Preliminary study on serum paraoxonase-1 status and chemokine (C-C motif) ligand 2 in hospitalized elderly patients with catheter-associated asymptomatic bacteriuria.

Urinary tract infections (UTI) are common among elderly patients in residential care facilities, as well as in the hospital setting. Identifying new biochemical markers of UTI is an active line of research since UTI management is resource intensive. Paraoxonase-1 (PON1) forms part of the patient's immune system, the response-to-injury and inflammation. Our study sought to evaluate alterations in inflammation-related paraoxonase-1 (PON1) and chemokine (C-C motif) ligand 2 (CCL2) in patients with an indwelling catheter to assess their potential usefulness as biomarkers of infection. Patients (n = 142) who had had the urinary catheter removed and 100 healthy volunteers were recruited. In all participants we measured serum PON1 activity, PON1 concentration, CCL2, procalcitonin and C-reactive protein (CRP). Results indicated that patients had higher CCL2, CRP and procalcitonin concentrations than the control group, and lower paraoxonase activity. There were no significant differences in PON1 concentrations. When comparing the diagnostic accuracy of CRP, procalcitonin, CCL2 and the PON1-related variables in discriminating between patients with and those without UTI, we found a considerable degree of overlap between groups, i.e., a low diagnostic accuracy. However, there were significant inverse logarithmic correlations between serum paraoxonase activity and the number of days the urinary catheter had been in situ. Our results suggest that measurement of these biochemical variables may be useful in investigating complications of long-term use of these devices and help to improve the economic and clinical investment required in the management of the often-associated infection.

[Thromboembolic prophylaxis in bariatric surgery. A multidisciplinary protocol]. / Cirugía bariátrica. Profilaxis tromboembólica.

Severe or morbid obesity is one of the 21st century epidemics. Surgery is the most important and cost-effective treatment. Bariatric procedures are becoming very common in our Hospitals. Thromboembolic events such us deep venous thrombosis or pulmonary embolism (PE) are the most common medical cause of death after these procedures. Incidence of PE may arise to 3% after surgery and its mortality is about 75%. Prophylactic protocols have not been clearly defined until now. These protocols have to consider special patients, such as morbid obese ones; different kind of procedures, most of the laparoscopic; and patients' comorbidities. By the other hand, treatment for morbid obesity has to be considered by a multidisciplinary approach. Here we present the protocol that has been initiated at our Institution. After a long and high experience in bariatric procedures, we have defined a multidisciplinary protocol to prevent thromboembolic events after surgery where nurses and surgeons play a leading role. The combination of physical, pharmaceutical and educational measures all together are the key for the adequate prevention in these patients.

'Aeromonas intestinalis' and 'Aeromonas enterica' isolated from human faeces, 'Aeromonas crassostreae' from oyster and 'Aeromonas aquatilis' isolated from lake water represent novel species.

Four Aeromonas strains from clinical and environmental samples differed from known species on the basis of rpoD gene sequence. Multilocus phylogenetic analysis and in silico DNA-DNA hybridization confirmed them as four new species even though their 16S rRNA gene sequence similarity with their closest relatives was >98.7%, as occurred for other Aeromonas spp.

In women with gestational diabetes mellitus factors influencing growth have a larger effect on placental weight than on birth weight.

BACKGROUND AND AIMS: Excessive fetal and placental growth are very common in diabetic pregnancy. We aimed to analyze in women with gestational diabetes mellitus (GDM) the association with birth weight (BW), placental weight (PW) and placental-to-birth weight (PWBW) ratio of acknowledged BW predictors. MATERIAL AND METHODS: We performed a retrospective analysis of a prospective cohort database from a tertiary hospital. Inclusion criteria were singleton pregnancy, diagnosis of GDM, delivery between 1982 and 2011 and gestational age at birth ≥23 weeks. Multiple regression analysis was performed using as dependent variables BW, PW and PWBW ratio and as independent ones maternal characteristics at baseline, metabolic characteristics (GDM diagnosis, treatment, control), pregnancy-induced hypertension, gestational age at delivery and fetal sex. Two sensitivity analyses were performed. RESULTS: We evaluated 2547 women, PW being available in 85.3%. BW was 3260g (2976, 3575), PW 620g (540, 720) and PWBW ratio 19.27 (17.20, 21.47). Among the 24 analyzed variables, there was an important overlap among those associated with BW, PW and PWBW ratio. For most characteristics associated with both BW and PW, the magnitude of the association was greater for the latter, both when promoting growth (i.e. prepregnancy body mass index, 3h plasma glucose at diagnosis) and when restricting it (insulin treatment). CONCLUSION: We conclude that in women with GDM and singleton pregnancies, variables associated with BW, PW and PWBW ratio overlap. The latter is the result of disproportionate associations with BW and PW, usually larger with PW.

Gestational diabetes mellitus in women with multiple pregnancies: is the metabolic abnormality milder?

OBJECTIVE: We aimed to compare maternal characteristics and dysglycemia after delivery in women with gestational diabetes mellitus (GDM) according to pregnancy being multiple (MP) or singleton (SP). The hypothesis was that women with GDM and MP would have a milder glycemic abnormality before and after pregnancy than those with SP. METHODS: We performed a cohort study of 2908 women giving birth between 1986 and 2009. Logistic regression was performed to discriminate between MP and SP after anamnestic pre-pregnancy characteristics. Kaplan-Meier and Cox regression analyses were performed to assess if MP was independently associated with both impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) and diabetes after delivery. RESULTS: Family history of diabetes was the only independent anamnestic pre-pregnancy characteristic discriminating MP versus SP, OR 2.04 (95% CI 1.12, 3.70, p 0.019). The median time to progress to IFG/IGT was 7.52 years in SP (95% CI 6.92, 8.13) and 7.41 in MP (95% CI 3.84, 10.98), ns and the progression to DM did not differ. In addition, MP was not associated to IFG/IGT or to DM in the Cox regression analysis. CONCLUSIONS: In this cohort of women with GDM, those with MP did not demonstrate a lesser degree of dysglycemia after controlling for other pregnancy characteristics and pregnancy-independent factors.

Acute cyanide poisoning by subcutaneous injection.

A 30 year old woman with a history of depression and previous suicide attempts was brought to the emergency department in coma. She had injected herself with cyanide subcutaneously and had severe metabolic acidosis. She underwent sustained haemodialysis in the intensive care unit (ICU) before laboratory confirmation of cyanide poisoning. The serum cyanide concentration was 4.6 microg/ml. After 48 hours the patient, now asymptomatic, was discharged from the ICU.

Experimental pathogenicity of four opportunist Fusarium species in a murine model.

A murine model with immunocompetent animals was used in a comparative study of experimental pathogenicity of 13 isolates belonging to the four most frequent pathogenic species of Fusarium in man (F. solani, F. oxysporum, F. verticillioides and F. proliferatum). Inocula of 5 x 10(6) conidia/mouse of each isolate of Fusarium were injected into a lateral vein of the tail of the mice to produce a systemic infection. F. solani was the most virulent species; the five strains of this species assayed caused the death of all the animals tested in <19 days. The other species of Fusarium were not virulent in this model. The organs mainly affected by F. solani were the kidneys and the heart. These findings correlate with the clinical evidence and demonstrate that there is a high risk associated with infection by F. solani, especially for immunocompromised patients.

A severe case of persistent diarrhoea associated with Arcobacter cryaerophilus but attributed to Campylobacter sp. and a review of the clinical incidence of Arcobacter spp.

Although rarely, Arcobacter spp. have been associated with diarrhoea and bacteraemia. We report a persistent case in a healthy 26-year-old Spanish male of bloody diarrhoea, which was attributed to Campylobacter but in fact was caused by Arcobacter cryaerophilus, as determined by sequencing of the rpoB gene. The isolate was re-identified by matrix-assisted laser desorption ionization time of flight (MALDI-TOF) and genotyped for five putative virulence genes and for seven genes included in the Arcobacter multilocus sequence typing database. The low score obtained by MALDI-TOF indicates the need to complement the database with more isolates. Only the ciaB gene, which encodes for an invasin, was detected. Despite the isolate belonging to a new sequence type, three of the alleles (glnA, pgm and tkt) had been found previously in isolates from faeces of patients with diarrhoea. This study, together with the reviewed literature, indicates that Arcobacter can produce bacteraemia and that the isolation from patients with diarrhoea range from 0.11% to 1.25%. This study also demonstrates that Arcobacter species are confused with Campylobacter spp., as previously suggested. This is one of the factors that leads to underestimation of their incidence together with the use of inappropriate detection and identification methods.

[Rapid diagnosis unit in a third level hospital. Descriptive study of the first year and a half]. / Unidad de diagnóstico rápido en un hospital de tercer nivel. Estudio descriptivo del primer año y medio de funcionamiento.

BACKGROUND AND AIM: We show a descriptive study of a Rapid Diagnosis Unit as an alternative of the traditional hospital admission. MATERIAL AND METHODS: An Internist, a Radiologist and a Nurse have constituted Rapid Diagnosis Unit. A retrospective and descriptive study of 1132 patients visited in the first and a half- year is described. RESULTS: 1132 patients have been attended, 71% coming from Emergency Department and 26% from Primary Health Care. Mean stay was 9 days. Anaemia, wasting syndrome and lymph nodes enlargement were the most likely complaints. The outcome of these patients was diverse: 38% have been discharged, 52% carried on as outpatients in our hospital and 10% required hospitalization. In 199 patients (18%) cancer was diagnosed. Colon, lymphoma and lung cancer were the most common malignant disorders involved. About 4,5 beds per day have been saved from the Internal Medicine Department. CONCLUSIONS: Rapid Diagnosis Unit is an efficient alternative to conventional hospital admissions for patients in study of potential and serious disorders allowing an out-patient management.

Biofeedback de resistencia galvánica y psicoterapia. Una combinación de éxito en la lucha contra el dolor / No disponible

No disponible

Experiencia de un año de hemodiafi ltración “on-line” en pacientes tratados previamente con hemodiálisis convencional / No disponible

No disponible

[The seroprevalence of Listeria infections without clinical sign in a population of pregnant women from the Reus area]. / Seroprevalencia de infecciones listeriósicas sin clínica acompañante en una población de mujeres gestantes del área de influencia de Reus.

We describe the results of a study of asymptomatic Listeria monocytogenes serum prevalence in a population of pregnant women in the Reus area. The study includes newborn exam and correlation with laboratory data obtained by an indirect immunofluorescence method recently developed. The incidence of anti-Listeria antibody carriers was high (12%) but in no cases spontaneous abortions or fetal malformations were associated to high titers.

Endogenous endophthalmitis by Fusarium solani: an animal experimental model.

An experimental model of endophthalmitis by Fusarium solani in immunocompetent mice that could be useful for evaluating the efficacy of different treatments and the pathogenicity of the fungus in ocular structures was established. Five clinical isolates of F. solani were injected into the lateral tail vein of groups of 20 mice, in order to produce systemic infection with ocular infection. Inocula of 5 x 10(6) conidia per mouse were used. The eyes of the animals that died were enucleated for histopathological study to determine the degree of ocular infection. We found fungal infections in 34% of the mice studied. Panophthalmitis was detected in 16 animals, four with bilateral infections. Fungal endophthalmitis can become a severe complication of systemic mycoses by F. solani.