Chryseobacterium spp., ¿nuevo patógeno oportunista asociado a fibrosis quística?

Introduction

There is an increase in the isolation of non-fermenting gramnegative bacilli in patients with cystic fibrosis (CF). The present study evaluates the frequency of isolates of Chryseobacterium spp., analyzing its characteristics, resistance patterns and clinical outcome of patients.

Methods

It has been collected all respiratory isolates of Chryseobacterium spp. of patients attended in the CF unit of Hospital de la Princesa for three years (march 2009-march 2012). For phenotypic and genotypic identification and sensitivity study conventional methodology was used. For the assessment of the patients lung function was considered the forced expiratory volume in one second (FEV1) and the results were analyzed with SPSS.

Results

There was an increase in the incidence of Chryseobacterium spp. with 17 isolates from 9 patients. Three patients had chronic colonization by this microorganism and one showed significant impairment of lung function. Seven patients showed also colonization with Staphylococcus aureus and 4 of them with Pseudomonas aeruginosa.

Conclusion

Chryseobacterium spp. should be considered as a new emerging opportunistic pathogen in patients with CF. It is essential the clinical and microbiological monitoring of this group of patients for detection of Chryseobacterium spp. colonization and to prevent the chronic infection. In these circumstances it must assess its possible eradication, though its clinical impact is unknown. Cotrimoxazole being the best treatment option.     

Evaluación de la progresión y la regresión de la aterosclerosis coronaria mediante ecografía intravascular. ¿Un nuevo cambio de paradigma?

Intravascular ultrasound (IVUS) has emerged as a powerful imaging modality for the assessment of the arterial wall and it's response to the accumulation of atherosclerotic plaque. The ability to image the coronary arteries on a serial basis provides a unique opportunity for IVUS to monitor the impact that potential anti-atherosclerotic strategies exert on plaque burden. As a result, studies incorporating serial IVUS imaging as the primary endpoint have demonstrated that therapeutic strategies that modify LDL, HDL and blood pressure in patients with established coronary artery disease can have a profound impact on the progression of atherosclerotic plaque. This heralds a paradigm shift that emphasizes plaque regression as a potential target in the development of preventive strategies.     

Aféresis en enfermedad inflamatoria intestinal. ¿Una opción válida?

Leukocyte apheresis works by purifying distinct populations of active leukocytes and by modifying inflammatory mediators. Based on their theoretical immunomodulatory effect, these techniques have begun to be used in inflammatory bowel disease. There are two types of devices: granulocytapheresis, which performs selective granulocyte and monocyte absorption, and leukocytapheresis, which carries out non-selective filtration. Conventional treatment regimens consist of between 5 and 10 sessions, normally one session per week, to induce remission. Although the indications for apheresis have not been clearly defined, this technique can be considered a valid option in selected patients with ulcerative colitis, mainly those with corticosteroid-dependent or corticosteroid-refractory disease when other, better-established immunosuppressive or biological treatments have failed. In addition to avoiding the use of corticosteroids, due to its excellent safety profile, apheresis is an attractive option to avoid the risks of immunosuppressive and biological treatments and for use in the pediatric population. The present reviews analyzes the data on the safety and efficacy of apheresis in those patients with inflammatory bowel diseases who could benefit from this technique.     

Reparación valvular en la insuficiencia aórtica por válvula bicúspide: ¿una alternativa?

Bicuspid aortic valve is the most common form of congenital heart disease. It is associated with both valvular pathology and aortic disease. Aortic regurgitation caused by a bicuspid aortic valve can be corrected by surgical valve repair, which has good short-term results. However, the significant rate of aortic regurgitation recurrence found on long-term follow-up remains a problem, partly because of the progressive aortic dilatation that is characteristic of this disease. We report three different cases of bicuspid aortic valve treated by surgical valve repair at our centre.