the CRF and the statistical analysis was done with the SPSS v18.0 software. RESULTS: The mean number of errors in the first questionnaire on CARs of penicillin allergic patient and on CARs of NSAIDs allergic patients was 20.53 and 27.62, respectively. The mean number of errors in the second questionnaire on CARs of penicillin allergic patient and on CARs of NSAIDs allergic patients was 2.27 and 7.26, respectively. All the results were significant for a p level < 0.005. CONCLUSIONS: - There is insufficient knowledge on CARs to penicillins and NSAIDS, which justifies improvement measures. - After the implementation of improvement measures, there is an increased knowledge on CARs to penicillins and NSAIDs in the study groups.

Objetivos: Identificar oportunidades de mejora, sobre el conocimiento disponible del personal sanitario (en concreto a personal médico, farmacéutico y de enfermería), sobre reacciones alérgicas cruzadas (RAC) de penicilinas y AINEs. Método: Estudio prospectivo cuasiexperimental pre-exposición en un hospital de 412 camas. Se realizó una valoración del conocimiento sobre RAC de penicilinas y AINEs, a través de encuestas anónimas, antes (1a encuesta) y después (2a encuesta) de la implantación de una serie de medidas de mejora: protocolo "paciente alérgico a medicamentos", tarjeta de bolsillo, póster resumen de información y charlas divulgativas. Las propias encuestas sirvieron de hoja de recogida de datos y el análisis estadístico se llevó a cabo con el programa SPSS v18.0. Resultados: La media de errores en las 1as encuestas sobre "RAC en paciente alérgico a penicilinas" y sobre "RAC en paciente alérgico a AINEs", fue de 20,53 y 27,62, respectivamente. La media de errores en las 2as encuestas sobre "RAC en paciente alérgico a penicilinas" y sobre "RAC en paciente alérgico a AINEs", fue de 2,27 y 7,26, respectivamente. Todos los resultados se consideraron significativos para un nivel 945;< 0,05. Conclusiones: - No se dispone de un nivel adecuado de conocimiento sobre RAC de penicilinas y AINEs, lo que justifica la realización de un ciclo de mejora. - Tras la implantación de las medidas de mejora se aprecia un aumento en el nivel de conocimiento sobre RAC en penicilinas y AINEs, en los grupos de estudio.

[Coagulase-negative Staphylococcus bacteraemia: prognosis factors and influence of antibiotic treatment]. / Bacteriemias por Staphylococcus coagulasa negativa: análisis de factores pronóstico e influencia del tratamiento antibiótico.

INTRODUCTION: Coagulase-negative staphylococci (CNS) are the most frequent isolated microorganism in blood cultures; mortality has been associated to severity and to adequacy of empirical treatment but the relevance of the latter is not clearly recognised. The aims of the study were to analyze clinical and microbiological factors related to mortality in patients with CNS bacteraemia and the influence of empirical treatment in prognosis. PATIENTS AND METHODS: A prospective cohort study of patients with CNS bacteraemia was performed (January to June 2010) at a university-affiliated hospital; a determination of clinical significance was made and true bacteraemia was defined according to CDC criteria. We analysed epidemiological, clinical and microbiological variables related to mortality. RESULTS: A total of 269 cases were included (97 were considered true bacteraemia); 92% survived and mortality was 8% (1.6% CNS bacteraemia related mortality). Staphylococcus epidermidis was the most frequent isolated species; 93 patients were included in the related mortality study of patients with true bacteraemia. Factors associated to mortality in the bivariate analysis (p<0.05) were: Winton score I-III, presence of pacemakers, sepsis or infective endocarditis and persistent bacteraemia. Adequate empirical treatment was not associated to survival. CONCLUSIONS: Severity at onset, the development of septic complications and having a pacemaker are associated to mortality in patients with CNS bacteraemia; in our cohort, inadequate empirical treatment is not related to mortality.

Histological changes in connective tissue of rat tails after bipolar radiofrequency treatment.

Radiofrequency (RF) has been included in the techniques used in aesthetic surgery/medicine. To date, no studies have performed a histological assessment of changes in the tissue after application of bipolar radiofrequency (BRF) with low energy and frequency. The aim of this study was to examine changes that are produced in connective tissue, principally in the fibroblasts, following BRF treatment. Four groups of rats received a different number of RF sessions (1, 2, 3 and 5). The following parameters were determined: the number of fibroblasts/unit area (FA), the proliferation index (PI), the Heat shock Protein 47 index (HSPI) and the percentage of connective tissue (PC). For statistical analysis, two subgroups (A and B) were made for the variables FA, PI and PC, and another two subgroups (C and D) for the variable HSPI. Significant differences for FA, PI and PC were observed between subgroups A and B, FA and PI having higher values in A, while PC had higher values in B. The HSPI in subgroup C showed significantly higher values than in D. Low energy and frequency BRF led to an increase in the number, proliferation and biosynthetic activity of fibroblasts. The resulting stress suffered by fibroblasts as a result of heat may be associated with the phenomenon of hormesis.

Validation of a questionnaire on emotional eating for use in cases of obesity: the Emotional Eater Questionnaire (EEQ).

INTRODUCTION: Emotions have a powerful effect on our choice of food and eating habits. It has been found that in some people there is relationship between eating, emotions and the increased energy intake. This relationship should be measurable to better understand how food is used to deal with certain mood states and how these emotions affect the effectiveness of weight loss programs. OBJECTIVE: To develop and analyze the psychometric characteristics of a questionnaire on emotional eating for obesity easy to apply in clinical practice. SUBJECTS AND METHODS: A ten-item questionnaire called Emotional-Eater-Questionnaire (EEQ) was developed and administered to a total of 354 subjects (body mass index, 31 ± 5), aged 39 ± 12, who were subjected to a weight-reduction program. The questionnaire was specifically designed for obesity. Analysis of the internal structure, internal consistency, test-retest reliability and convergent validity with Mindful-Eater-Questionnaire (MEQ) were conducted. RESULTS: After principal components analysis, the questionnaire was classified in three different dimensions that explained 60% of the total variance: Disinhibition, Type-of-food and Guilt. Internal consistency showed that Cronbach's alpha was 0.773 for the "Dishinibition" subscale, 0.656 for the "Type of food" subscale and 0.612 for the "Guilt" subscale. The test-retest stability was r = 0.70. The data showed that the percentage of agreement between the EEQ and the MEQ was around 70% with a Kappa index of 0.40; P < 0.0001. CONCLUSION: We have presented a new questionnaire, which classifies individuals as a function of the relation between food intake and emotions. Such information will permit personalized treatments to be designed by drawing up early strategies from the very beginning of treatment programmes.

Validation of a questionnaire on emotional eating for use in cases of obesity; the Emotional Eater Questionnaire (EEQ) / Validación de un cuestionario de comedores emocionales para uso en casos de obesidad; Cuestionario de Comedor Emocional (CCE)

Introduction: Emotions have a powerful effect on our choice of food and eating habits. It has been found that in some people there is relationship between eating, emotions and the increased energy intake. This relationship should be measurable to better understand how food is used to deal with certain mood states and how these emotions affect the effectiveness of weight loss programs. Objective: To develop and analyze the psychometric characteristics of a questionnaire on emotional eating for obesity easy to apply in clinical practice. Subjects and methods: A ten-item questionnaire called Emotional-Eater-Questionnaire (EEQ) was developed and administered to a total of 354 subjects (body mass index, 31 ± 5), aged 39 ± 12, who were subjected to a weight-reduction program. The questionnaire was specifically designed for obesity. Analysis of the internal structure, internal consistency, test-retest reliability and convergent validity with Mindful-Eater-Questionnaire (MEQ) were conducted. Results: After principal components analysis, the questionnaire was classified in three different dimensions that explained 60% of the total variance: Disinhibition, Type-of-food and Guilt. Internal consistency showed that Cronbach's alpha was 0.773 for the "Dishinibition" subscale, 0.656 for the "Type of food" subscale and 0.612 for the "Guilt" subscale. The test-retest stability was r = 0.70. The data showed that the percentage of agreement between the EEQ and the MEQ was around 70% with a Kappa index of 0.40; P < 0.0001. Conclusion: We have presented a new questionnaire, which classifies individuals as a function of the relation between food intake and emotions. Such information will permit personalised treatments to be designed by drawing up early strategies from the very beginning of treatment programmes (AU)

Introducción: Las emociones tienen un poderoso efecto sobre la elección de alimentos y los hábitos alimentarios. Existe una relación entre comer, emociones y el aumento del aporte calórico. Esta relación debería ser medible para comprender mejor cómo utilizamos los alimentos en determinados estados de ánimo y cómo las emociones afectan a la eficacia de los programas de pérdida de peso. Objetivo: Desarrollar y analizar las características psicométricas de un cuestionario para identificar la ingesta emocional en la obesidad de fácil aplicación en la práctica clínica. Material y métodos: Se ha desarrollado y administrado un cuestionario de diez ítems llamado Cuestionario-de-Comedor-Emocional (CCE) a un total de 354 sujetos (Índice de Masa Corporal: 31 ± 5), (Edad: 39 ± 12 años), pertenecientes a un programa de reducción de peso. Se llevó a cabo un análisis de la estructura interna del cuestionario, de la consistencia interna, la fiabilidad testretest y la validez convergente con el Mindful-Eater-Questionnaire (MEQ). Resultados: El análisis de componentes principales del cuestionario encontró tres dimensiones diferentes que explicaban el 60% de la varianza: desinhibición, tipo de alimento y culpa. La consistencia interna mostró que el alfa de Cronbach fue de 0,773 para la subescala "Desinhibición", 0,656 para "Tipo de alimentos" y 0,612 para "culpa". La estabilidad test-retest fue de r = 0,70. Los datos mostraron que el porcentaje de acuerdo entre el CCE y MEQ era del 70% con un índice Kappa de 0,40, P < 0,0001. Conclusión: Hemos presentado un nuevo cuestionario, que clasifica a los individuos en función de la relación entre la ingesta de alimentos y las emociones. Esta información permitirá el diseño de tratamientos personalizados desde el inicio para la obesidad (AU)

Influencia de un programa de intervención múltiple en el cumplimiento de la higiene de manos en una unidad de cuidados intensivos / Influence of a multiple intervention program for hand hygiene compliance in an ICU

Objetivo: Evaluar el cumplimiento de las recomendaciones sobre «higiene de manos» (HM) en una unidad de cuidados intensivos (UCI) en una fase previa (F1) y posterior (F2) a la intervención descrita y analizar los factores asociados de forma independiente al cumplimiento de dichas recomendaciones (antes y después del contacto con el paciente). Diseño: Cincuenta horas de observación en F1 y F2; programa de intervención (PI) (6 meses) que incluye la distribución de dispensadores de solución alcohólica. Ámbito: UCI de un centro asistencial de segundo nivel. Participantes: Personal sanitario de la UCI. Intervenciones: Estudio cuasi experimental que evalúa la situación antes y después de un PI para mejorar el cumplimiento de la HM. Variables de interés: Variable dependiente: cumplimiento de la HM antes-después del contacto con el paciente; variables independientes que pudieran influir en dicha pauta (entre ellas el PI). Resultados: En F1 se recogieron 338 oportunidades para la HM (antes y después del contacto con el paciente); la HM se realizó en 118 (34,9%) y 175 (51,7%), respectivamente. En F2 se observaron 355 oportunidades (antes y después del contacto con el paciente), realizándose la HM en 161 (45,3%) y 224 (63%), respectivamente. En el análisis multivariado la presencia de un PI se asoció de forma independiente, junto con otras variables, con la realización de la HM antes y después del contacto con el paciente. Conclusiones: La introducción de un PI sobre HM en una UCI aumenta de forma estadísticamente significativa el porcentaje de actos de HM antes y después del contacto con el enfermo (AU)

Objective: To assess compliance with hand hygiene (HH) in ICU workers before (P1) and after (P2) implementation of a HH promotion program and distribution of an alcoholic solution for HH, and to analyze factors independently associated to HH before and after patients care. Design: Fifty hours of observational evaluation were carried out during each period of the study (P1 and P2); the number of opportunities for HH (before and after patients care) was registered. Educational program (6 months): poster campaign, educational meetings with staff about HH, and the provision of alcohol hand rubs. Setting: ICU in a secondary level hospital. Participants: Healthcare workers in the ICU. Interventions: A quasi-experimental design was used to evaluate compliance with HH before and after implementation of the educational program. Variables: Dependent variable: HH compliance before-after patients care; independent variables that might be associated to compliance (including the educational program). Results: In P1 there were 338 opportunities for HH both before and after patients care, versus 355 in P2 (before and after patients care). The hand-washing rate was significantly higher in P2 than in P1 (prior to patient care: 45.3% and 34.9%, respectively, and after patient care: 63% and 51.7%, respectively). In the multivariate analysis, the educational program, together with other variables, was significantly associated to HH before and after patients care. Conclusion: There was a significant increase in compliance with hand hygiene among the ICU personnel during the educational phase, both before and after patients care (AU)