[Infectious Disease Prevention Group: Update on vaccines, 2022]. / Prevención de las enfermedades infecciosas. Actualización en vacunas PAPPS 2022.

The update of the preventive activities for this year 2022 in the field of infectious diseases is of special relevance due to the importance that prevention has gained and more specifically, vaccination as a tool to control the pandemic caused by the SARS-CoV-2 virus declared on March 11, 2020. The pandemic has focused much of the prevention efforts on its containment, but the importance of maintaining high vaccination coverage of the rest of the recommended vaccines to maintain good control of vaccine-preventable diseases and avoid complications in particularly vulnerable patients should not be forgotten. In this year's review we present a practical document with the aim of providing tools to primary care professionals who work with adults, to make the indication of each vaccine whether it is systematically recommended or if it is because the patient belongs to some risk group due to their condition or underlying pathology. In this way, throughout the document, we will comment on the most innovative aspects of systematic vaccination (flu, pneumococcus, meningococcal vaccines and vaccines against the human papillomavirus [HPV]), the new vaccines (pandemic vaccines against COVID-19, vaccines against herpes zoster of subunits, vaccines against monkeypox) and the recommended vaccines according to risk condition (pregnancy and lactation, travelers, patients with immunosuppression or underlying pathology).

[Infectious Disease Prevention Group. Update on vaccines, 2020]. / Prevención de las enfermedades infecciosas. Actualización en vacunas, 2020.

Vaccine development is one of the fastest growing sectors in medicine now and in the future, as we are living with the emergency health care for the SARS-CoV-2 coronavirus. The semFYC PAPPS program biannually publishes the recommendations of the group and, in this edition, special emphasis is placed on the common vaccination proposed by the Ministry of Health, where, at last, it no longer discriminates between paediatrics and adults, and proposes a calendar throughout life. The main novelties in the field of vaccinology today are focused on the consolidation of the nonavalent vaccine against the human papilloma virus and in the change of the dose of monovalent meningitis vaccine C for the tetravalent one, ACWY, at age 12. The pandemic we are experiencing has led to the postponement of most preventive activities. On the return to «normality¼, the vaccination calendar must be examined, and completed if necessary.

Genetic inhibition of flowering differs between juvenile and adult Citrus trees.

BACKGROUND AND AIMS: In woody species, the juvenile period maintains the axillary meristems in a vegetative stage, unable to flower, for several years. However, in adult trees, some 1-year-old meristems flower whereas others remain vegetative to ensure a polycarpic growth habit. Both types of trees, therefore, have non-flowering meristems, and we hypothesize that the molecular mechanism regulating flower inhibition in juvenile trees is different from that in adult trees. METHODS: In adult Citrus trees, the main endogenous factor inhibiting flower induction is the growing fruit. Thus, we studied the expression of the main flowering time, identity and patterning genes of trees with heavy fruit load (not-flowering adult trees) compared to that of 6-month-old trees (not-flowering juvenile trees). Adult trees without fruits (flowering trees) were used as a control. Second, we studied the expression of the same genes in the meristems of 6-month, and 1-, 3-, 5- and 7-year-old juvenile trees compared to 10-year-old flowering trees. KEY RESULTS: The axillary meristems of juvenile trees are unable to transcribe flowering time and patterning genes during the period of induction, although they are able to transcribe the FLOWERING LOCUS T citrus orthologue (CiFT2) in leaves. By contrast, meristems of not-flowering adult trees are able to transcribe the flowering network genes but fail to achieve the transcription threshold required to flower, due to CiFT2 repression by the fruit. Juvenile meristems progressively achieve gene expression, with age-dependent differences from 6 months to 7 years, FD-like and CsLFY being the last genes to be expressed. CONCLUSIONS: During the juvenile period the mechanism inhibiting flowering is determined in the immature bud, so that it progressively acquires flowering ability at the gene expression level of the flowering time programme, whereas in the adult tree it is determined in the leaf, where repression of CiFT2 gene expression occurs.

[Management of odontogenic infections in Primary Care: Antibiotic?] / Manejo de las infecciones odontogénicas en las consultas de atención primaria: ¿antibiótico?

Our aim is to contribute to the rational use of antibiotics prescribed by family doctors when a patient consults for a dental problem. Nowadays we should not ask which antibiotic to give. The question has to be if we need to prescribe antibiotics in front of the most common odontogenic infections seen in our practice. We review the main dental infections, which should be their appropriate management and the role of prevention. We need to know the complexity of the oral microbiome because it?ll depend on the appropriateness of the antibiotherapy, the evolution towards cure or progression of some odontogenic infections. The bacterial plaque, formed by the biofilm, behaves as a barrier to the action of antimicrobials. It?s in the prevention of its development as well as in it mechanical elimination once shaped, in what the family doctor should insist. We must transmit antibiotics don?t heal dental pain.

Pomological Traits, Sensory Profile and Nutraceutical Properties of Nine Cultivars of Loquat (Eriobotrya japonica Lindl.) Fruits Grown in Mediterranean Area.

In this paper the diversity of fruit quality within nine loquat cultivars, including five international affirmed cultivars (Algerie, Golden Nugget, Peluche, Bueno, El Buenet) and four local cultivars (Sanfilippara, Nespolone di Trabia, BRT20 and Claudia), were investigated in order to discriminate the variation in pomological characteristics, sensory profile, and antioxidant properties. Finally, to evaluate potential bioactivity, antiproliferative activity of hydrophilic extracts from loquat fruits was assessed, at dietary relevant concentrations, against three human epithelial cell lines. Even though the international cultivars confirmed an appropriate level of commercial qualities in association to high levels in antioxidant compounds, the local cultivars revealed the best performances in a wide range of chemical-physical and sensory characteristics. Concerning bioactivity, our results indicate that hydrophilic extracts from all tested cultivars showed concentration-dependent antiproliferative activity with a significant variability of effects between different cell lines and between different cultivars. HeLa cells, the most sensitive and hydrophilic extracts from Peluche, showed the highest inhibitory effect followed by Nespolone di Trabia and Claudia. The results of this trial provide useful information on the pomological traits and the not yet known specific nutritional and functional properties of loquat fruits. Our data, besides helping to promote specific local cultivars, could serve to establish a database that will permit to improve the utilization of specific genetic resources in breeding programs.

Monitoring hypnotic effect and nociception with two EEG-derived indices, qCON and qNOX, during general anaesthesia.

BACKGROUND: The objective of the present study was to validate the qCON index of hypnotic effect and the qNOX index of nociception. Both indices are derived from the frontal electroencephalogram (EEG) and implemented in the qCON 2000 monitor (Quantium Medical, Barcelona, Spain). METHODS: The study was approved by the local ethics committee, including data from 60 patients scheduled for ambulatory surgery undergoing general anaesthesia with propofol and remifentanil, using TCI. The Bis (Covidien, Boulder, CO, USA) was recorded simultaneously with the qCON. Loss of eyelash reflex [loss of consciousness (LOC)] was recorded, and prediction probability for Bis and qCON was calculated. Movement as a response to noxious stimulation [laryngeal mask airway (LMA) insertion, laryngoscopy and tracheal intubation] was registered. The correlation coefficient between qCON and Bis was calculated. The patients were divided into movers/non-movers as a response to noxious stimulation. A paired t-test was used to assess significant difference for qCON and qNOX for movers/non-movers. RESULTS: The prediction probability (Pk) and the standard error (SE) for qCON and Bis for detecting LOC was 0.92 (0.02) and 0.94 (0.02) respectively (t-test, no significant difference). The R between qCON and Bis was 0.85. During the general anaesthesia (Ce propofol > 2 µg/ml, Ce remifentanil > 2 ng/ml), the mean value and standard deviation (SD) for qCON was 45 (8), while for qNOX it was 40 (6). The qNOX pre-stimuli values were significantly different (P < 0.05) for movers/non-movers as a response to LMA insertion [62.5 (24.0) vs. 45.5 (24.1)], tracheal intubation [58.7 (21.8) vs. 41.4 (20.9)], laryngoscopy [54.1 (21.4) vs. 41.0 (20.8)]. There were no significant differences in remifentanil or propofol effect-site concentrations for movers vs. non-movers. CONCLUSION: The qCON was able to reliably detect LOC during general anaesthesia with propofol and remifentanil. The qNOX showed significant overlap between movers and non-movers, but it was able to predict whether or not the patient would move as a response to noxious stimulation, although the anaesthetic concentrations were similar.

[Introduction to antiseptics]. / Introducción a los antisépticos.

Antiseptics are anti-infectious agents for local use on the skin or mucosa, which distinguishes them from disinfectants, which are used on inanimate surfaces usually because of their toxicity. The present article explains the differences among the multiple possible antiseptics; special attention is paid to the most common, such as alcohol, chlorhexidine, povidone iodine, and oxygenated water. Finally, we stress the different antiseptic formulations, which increase the usefulness of these agents in specific indications.

[Antiseptic use in primary care]. / Uso de los antisépticos en atención primaria.

Wounds can be classified according to their mechanism of action into surgical or traumatic (which may be incision wounds, such as those provoked by a sharp object; contusions, caused by a blunt force; puncture wounds, caused by long, sharp objects; lacerations, caused by tears to the tissue; or bites, which have a high risk of infection and consequently should not be sutured). Wounds can also be classified by their healing process into acute or chronic (pressure ulcers, vascular ulcers, neuropathic ulcers, acute wounds with torpid clinical course). The use of antiseptics in any of these wounds is usually limited to cleaning and initial care -up to 48 hours- and to washing of hands and instruments. The use of antiseptics in chronic or persistent wounds is more debatable. The same is true of burns, in which the use of formulations that encourage hydration is recommended. In the pediatric population, the use of antiseptics with a known safety profile and low absorption is usually recommended, especially in the care of the umbilical cord, in which evidence supports the use of chlorhexidine gluconate. Another use of antiseptics is the care of wounds produced by procedures used in body esthetics, such as piercings; in these procedures, it is advisable to use transparent antiseptics that allow visualization of the technique.

[Patient advice]. / Consejos para pacientes.

In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material.

[I'm going to the dentist: antibiotic as a prevention or as a treatment?]. / Me voy al dentista: ¿antibiótico como prevención o como tratamiento?

Odontogenic infections account for 10% of all antibiotic prescriptions in Spain. Despite the frequency and importance of these infections, there is often confusion between prophylaxis and treatment. The oral cavity is a complex ecosystem made up of over 500 bacterial species. It is essential to take the medical history, examine each infection, and know about previous illnesses that could change our therapeutic and/or prophylactic attitude. The use of prophylaxis with antibiotics in patients at risk of infective endocarditis has been accepted for many years. Nowadays this is being restricted, and in many cases the risks of taking preventive antibiotics outweigh its benefits. There are no serious studies to determine the best antibiotic and its dosage, thus the Spanish consensus guidelines have to be followed. It is not known how the misuse of antibiotics influences bacterial resistance, not only on pathogen strains, but also on the common oral flora.

Advances in Citrus Flowering: A Review.

Citrus are polycarpic and evergreen species that flower once in spring or several times a year depending on the genotype and the climatic conditions. Floral induction is triggered by low temperature and water-deficit stress and occurs 2-3 months before bud sprouting, whereas differentiation takes place at the same time as sprouting. The induced buds develop single flowers or determinate inflorescences, so that vegetative growth is required at the axillary buds to renew the polycarpic habit. The presence of fruits inhibits sprouting and flower induction from nearby axillary buds in the current season. In some species and cultivars, this results in low flowering intensity the following spring, thus giving rise to alternate bearing. A number of key flowering genes act in the leaf (CiFT3, CcMADS19, etc.) or in the bud (CsLFY, CsTFL1, etc.) to promote or inhibit both flowering time and reproductive meristem identity in response to these climatic factors, the fruit dominance, or the age of the plant (juvenility). The expression of some of these genes can be modified by gibberellin treatments, which reduce bud sprouting and flowering in adult trees, and constitute the main horticultural technique to control flowering in citrus. This review presents a comprehensive view of all aspects of the flowering process in citrus, converging the research published during the past half century, which focused on plant growth regulators and the nutritional source-sink relationships and guided research toward the study of gene transcription and plant transformation, and the advances made with the development of the tools of molecular biology published during the current century.

Oral cavity colon adenocarcinoma metastases: case report with surgical approach and review of more than 30 years literature.

INTRODUCTION: Metastatic oral tumours are rare, contributing to 1% of all malignant oral cavity tumours. CASE REPORT: We report the case of a 59-year-old man with colon cancer at an advanced disease stage, with progression to the peritoneum and maxillary gingiva. Palliative surgery was indicated to improve the patient's quality of life. DISCUSSION: In a review of the literature, we compiled a list of 27 cases (including the present case) reflecting some 30 years of literature on oral cavity metastatic disease originating in colon cancer. CONCLUSION: Oral cavity metastasis should be taken into account in the differential diagnosis of a synchronous or metachronous oral cavity lesion. The therapeutic goal should include palliative alternatives when necessary. Intraoral reconstruction using local flaps may be a simple and reliable palliative resection option aimed at improving the patient's quality of life.

Inhaled drugs as risk factors for community-acquired pneumonia.

The effect of inhaled drugs in community-acquired pneumonia (CAP) is unclear. This case-control study was designed to determine whether inhaled drugs were risk factors for CAP. All incident cases of confirmed CAP that occurred over 1 yr in patients with chronic bronchitis (CB), chronic obstructive pulmonary disease (COPD) or asthma were included, as well as CB, COPD and asthma controls. Risk factors for CAP and inhaled treatment were recorded during a personal interview. An effect of inhaled drugs on the risk of CAP was observed in COPD and asthma patients after adjusting for the effect of other respiratory diseases and their concomitant treatments. In COPD patients, inhaled steroids had a risk OR of 3.26 (95% CI 1.07-9.98) and in asthma patients inhaled anticholinergics had a risk OR of 8.80 (95% CI 1.02-75.7). In CB patients, no association with CAP was observed for any inhaler. These effects were independent of adjusting variables related to severity and other respiratory and non-respiratory risk factors for CAP, including vaccines. Inhaled ß(2)-adrenergic agonists did not show a significant effect on the risk of CAP in any of the respiratory diseases. Inhaled steroids may favour CAP in COPD patients, whereas anticholinergics may favour CAP in asthma patients. It is difficult to differentiate the effect of inhaled therapy from the effect of COPD or asthma severity on the risk of CAP, and these relationships may not be causal, but could call attention to inhaled therapy in COPD and asthma patients.

Pharyngeal closure after a total laryngectomy: mechanical versus manual technique.

OBJECTIVE: To verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique. METHODS: A retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent). RESULTS: Mechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009). CONCLUSION: Mechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.

The flower to fruit transition in Citrus is partially sustained by autonomous carbohydrate synthesis in the ovary.

Why evergreen fruit tree species accumulate starch in the ovary during flower bud differentiation in spring, as deciduous species do during flower bud dormancy, is not fully understood. This is because in evergreen species carbon supply is assured by leaves during flower development. We suggest the existence of an autonomous mechanism in the flowers which counteracts the competition for photoassimilates with new leaves, until they become source organs. Our hypothesis is that starch accumulated during Citrus ovary ontogeny originates from 1) its own photosynthetic capacity and 2) the mobilization of reserves. Through defoliation experiments, we found that ovaries accumulate starch during flower ontogeny using a dual mechanism: 1) the autotrophic route of source organs activating Rubisco (RbcS) genes expression, and 2) the heterotrophic route of sink organs that hydrolyze sucrose in the cytosol. Defoliation 40 days before anthesis did not significantly reduce ovary growth, flower abscission or starch concentration up to 20 days after anthesis (i.e. 60 days later). Control flowers activated the energy depletion signaling system (i.e. SnRK1) and RbcS gene expression around athesis. Defoliation accelerated and boosted both activities, increasing SPS gene expression (sucrose synthesis), and SUS1, SUS3 and cwINV (sucrose hydrolysis) to maintain a glucose threshold which satisfied its need to avoid abscission.

New evidence of risk factors for community-acquired pneumonia: a population-based study.

The aim of the present study was to identify risk factors for community-acquired pneumonia (CAP), with special emphasis on modifiable risk factors and those applicable to the general population. A population-based, case-control study was conducted, with a target population of 859,033 inhabitants aged >14 yrs. A total of 1,336 patients with confirmed CAP were matched to control subjects by age, sex and primary centre over 1 yr. In the univariate analysis, outstanding risk factors were passive smoking in never-smokers aged >65 yrs, heavy alcohol intake, contact with pets, households with >10 people, contact with children, interventions on the upper airways and poor dental health. Risky treatments included amiodarone, N-acetylcysteine and oral steroids. Influenza and pneumococcal vaccine, and visiting the dentist were protective factors. Multivariable analysis confirmed cigarette smoking, usual contact with children, sudden changes of temperature at work, inhalation therapy (particularly containing steroids and using plastic pear-spacers), oxygen therapy, asthma and chronic bronchitis as independent risk factors. Interventions for reducing community-acquired pneumonia should integrate health habits and lifestyle factors related to household, work and community, together with individual clinical conditions, comorbidities and oral or inhaled regular treatments. Prevention would include vaccination, dental hygiene and avoidance of upper respiratory colonisation.

Hormonal control of parthenocarpic fruit set in 'Rojo Brillante' persimmon (Diospyros kaki Thunb.).

In persimmon (Diospyros kaki Thunb.), one to three waves of fruit abscission can occur. The parthenocarpic cv. Rojo Brillante may abscise close to 50% of flowers, which implies a major economic losses. In order to study this process, 700 flowers were labelled, 600 had the lobes of the calyx removed at three stages to promote abscission. Half of them were also treated with gibberellic acid (GA3; 10 mg l-1) to counteract the effect, and 100 were used as control. In the second year, GA3 (25 mg l-1) was applied to whole trees. Calyx lobe removal (CLR) reduced fruit growth rates and advanced and increased fruitlet abscission, whereas GA3 counteracted this effect. Furthermore, when GA3 was applied to the whole tree, fruit set was increased. The time-course of fruit abscission paralleled a decreased in hormonal and carbohydrate contents. Control fruit showed a peak of gibberellin (GA1 and GA4) and IAA concentration at anthesis. Hexose concentrations remained almost constant from flower bud to fruit set, whereas that of sucrose diminished with time. A peak in ethylene production occurred at anthesis, which increased when CLR was performed prior to or at anthesis, but not when performed at fruit set, when ethylene was markedly smaller. GA3 also counteracted it. Accordingly, we suggest that fruit set depends on the induction of gibberellin (GA) and IAA responses in the persimmon, and since there is no shortage of hormones or carbohydrates at anthesis, ethylene production at anthesis seems the most plausible cause of the physiological fruitlet abscission.

Effectiveness of the I2AO2 interdisciplinary programme led by nurses on metabolic syndrome and cardiovascular risk: a randomized, controlled trial.

Objective To evaluate the effectiveness of an interdisciplinary programme led by nurses in relation to metabolic syndrome (MS) and cardiovascular risk (CVR). Methods This randomized, controlled, clinical trial included 74 patients diagnosed with MS (experimental group [EG], n = 37; control group [CG], n = 37). The intervention consisted of a 12-month interdisciplinary programme (pre-test, 6 months of intervention, 12 months of intervention, and 1-year follow-up post-intervention) coordinated by nursing. Results We found a progressive and significant reduction for all clinical, biochemical, and anthropometric parameters analysed at different time points. In the EG, remission of MS by 48.1% in the short term was observed (83.8% in the medium term) and maintained at 1 year post-intervention. In the CG, the prevalence of MS increased by 2.7% from the initial evaluation to study completion. A similar trend was observed for CVR. In the EG, 100% of subjects had a moderate-low risk of CVR at 1 year post-intervention, whereas the CG had CVR in all categories. Conclusion An interdisciplinary, nurse-led programme improves participants' metabolic and cardiovascular health, while maintaining long-term effects. Our findings suggest an important role of the professional nurse as a nexus between the patient, different professionals, and the community.

Simultaneous determination of tyramine and tryptamine and their precursor amino acids by micellar liquid chromatography and pulsed amperometric detection in wines.

Two biogenic amines, tryptamine and tyramine, and their precursors, tryptophan and tyrosine, were determined by a liquid chromatographic procedure. A hybrid micellar mobile phase of sodium dodecyl sulphate (SDS) and 1-propanol, a C18 column and electrochemical detection were used. A pH study in the range of 3-9 was performed and pH 3 was finally selected in accordance with resolution and analysis time. Oxidation potential was also checked in the range 0.6-0.9V: the maximum area obtained in all those potentials was at 0.8V, which was selected to carry out the analysis using a sequence of pulsed amperometric detection waveform. The four compounds were resolved using a mobile phase of 0.15M SDS-5% 1-propanol with an analysis time of 16 min. Repeatabilities and intermediate precision were evaluated at three different concentrations for each compound with RSD values lower than 2.6 and 4.8%, respectively. Limits of detection and quantification were also obtained within the 10-40 and 33-135 ng/ml ranges, respectively. Finally, the applicability of the procedure was tested in several types of wine and no matrix effect was observed. The possibility of direct sample introduction simplifies and greatly expedites the treatments with reduced cost, improving the accuracy of the procedures.