Tetracycline resistance transmission in Campylobacter is promoted at temperatures resembling the avian reservoir.

Campylobacter is the causal agent of campylobacteriosis in humans, a self-limiting gastroenteritis. Campylobacteriosis is a zoonosis, commonly transmitted from contaminated chicken meat by either direct consumption or cross contamination during food manipulation. Presence of plasmids encoding for resistance to antibiotics such as tetracycline is common among Campylobacter isolates. In this report, we studied the effect of the temperature in the conjugation frequency of several tet(O) carrying plasmids, providing tetracycline resistance to the recipient cells. The conjugation frequency from donor cells carrying three previously characterized plasmids (pCjA13, pCjA9 and pTet) and from two clinical isolates was determined. Two temperatures, 37 and 42 °C, mimicking the conditions encountered by C. jejuni in the human and broiler chicken gastrointestinal tracts, respectively, were assessed. Our results clearly indicate that the conjugation process is promoted at high temperature. Accordingly, the transcriptional expression of some putative conjugative apparatus genes is thermoregulated, being induced at 42 °C. The two plasmids present in the clinical isolates were sequenced and assembled. Both plasmids are highly related among them and to the pTet plasmid. The high identity of the genes putatively involved in the conjugation process among the plasmids is in agreement with the similar behavior regarding the temperature dependency of the conjugative process. This report suggest that conjugation of plasmids carrying antibiotic resistance genes occurs preferentially at temperatures that resemble the gastrointestinal tract of birds, the main reservoir of C. jejuni.

[Enteral feeding of critical patients]. / Nutrición enteral en el paciente crítico.

Artificial nutrition support forms part of the basic care of critical patients. Enteral feeding has been shown to be better than total parenteral nutrition at improving morbidity (infectious complications) and reducing the length of hospital stays, number of days with mechanical ventilation, and costs. As with any other treatment, enteral feeding has associated complications and side effects which should be understood and treated in order to obtain the greatest benefit from it and reduce possible adverse effects. In this review, we attempt to provide a practical summary of the use of enteral feeding in critical patients. We cover the management of the most frequent associated complications, based on new studies and current scientific evidence. The review is intended to serve as a practice guide for the routine care of severely ill patients.

Nutrición enteral en el paciente crítico / Enteral feeding of critical patients

El soporte nutricional artificial forma parte del cuidadobásico del paciente crítico. La nutrición enteral(NE) se ha mostrado superior a la nutrición parenteraltotal (NPT) en la mejoría de la morbilidad (complicacionesinfecciosas), y en la reducción de la estancia hospitalaria,días de ventilación mecánica y costes.Como cualquier otro tratamiento, la NE no está exentade complicaciones y efectos secundarios, que debemosconocer y tratar para obtener el máximo beneficio deésta y disminuir en lo posible los efectos adversos.En esta revisión intentamos resumir de manera prácticael uso de la NE en el paciente crítico, así como elmanejo de las complicaciones más frecuentes que podemosencontrar en relación con dicha nutrición en base alas nuevas publicaciones y la evidencia científica existente,de manera que pueda servir como Guía de actuaciónal profesional en la asistencia diaria al paciente gravementeenfermo (AU)

Artificial nutrition support forms part of thebasic care of critical patients. Enteral feeding has beenshown to be better than total parenteral nutrition atimproving morbidity (infectious complications) andreducing the length of hospital stays, number of days withmechanical ventilation, and costs. As with any othertreatment, enteral feeding has associated complicationsand side effects which should be understood and treatedin order to obtain the greatest benefit from it and reducepossible adverse effects. In this review, we attempt toprovide a practical summary of the use of enteral feedingin critical patients. We cover the management of the mostfrequent associated complications, based on new studiesand current scientific evidence. The review is intended toserve as a practice guide for the routine care of severely illpatients (AU)

Comorbilidad, pluripatología, consumo de recursos y pronóstico de pacientes ingresados en una unidad de Medicina Interna / Comorbidity, pluripathology, resource use and prognosis of patients hospitalized in Internal Medicine Areas

Objetivo: Comparar la definición de paciente con pluripatología (PP) del Servicio de Salud de Andalucía con el índice de comorbilidad de Charlson (IC) respecto al consumo de recursos y pronóstico de enfermos hospitalizados. Pacientes y métodos: Estudio prospectivo observacional de 207 pacientes ingresados de forma consecutiva en una unidad de medicina interna en los que se determinó la presencia de PP, una variante de PP obtenida de aplicar al menos tres categorías clínicas en lugar de dos (PP3), el IC y su valor ajustado con la edad (ICE), y la relación de estas variables con el consumo de recursos (atenciones urgentes, consultas programadas de especialidades y episodios de hospitalización en los doce meses previos, duración de la estancia, procedimientos propios, procedimientos deotras especialidades e interconsultas) y pronóstico (mortalidad intrahospitalaria, deterioro funcional significativo y reingreso precoz). Resultados: La frecuencia de PP fue de 40,6% y la de PP3 de 16,9%. La mediana de la puntuación del IC fue de 2 (0-7) y la del ICE de 4 (0-11). Se detectaron las siguientes relaciones independientes: IC de 3 o mayor con reingreso precoz y duración de la estancia; ICE de 5 o mayor con la mortalidad; PP3 con la mortalidad, reingreso precoz y con urgencias, ingresos y consultas en el último año; categorías B y F de PP con las hospitalizaciones en el último año; categoría D de PP con las consultas en el último año; y la asociación de categorías A, B y C con la mortalidad y hospitalizaciones en el último año. PP no se relacionó de forma independiente con ninguna variable. Conclusión: El IC y la definición de PP no identifican la misma población de pacientes hospitalizados. Modificaciones de la definición de PP, como PP3, o el análisis de las distintas categorías clínicas de PP y sus asociaciones, podrían mejorar la utilidad de este concepto

Objective: To compare the concept of patient with pluripathology (PP) with the index of comorbidity of Charlson (IC) respect to there sources use and prognosis of hospitalized patients. Patients and methods: An observational prospective study of 207 consecutively hospitalized patients in an internal medicine unit was conducted. The PP, a variant of PP with three or more criteria (PP3), ICand IC fit to the age (ICE) were determined, and their relation with the consumption of resources (emergency attentions, programmed consultations of specialties and episodes of hospitalization in the last year, length of stay, own procedures, other specialty procedures and consulting) and prognosis (hospital mortality, significant functional deterioration and rehospitalization) were stayed. Results: The frequency of PP and PP3 was 40.6 and 16.9%, respectively.The median of the IC and ICE score were 2 (0-7) and 4 (0-11), respectively. We found the following independent relations: IC of 3 or greater with the rehospitalization and the length of stay; ICE of 5 or greater with mortality; PP3 with mortality, rehospitalization and emergency visits, hospitalizations and consultations in the last year; the categories B and F of PP with hospitalizations in the last year; the category D of PP with consultations in the last year; and the association of categories A, B and C with mortality and hospitalizations in the last year. PP was not related in an independent form with any variable. Conclusion: The IC and the concept of PP do not identify the same hospitalized patient population. Modifications of the PP definition, like PP3, or the analysis of the different clinical categories of PP and their associations, could improve the utility of this concept

[Prevalence of metabolic syndrome in the province of Albacete (Spain)]. / Prevalencia del síndrome metabólico en la provincia de Albacete.

OBJECTIVE: The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). PATIENTS AND METHODS: A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. RESULTS: Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. CONCLUSIONS: Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome.

Prevalencia del síndrome metabólico en la provincia de Albacete / Prevalence of metabolic syndrome in the province of Albacete (Spain)

Objetivo. El objetivo principal del estudio es determinar la prevalencia del síndrome metabólico (SM) en personas entre 40 y 70 años en la provincia de Albacete. Pacientes y métodos. Se trata de un estudio transversal poblacional en personas entre 40 y 70 años en tres municipios representativos de la provincia de Albacete. La participación total del estudio fue de 425 individuos. La edad media de la muestra fue de 53,1 años (intervalo de confianza [IC] 95%: 52,3-54), con un 50,4% de mujeres y un 49,6% de hombres. A todos los participantes se les realizó una analítica general y una exploración física con medición de parámetros antropométricos. El SM se definió según los criterios del Adult Treatment Panel-III (ATP-III). En el análisis estadístico se calculó la prevalencia del SM, así como su distribución según sus características epidemiológicas. Resultados. La prevalencia total del SM fue del 20,9% (88/421), con una edad media de 57 años (IC 95%: 55,1-59). Su prevalencia aumenta con la edad, siendo de hasta un tercio de la población mayor de 60 años. Por otra parte, se han encontrado diferencias significativas con antecedentes de cardiopatía isquémica, elevación de la proteína C reactiva ultrasensible y la detección de microalbuminuria en los pacientes con SM. La hipertensión arterial y la obesidad abdominal fueron los criterios más prevalentes en los pacientes con SM. Conclusiones. Teniendo en cuenta la importante comorbilidad que este síndrome conlleva, el conocimiento de su prevalencia y sus características en nuestro medio, así como su identificación y la intervención precoz sobre los distintos factores que la componen, contribuirían a una disminución de eventos cardiovasculares que se relacionan con este síndrome

Objective. The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). Patients and methods. A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. Results. Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. Conclusions. Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome

[Comorbidity, pluripathology, resource use and prognosis of patients hospitalized in internal medicine areas]. / Comorbilidad, pluripatología, consumo de recursos y pronóstico de pacientes ingresados en una unidad de Medicina Interna.

OBJECTIVE: To compare the concept of patient with pluripathology (PP) with the index of comorbidity of Charlson (IC) respect to the resources use and prognosis of hospitalized patients. PATIENTS AND METHODS: An observational prospective study of 207 consecutively hospitalized patients in an internal medicine unit was conducted. The PP, a variant of PP with three or more criteria (PP3), IC and IC fit to the age (ICE) were determined, and their relation with the consumption of resources (emergency attentions, programmed consultations of specialties and episodes of hospitalization in the last year, length of stay, own procedures, other specialty procedures and consulting) and prognosis (hospital mortality, significant functional deterioration and rehospitalization) were stayed. RESULTS: The frequency of PP and PP3 was 40.6 and 16.9%, respectively. The median of the IC and ICE score were 2 (0-7) and 4 (0-11), respectively. We found the following independent relations: IC of 3 or greater with the rehospitalization and the length of stay; ICE of 5 or greater with mortality; PP3 with mortality, rehospitalization and emergency visits, hospitalizations and consultations in the last year; the categories B and F of PP with hospitalizations in the last year; the category D of PP with consultations in the last year; and the association of categories A, B and C with mortality and hospitalizations in the last year. PP was not related in an independent form with any variable. CONCLUSION: The IC and the concept of PP do not identify the same hospitalized patient population. Modifications of the PP definition, like PP3, or the analysis of the different clinical categories of PP and their associations, could improve the utility of this concept.

[Intracranial hypotension syndrome treated with an epidural blood patch]. / Síndrome de hipotensión intracraneal espontánea tratada con parche hemático epidural.

A 41-year-old woman was admitted to the internal medicine department to assess incapacitating postural headache. Clinical findings suggested the need for computed tomography and nuclear magnetic resonance scanning of the head, which led to a diagnosis of spontaneous intracranial hypotension syndrome. Later, isotopic cysternography and nuclear magnetic resonance imaging of the spine were used unsuccessfully to try to locate the cerebrospinal fluid leak that caused the syndrome. When conservative treatment proved ineffective, the pain clinic was called in to perform an epidural blood patch procedure. The patch led to an improvement in symptoms and the syndrome resolved completely after a second lumbar blood patch was used.

Síndrome de hipotensión intracraneal espontánea tratada con parche hemático epidural / Intracranial hypotension syndrome treated with an epidural blood patch

Paciente mujer de 41 años que ingresó en el servicio de Medicina Interna para estudio de cefalea postural invalidante. Ante los hallazgos clínicos se le realizó una tomografía axial computerizada y resonancia magnética nuclear craneales llegando al diagnóstico de síndrome de hipotensión intracraneal espontáneo. Posteriormente se intentó localizar el punto de fuga de líquido cefalorraquídeo causante del síndrome mediante cisternografía isotópica y resonancia magnética nuclear de columna sin éxito. El tratamiento conservador resultó ineficaz y se solicitó la colaboración de la unidad de dolor para la realización de un parche hemático epidural. La aplicación de un parche epidural a nivel dorsal mejoró los síntomas, que se resolvieron definitivamente tras un segundo parche a nivel lumbar

A 41-year-old woman was admitted to the internal medicine department to assess incapacitating postural headache. Clinical findings suggested the need for computed tomography and nuclear magnetic resonance scanning of the head, which led to a diagnosis of spontaneous intracranial hypotension syndrome. Later, isotopic cysternography and nuclear magnetic resonance imaging of the spine were used unsuccessfully to try to locate the cerebrospinal fluid leak that caused the syndrome. When conservative treatment proved ineffective, the pain clinic was called in to perform an epidural blood patch procedure. The patch led to an improvement symptoms and the syndrome resolved completely after a second lumbar blood patch was used

Presentación inusual de absceso por Staphyloccoccus aureus / Unusual presentation of an abscess by Staphyloccoccus aureus

No disponible

Anestesia epidural en el déficit de factor XI / Epidural anesthesia with factor XI deficit

No disponible

Deterioro neurológico y crisis convulsiva / Neurologic impaiment and seizures

No disponible