Actualización de los métodos de estudio de sensibilidad in vitro a los antifúngicos

Fungal diseases, including those caused by (multi)drug-resistant fungi, still represent a global public health concern. Information on the susceptibility of these microorganisms to antifungal agents must be quickly produced to help clinicians initiate appropriate antifungal therapies. Unfortunately, antifungal susceptibility tests are not as developed or widely implemented as antibacterial tests, being similar in design, accuracy and reproducibility, but also laborious and slow. In this article, we review the methods of in vitro susceptibility testing, both reference (CLSI and EUCAST), commercial and new methods based on proteomics (MALDI-TOF MS) and in the detection of resistance genes by nucleic acid amplification techniques. In addi-tion, we discuss the newly established clinical breakpoints, as well as the epidemiological cut-off points, which constitute a new category that can help in the early identification of isolates that have acquired resistance mechanisms. We also discuss the advantages and limitations of each of the methods studied. Therefore, we can conclude that, although there has been much progress in studies of in vitro susceptibility testing to antifungals, there are still limitations in its application in the daily routine of microbiology labo-ratories, although it seems that the future is promising with the new technologies based on proteomics and nucleic acid amplification. Supplement information: This article is part of a supplement entitled «SEIMC External Quality Control Programme. Year 2016», which is sponsored by Roche, Vircell Microbiologists, Abbott Molecular and Francisco Soria Melguizo, S.A.© 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosasy Microbiología Clínica. All rights reserved.     

Alfabetización en salud y resultados de salud en pacientes muy ancianos con insuficiencia cardiaca

Introduction and objectives

Health literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level.

Prevalencia del síndrome complejo de malnutrición e inflamación y su correlación con las hormonas tiroideas en pacientes en hemodiálisis crónica

Introduction

Low levels of thyroid hormones, total triiodothyronine (T3) and free triiodothyronine (FT3) in haemodialysis patients is a marker of malnutrition and inflammation and are predictors of mortality. The aim of this study was to determine the prevalence of malnutrition-inflammation complex syndrome in haemodialysis and its relationship with the thyroid hormones thyrotropin, T3, FT3 and free thyroxine (FT4), as well as to evaluate the prevalence of low FT3 syndrome and its correlation with nutritional and inflammatory markers.

Control del fósforo y prevención de fracturas en el paciente renal

Patients with chronic kidney disease have a higher risk of fractures than the general population due to the added factor of uraemia. Although the mechanisms behind uraemia-associated fractures are not fully understood, it is widely accepted that the decrease in bone mineral content and alteration in bone architecture both increase bone fragility. As chronic kidney disease progresses, the risk of fracture increases, especially once the patient requires dialysis. Among the many causes of the increased risk are advanced age, amenorrhoea, steroid exposure, decreased vitamin D, increased parathyroid hormone (PTH), malnutrition and chronic inflammation. Serum phosphorus, whether high or very low, seems to correlate with the risk of fracture. Moreover, increased serum phosphate is known to directly and indirectly affect bone metabolism through the development of adaptive hormonal mechanisms aimed at preventing hyperphosphataemia, such as the increase in PTH and fibroblast growth factor 23 (FGF23) and the reduction in calcitriol. These adaptive mechanisms are less intense if the intestinal absorption of phosphorus is reduced with the use of phosphorus captors, which seem to have a positive impact in reducing the risk of fractures. We describe here the possible mechanisms associating serum phosphorus levels, the adaptive mechanisms typical in kidney disease and the use of drugs to control hyperphosphataemia with the risk of fractures. We found no studies in the literature providing evidence on the influence of different treatments on the risk of fractures in patients with chronic kidney disease. We suggest that control of phosphorus should be an objective to consider.     

Nuevas técnicas in vitro en el diagnóstico de la infección tuberculosa

The biological therapies based in the anti-tumor necrosis factor-α (TNF) are an effective alternative for the treatment of chronic inflammatory diseases. However, given that anti-TNF-α therapy has been associated with reactivation of latent tuberculosis infection, a previous evaluation of the patients is required in order to avoid their progression to active TB in case of being infected. Tuberculin skin testing (TST) is used to diagnose tuberculosis infection but it has low specificity in patients who have received the BCG vaccine and low sensitivity in patients with altered cell-mediated immunity. In vitro assays based on the detection of interferon-γ (IFN) released by T cells stimulated by specific Mycobacterium tuberculosis antigens have emerged as an option for the diagnosis of tuberculosis infection. The results to date show, that they are a viable alternative to TST thanks to their higher specificity and sensitivity. Although there are some preliminary results indicating that the IFN-γ tests could be used alone, at the moment it seems more prudent to use them in combination with the TST, considering infection when either of them is positive.     

Mortalidad y fibrilación auricular en el estudio FIACA: evidencia de un efecto diferencial según el diagnóstico al ingreso hospitalario

Introduction and objectives

Atrial fibrillation (AF) is an independent risk factor for mortality in several diseases. However, data published in acute decompensated heart failure (DHF) are contradictory. Our objective was to investigate the impact of AF on mortality in patients admitted to hospital for DHF compared with those admitted for other reasons.

Oferta de la prueba del VIH en fluido oral en actividades de acercamiento y consulta de los resultados online: intervención piloto en Cataluña

IntroductionThe aim of the intervention was to describe the feasibility and cost-effectiveness of offering HIV testing in outreach interventions and subsequent consultation of the results through a secure web page.MethodsThe HIV test was offered “in situ” to men who have sex with men (MSM), migrant sex workers and trans women recruited in places of leisure and sex. Four collaborating NGOs recruited the participants and assisted them to register on the study website (www.swab2know.eu) through a tablet or the smartphone of the same participant. The samples were sent to the reference laboratory and the results were published on the website.Results834 participants (612 MSMs, 203 women sex workers and 19 trans women) were recruited. In total 22 reagent results (2.6%) were detected: 21 among MSMs (3.4%) and 1 in a trans women (5.3%). While 82.6% of MSMs consulted their outcome, only 39.9% and 26.3% of women sex workers and trans women respectively consulted their outcomeConclusionsProviding self-sampling in outreach activities, dispatch and analysis in a reference laboratory as well as online communication of test results is feasible. A high proportion of participants with a HIV reactive result were detected among MSMs and trans women.     

Brote de sarampión en el área sanitaria de Guadalajara (España): dificultad en el diagnóstico microbiológico en la era de su eliminación

IntroductionIn Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tools for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain).MethodsSerological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system.ResultsA total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in 2 that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or 2 vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis.ConclusionsThe combination of molecular tests and the presence of specific IgG and IgM are necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.     

Construcción y validación de la escala EsVida para la valoración del requerimiento de manejo en urgencias de una gastroenteritis infecciosa

IntroductionInfectious gastroenteritis can result in unnecessary emergency room consultations. Instruments are needed to detect the risks for unfavorable progression.AimTo develop and validate a comprehensive severity scale for acute gastroenteritis in children.Materials and methodsData associated with complications (probable items) were determined through a MeSH search. The EsVida scale was developed with 4 theoretic domains: personal history (3 items), social problems (2 items), risks for severe gastroenteritis (4 items), and signs of fluid and electrolyte imbalance (4 items). The items were evaluated as present (one point) or absent (zero points) on a 0 to 13-point scale. To validate the instrument, an observational study was conducted at the emergency service on children from one to 13 years of age with acute gastroenteritis. The scale was re-developed utilizing the risks calculated by logistic regression analysis.ResultsNinety-seven pediatric patients were evaluated using the EsVida scale (theoretic development). Its initial version showed an area under the ROC curve of 0.69 (95% CI of 0.6 to 0.79). After risk adjustment, it was simplified to a total of 5 items, with a score of 0 to 42.5. The new scale produced an area under the ROC curve of 0.85 (95% CI of 0.75 to 0.90). At a cutoff value of 12 points, the scale had 69.8% sensitivity and 70.5% specificity. A score below 6 indicated that patients could be managed at home at no risk.ConclusionsThe modified EsVida scale could be used as an aid in deciding on at-home management in cases of acute infectious gastroenteritis.     

Biobancos y su importancia en el ámbito clínico y científico en relación con la investigación biomédica en España

The reality of biomedical research in Spain requires having an updated knowledge of the research reality and its ethical/legal framework. Research studies with human biological samples should be made with a sufficiently large number of samples to reflect the diversity of the human population, which meets the standard requirements to ensure optimum quality of the research results for further development. Furthermore, research with humans, and obtaining and/or deriving human biological samples and clinical research studies information is subject to a number of legal requirements and restrictions. Biobanks and biobank networks are established as the optimal structures that favor the storage of large volumes of human biological samples based on criteria to ensure their optimum quality, harmonization and security, respecting at all times, the ethical and legal requirements guaranteeing the rights of citizens.