Comparative Analysis of Strabismus Measurement Using a Video Oculagraphy System and Alternate Prism Cover Test.

PURPOSE: The aim of the study was to compare distance vision measurements obtained with video oculography (VOG) and an alternate prism cover test (APCT). DESIGN: Single-center, retrospective, and cross-sectional. METHODS: Eighty-seven subjects with strabismus were included. All patients underwent an optometric examination. The measurement of strabismus in distance vision was performed with the best optical correction using the APCT and the VOG GazeLab. Subjects were divided according to the type of strabismus; 41 were esotropic and 46 were exotropic. RESULTS: The general comparison of APCT and VOG showed a mean difference of 0.60±2.74 prism diopters (Δ), not observing statistical differences between both methods ( P =0.059) and presenting a correlation of 0.976 ( P <0.001). Using APCT, the mean amount of esotropia for the group was 18.31±11.64 Δ and that of exotropia was 19.62±8.80 Δ. Compared with the VOG, the mean value of esotropia for the group was 18.65±11.65 Δ and that of exotropia was 19.48±8.62 Δ. The means are statistically different for the esotropia group ( P =0.005) but not for the exotropia group ( P =0.318). There was a high direct correlation between the methods of measurement for both the esotropic ( R =0.980; P <0.001) and exotropic patients ( R =0.975; P <0.001). Bland-Altman analysis shows a mean difference of 1.37±2.76 Δ for the esotropia patients and 0.31±2.66 Δ for the exotropic patients, respectively. CONCLUSIONS: This study demonstrated comparable results in measuring strabismus between VOG and APTC for esotropia and exotropia, with an excellent correlation between both methods and good agreement, especially in subjects with exotropia.

[Three-month course of rifampicin and isoniazid for the treatment of latent tuberculous infection]. / Pauta de tres meses de rifampicina e isoniacida para el tratamiento de la infección latente tuberculosa.

BACKGROUND AND OBJECTIVES: Isoniazid (I) is the drug of choice for treating latent tuberculous infection (LTI). Duration of treatment with I and its liver toxicity represent a serious drawback for a correct enforceability. In several clinical guides, a 3-month course with rifampicin (Rif) and I is recommended as an acceptable alternative to the 6-9 month course with I. Here we present our experience with this new regimen. PATIENTS AND METHODS: From 2001, the 3-month regimen with Rif and I was offered to patients older than 14 years, who were recruited in the contacts study. A good adherence was considered when the patient manifested so and he/she went to the scheduled monthly controls. We performed baseline liver analyses in those patients at risk of hepatotoxicity and in all patients older than 35 years. In all cases, a liver laboratory control was done at the first month of treatment and whenever patients had symptoms suggestive of intolerance. Databases of tuberculosis controls and contacts were crossed to evaluate the number of individuals who developed tuberculosis. RESULTS: Between 2000 and 2008, treatment for LTI was indicated in 547 contacts (7.8% refused treatment, 34.1% with the 6-month I course, 63.5% with the 3-month Rif and I course and 2.3% with other regimens). A total of 84.97% (147/173) patients with the 6-month I regimen and 92.55% (302/322) with the 3-month Rif and I course fulfilled the treatment (p=0.024). 2.37% (4/169) and 1.6% (5/313) patients with the 6-month I course and 3-month Rif and I course, respectively, withdrew because of hepatotoxicity (p=0.33). There were no patients among those who fulfilled the treatment in any of the 2 study arms. CONCLUSION: There was a higher adherence (statistically significant) and lower hepatotoxicity with the 3-month Rif and I regimen. Both regimens showed a full effectivity.

Predicting 1-year mortality after hospitalization for community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia (CAP) is a major public health problem with high short- and long-term mortality. The main aim of this study was to develop and validate a specific prognostic index for one-year mortality in patients admitted for CAP. METHODS: This was an observational, prospective study of adults aged ≥18 years admitted to Galdakao-Usansolo Hospital (Bizkaia, Spain) from January 2001 to July 2009 with a diagnosis of CAP surviving the first 15 days. The entire cohort was divided into two parts, in order to develop a one-year mortality predictive model in the derivation cohort, before validation using the second cohort. RESULTS: A total of 2351 patients were included and divided into a derivation and a validation cohort. After deaths within 15 days were excluded, one-year mortality was 10.63%. A predictive model was created in order to predict one-year mortality, with a weighted score that included: aged over 80 years (4 points), congestive heart failure (2 points), dementia (6 points), respiratory rate ≥30 breaths per minute (2 points) and blood urea nitrogen >30 mg/dL (3 points) as predictors of higher risk with C-index of 0.76. This new model showed better predictive ability than current risk scores, PSI, CURB65 and SCAP with C-index of 0.73, 0.69 and 0.70, respectively. CONCLUSIONS: An easy-to-use score, called the one-year CAPSI, may be useful for identifying patients with a high probability of dying after an episode of CAP.

Blind comparison of traditional serotyping with three multiplex PCRs for the identification of Salmonella serotypes.

Salmonella serotypes are defined on the basis of somatic (O) antigens which define the serogroup and flagellar (H) factor antigens, both of which are present in the cell wall of Salmonella. Most Salmonella organisms alternatively express phase-1 or phase-2 flagellar antigens encoded by fliC and fljB genes, respectively. Our group previously published two multiplex PCRs for distinguishing the most common first- and second-phase antigens. In this paper we describe a third multiplex PCR to identify the most common serogroups (O:B; O:C1; O:C2; O:D and O:E). The combination of these three PCRs enabled us to completely serotype organisms belonging to the Salmonella species. This multiplex PCR includes 10 primers. A total of 67 Salmonella strains belonging to 32 different serotypes were tested. Each strain generated one serogroup-specific fragment ranging between 162 and 615bp. Twenty-eight strains belonging to 21 serotypes, with a serogroup different from those tested in this work, did not generate any fragments. To compare molecular serotyping with traditional serotyping, 500 strains, received according to the order of arrival in the laboratory, were serotyped using both methods. The three multiplex PCRs were able to serotype 84.6% of the tested strains. This method was found to be very helpful in our laboratory as an alternative method for typing strains causing outbreaks, and it can be used to supplement conventional serotyping, since it is also applicable to motionless and rough strains.

[Longitudinal incidence of tuberculosis in a cohort of contacts: factors associated with the disease]. / Incidencia longitudinal de la tuberculosis en una cohorte de contactos: factores asociados a la enfermedad.

OBJECTIVE: To investigate the incidence of tuberculosis (TB) in a cohort of contacts and to analyze the variables associated with the disease. METHODS: A prospective analysis was undertaken of all the contact investigations carried out in a health district in the Basque Country in northern Spain between January 1, 1995 and December 31, 2004. The dependent variable was the number of cases of TB detected among the contacts. Independent variables were age, sex, tuberculin skin test result, and the degree of contact. In index cases, additional variables were the site of the disease and smear test result. RESULTS: Analysis of 5444 contacts of 596 patients with TB yielded 66 secondary cases of TB (40 at the time of the contact investigation and 26 at a later stage); the majority (73%) developed the disease within 12 months. Multivariate analysis revealed a significant relationship between the detection of secondary cases and the following variables: close contact (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.75-5.31), positive smear test (OR, 8.54; 95% CI, 2.06-35.43), induration of 10 mm or larger (OR, 10.18; 95% CI, 4.27-24.26), and age under 30 years (OR, 3.35; 95% CI, 1.88-5.98). The final predictive model constructed on the basis of these 3 variables had a sensitivity of 77.4%, a specificity of 80.3%, and an area under the curve of 0.83 (95% CI, 0.78-0.88). CONCLUSIONS: The contact investigation is a valid strategy for the detection of new cases of TB. Prophylactic treatment should be implemented at an early stage and priority should be given to young contacts of smear positive patients using an induration size of 10 mm or more as a reference.

[Tuberculosis screening program for undocumented immigrant teenagers using the QuantiFERON(®)-TB Gold In-Tube test]. / Cribado de la tuberculosis en inmigrantes adolescentes indocumentados usando el QuantiFERON(®)-TB Gold In-Tube.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the prevalence of tuberculosis infection in undocumented immigrant teenagers using a tuberculin skin test (TST) for initial screening and QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) as a confirmatory test. PATIENT AND METHOD: From 2007 to 2012, under 19 year-old immigrant teenagers from 2 accommodation centers of the Basque Country (Spain) were included in the study. The TST was done in all of them and the QFT-GIT was done in selected patients with a TST≥5mm. RESULTS: Eight hundred and forty-five immigrants were included, most of them from Africa (99.5%). Fifty-one percent of immigrants with TST ≥ 5 mm has a positive QFT-GIT. We found 2 cases of active tuberculosis (2/845: 0.24%). The concordance between TST (≥ 10 mm) and QFT-GIT was 63%, with 57% of positive concordance cases and 96% of negative concordances. There were 246 cases with TST ≥ 10 mm (29%), with significant differences between Magrebis (21.5%) and Subsaharians (67%) (P<.001). Vaccination with Calmette-Guéin bacille was an independent predictor for having a TST ≥ 10 mm (OR: 2.11; P<.001) and for the discordance TST+/QFT-GIT-, both for a TST≥5 and a TST≥10mm (OR 2.16, 95% confidence interval [95% CI] 1.46-3.20, and OR 1.91 95% CI 1.23-2.97, respectively). The positive value of QFT-GIT increased significantly as the TST increased, with a positive association in all the cut-off points analyzed: 10-14 mm (OR 7.95, 95% CI 1.79-35.33), 15-19 mm (OR 35, 95% CI 7.93-154.52) and ≥ 20 mm (OR 91.3, 95% CI 18.20-458.11). CONCLUSION: Due to the high prevalence of latent tuberculosis infection in Subsaharian immigrants, we recommend implementing screening programs in this population. Using QFT-GIT, the number of candidates for chemoprophylaxis was reduced to 43% compared with TST alone (≥ 10 mm).

Performance of pro-adrenomedullin for identifying adverse outcomes in community-acquired pneumonia.

BACKGROUND: We sought to evaluate the usefulness of biomarkers-procalcitonin (PCT), C-reactive protein (CRP) and proadrenomedullin (pro-ADM)-combined with prognostic scales (PSI, CURB-65 and SCAP score) for identifying adverse outcomes in patients with community-acquired pneumonia (CAP) attending at an Emergency Department (ED). METHODS: Prospective observational study in a teaching hospital among patients with CAP. In addition to collecting data for the prognostic scales, samples were taken at the ED for assessing PCT, CRP and pro-ADM levels. We compared the prognostic accuracy of these biomarkers with severity scores to predict pneumonia related complications, using the area under the receiver operating characteristics curves (AUC), which evaluates how well the model discriminate between patients who had a pneumonia related complication or not. RESULTS: A total of 491 patients with CAP were enrolled, 256 being admitted to the hospital and 235 treated as outpatients. Admitted patients had higher biomarker levels than outpatients (p < 0.001). The SCAP score and pro-ADM level had the best AUCs for predicting pneumonia related complications (0.83 and 0.84, respectively). Considering SCAP score plus pro-ADM level, the AUC increased significantly to 0.88. SCAP score class 0 or 1 with a pro-ADM level <0.5 ng/mL was the best indicator for selecting patients for outpatient care. CONCLUSIONS: A new risk score combining SCAP score with pro-ADM level is useful to classify severity risk in CAP patients and hence supporting decision-making on hospital admission.

Prevalence and characteristics of attaching and effacing strains of Escherichia coli isolated from diarrheic and healthy sheep and goats.

OBJECTIVE: To determine the prevalence and characteristics of attaching and effacing Escherichia coli (AEEC) in diarrheic and healthy small ruminants. ANIMALS: 502 lambs and kids with diarrhea and 511 healthy sheep and goats. PROCEDURE: Fecal samples from diarrheic and healthy sheep and goats were screened for the eae gene. In addition, E coli isolates with positive results for the eae gene (E coli eae+) were analyzed for the espB gene, production of verotoxins (VT), and serogroup. RESULTS: A significantly higher prevalence of healthy lambs and kids were infected with AEEC, compared with diarrheic lambs and kids and healthy adult sheep and goats. Some differences in the characteristics of E coli eae strains isolated from diarrheic and healthy animals were detected. Thus, the espB gene was detected more frequently among E coli eae+ strains isolated from healthy animals than in those isolated from diarrheic animals, and VT production was only detected in E coli eae+ strains isolated from healthy lambs and kids. The E coli eae+ isolates belonged to several O serogroups. However, 17 of 40 (42.5%) isolates from diarrheic lambs and only 4 of 168 (2.4%) isolates from healthy sheep belonged to serogroup 026. CONCLUSIONS AND CLINICAL RELEVANCE: Our results suggest that E coli eae+ 026 strains may play a role in diarrheal disease in lambs, whereas E coli eae+ strains that also had VT production and eae+ strains that had positive results for the espB gene did not appear to be associated with diarrhea in small ruminants.

[Analysis of discordance between tuberculin test and QuantiFERON-TB® Gold In-Tube in studies of contacts]. / Análisis de la discordancia entre la prueba de la tuberculina y el QuantiFERON-TB® Gold In-Tube en estudios de contactos.

BACKGROUND AND OBJECTIVES: Our objective is to compare the tuberculin skin test (TST) and the QuantiFERON-TB(®) Gold In-Tube (QFT) in the diagnosis of latent tuberculosis infection (LTI) in a population of contacts of patients with pulmonary tuberculosis, and to analyze the influence of different variables in the discordance. PATIENTS AND METHOD: From March 2008 to September 2010, among a population of 300,000 inhabitants of the Basque Country, we analyzed all contacts of patients with pulmonary tuberculosis. All patients underwent the TST and the value of QFT was measured. Sociodemographic variables and vaccination were examined and we analyzed the discordance between the 2 tests. RESULTS: Seven hundred and four were included in the study, with a mean age of 27 years. Of these, 397 were vaccinated, with similar proportion between native and foreign. Increasing the age to 59 years (odds ratio [OR] 10.53, P<.001), being foreign (OR 2.71, P=.02) and vaccination (OR 4.22, P<.001) were predictors of the discordance between a positive TST and negative QFT. CONCLUSIONS: It seems that the QFT, alone or combined with the TST, is a safe method for the diagnosis of LTI and its use would contribute to a more specific selection of individuals who would need preventive treatment.

Restoring catalase activity in Staphylococcus aureus subsp. anaerobius leads to loss of pathogenicity for lambs.

Staphylococcus aureus subsp. anaerobius, a microaerophilic and catalase-negative bacterium, is the etiological agent of abscess disease, a specific chronic condition of sheep and goats, which is characterized by formation of necrotic lesions that are located typically in superficial lymph nodes. We constructed an isogenic mutant of S. aureus subsp. anaerobius (RDKA84) that carried a repaired and functional catalase gene from S. aureus ATCC 12600, to investigate whether the lack of catalase in S. aureus subsp. anaerobius plays a role in its physiological and pathogenic characteristics. The catalase activity had no apparent influence on the in vitro growth characteristics of RDKA84, which, like the wild-type, did not grow on aerobically incubated agar plates. Restoration of catalase activity in RDKA84 substantially increased resistance to H2O2 when analyzed in a death assay. The intracellular survival rates of the catalase-positive mutant RDKA84 in polymorphonuclear neutrophils (PMN) isolated from adult sheep were significantly higher than those of the wild-type, while no differences were found with PMN isolated from lambs. RDKA84 showed significantly lower survival rates in murine macrophages (J774A.1 cells) than the wild-type strains did, whereas, in bovine mammary epithelial cells (MAC-T), no differences in intracellular survival were observed. Interestingly, the virulence for lambs, the natural host for abscess disease, of the catalase-positive mutant RDKA84 was reduced dramatically in comparison with wild-type S. aureus subsp. anaerobius in two experimental models of infection.

Validation and comparison of SCAP as a predictive score for identifying low-risk patients in community-acquired pneumonia.

PURPOSES: (1) To validate the Severe Community Acquired Pneumonia (SCAP) score in predicting 30-day mortality. (2) To validate its ability to identifying patients at low risk of death. (3) To compare it against the Pneumonia Severity Index (PSI), and the British Thoracic Society's CURB-65 rules. METHODS: The SCAP score was validated to predict 30-day mortality in an internal validation cohort of consecutive adult patients seen in one hospital. Consecutive inpatients from other three hospitals were used to externally validate the score and compare the SCAP with the PSI and CURB-65. The discriminatory power of these rules to predict 30-day mortality was tested by the Area under Curve (AUC), and their predictive accuracy with the sensitivity, specificity and predictive values. RESULTS: The 30-day mortality rate increased directly with increasing SCAP score (class 0: 0.5%, to class 4: 66.5% risk) in the internal validation cohort, and from 1.3% to 29.2% in external cohort (P<0.001) with an AUC of 0.83 and 0.75, respectively (P=0.024). The SCAP score identified 62.4% (95% IC 58.8-66.0) low-risk patients, 52.5% (95% IC 48.8-56.2) the PSI and 46.2% (95% CI 42.5-49.9) the CURB-65 in the external cohort. Patients classified as low risk by the three rules had similar 30-day mortality (SCAP: 2.5%, PSI: 1.6% and CURB-65: 2.7%). CONCLUSION: The SCAP is valid to predict 30-day mortality among low-risk patients and identifies a larger proportion of patients as low-risk than the other studied rules.

Predictors of short-term rehospitalization following discharge of patients hospitalized with community-acquired pneumonia.

BACKGROUND: Among patients hospitalized for community-acquired pneumonia (CAP), the risk factors for short-term hospital readmission after discharge are unknown. METHODS: We conducted a prospective observational study of 1,117 patients who had been discharged alive after hospitalization for CAP. We collected variables associated with CAP severity at hospital admission, in-hospital clinical evolution, clinical instability factors on hospital discharge, therapy employed during hospitalization, and diagnostic bacteriology. We assessed hospital readmission within 30 days after discharge for the index hospitalization. Risk factors independently associated with 30-day hospital readmission were identified using Cox regression models. RESULTS: Of the 81 patients (7.3%) who were readmitted to the hospital within 30 days, 29 (35.8%) were rehospitalized for pneumonia-related causes. Variables associated with pneumonia-related hospital readmission were treatment failure (hazard ratio [HR], 2.9; 95% CI, 1.2 to 6.8), and one or more instability factors on hospital discharge (HR, 2.8; 95% CI, 1.3 to 6.2). The predictive performance of these variables measured by the area under the curve (AUC) of the receiver operating characteristic was 0.65. Variables associated with pneumonia-unrelated hospital readmission were age >or= 65 years (HR, 4.5; 95% CI, 1.4 to 14.7), Charlson comorbidity index >or= 2 (HR, 1.9; 95% CI, 1.0 to 3.4), and decompensated comorbidities during in-hospital evolution (HR, 3.5; 95% CI, 2.0 to 6.3); the AUC for this model was 0.77. Patients with at least two risk factors were at significantly increased risk of 30-day hospital readmission (pneumonia-related CAP: HR, 9.0; 95% CI, 3.2 to 25.3; pneumonia-unrelated CAP: HR, 5.3; 95% CI, 1.6 to 18.1). CONCLUSIONS: Among patients hospitalized for CAP, different risk factors are associated with hospital readmission related to pneumonia or to other causes. The identification of two different groups of patients who were at high risk of hospital readmission raises the possibility that different management strategies could decrease the rate of hospital readmissions.

Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia.

BACKGROUND: The comparative accuracy and discriminatory power of three validated rules for predicting clinically relevant outcomes other than mortality in patients hospitalized with community-acquired pneumonia (CAP) are unknown. METHODS: We prospectively compared the newly developed severe community-acquired pneumonia (SCAP) score, pneumonia severity index (PSI), and the British Thoracic Society confusion, urea > 7 mmol/L, respiratory rate > or = 30 breaths/min, BP < 90 mm Hg systolic or < 60 mm Hg diastolic, age > or = 65 years (CURB-65) rule in an internal validation cohort of 1,189 consecutive adult inpatients with CAP from one hospital and an external validation cohort of 671 consecutive adult inpatients from three other hospitals. Major adverse outcomes were admission to ICU, need for mechanical ventilation, progression to severe sepsis, or treatment failure. Mean hospital length of stay (LOS) was also evaluated. The rules were compared based on sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic. RESULTS: The rate of all adverse outcomes and hospital LOS increased directly with increasing SCAP, PSI, or CURB-65 scores (p < 0.001) in both cohorts. Patients classified as high risk by the SCAP score showed higher rates of adverse outcomes (ICU admission, 35.8%; mechanical ventilation, 16.4%; severe sepsis, 98.5%; treatment failure, 22.4%) than PSI and CURB-65 high-risk classes. The discriminatory power of SCAP, as measured by AUC, was 0.75 for ICU admission, 0.76 for mechanical ventilation, 0.79 for severe sepsis, and 0.61 for treatment failure in the external validation cohort. AUC differences with PSI or CURB-65 were found. CONCLUSIONS: The SCAP score is as accurate or better than other current scoring systems in predicting adverse outcomes in patients hospitalized with CAP while helping classify patients into different categories of increasing risk for potentially closer monitoring.

[Serotype and phage type distribution of human Salmonella strains isolated in Spain, 1997-2001]. / Distribución de los serotipos y fagotipos de Salmonella de origen humano aislados en España en 1997-2001.

INTRODUCTION: Salmonellosis is one of the most frequent causes of gastroenteritis in Spain. Serotyping is the gold standard epidemiological marker for subdividing Salmonella spp. strains. A small number of serotypes are very frequently isolated, reducing the discriminatory power of serotyping. Thus, to increase our knowledge of Salmonella spp. epidemiology, additional epidemiological markers, such as phage typing, should be used for this purpose. METHODS: Salmonella spp. strains of human origin sent to the Laboratorio Nacional de Referencia de Salmonella y Shigella (LNRSSE, Spanish Reference Laboratory for Salmonella and Shigella) between 1997 and 2001 were serotyped using conventional agglutination methods, and Enteritidis, Typhimurium, Hadar, Virchow and Typhi serotypes were additionally phage typed according to internationally-developed schemes. RESULTS: A total of 30,856 Salmonella spp. strains, isolated in the majority of Spanish Autonomous Communities, were analyzed. Enteritidis (51%) and Typhimurium (24%) were the most frequently isolated serotypes. The following were the most frequent serotype/phage type combinations: Enteritidis/PT1 (18%), Enteritidis/PT4 (15%), Enteritidis/PT6a (5%), Typhimurium/DT104 (5%) and Enteritidis/PT6 (3%). The serotype Enteritidis/PT1 showed the greatest increase over the period studied, from 11.61% in 1997 to 24.74% in 2001. CONCLUSIONS: A hierarchical typing approach for Salmonella spp., using serotyping coupled with phage typing allowed a higher level of discrimination among Salmonella serotypes. Application of this approach in epidemiological studies could be highly useful for early characterization of related strains.

Catalase deficiency in Staphylococcus aureus subsp. anaerobius is associated with natural loss-of-function mutations within the structural gene.

Degenerate oligonucleotide primers based on internal peptide sequences obtained by HPLC from purified Staphylococcus aureus catalase were used to locate the S. aureus and S. aureus subsp. anaerobius kat regions by PCR. Southern hybridization analysis with a probe derived from a 1.1 kb PCR-amplified fragment showed that a single copy of the putative catalase gene was present in the S. aureus and S. aureus subsp. anaerobius chromosome. The nucleotide sequence of S. aureus katA revealed a 1518 bp open reading frame for a protein with 505 amino acids and a predicted molecular mass of 58347 Da, whereas S. aureus subsp. anaerobius katB is 1368 nt long and encodes a polypeptide of 455 amino acids with a predicted molecular mass of 52 584 Da. These catalases are highly homologous to typical monofunctional catalases from prokaryotes. The active-site residues, proximal and distal haem-binding ligands and NADPH-binding residues of the bovine liver catalase-type enzyme were highly conserved in S. aureus KatA. Escherichia coli cells carrying cloned katA had a catalase activity approximately 1000 times that of untransformed E. coli, but no detectable increase in catalase activity was observed with E. coli carrying cloned katB. Northern blotting showed the presence of a kat-specific transcript in S. aureus subsp. anaerobius, suggesting that the lack of catalase activity in this bacterium is due to a post-transcriptional alteration. Compared to the nucleotide sequence of katA, katB showed a single base-pair deletion and six mis-sense mutations, and these alterations were present in three other S. aureus subsp. anaerobius strains analysed. The deletion, located at 1338 bp from the initiation codon, originates a shift of the nucleotide reading frame and is responsible for the premature translation termination at 1368 bp, generating a KatB polypeptide 50 amino acid residues shorter than KatA. Moreover, four of the mis-sense mutations present in katB lead to non-conservative amino acid replacements, the most significant being that located at residue 317 (Pro in KatA-->Ser in KatB) because the affected amino acid is involved in determining the proximal haem-binding site. Both the main alterations found in KatB (the deletion and the substitution in residue 317) seem to contribute to the lack of catalase activity in S. aureus subsp. anaerobius, as deduced from results obtained with chimeric catalase constructs.

Cómo dializamos a la injuria renal aguda (IRA) en la Argentina: resultados de una encuesta nacional / How do we treat acute kidney injury (AKI) with dialysis in Argentina?: results of a national survey

Introducción: La incidencia de injuria renal aguda (IRA) con requerimiento de diálisis ha aumentado en estos últimos años, con un alto impacto en términos de mortalidad y morbilidad.Nuestro objetivo fue realizar un diagnóstico de situación de las TRR aplicadas en IRA en nuestro país. Métodos: Se realizó una encuesta de carácter anónimo on-Iine por medio de un cuestionario de 22 preguntas con respuestas fijas. Resultados: Se analizaron 101 centros. El 90% de las terapias de reemplazo renal (TRR) se efectuaron en unidades críticas en el 67% de los centros. El 10% utiliza aún máquinas sin módulo de UF y un 3% utiliza acetato como solución de hemodiálisis. El agua utilizada en HD, fue en el 49% agua tratada en vasca o bidones y 2% agua sin o con tratamiento parcial. La membrana más utilizada fue la polisulfona 82%, (cuprofan en el 3%). El 90% y 73% de los encuestados no realizan ningún tipo de terapia continua o HD extendida respectivamente. Sólo 5% realizaron HD extendidas en más de la mitad de sus pacientes. 72% de los encuestados no cuenta con enfermeros con dedicación exclusiva para IRA. Conclusiones: Aún hay centros que utilizan membranas incompatibles, baño con acetato, agua parcialmente tratada o sin módulo de ultrafiltración. La TRR más utilizada es la hemodiálisis intermitente. La mayoría no aplica técnicas extendidas o continuas.

Introduction: The incidence of the acute kidney injury (AKI) which requires dialysis has increased in recent years, with a high impact in terms of morbidity and mortality. Our aim was to conduct a diagnosis of situation of the RRT applied in Aki in our country. Methods: The AKI, work group, part of the Argentine Nephrology Society (SAN) developed an anonymous online survey directed to all SAN members, which 22 questions with fixed answers. Results: 101 units were analyzed. -90% of the renal replacement therapy (RRT) were performed to patients in critical units in 67% of centers surveyed. 10% still use machines without ultrafiltration module (UF), and 3% uses acetato as hemodialysis (HD) solution. The water used in (HD) is mostly treated water in tank or drums (49%); two units (2%) use water without or with partial treatment. The rnost used dialysis membrane was polvsulphone in 82%, cuprophan are applied in 3% of the treatments. 90% and 73% of the units surveyed do no perform any extended continuous therapy or HD respectively. Only 5% undertake extended HD by more than the half of their patients. 72% of respondents do not have exclusive nurses to AKI treatment. Conclusions: Despite of the medical evidence and technology development some centers are still using incompatible membranes, hemodialysis with acetate, partially treated water and equipment without ultrafiltration module. The most used RRT was intermittent hemodialysis, even in critical patients. Most units do not apply extended or continuous techniques.