Perfil de Enfermedad Neumocócica Invasora atendida en el Hospital Severo Ochoa de Leganés. Años 2002-2012 / No disponible

Introducción: La Enfermedad Neumocócica Invasora (ENI) está causada por S. pneumoniae, es la causa más frecuente de Neumonía adquirida en la comunidad (NAC), otitis media aguda (OMA) y la causa más frecuente de muerte por infección en los países desarrollados y la principal causa de muerte prevenible mediante vacunación. El presente trabajo se realizó para describir el perfil de los pacientes con esta infección atendidos en el Hospital Universitario Severo Ochoa de Leganés (HUSO), así como el estado vacunal de los mismos y las resistencias a antimicrobianos de las cepas aisladas. Métodos: Se realizó este estudio transversal descriptivo retrospectivo revisando la documentación clínica de los pacientes con ENI en el HUSO atendidos entre 2002 y 2012 mediante el programa HP_HIS y se analizaron las variables incluidas en el formulario de enfermedad de declaración obligatoria (EDO) de la Comunidad de Madrid (CAM), el estado vacunal de los pacientes y la información relativa a sensibilidad a antimicrobianos. El análisis estadístico se realizó mediante el programa SPSS 24.0. Resultados: Se estudiaron 470 casos, el 63,4% fueron hombres con una mediana de 62 años de edad. El 87,9% de los pacientes requirió ingreso hospitalario con una mediana de 18 días principalmente en los servicios de Medicina Interna y UCI. En el 67,4% de los casos la forma de presentación clínica fue la neumonía y el 79,8% evolucionó favorablemente. El 80,4% presentó antecedentes clínicos de interés como inmunosupresión, cardiopatía crónica y enfermedad pulmonar crónica. Los serotipos más aislados fueron el 19A, 1 y 3. El 32,3% de los pacientes tenía resistencia a algún antimicrobiano. El 44,9% estaba vacunado y, en caso de vacuna conjugada solo se aisló un serotipo incluido en ella en un paciente. Conclusiones: El sexo masculino, la edad superior a los 65 años y la comorbilidad son las variables que más se asocian a presencia de ENI. Las formas de presentación clínica son por este orden, neumonía, infección respiratoria, bacteriemia y meningitis. Las secuelas asociadas a ENI son el derrame pleural y la insuficiencia respiratoria. Los serotipos más aislados son los de reemplazo, 19A, 1 y 3. La resistencia es elevada, especialmente a macrólidos y betalactámicos. La vacunación de los pacientes estudiados es correcta

Invasive pneumococcal disease (IPD) is caused by S. pneumoniae, it is the most common cause of community-acquired pneumonia (CAP), acute otitis media (AOM) and the most common cause of death from infection in the developed countries. Besides this, IPD remains a leading cause of vaccine preventable death. This work was done to describe patients with this infection attended at Severo Ochoa University Hospital (HUSO), immunization and antimicrobial resistance of isolated strains. Methods: A retrospective, cross-sectional, descriptive study was performed by the review of clinical record of patients with IPD attended at HUSO from 2002 to 2012, by the program HP-HIS. Variables included in the notification form of the Community of Madrid (CAM), immunization status of patients and information related to antimicrobial resistance were analyzed. Statistical analysis of data was performed using SPSS v. 24.0. Results: Up to 470 patients were assessed, 63,4% of whom were male with a median age of 62 years. 87,9% of patients were admitted to hospital with a median of 18 day's admission, especially at the Department of Internal Medicine and ICU. In 67,4% of patients the disease debut implied pneumonia and 79,8% evolved favorably. Of these, 80,4% had a medical history of interest, such as immunosuppression, chronic cardiopathy or chronic respiratory disease. Serotypes 19A, 1 and 3 were most prevalent. Up to 32,3% of patients had antimicrobial resistance and 44,9% of them were vaccinated. In case of conjugated vaccine, one serotype included in it was isolated in one patient. Conclusions: Being male, ager over 65 years and high comorbidity are variables with high occurence of IPD associated to them. The typical forms of the disease are pneumonia, respiratory infection, bacteriemia and meningitis, in that order. Sequels associated with IPD are pleural effusion and respiratory failure. Replacement serotypes 19A, 1 and 3 are commonly isolated. Resistance to macrolide and beta-lactam is high. Vaccination of the patients assessed is correct

¿Qué tratamiento empírico es el más adecuado en pacientes con uretritis? / Which is the best empirical treatment in patients with urethritis?

Objetivo. Conocer el tratamiento empírico más adecuado de uretritis, en pacientes de la zona Centro de Madrid. Métodos. Se analizó el exudado uretral de 2.021 hombres entre Enero 2003-Diciembre 2007. Además de los cultivos tradicionales se determinó la presencia de Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis y Herpes simplex. La sensibilidad de Neisseria gonorrhoeae y Haemophilus spp. se realizó mediante el método de difusión en disco y la sensibilidad de U. urealyticum mediante Micoplasma IST2. Resultados. El porcentaje de muestras positivas fue de 30,6%. Los microorganismos aislados más frecuentemente fueron: U. urealyticum 9,9%, N. gonorrhoeae 7,4%, C. trachomatis 5,1% y Haemophilus spp 3,8%. La resistencia de N. gonorrhoeae en el primer periodo fue: penicilina 11,8%, tetraciclina 5,9%, ciprofloxacino 8,8% y presencia de betalactamasas 11,8%. En el segundo periodo: penicilina 9,7%, amoxicilina/ácido clavulánico 1,4%, tetraciclina 8,3%, ciprofloxacino 23,6% y presencia de betalactamasas 10,5%. La resistencia a ciprofloxacino en no HSH (hombres que tienen relaciones sexuales con hombres) 20% y en HSH 56,2% (p<0,05). La resistencia de Haemophilus spp en el primer periodo fue: ampicilina 38,2%, amoxicilina/ácido clavulánico 8,8%, claritromicina 35,3%, cotrimoxazol 64,7%, cefuroxima 5,9%, ciprofloxacino 8,8%, tetraciclina 12,1% y presencia de betalactamasas 26,5%. En el segundo periodo: presencia de betalactamasas 41,9%, ampicilina 53,1%, amoxicilina/ácido clavulánico 9,4%, cefuroxima 9,4%, claritromicina 18,7%, tetraciclina 34,4%, ciprofloxacino 15,6% y cotrimoxazol 68,7%. La resistencia de U. urealyticum fue: 80,7% ciprofloxacino, 32,4% ofloxacino, 17,5% eritromicina, 9,6% azitromicina, 3,5% tetraciclina y 0,8% doxiciclina. Conclusiones. N. gonorrhoeae presentó mayor resistencia a tetraciclina y ciprofloxacino en el segundo periodo, siendo estadísticamente significativo para ciprofloxacino (p<0.05). La resistencia a quinolonas fue más elevada en HSH. Haemophilus spp presentó mayor resistencia a ampicilina, ciprofloxacino y tetraciclina en el segundo periodo; siendo significativo para tetraciclina (p<0,05). U. urealyticum presentó elevada resistencia a ciprofloxacino (80,7%) y ofloxacino (32,4%) y baja para doxiciclina (0,8%) y tetraciclina (3,5%)(AU)

Objective. To know the best empirical treatment of urethritis in patients at the City Center of Madrid. Methods. 2.021 urethral exudates were analyzed in men between January 2003-December 2007. In addition to the traditional cultures, it was determined the presence of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis and Herpes simplex. The susceptibility of N.gonorrhoeae and Haemophilus spp was performed by disk diffusion method and U. urealyticum by Mycoplasma IST. Results. The percentage of positive samples was: 30.6%. The most frequently isolated microorganisms were: U. urealyticum 9.9%, N. gonorrhoeae 7.4%, C. trachomatis 5.1% and Haemophilus spp 3.8%. The resistance of N. gonorrhoeae in the first period was: penicillin 11.8%, tetracycline 5.9%, ciprofloxacin 8.8% and presence of betalactamase 11.8%. In the second period: penicillin 9.7%, amoxicillin/clavulanic acid 1.4%, tetracycline 8.3%, ciprofloxacin 23.6% and presence of betalactamase 10.5%. Resistance to ciprofloxacin in non-MSM (men having sex with men) was 20% and in MSM 56.2% (p <0.05). Resistance of Haemophilus spp in the first period was: 38.2% ampicillin, amoxicillin/ clavulanic acid 8.8%, clarithromycin 35.3%, cotrimoxazole 64.7%, cefuroxime 5.9%, ciprofloxacin 8.8%, tetracycline 12.1% and presence of betalactamase 26.5%. In the second period: presence of betalactamase 41.9%, ampicillin 53.1%, amoxicillin/ clavulanic acid 9.4%, cefuroxime 9.4%, clarithromycin 18.7%, tetracycline 34.4%, ciprofloxacin 15.6%, and cotrimoxazole 68.7%. Resistance of U. urealyticum was: ciprofloxacin 80.7%, ofloxacin 32.4%, erythromycin 17.5%, azithromycin 9.6%, tetracycline 3.5% and doxycycline 0.8%. Conclusions. N. gonorrhoeae showed a level of resistance to tetracycline and ciprofloxacin higher in the second period, being significant for ciprofloxacin (p<0.05). Quinolone resistance was higher in MSM. Haemophilus spp showed a level of resistance to ampicillin, ciprofloxacin and tetracycline higher in the second period, being significant for tetracycline (p <0.05). U.urealyticum showed high level of resistance to ciprofloxacin (80.7%) and ofloxacin (32.4%) and low level of resistance to doxycycline (0.8%) and tetracycline (3.5%)(AU)

Neutron skin of (208)Pb, nuclear symmetry energy, and the parity radius experiment.

A precise determination of the neutron skin Δr(np) of a heavy nucleus sets a basic constraint on the nuclear symmetry energy (Δr(np) is the difference of the neutron and proton rms radii of the nucleus). The parity radius experiment (PREX) may achieve it by electroweak parity-violating electron scattering (PVES) on (208)Pb. We investigate PVES in nuclear mean field approach to allow the accurate extraction of Δr(np) of (208)Pb from the parity-violating asymmetry A(PV) probed in the experiment. We demonstrate a high linear correlation between A(PV) and Δr(np) in successful mean field forces as the best means to constrain the neutron skin of (208)Pb from PREX, without assumptions on the neutron density shape. Continuation of the experiment with higher precision in A(PV) is motivated since the present method can support it to constrain the density slope of the nuclear symmetry energy to new accuracy.

Nuclear symmetry energy probed by neutron skin thickness of nuclei.

We describe a relation between the symmetry energy coefficients c(sym)(rho) of nuclear matter and a(sym)(A) of finite nuclei that accommodates other correlations of nuclear properties with the low-density behavior of c(sym)(rho). Here, we take advantage of this relation to explore the prospects for constraining c(sym)(rho) of systematic measurements of neutron skin sizes across the mass table, using as example present data from antiprotonic atoms. The found constraints from neutron skins are in harmony with the recent determinations from reactions and giant resonances.

Identification of the transferrin receptor as a novel immunoglobulin (Ig)A1 receptor and its enhanced expression on mesangial cells in IgA nephropathy.

The biological functions of immunoglobulin (Ig)A antibodies depend primarily on their interaction with cell surface receptors. Four IgA receptors are presently characterized. The FcalphaRI (CD89) expressed by myeloid cells selectively binds IgA1 and IgA2 antibodies, whereas the poly-IgR, Fcalpha/muR, and asialoglycoprotein receptors bind other ligands in addition to IgA. IgA binding by mesangial cells, epithelial cells, and proliferating lymphocytes is also well documented, but the nature of the IgA receptors on these cells remains elusive. A monoclonal antibody (A24) is described here that specifically blocks IgA binding to epithelial and B lymphocyte cell lines. Both the A24 antibody and IgA1 myelomas bind a cell surface protein that is identified as the transferrin receptor (CD71). The transferrin receptor selectively binds IgA1 antibodies, monomeric better than polymeric forms, and the IgA1 binding is inhibitable by transferrin. Transferrin receptor expression is upregulated on cultured mesangial cells as well as on glomerular mesangial cells in patients with IgA nephropathy. The characterization of transferrin receptor as a novel IgA1 receptor on renal mesangial cells suggests its potential involvement in the pathogenesis of IgA nephropathy.

¿Son útiles los antimicrobianos utilizados en infección respiratoria de la comunidad para prevenir contactos de enfermedad meningocócica? Estudio in vitro / Association between MLS antibiotic and tetracycline resistance genes in Streptococcus pneumoniae respiratory infection useful for preventing carriage of meningococcal disease? In vitro study

En el presente estudio valoramos la capacidad que tienen ciertos antimicrobianos utilizados en el tratamiento de la infección respiratoria de la comunidad frente a un patógeno como Neisseria meningitidis, cuyo hábitat natural lo constituye la mucosa nasofaríngea. Mediante determinación de las concentraciones mínimas inhibitorias y bactericidas, las curvas de letalidad y el efecto postantibiótico, se estudiaron los antimicrobianos habitualmente administrados de forma empírica en atención primaria (betalactámicos y macrólidos), quinolonas y rifampicina. Todos mostraron in vitro actividad bactericida a las 24 horas del ensayo, y pensamos que son capaces de eliminar empíricamente de la nasofaringe al agente causal de la meningitis meningocócica. No obstante, los únicos antimicrobianos capaces de inducir efecto postantibiótico significativo en la cepa probada son las quinolonas, que retardan el crecimiento del microorganismo en más de una hora (AU)

[Comparison of the in vitro and in vivo effects of meropenem and ciprofloxacin on the morphology of Escherichia coli and Staphylococcus aureus]. / Comparación del efecto in vitro e in vivo de meropenem y ciprofloxacino sobre la morfología de Escherichia coli y Staphylococcus aureus.

In the treatment of infections, subinhibitory concentrations are commonly present and induce a wide range of effects. Some of these effects have been reported to improve the efficacy of these compounds. One of these effects, the change of the bacterial morphology, was assayed in this study both in vitro and in vivo, and their results were compared. Two antimicrobial agents (meropenem and ciprofloxacin) and two standard Gram-positive and Gram-negative strains (S. aureus y E. coli) were used. The methods employed included the in vitro exposure of microorganisms on Mueller-Hinton agar plates, and the in vivo intraperitoneal infection model in mice. With all the sub-MICs tested, the in vitro results showed that meropenem induced the formation of round cells (spheroplasts) on E. coli, while ciprofloxacin produced filaments. With S. aureus, the two antimicrobial agents induced the formation of cellular aggregates (clusters) with a diameter greater than 1 mm. The in vivo results confirmed those observed in vitro, but to a lesser extent. These results agree with those expected in relation with the mechanisms of action of each drug, and could be important in order to prevent a lost in efficacy when the levels of the drug are below the MIC.

Phase II study with high doses of epirubicin in patients with advanced rectal cancer.

We tested the possible role of epirubicin, 100 to 130 mg/m2 administered i.v. every 3 weeks, in patients with advanced adenocarcinoma of the rectum untreated with chemotherapy. Sixteen of 17 entered cases were evaluable. No complete or partial responses were observed. The median time to progression was 6 weeks, and the median survival was 36 weeks. Reversible leukopenia was the major toxic side effect. The median epirubicin cumulative dose was 330 mg/m2; no patient had clinical cardiac toxicity. With no responses recorded in 16 evaluable patients, the activity of epirubicin in rectal cancer ranged between 0 and 18%, with 95% probability. Further studies with epirubicin in this tumor are not indicated.