Validación del método inverso para la determinación del flujo de acceso con termodilución

IntroductionThermodilution is a widely used method for measuring vascular access flow (Q_A). Among the possibilities of thermodilution, the reverse method (RM) can be beneficial in the execution time, without impact on the dialysis efficacy (K_t). However, it is not a sufficiently studied technique.MethodTransversal study of 117 arteriovenous fistulas. Two Q_A measurements were taken with the method described by the manufacturer (MR) and another with RM. RM is based on the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen's Kappa index were used.ResultsVery good concordance between MR and RM was evidenced for Q_A below 700 ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (?17.13). This value did not differ from the median variability generated between MR and RM (inter-method variability), which was 2% (?14,12) (P = .287). The degree of agreement between the 2 to identify arteriovenous fistulas susceptible to intervention was very good (Kappa = 0.834). The time spent using the RM was significantly shorter (P = .000) without evidence of variations in the K_t of the measurement sessions (P = .201).ConclusionsThe thermodilution RM is valid to determine the flow of the vascular access, especially in Q_A lower than 700 ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and RM is similar to that of MR. The concordance between methods in identifying potentially pathological arteriovenous fistulas is very good.     

Evaluación clínica de un nuevo método molecular para la detección de microorganismos multirresistentes

IntroductionThe main objective of this work is to carry out the clinical validation of the trial with the AMR Direct Flow Chip® starting from either nasal swabs, rectal swabs directly or from isolated strains to detect antibiotic resistance genes.MethodsWe developed the preclinical validation of the assay with 104 known bacterial isolates. A total of 210 nasal or rectal swab samples were analyzed. The AMR assay is based on multiplex PCR followed by reverse dot blot hybridization on DNA arrays fully automated by using the HS24 platform. The completion time of the full analysis is 3 hours.ResultsBoth the sensitivity and specificity of the preclinical assay were 100%, with the 104 samples correctly identified. In the clinical validation, the sensitivity was 100% and the specificity was between 100% in rectal swabs and 97% in nasal swabs.ConclusionsThe AMR Direct Flow Chip® is a rapid and effective assay for the detection of multidrug-resistant microorganisms from nasal and rectal swab samples.     

Evaluación de la precisión diagnóstica del sistema Cobas 6800 para la detección de los niveles de viremia del virus de la hepatitis C a partir de muestras de gotas de sangre seca en papel de filtro

IntroductionBecause hepatitis C virus (HCV) infection is curable in the majority of cases, the diagnosis of all infected patients has become a priority. In difficult-to-diagnose populations, simpler diagnostic methods are required such as the use of dried blood spots (DBS) as an alternative to blood drawn by venipuncture (VP). Before being able to include it as a HCV diagnostic detection method within the Spanish National Health System, the diagnostic accuracy of standard hospital equipment must be evaluated.MethodologyDBS samples were evaluated in vitro and in a field test after being processed in the Cobas 6800 system, establishing a correlation with the result by VP. Performance with different viral loads and intra-assay variability was compared.ResultsIn samples with a viral load of > 3 log₁₀ IU/ml, viraemia was detected in all cases when at least two blood spot elutions were used (94 detections out of 95 spot elutions). The performance with 2 spots was lower in samples with < 3 log₁₀ IU/ml (7/20). Correlation between VP and DBS viraemia was excellent (maximum with 2 spots, r² = 0.906, P < .001) with a coefficient of variation of 0.05%. In routine clinical practice with specimens from screened subjects (n = 61), excellent diagnostic accuracy was also observed.ConclusionViral load detection using DBS of at least two spots is a reliable method for HCV diagnosis. The standardisation of the method is feasible and our results support the incorporation of this diagnostic tool in Spain's Public Health System.     

Uso de las tecnologías de secuenciación masiva para el diagnóstico y epidemiología de enfermedades infecciosas

For the first time, next generation sequencing technologies provide access to genomic information at a price and scale that allow their implementation in routine clinical practice and epidemiology. While there are still many obstacles to their implementation, there are also multiple examples of their major advantages compared with previous methods. Their main advantage is that a single determination allows epidemiological information on the causative microorganism to be obtained simultaneously, as well as its resistance profile, although these advantages vary according to the pathogen under study. This review discusses several examples of the clinical and epidemiological use of next generation sequencing applied to complete genomes and microbiomes and reflects on its future in clinical practice.     

Métodos microbiológicos para la monitorización de la limpieza,desinfección y esterilización de dispositivos médicos

The use of reusable semi-critical devices has been extended in current medical practice for both diagnostic and therapeutic purposes. However, reuse of these instruments carries the risk of cross-transmission of microorganisms from one patient to another. The process of cleaning and disinfecting these devices is complex, long, expensive and very error-prone. This paper analyses the epidemiological aspects of infections associated with the reuse of semi-critical devices and the role of the Microbiology laboratory in monitoring the cleaning and disinfecting process through microbiological controls. The recommendations of different scientific societies on the relevance of such controls are reviewed and specific recommendations are proposed for the taking and processing of the samples, interpretation of the results and measures to be taken depending on the results obtained.     

Propuestas para la incorporación del rol de enfermería en la certificación de unidades de espondiloartritis axial. Revisión bibliográfica y consenso entre expertas

ObjectiveTo analyse the role of nursing in the approach to axial spondyloarthritis (axSpA) and to make proposals to include the role of rheumatology nursing consultations (RECs) in the quality certification of these specialized units.MethodsA systematic review of the nursing role in quality certification systems in the management of axSpA was conducted. Subsequently a consensus conference was held with the participation of 3 rheumatology nurses to determine elements that should be considered in future revisions of certification standards.ResultsThe systematic review yielded 5 papers as relevant. None of the publications reviewed explicitly proposed standards applicable to nursing care in the management of patients with axSpA, although they contemplated the activities of this professional group. The proposals agreed upon to incorporate the role of RECs in the certification standards for axSpA monographic units included the following: basic equipment and resources, organization, administration of pharmacological treatments and promotion of adherence, standardized programmes for axSpA, telematic consultation (e-consultation) for monitoring the stable patient and promoting continuity of care and registry of patient-reported outcome measures.ConclusionsThe literature on quality standards and certification standards for axSpA monographic units is scarce and hardly reflects the role of RECs in providing quality care. The consensus proposals in this study would incorporate RECs into quality certification standards. In the future, the increased presence of RECs in Spain should be accompanied by a review of the indicators regarding their role.     

Validación del KDRI/KPDI para la selección de donantes renales con criterios expandidos

Introduction

KDRI / KDPI are tools use in kidney donor evaluation. It has been proposed as a substitute of, or complementary to preimplantation renal biopsy. These scores has not been validated in Spain.

Descripción de la deficiencia de alfa-1-antitripsina asociada al alelo PI*Q0ourém en la isla de La Palma (España) y de un método de genotipado para su detección

By analysis of a case of discrepancy between serum alpha-1-antitrypsin (AAT) level and genotype for the most common defective alleles associated with AAT deficiency (PI*S and PI*Z), a patient carrying the allele PI*Q0_ourém has been identified for the first time outside of Portugal. This null allele has been implicated in cases of severe pulmonary emphysema. After developing a clinical assay for detection of c.1130insT mutation, based on fluorescent probes (HybProbe^®), another 4 carriers of PI*Q0_ourém allele were identified among 43 patients with abnormally low serum AAT levels based on their genotypes for PI*S and PI*Z alleles. Since 4 out 5 cases are from the same locality (La Palma Island, Spain), it is advisable to conduct genetic analyses of affected families and, possibly, a focused population screening.     

Documento de consenso para la formación en ecografía en la especialidad de Nefrología

Ultrasound is an essential tool in the management of the nephrological patient allowing the diagnosis, monitoring and performance of kidney intervention. However, the usefulness of ultrasound in the hands of the nephrologist is not limited exclusively to the ultrasound study of the kidney. By ultrasound, the nephrologist can also optimize the management of arteriovenous fistula for hemodialysis, measure cardiovascular risk (mean intimate thickness), implant central catheters for ultrasound-guided HD, as well as the patient's volemia using basic cardiac ultrasound, ultrasound of the cava inferior vein and lungs.From the Working Group on Interventional Nephrology (GNDI) of the Spanish Society of Nephrology (SEN) we have prepared this consensus document that summarizes the main applications of ultrasound to Nephrology, including the necessary basic technical requirements, the framework normative and the level of training of nephrologists in this area. The objective of this work is to promote the inclusion of ultrasound, both diagnostic and interventional, in the usual clinical practice of the nephrologist and in the Nephrology Services portfolio with the final objective of offering diligent, efficient and comprehensive management to the nephrological patient.     

El embarazo como una oportunidad de diagnóstico del virus de la inmunodeficiencia humana en mujeres inmigrantes en Catalunya

Introduction

Mother-to-child transmission (MTCT) is relevant in the global epidemiology of human-immunodeficiency virus (HIV), as it represents the main route of infection in children. The study objectives were to determine the rate of HIV-MTCT and its epidemiological trend between the Spanish-born and immigrant population in Catalonia in the period 2000-2014.

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.     

Tecnologías de endoscopia avanzada para mejorar la detección y caracterización de los pólipos colorrectales

Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques.