Effects of Vitamin D Supplementation on Telomere Length: An Analysis of Data from the Randomised Controlled D-Health Trial.

OBJECTIVES: Observational studies have suggested that a higher 25-hydroxyvitamin D concentration may be associated with longer telomere length; however, this has not been investigated in randomised controlled trials. We conducted an ancillary study within a randomised, double-blind, placebo-controlled trial of monthly vitamin D (the D-Health Trial) for the prevention of all-cause mortality, conducted from 2014 to 2020, to assess the effect of vitamin D supplementation on telomere length (measured as the telomere to single copy gene (T/S) ratio). DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: Participants were Australians aged 60-84 years and we randomly selected 1,519 D-Health participants (vitamin D: n=744; placebo: n=775) for this analysis. We used quantitative polymerase chain reaction to measure the relative telomere length (T/S ratio) at 4 or 5 years after randomisation. We compared the mean T/S ratio between the vitamin D and placebo groups to assess the effect of vitamin D supplementation on relative telomere length, using a linear regression model with adjustment for age, sex, and state which were used to stratify the randomisation. RESULTS: The mean T/S ratio was 0.70 for both groups (standard deviation 0.18 and 0.16 for the vitamin D and placebo groups respectively). The adjusted mean difference (vitamin D minus placebo) was -0.001 (95% CI -0.02 to 0.02). There was no effect modification by age, sex, body mass index, or predicted baseline 25-hydroxyvitamin D concentration. CONCLUSION: In conclusion, routinely supplementing older adults, who are largely vitamin D replete, with monthly doses of vitamin D is unlikely to influence telomere length.

Genome-based epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in Spain: A prospective multicentre study.

BACKGROUND: Whole-genome sequencing (WGS) of Neisseria gonorrhoeae isolates combined with epidemiological and phenotypic data provides better understanding of population dynamics. AIM: The objective of this study was to investigate the molecular epidemiology of N. gonorrhoeae isolates from three centres in Spain and determine associations of antimicrobial resistance. METHODS: Genetic characterization was performed in 170 N. gonorrhoeae isolates. WGS was carried out with the HiSeq platform (Illumina). Genome assemblies were submitted to the PubMLST Neisseria database website to determine NG-MAST, MLST and NG-STAR. Antimicrobial resistance genes and point mutations were identified with PubMLST. Phylogenomic comparison was based on whole-genome single nucleotide polymorphism analysis. RESULTS: Twenty-six MLST, 49 NG-MAST and 41 NG-STAR sequence types were detected, the most prevalent being MLST-ST9363 (27.1%), NG-MAST ST569 (12.4%) and NG-STAR ST193 (14.7%). Phylogenetic analysis identified 13 clusters comprising 69% of the isolates, with two of note: one involved cefixime-resistant isolates from Barcelona presenting a mosaic penA X and belonging to MLST-ST7363 and the other involved azithromycin-resistant isolates from Mallorca that possessed the C2611T mutation in the four 23S rRNA alleles belonging to MLST-ST1901. CONCLUSION: The population of N. gonorrhoeae is quite heterogeneous in Spain. Our results agree with previous data published in Europe, albeit with some differences in distribution between regions. This study describes the circulation of two gonococcal populations with a specific resistance profile and sequence type in a specific geographic area. WGS is an effective tool for epidemiological surveillance of gonococcal infection and detection of resistance genes.

Estudio proteomico diferencial entre liquidos pleurales secundarios a cáncer de pulmón versus mesotelioma / Differential proteomic study between pleural fluid secondary to lung cancer versus mesothelioma

Objetivo: Encontrar perfiles proteicos en líquido pleural que diferencien derrames pleurales secundarios a cáncer de pulmón (CP) versus mesotelioma pleural maligno (MPM).Metodología: Recogimos líquidos pleurales de 60 pacientes de tres grupos diferentes: MPM (N = 20), CP (N = 20) y derrames pleurales benignos (N = 20). Realizamos un análisis con proteómica diferencial con ITRAQ 4 plex (Applied Biosystem). Realizamos la identificación y cuantificación relativa de las proteínas con el programa Proteome Discoverer 1.4 (Termofisher Scientific). Construimos diagramas de Venn con las proteínas sobre/infra-expresadas en cada grupo. Realizamos una validación interna/externa mediante ELISA (Myobiosorce) añadiendo 25 muestras de CP y 14 de MPM.Resultados: Encontramos sobreexpresión de Pi3K en los derrames pleurales neoplásicos (16,86 +/- 25,83 ng/ml en CP; 20,66 +/- 17,26 ng/ml en MPM vs 5,92 +/- 0,99 ng/ml en controles). Hubo sobreexpresión de SPRM en MPM (30.702 +/- 30.310,53 ng/ml en el grupo MPM vs 10.404 +/- 10.157,72 ng/ml en el grupo CP vs 8.498 + /- 3.437,18 ng/ml en controles). Existió sobreexpresión de RhoB en CP (4,46 +/- 1,65 mg/ml en CP vs 1,65 +/- 2,65 mg/ml en MPM vs 0,92 +/- 1,6 mg/ml en controles). También encontramos sobreexpresión de PDGFR-alfa en derrames pleurales benignos (74,12 +/- 22,57 ng/ml en controles vs 43,05 +/- 23,96 ng/ml en CP vs 36,12 +/- 21,51 ng/ml en MPM).Conclusión: Existe un perfil diferencial proteico entre los derrames secundarios a CP (sobreexpresión de RhoB) y a MPM (sobrexpresión de SPRM). La sobrexpresión de Pi3K indica asociación a derrames pleurales malignos y la de PDGFR-alfa a derrames benignos. (AU)

Objetivo: Find protein profiles in pleural fluid that differentiate pleural effusions secondary to lung cancer (LC) versus malignant pleural mesothelioma (MPM).Metodología: We collected pleural fluids from 60 patients from three different groups: MPM (N = 20), CP (N = 20), and benign pleural effusions (N = 20). We performed differential proteomics analysis with ITRAQ 4 plex (Applied Biosystem). We performed the identification and relative quantification of the proteins with the Proteome Discoverer 1.4 program (Termofisher Scientific). We built Venn diagrams with the over/under-expressed proteins in each group. We performed an internal/external validation using ELISA (Myobiosorce) adding 25 CP and 14 MPM samples.Resultados: We found Pi3K overexpression in neoplastic pleural effusions (16.86 +/- 25.83 ng/ml in PC; 20.66 +/- 17.26 ng/ml in MPM vs 5.92 +/- 0.99 ng/ml in controls). There was overexpression of SPRM in MPM (30,702 +/- 30,310.53 ng/ml in the MPM group vs 10,404 +/- 10,157.72 ng/ml in the CP group vs 8,498 +/- 3,437.18 ng/ml in controls). There was overexpression of RhoB in CP (4.46 +/- 1.65 mg/ml in CP vs 1.65 +/- 2.65 mg/ml in MPM vs 0.92 +/- 1.6 mg/ml in controls). We also found overexpression of PDGFR-alpha in benign pleural effusions (74.12 +/- 22.57 ng/ml in controls vs 43.05 +/- 23.96 ng/ml in PC vs 36.12 +/- 21.51 ng/ml in MPM ).Conclusión: There is a differential protein profile between effusions secondary to CP (RhoB overexpression) and MPM (SPRM overexpression). Pi3K overexpression indicates association with malignant pleural effusions and PDGFR-alpha overexpression with benign effusions. (AU)

Factors affecting the performance of P22 ELISA for the diagnosis of caprine tuberculosis in milk samples.

Caprine tuberculosis (TB) is a zoonosis caused by members of the Mycobacterium tuberculosis complex (MTBC). Caprine TB eradication programmes are based mainly on intradermal tuberculin tests and slaughterhouse surveillance. However, the use of serological test has been extended as a potential diagnostic tool in goats through the use of serum, plasma, or even milk samples. Milk production and the antibodies (Ab) present in milk can vary depending on several circumstances. In the present study, different factors that may affect the performance of humoral TB diagnosis were analysed using goat milk samples: 1) lactation stage, 2) a recent previous skin test (booster effect) and 3) the effect of freeze-thaw cycles on milk samples preserved with azidiol. TB-infected animals (n = 44) were selected to evaluate the evolution of the Ab levels during the 6-month lactation period, along with its potential effect on the P22 ELISA results. In general, no significant changes (p = 0.079) were observed throughout the study as regards Ab levels in milk samples between consecutive analysis although the reactivity to P22 ELISA decreased when samplings were performed at the last two months of the lactation. Regarding the booster effect, the quantitative results showed a significant variation (p < 0.001) for both milk and serum samples when serological tests were carried out 15 days after the skin test. Finally, there were no significant differences (p = 0.99) in the P22 ELISA results when using milk samples preserved with azidiol that had undergone freeze-thaw cycles.

Effect of the topical administration of corticosteroids and tuberculin pre-sensitisation on the diagnosis of tuberculosis in goats.

BACKGROUND: Caprine tuberculosis (TB) is a zoonosis caused by members of the Mycobacterium tuberculosis complex (MTBC). Caprine TB control and eradication programmes have traditionally been based on intradermal tuberculin tests and slaughterhouse surveillance. However, this strategy has limitations in terms of sensitivity and specificity. Different factors may affect the performance of the TB diagnostic tests used in goats and, subsequently, the detection of TB-infected animals. In the present study, the effect of two of the factors that may affect the performance of the techniques used to diagnose TB in goats, the topical administration of corticosteroids and a recent pre-sensitisation with tuberculin, was analysed. METHODS: The animals (n = 151) were distributed into three groups: (1) a group topically treated with corticosteroids 48 h after intradermal tuberculin tests (n = 53); (2) a group pre-sensitised with bovine and avian purified protein derivatives (PPDs) 3 days before the intradermal tuberculin test used for TB diagnosis (n = 48); and (3) a control group (n = 50). All the animals were tested using single and comparative intradermal tuberculin (SIT and CIT, respectively) tests, an interferon-gamma release assay (IGRA) and a P22 ELISA. RESULTS: The number of SIT test reactors was significantly lower in the group treated with corticosteroids when compared to the pre-sensitised (p < 0.001) and control (p = 0.036) groups. In contrast, pre-sensitisation with bovine and avian PPDs did not cause a significant reduction in the number of SIT and CIT test reactors compared with the control group. In fact, a higher number of reactors was observed after the prior tuberculin injection in the pre-sensitised group (p > 0.05). No significant effect was observed on IGRA and P22 ELISA due to corticosteroids administration. Nevertheless, a previous PPD injection affected the IGRA performance in some groups. CONCLUSIONS: The application of topical corticosteroid 24 h before reading the SIT and CIT tests can reduce the increase in skin fold thickness and subsequently significantly decrease the number of positive reactors. Corticosteroids used can be detected in hair samples. A previous pre-sensitisation with bovine and avian PPDs does not lead to a significant reduction in the number of intradermal tests reactors. These results are valuable in order to improve diagnosis of caprine TB and detect fraudulent activities in the context of eradication programs.

Direct PCR on Tissue Samples To Detect Mycobacterium tuberculosis Complex: an Alternative to the Bacteriological Culture.

Bovine tuberculosis (bTB) is an ongoing issue in several countries within the European Union. Microbiological culture is the official confirmation technique for the presence of Mycobacterium tuberculosis complex (MTBC) members in bovine tissues, but several methodological issues, such as moderate sensitivity and long incubation times, require the development of more sensitive and rapid techniques. This study evaluates the analytical and diagnostic performance, comparative to culture, of a real-time PCR targeting the MTBC-specific IS6110 transposon using a panel of bovine tissue samples sourced from the Spanish bTB eradication campaign. Robustness and repeatability were evaluated in an interlaboratory trial between European Union National Reference Laboratories. The limit of detection with 95% confidence was established at 65 fg/reaction of purified genomic equivalents. Diagnostic sensitivity (Se) and specificity (Sp) were, respectively, 96.45% and 93.66%, and the overall agreement (κ) was 0.88. Cross-reactivity was detected against two mycobacterial isolates identified as Mycobacterium marinum and "Mycobacterium avium subsp. hominissuis," and whole-genome sequencing (WGS) analysis of the latter isolate revealed an IS6110-like sequence with 83% identity. An identical IS-like element was found in other Mycobacterium avium complex species in the NCBI nucleotide and WGS databases. Despite this finding, this methodology is considered a valuable alternative to culture, and the strategy of use should be defined depending on the control or eradication programs.

Tuberculosis caused by Mycobacterium caprae in a camel (Camelus dromedarius).

BACKGROUND: Animal tuberculosis (TB) is distributed worldwide and has a wide range of wild and domestic reservoirs. Few studies concerning TB in camelids have been published in the last decade, particularly as regards Old World Camelids (OWC), but the increase in reports of TB outbreaks in these species in recent years suggests a high susceptibility to the infection. CASE PRESENTATION: We studied a dromedary camel (Camelus dromedarius) herd (n = 24) in which a Mycobacterium caprae infection was detected. The TB infection was confirmed in one animal at necropsy through the detection of TB lesions, mainly in the abdominal organs, and the subsequent isolation of M. caprae (SB0157 spoligotype). The whole herd was additionally tested using cellular and humoral based diagnostic techniques. The intradermal tuberculin test results were compared with those obtained using P22 ELISA for the detection of specific antibodies against the M. tuberculosis complex. The TB infected animal was a positive reactor to both the intradermal tuberculin tests and P22 ELISA, while the others were negative to all the diagnostic tests. CONCLUSION: The present study found M. caprae infection in OWC. This is the first report of M. caprae infection in an OWC not living in a zoo. Since the animal was born in the herd and fed with goat's milk, this practice was suspected to be the potential source of TB infection, which was not confirmed in the other animals present in the herd. Moreover, our results highlight that the intradermal tuberculin test and the P22 ELISA could be valuable tools for the diagnosis of TB in OWC.

Mareo residual, una condición clínica frecuente posterior a maniobra de reposición exitosa en vértigo posicional paroxístico benigno: una revisión / Residual dizziness, a frequent clinical condition following successful repositioning maneuver for benign paroxysmal positional vertigo: a review

El vértigo posicional paroxístico benigno (VPPB) es reconocido como la principal causa de vértigo de origen periférico en adultos, ya que, si bien la etiología del VPPB aún no se ha demostrado plenamente y se clasifica como la mayoría de los casos, se puede identificar el desprendimiento de otolitos y su desplazamiento en uno de los tres canales semicirculares. Una anamnesis cuidadosa puede abordar el diagnóstico clínico del VPPB, pero la confirmación se obtendrá por medio de maniobras de diagnóstico especificas de acuerdo a cuál de los canales está involucrado. Este trastorno altera la capacidad de llevar a cabo actividades de la vida cotidiana que determinan un aumento significativo en el riesgo de caídas y las consiguientes lesiones. La mayoría de los pacientes se recuperan después del tratamiento, sin embargo, hasta dos tercios de éstos pueden percibir inestabilidad prolongada, aturdimiento y malestar definidos como mareo residual. Esta sintomatología residual después de la resolución del VPPB es variable entre los pacientes, siendo el tiempo de duración de los síntomas residuales de aproximadamente de 1 a 3 semanas, existiendo algunos pacientes que pueden recuperarse más tardíamente. En esta revisión analizaremos el mareo residual, describiendo su expresión clínica, diagnóstica, fisiopatológica y tratamientos actuales de esta entidad clínica.

Benign paroxysmal positional vertigo (BPPV) is recognized as the main cause of peripheral vertigo in adults, although the etiology of BPPV has not yet been fully demonstrated and is classified as idiopathicin most cases, detachment of otoliths and their displacement in one of the three semicircular canals can be identifie. A careful history can address the clinical diagnosis of BPPV, but confirmation will be obtained through specific diagnostic maneuvers according to which canal is involved. This disorder alters the ability to carry out activities of daily living that determine a significant increase in the risk of falls and consequent injuries. Most patients recover after treatment, however, up to two thirds of these patients may perceive prolonged instability, dizziness and discomfort defined as residual dizziness. This residual symptomatology following BPPV resolution is variable among patients, the duration of residual symptoms can last 1 to 3 weeks, with some patients may recover later on. In this review, we will analyze residual dizziness, describing its clinical presentation, diagnosis, pathophysiology and current treatments of this clinical entity.

Estudio de los niveles basales de survivina y otros marcadores para la predicción de los resultados de la pleurodesis con talco en derrames pleurales malignos / Study on the baseline levels of survivin and other markers to predict the results of pleurodesis with talc in malignant pleural effusions

La survivina se encuentra sobre-expresada en tumores, y podría ser un buen biomarcador diagnóstico y pronóstico en derrames pleurales malignos. OBJETIVO: estudiar la concentración de survivina en pacientes con derrame pleural maligno sometidos a pleurodesis con talco, relacionarla con el resultado de ésta y comparar sus resultados con otros marcadores como pH, glucosa y LDH en líquido pleural. MÉTODOS: se han incluido 84 pacientes con derrame pleural maligno (32 con cáncer de mama, 25 de pulmón y 27 mesoteliomas) sometidos a toracoscopia y pleurodesis con talco. Se recogieron muestras de líquido pleural antes (basal) y 24 horas después de la pleurodesis, y en ellas se midieron los niveles de survivina, pH, glucosa y LDH. También se estudió la carga tumoral en la pleura y la re-expansión del pulmón tras la toracoscopia y pleurodesis.R RESULTADOS: la presencia de niveles basales de survivina > 30 pg/mL se asoció a alto índice de fracaso de la pleurodesis (p = 0,002), y superó en poder predictivo a pH (p = 0,004), glucosa (p = 0,005) y LDH (p = 0,013) CONCLUSIÓN: la survivina juega un poderoso papel como marcador pronóstico en derrames pleurales malignos, y se suma a otros marcadores clásicos como pH, glucosa y LDH, que están asociados a la agresividad tumoral

Survivin is found to be overexpressed in tumors and could be a good diagnostic and prognostic biomarker in malignant pleural effusions. OBJECTIVE: To study the concentration of survivin in patients with a malignant pleural effusion who undergo pleurodesis with talc, associate it with the result of the procedure and compare the results with other markers like pH, glucose and LDH in pleural liquid. METHODS: 84 patients with malignant pleural effusion (32 with breast cancer, 25 lung cancer and 27 mesotheliomas) who underwent thoracoscopy and pleurodesis with talc were included in the study. Pleural liquid samples were taken before (baseline) and 24 hours after the pleurodesis, measuring the levels of survivin, pH, glucose and LDH. The tumor burden in the pleura and the re-expansion of the lung after thoracoscopy and pleurodesis were also studied. RESULTS: The presence of baseline levels of survivin >30 pg/mL was associated with a high rate of pleurodesis failure (p = 0.002) and surpassed the predictive power of pH (p = 0.004), glucose (p = 0.005) and LDH (p = 0.013). CONCLUSION: Survivin plays a powerful role as a prognostic marker in malignant pleural effusions and joins other classic markers like pH, glucose and LDH, which are associated with tumor aggression

[Neuropsychological assessment protocol for adults in epilepsy surgery]. / Protocolo de evaluación neuropsicológica para adultos en cirugía de la epilepsia.

INTRODUCTION: Refractory epilepsy means that the seizures are untreatable, and therefore one of the interventions that makes it possible to eliminate them or to accomplish a reduction in the number of seizures is neurosurgery. DEVELOPMENT: A neuropsychological evaluation model aimed at measuring the cognitive performance of adult patients who are candidates for epilepsy surgery is proposed. In line with the proposals most frequently put forward by the various reference centres for epilepsy, an open protocol is proposed that is aimed at obtaining a baseline of overall cognitive performance, cognitive reserve and manual dominance, as well as cognitive processes such as attention, language, visuoconstructive and manipulative skills, memory and executive functions, among others, without neglecting the psychopathological examination and the patient's quality of life. This, together with the results of other diagnostic specialities, will contribute to the localisation and minimisation of the cognitive sequelae secondary to the surgical intervention on the epileptic focus, as well as to providing information to the medical team responsible for the case and to patients and relatives about the possibilities and prognosis of the intervention. It is necessary to have a battery of techniques and an adequate consensus when evaluating the data obtained. CONCLUSIONS: An assessment model is proposed that allows information to be obtained about the neuropsychological profile of the candidate for epilepsy surgery, which is open to debate and serves as a model for discussion by the other epilepsy reference centres.

TITLE: Protocolo de evaluación neuropsicológica para adultos en cirugía de la epilepsia.Introducción. La epilepsia refractaria conlleva la intratabilidad de las crisis, por lo que una de las intervenciones que permiten su eliminación o la disminución del número de crisis es la neurocirugía. Desarrollo. Se plantea la propuesta de un modelo de evaluación neuropsicológica dirigida a la medición del rendimiento cognitivo de pacientes adultos candidatos a cirugía de la epilepsia. Se propone un protocolo abierto, en consonancia con las propuestas más señaladas en los distintos centros de referencia para la epilepsia, dirigido a la obtención de una línea de base del rendimiento cognitivo global, la reserva cognitiva y la dominancia manual, así como procesos cognitivos como la atención, el lenguaje, las habilidades visuoconstructivas y manipulativas, la memoria y las funciones ejecutivas, entre otros, sin prescindir de la exploración psicopatológica y la calidad de vida del paciente, de forma que permita contribuir, junto con los resultados de otras especialidades diagnósticas, a la localización y minimización de las secuelas cognitivas secundarias a la intervención quirúrgica sobre el foco epiléptico, así como a la facilitación de información al equipo médico responsable del caso y a pacientes y familiares sobre las posibilidades y el pronóstico de la intervención. Es necesario disponer de un arsenal de técnicas y contar con un adecuado consenso a la hora de realizar la valoración de los datos obtenidos. Conclusiones. Se propone un modelo de evaluación que permite obtener información del perfil neuropsicológico del paciente candidato a cirugía de la epilepsia, abierto a la discusión y que sirva de modelo para el debate al resto de centros de referencia de la epilepsia.

Evaluation of a new enzyme-linked immunosorbent assay for the diagnosis of tuberculosis in goat milk.

Caprine tuberculosis (TB) is a zoonosis with sanitary and economic repercussions. Caprine TB control programs are based on a test and cull strategy using the intradermal tuberculin tests and slaughterhouse surveillance. However, this approach is not always feasible and may have a limited sensitivity under specific circumstances. In this study, performance of a new experimental test based on the P22 protein complex (P22 ELISA) was evaluated in two TB-infected herds using milk and serum samples and compared with cell-based diagnostic tests. Samples from a low (n = 62, herd 1) and a high (n = 52, herd 2) TB prevalence herd were selected. Moreover, bulk tank milk samples from both herds were analysed using the P22 ELISA. At the end of the study, a group of animals (n = 21) was euthanized and subjected to post-mortem analysis and bacteriological culture. Significant differences (p < .001) on the qualitative and quantitative (ODs) results were observed between herds using both serum and milk samples in the P22 ELISA. The correlation observed in the quantitative results obtained in serum and milk samples was very strong in animals from flock 2 (rs = 0.91) and moderate in animals from flock 1 (rs = 0.46). Among the slaughtered animals, the P22 ELISA detected a higher proportion of lesion-culture positive animals than cell-based diagnostic tests (61.9 and 66.7% using milk and serum samples, respectively). The P22 ELISA using milk samples demonstrated a similar sensitivity compared with serum samples, suggesting it might be a valuable test for TB control in dairy goats.

Diseño de un timbre avisador previo a la finalización de la irrigación vesical / No disponible

El uso de sueros lavadores es una de las terapias más comunes empleadas en nuestra unidad. Su principal complicación es la interrupción del lavado por la finalización del suero lavador con un retraso en el cambio de bolsa y sus consecuencias. Una vez detectado el problema, y vista la imposibilidad, previa investigación, de encontrar en el mercado algún dispositivo que nos avise de la finalización de los sueros lavadores, comenzamos el desarrollo de un prototipo lo más sencillo posible, que nos permita mejorar los cuidados a este tipo de usuarios

The use of washers is one of the most common techniques used in our unit. The main problem is the interruption of the cleaning due to finalization of the washer, which implies a delay in the change of the bag. Since it is impossible to find a device to notify us of the termination of the washers in the market, we are starting to develop a prototype as simple as possible which allows us to improve patient’s care

Nivel de dependencia a la nicotina en personal de Centros Asistenciales de Salud del Municipio Naguanagua, Estado Carabobo / Degree of nicotine dependence among healthcare workers at the Centers of the Naguanagua Municipality, Carabobo State

El tabaquismo es un problema de salud pública mundial. La dependencia a la nicotina y sus niveles están determinados por factores individuales genéticos y psicosociales, así como la combinación de estos. Esta investigación evaluó la dependencia a la nicotina y su relación con el estrés en personal de instituciones hospitalarias del Municipio Naguanagua del Estado Carabobo. La investigación fue descriptiva, con diseño transversal y no experimental. La muestra estuvo constituida por 50 sujetos categorizados como grupo de profesionales de la salud (GS) del Municipio Naguanagua, todos con tabaquismo y un grupo control de 50 fumadores (GC), con similar nivel educativo, pero sin laborar en centros asistenciales de salud. Se aplicó el Test de Fagerström para medir nivel de dependencia a la nicotina y para el nivel de estrés se utilizó el test psicosomático. Los grupos fueron homogéneos en cuanto a la edad, se evidenció el predominio del género masculino en ambos grupos de estudio. Hubo asociación entre el área laboral y nivel de dependencia a la nicotina (NDN), GS presentó mayor NDN (p=0,000). El NDN y el nivel de estrés no estuvieron asociados al género. Se encontró fuerte asociación significativa y positiva (r: 0,064 p=0,000) entre NDN y el nivel de estrés. En conclusión, el nivel de dependencia fue de moderado a alto en GS y se asoció significativamente con el estrés(AU)

Specificity of serological test for detection of tuberculosis in cattle, goats, sheep and pigs under different epidemiological situations.

BACKGROUND: Serum antibody detection has potential as a complementary diagnostic tool in animal tuberculosis (TB) control, particularly in multi-host systems. The objective of the present study was to assess the specificity (Sp) of an enzyme-linked immunosorbent assay (ELISA) based on the new multiprotein complex P22 for the detection of specific antibodies against the Mycobacterium tuberculosis complex (MTC) in the four most relevant domestic animals acting as MTC hosts: cattle, goat, sheep and pig. We used sera from an officially TB-free (OTF) country, Norway, and from a non-OTF one, Spain. The samples included sera from goats that had been vaccinated against M. avium subsp. paratuberculosis (MAP) and sheep from a herd in which Corynebacterium pseudotuberculosis had been isolated. RESULTS: In cattle, the Sp ranged from 92.5 (IC95% 90.7-94) to 99.4% (IC95% 98.3-99.8) depending on the cut-off used and the origin of the samples (Spain or Norway). Sp in cattle (cut-off point 100) was significantly higher (P < 0.05) for Norwegian samples. By contrast, Sp in goats was consistently low at the 100 cut-off [30.9 (CI95%23.4-39.5)-78% (CI95% 68.9-85)]. A higher cut-off of 150 improved Sp in Norwegian goats [97% (CI95% 91.6-99)], but still yielded a poor Sp of 56.1% (CI95% 47.3-64.6) in Spanish goats. In Norway at the 100 cut-off the Sp was 58.3 (CI95% 42.2-72.9) and 90.6% (CI95% 81-95.6) in MAP vaccinated and non-vaccinated goats, respectively, indicating interference due to MAP vaccination. Sp in sheep was between 94.4 (CI95% 91.7-96.3) and 100% (CI95% 96.3-100) depending on the cut-off and country, and no diagnostic interference due to infection with C. pseudotuberculosis was recorded. Sp in pigs was 100%, regardless the cut-off point applied, and no significant differences were observed between pigs from Norway and from Spain. CONCLUSIONS: Due to its excellent Sp in pigs and acceptable Sp in cattle and sheep, this ELISA may constitute a suitable option for TB screening at herd level, particularly in OTF-countries.

A new test to detect antibodies against Mycobacterium tuberculosis complex in red deer serum.

Red deer (Cervus elaphus) farming is a growing economic activity worldwide. However, the capacity of this species to act as reservoir of animal tuberculosis (TB) poses a threat to other wildlife and to livestock. Diagnostic assay accuracy in this species is therefore highly relevant for prevention and control measures. Our aim was to evaluate the diagnostic performance of the protein complex P22, obtained from Mycobacterium bovis derived purified protein derivative (bPPD), as a candidate antigen for the detection of antibodies against Mycobacterium tuberculosis complex (MTC). We assessed the performance of this new antigen in indirect enzyme-linked immunosorbent assays (ELISA) in TB-positive and TB-negative red deer, in comparison with a bPPD-based ELISA. The P22 ELISA achieved a higher specificity (Sp) and similar sensitivity (Se) in comparison with the bPPD ELISA at all the cut-off points considered. The P22 ELISA yielded optimal Sp (99.02%; 95% confidence intervals [CI95%]: 96.5-99.8) and appropriate Se (70.1%; CI95%: 63.6-76) at the selected cut-off point of 100%. These results suggest that P22 can be used as an alternative antigen in the immunodiagnosis of animal TB through the use of an ELISA-type detection of antibodies against MTC in red deer, thus contributing to the diagnosis of animal TB in this species as a measure for further disease prevention and control programs.

Helicobacter pylori eradication in Mexico with a levofloxacin-based scheme versus standard triple therapy: Results from an open-label, randomized, noninferiority phase iiib trial. / Erradicación de Helicobacter pylori en México con un esquema basado en levofloxacina versus la triple terapia estándar: resultados de un estudio clínico de fase iiib, abierto, aleatorizado, de no inferioridad.

INTRODUCTION AND AIMS: Helicobacter pylori (H. pylori) infection remains the leading cause of several gastroduodenal diseases. Despite the fact that multiple antibiotic regimens have been used to change its associated morbidity and mortality, the prevalence of this bacterial infection continues to be disproportionately high worldwide, mainly due to antibiotic resistance. To assess the noninferiority efficacy and safety of 210-day triple regimens on H. pylori eradication, we evaluated clarithromycin 500mg, lansoprazole 30mg, and amoxicillin 1g, all bid (standard triple therapy or CLA, Group 1) vs. pantoprazole 80mg, levofloxacin 500mg and azithromycin 500mg, all od (PLA, Group 2). Both regimens were compared in treatment-naïve patients. MATERIALS AND METHODS: An open label phase IIIb randomized and noninferiority trial comparing CLA vs. PLA was carried out for a 10-day period, within the time frame of June 2012 and March 2014. Eradication was verified with 13C-urea breath testing. Gastric biopsies were tested for fluorescence in situ hybridization (FISH)-clarithromycin resistance prior to any antibiotic administration. Efficacy and safety results were analyzed according to the noninferiority methodological approach. RESULTS: From the 227 H. pylori positive subjects that were randomized, 194 were finally analyzed as per-protocol. The group 2 eradication rate was 63% and was noninferior to the group 1 eradication rate of 58.5% (upper limit 95% CI: 0.11608; below the noninferiority margin: 0.1200). FISH clarithromycin-resistance was found in 28.2% of the cases. Adverse events, all minor and self-limited, were significantly higher in group 1 than in group 2 (86 vs. 65.4%; p=0.001). CONCLUSIONS: First-line H. pylori eradication with pantoprazole/levofloxacin/azithromycin combination therapy is as effective as the standard triple therapy, with better tolerability and easier dosing. Clarithromycin resistance should be considered when selecting antibiotics in Helicobacter pylori eradication treatments. ClinicalTrials.gov identifier NCT02726269.

Evaluation of psychometric properties of instruments measuring nursing-sensitive outcomes: a systematic review.

AIM: To evaluate the psychometric properties of instruments measuring Nursing-sensitive Outcomes in acute care hospitals. INTRODUCTION: Nursing-sensitive outcomes have been shown to play an active role in the quality of care and cost-effectiveness of health systems. Tools for assessing nursing-sensitive outcomes are necessary to evaluate the nurses' contributions to the health of patients. METHODS: Psychometric systematic review. The SCOPUS, PubMed, CINAHL, PsychoINFO, EMBASE, Science Direct and Web of Science databases were used. Searches were performed between March and May 2018. A search with screened titles and abstracts, assessment of methodological quality using the COSMIN checklist and risk of bias assessment using QUADAS-2 were carried out. RESULTS: Twenty-nine studies validated 26 different instruments. The methodological quality, measured with the COSMIN checklist, showed that the studies which assessed fewer psychometric properties had poorer quality. The majority of studies had high quality, and optimally assessed the risk of bias evaluated with QUADAS-2. DISCUSSION: Concerning the focus of the scales, some of them focused on the patients while others focused on the nursing staff. The scales found assessed aspects such as nursing-care quality, complexity and personalization. CONCLUSION: The majority of studies had a high methodological strength and a thorough validation process. The Nurse Caring Behaviours Scale, the MISSCARE Survey, the Patient Advocacy Engagement Scale and the INICIARE scale were the tools which best combined structure, methodological quality and risk of bias. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The instruments with the best psychometric properties should be implemented in acute care settings to improve the quality of care, assess the effectiveness of nursing interventions, reduce health expenditure and reduce the occurrence of adverse events.

Evaluation of the use of a needle-free injection syringe as a cause of non-specific reactions in the intradermal tuberculin test used for the diagnosis of bovine tuberculosis.

The objective of the study was to elucidate whether the use of the needle-free Dermojet syringe, which is based on a high pressure inoculation and is used to inject tuberculin in cattle in several countries, may, in itself, cause skin reactions that can be interpreted as positive reactions to the intradermal tests that are not, in fact, related to the real infection status of the animals. Forty-four cattle from an officially tuberculosis-free (OTF) herd were selected, and four single intradermal tuberculin (SIT) tests were performed on each animal, two on each side of the neck. Three different Dermojet (D1, D2 and D3) and one McLintock (M4) syringes were used to carry out sterile phosphate buffer saline (PBS) with 10% of glycerol and bovine PPD injections. No positive reactions to the SIT test were observed when using the D1-D3 syringes in the case of either bovine PPD or PBS. With regard to M4 (PBS), all the tests were negative when using a standard interpretation but three were positive in the case of the severe interpretation. Significant differences (p < 0.05) in the skin fold thickness measured were found only between certain Dermojet and McLintock syringes at certain inoculation sites. The results showed that the needle-free Dermojet syringe used for PPD intradermal testing in cattle did not cause significant reactions that could be misunderstood as positives.

Deshabituación tabáquica a largo plazo. Estudio de 1.639 pacientes incluidos en programa de intervención psicofarmacológico tras 12 años de seguimiento / Long-term tobacco cessation. A study of 1639 patients included in a sychopharmacological intervention program after 12 years of follow-up

Objetivos: evaluar la situación de abstinencia tras una media de 12 años en pacientes que realizaron un programa de intervención psicofarmacológica. Metodología: se incluyeron pacientes tratados en una Unidad Especializada de Tratamiento del Tabaquismo con terapia psicológica asociada, o no, a tratamiento farmacológico. El seguimiento inicial fue de 1 año. Se dividió en dos grupos: aquéllos pacientes en los que se objetivó abstinencia (cooximetría (CO) <5 ppm) tras el año de seguimiento (grupo A) y aquéllos pacientes no abstinentes (grupo B). Los pacientes fueron llamados por teléfono tras un periodo de 12 años de media y se comprobó la abstinencia. En caso de indicar que no fumaban, se invitó a que acudieran a nuestras consultas para confirmarlo con CO. Se consideró abstinencia confirmada (AC) si presentaban CO <5 ppm. En caso de no acudir, se indicó situación de abstinencia no confirmada (ANC). Se consideró fracaso (F) si el paciente indicaba que fumaba. Resultados: se estudiaron 1.639 pacientes (366 del grupo A y 1.273 del grupo B). A largo plazo, en el grupo A presentaron AC el 50,5% de los pacientes, ANC 11,7%, F el 20,8%, no fueron localizados el 13,9% y fallecieron el 3,6%. En el grupo B presentaron AC 5,8%, ANC 12,6%, F 45%, no localizados 29,7%, fallecidos 6,7% (p <0,01 entre ambos grupos, excepto ANC). Conclusiones: los pacientes que dejan el tabaco tras un año de seguimiento mantienen la abstinencia a largo plazo en más de la mitad de los casos

Objectives: to evaluate abstinence status after an average of 12 years in patients who underwent a psychopharmacological intervention program. Methods: the study included patients treated at a specialized tobacco cessation unit who received pharmacological treatment with or without associated psychological therapy. The initial follow-up lasted 1 year. Patients were divided into two groups: those who showed abstinence (CO-oximetry <5 ppm) after a year of followup (group A) and non-abstinent patients (group B). Patients were contacted by phone after an average of 12 years to confirm abstinence. If they indicated they did not smoke, they were invited to our clinics to confirm this with COoximetry. A CO-oximetry result of <5 ppm was considered confirmed abstinence. If patients did not visit the clinic, their status was recorded as unconfirmed abstinence. Status was considered failure if the patient indicated they smoked. Results: 1639 patients were studied (366 in group A and 1273 in group B). In the long run, abstinence was confirmed in 50.5% of patients, unconfirmed in 11.7%, 20.8% were recorded as failure, 13.9% could not be contacted and 3.6% had died in group A. In group B, 5.8% were recorded as confirmed abstinence, 12.6% as unconfirmed abstinence, 45% as failure, 29.7% could not be contacted and 6.7% had died (p <0.01 between both groups, except unconfirmed abstinence). Conclusions: patients who cease tobacco use after a year of follow-up maintain long-term abstinence in more than half of cases

Comparacion de un nuevo agente basado en nanotecnología con el talco convencional para el control de los derrames pleurales malignos / Comparison between a new nanotechnology-based agent and conventional talc in the control of malignant pleural effusions

En este trabajo usamos dióxido de titanio (TiO2), fabricado mediante nanotecnología. Para demostrar su superioridad respecto al talco, realizamos un estudio in vitro comparando la respuesta pro-inflamatoria de ambos agentes sobre células malignas y mesoteliales benignas; investigando la posible inducción de apoptosis y la posible inhibición de angiogénesis también por ambos agentes. Realizamos cultivo de líneas celulares derivadas de mesotelio humano, procedente de mesotelioma bifásico humano y adenocarcinoma bronquial humano. Las células se co-cultivaron con diferentes dosis de talco y de nanopartículas de TiO2. En todas las muestras de sobrenadantes de los cultivos se analizaron los niveles de diferentes mediadores inflamatorios. La tasa de apoptosis se analizó por la expresión de Caspasa-3. Para el estudio de angiostasis se determinaron los niveles de endostatina mediante técnica ELISA. Observamos que la viabilidad de las células mesoteliales benignas es mucho menor al emplear TiO2. En el caso de las células mesoteliales malignas, se observó el mismo efecto con dosis alta de TiO2. En el adenocarcinoma de pulmón, la viabilidad de estas células expuestas al talco fue netamente inferior a la que se observó en la línea celular benigna. La producción de IL-8 fue mucho mayor por parte de las células mesoteliales neoplásicas que por las benignas y aumentó siguiendo un patrón dosis dependiente frente al talco, mientras que cayó con el TiO2. Según estos resultados, se demuestra que el talco es superior al TiO2 en su capacidad de producir mediadores que favorecerían la pleurodesis para el control del derrame pleural maligno

For this study, we used titanium dioxide (TiO2), produced using nanotechnology. To show its superiority with respect to talc, we completed an in vitro study comparing the pro-inflammatory response of both agents towards malignant and benign mesothelial cells; researching the possible apoptosis induction and possible inhibition of angiogenesis for both agents. We took a culture of cell lines derived from human mesothelioma, originating from human biphasic mesothelioma and human bronchial adenocarcinoma. The cells were cocultured with different doses of talc and TiO2 nanoparticles. The levels of different inflammatory mediators were analyzed for each culture supernatant sample. The apoptosis rate was analyzed using caspase-3 expression. The endostatin levels were determined for the angiostasis study using the ELISA technique. We observed that the viability of the benign mesothelial cells is much lower after using TiO2. In the case of malignant mesothelial cells, the same effect was observed with a high dose of TiO2. In adenocarcinoma of the lung, the viability of these cells exposed to talc was distinctly lower than that which was observed in the benign cell line. IL-8 production was much higher in neoplastic mesothelial cells than in benign cells and increased following a dose-dependent pattern with talc, while it decreased with TiO2. According to these results, we can see that talc is superior to TiO2 in its ability to produce mediators which favor pleurodesis for the control of malignant pleural effusions