RESUMEN
Different multicentre epidemiological studies such as ENVIN-HELICS or EPINE, have remarked that catheter related bloodstream infection (CRBI) is an increasingly condition in hospital environment. The microbiologist plays a major role in the diagnosis, either by recommending what type of catheter must be considered for confirmatory diagnosis, when these samples must be sent for culture, when is indicated to perform surveillance studies of the catheter and what results are clinically significant to be informed. In this paper, different aspects of the CRBI, such as the pathogenesis, etiology, epidemiology and diagnosis are reviewed. The different microbiological diagnostic methods, both conservatives and those involving the removal of the catheter are up-to-dated.
Asunto(s)
Infecciones Relacionadas con Catéteres/microbiología , Microbiología , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/epidemiología , Catéteres , Infección Hospitalaria/microbiología , Contaminación de Equipos , HumanosRESUMEN
SHP-1, a haematopoietic cell-specific tyrosine phosphatase, is also expressed in human prostate. In this study, we report that SHP-1 depletion in PC-3 cells induced by small interfering RNAs causes G1 phase cell-cycle arrest accompanied by changes in some components of the cell-cycle machinery. SHP-1 knockdown increases p27(Kip1) (p27) protein stability, its nuclear localization and p27 gene transcription. These effects could be mediated by PI3K-AKT pathway as SHP-1 interacts with PI3K regulating its activity and p110 catalytic subunit phosphorylation. The increase in p27 protein stability could also because of reduced cyclin-dependent kinase (CDK2) activity. SHP-1 knockdown decreases the CDK6 levels, inducing retinoblastoma protein hypophosphorylation, downregulation of cyclin E and thereby a decrease in the CDK2 activity. However, the codepletion of SHP-1 and p27 does not produce re-entry into the cycle, implying that p27 is not required to maintain cell-cycle arrest induced by SHP-1 depletion. The maintenance of the PC-3 cell anti-proliferative response after p27 loss could be because of mislocalization of CDK2 induced by SHP-1 knockdown. This study shows that SHP-1 depletion promotes cell-cycle arrest by modulating the activity of cell-cycle regulators and suggests that SHP-1 may be required for the proper functioning of events governing cell-cycle progression.
Asunto(s)
Proteínas de Ciclo Celular/metabolismo , Ciclo Celular/fisiología , Proteína Tirosina Fosfatasa no Receptora Tipo 6/metabolismo , Interferencia de ARN , Western Blotting , Ciclo Celular/genética , Proteínas de Ciclo Celular/genética , Línea Celular Tumoral , Núcleo Celular/metabolismo , Proliferación Celular , Ciclina E/genética , Ciclina E/metabolismo , Quinasa 2 Dependiente de la Ciclina/genética , Quinasa 2 Dependiente de la Ciclina/metabolismo , Quinasa 6 Dependiente de la Ciclina/genética , Quinasa 6 Dependiente de la Ciclina/metabolismo , Inhibidor p27 de las Quinasas Dependientes de la Ciclina/genética , Inhibidor p27 de las Quinasas Dependientes de la Ciclina/metabolismo , Fase G1 , Regulación Neoplásica de la Expresión Génica , Humanos , Luciferasas/genética , Luciferasas/metabolismo , Masculino , Fosforilación , Regiones Promotoras Genéticas/genética , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patología , Proteína Tirosina Fosfatasa no Receptora Tipo 6/genética , Proteína de Retinoblastoma/genética , Proteína de Retinoblastoma/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Fase SAsunto(s)
Agrobacterium tumefaciens/aislamiento & purificación , Catéteres de Permanencia/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/microbiología , Antibacterianos/uso terapéutico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Peritonitis/tratamiento farmacológicoRESUMEN
INTRODUCCION: La práctica de la hemodiálisis (HD) requiere el abordaje del sistema vascular de forma segura y reiterada. La calidad del acceso vascular (AV) condiciona la eficiencia de la HD, la morbilidad y la calidad de vida de los pacientes con insuficiencia renal crónica (IRC) y el grado de satisfacción de los profesionales implicados en el cuidado de estos enfermos. En este estudio queremos resaltar, desde un punto de vista de enfermería, la importancia que tiene realizar un examen físico periódico para valorar la evolución y el desarrollo del AV. OBJETIVOS: 1. Comprobar que el examen físico es un buen método diagnóstico de la disfunción del AV. 2. Promover el uso de la valoración de enfermería del AV. MATERIAL Y MÉTODOS: Se ha realizado un estudio retrospectivo durante el periodo comprendido entre el l de enero de 2000 y el 28 de febrero de 2003, basado en la búsqueda de información sobre el AV de nuestros pacientes. Se utilizaron las historias clínicas, la hoja de registro del AV de enfermería y el protocolo de valoración de enfermería del AV, realizado en nuestro centro. RESULTADOS: Corno test diagnóstico para la disfunción del AV, la valoración clínica de enfermería tuvo una sensibilidad del 84,1 por ciento y una especificidad del 68 °lo. CONCLUSIONES: 1. La valoración de enfermería es un método efectivo y eficiente para la detección precoz de disfunción del AV. 2. Ante una valoración clínica de enfermería normal, no es necesario la realización de otras pruebas diagnosticas de forma rutinaria (AU)
Asunto(s)
Adulto , Anciano , Femenino , Masculino , Persona de Mediana Edad , Anciano de 80 o más Años , Humanos , Atención de Enfermería , Evaluación en Enfermería , Examen Físico , Diálisis Renal/enfermería , Catéteres de Permanencia , Estudios RetrospectivosRESUMEN
We describe an 84-year-old woman who developed remitting seronegative symmetrical synovitis with pitting edema (RS3PE) associated with a subcutaneous abscess of the hand due to Streptobacillus moniliformis. Polyarthritis and edema were relieved after therapy with corticosteroids. We review the association of RS3PE to different rheumatologic, neoplastic, or infectious diseases.
Asunto(s)
Absceso/microbiología , Artritis/microbiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Streptobacillus , Sinovitis/microbiología , Absceso/diagnóstico , Anciano , Anciano de 80 o más Años , Edema/microbiología , Femenino , HumanosRESUMEN
We performed limited autopsy with histological examination of tissue cores obtained percutaneously using the Tru-Cut needle and the Jamshidi trocar in 150 adult HIV-positive patients. Data were compared retrospectively with the antemortem clinical diagnosis. Eighty-one percent of the patients were male, and 78% were intravenous drug users. Specimens were obtained from the brain, liver, lung, bone marrow, and kidney of most patients. The main findings included liver cirrhosis in 22 cases (associated with HCV infection in 81%), Pneumocystis carinii pneumonia in 21, Cytomegalovirus (CMV) infection in 19, Mycobacterium avium-intracellulaire (MAI) infection in 17, bacterial pneumonia in 14, tuberculosis in 12, and lymphoma in 13 cases. Forty-six (30.6%) patients had at least one clinical diagnosis that was confirmed by autopsy, i.e., there was 40.6% agreement between pre- and postmortem findings. Forty-six (30.6%) patients had at least one clinical diagnosis that was not confirmed at autopsy, whereas 41 (27.3%) had at least one AIDS-related or unrelated disease that was not suspected clinically. The results obtained by limited autopsy are principally comparable to those achieved by full necropsy, with the advantages of decreasing the contagious risk, saving cost and time, including a rapid final diagnosis, and easily obtaining the consent for postmortem examination so that necropsy studies may be performed on a larger number of patients, thus contributing to a better understanding of the spectrum of HIV infection in our environment.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Autopsia/métodos , Linfoma Relacionado con SIDA/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adolescente , Adulto , Biopsia con Aguja , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , EspañaRESUMEN
BACKGROUND: Urea kinetic modelling is a method for verifying that the amount of dialysis prescribed equals the amount of dialysis delivered. DOQI guidelines help to assess the causes of a low Kt/V: fistula integrity, treatment duration, methods of obtaining BUN samples, dialysis machine and patient specific variables. OBJECTIVE: To demonstrate the relation between food intake during HD and measurement of Kt/V. METHODS: Prospective study on 14 patients. We measured the amount of dialysis during the second week, with and without food intake during HD. HD prescription (blood flow, dialysate flow, dialyser, dry weight, heparin) was not changed. Statistical analysis was performed using Paired T test. CONCLUSIONS: 1. There was no significant change in protein catabolic rate, average urea concentration and intradialysis gain with food intake. 2. There was a significant change in levels of Kt/V using Gotch formula and Dugirdas formula with food intake.
Asunto(s)
Ingestión de Alimentos , Fallo Renal Crónico/metabolismo , Diálisis Renal , Urea/metabolismo , Anciano , Femenino , Humanos , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diálisis Renal/instrumentación , Factores de TiempoRESUMEN
Basándose en la existencia de otras Psicosis diferentes a la Esquizofrenia (entre las que se encuentran las Psicosis Cicloides) en el presente trabajo los autores tratan de establecer variables del Rorschach que puedan diferenciar ambas Psicosis y comprobar si el SCZI (Índice de Esquizofrenia) es un índice válido para diferenciar ambos grupos. Se concluye que cuatro variables permiten diferenciar la Esquizofrenia de las Psicosis Cicloides, reflejando que el esquizofrénico posee un procesamiento de la información primitivo, pobre e inmaduro, con una forma peculiar de ver el mundo, con tendencia al negativismo y aislamiento social, dándose una mayor inadecuación perceptiva, mientras que el cicloide da un mayor número de Códigos Especiales reflejando Trastornos del Pensamiento (AU)
Asunto(s)
Humanos , Esquizofrenia , Trastornos Psicóticos , Prueba de RorschachRESUMEN
The aim of this study was to determine whether the high levels of erythromycin resistance in Streptococcus pyogenes found in Spain are due to the introduction and spread of one or more clones. Phenotypic and genotypic techniques were used to characterize all erythromycin-resistant S. pyogenes (ErR) isolated in Gipuzkoa, Spain, in the last 10 years and 128 ErR isolated in Vitoria and Madrid during 1996. Of 437 ErR, 97% had the M phenotype; all 283 of the strains studied had the mefA determinant of resistance. After biotyping, T serotyping, emm typing, and genotyping, four major clones were detected. Clones B (biotype I, type T4, emm4, pulsed-field gel electrophoresis [PFGE] II) and D (biotype V, type T8.25, emm75, PFGE IV) comprised 78.8% of all ErR. The resistance of S. pyogenes to erythromycin was mainly due to an efflux mechanism of resistance (M phenotype); few clones were responsible for it.
Asunto(s)
Antibacterianos/farmacología , Eritromicina/farmacología , Streptococcus pyogenes/efectos de los fármacos , Técnicas de Tipificación Bacteriana , Farmacorresistencia Microbiana , Electroforesis en Gel de Campo Pulsado , España , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/genéticaRESUMEN
The conventional study of obstructive sleep apnea syndrome (OSAS) requires two polysomnographic recordings on two different nights, one for diagnosis and the other for determining an effective level of continuous positive airway pressure (CPAP). In this study we examined an alternative method requiring a single night of polysomnographic recording encompassing both diagnostic and treatment functions. In order to obtain recordings of all phases of sleep, as well as recordings taken in supine decubitus position, the duration of polysomnographic readings was individualized ("made to order" polysomnograms). A single-night session was sufficient for diagnosis and for adjusting treatment in most cases. In some cases the night was extended well into the morning hours in an effort to obtain all the necessary data. "Made-to-order" polysomnograms were compared to traditional ones by contrasting breathing parameters (the U of Mann Whitney) and sleep architecture findings for two groups of men diagnosed consecutively of OSAS. Thirty-four patients were studied over two nights (mean age: 50 years; BMI 37 Kg/m2). Forty-six patients (mean age: 49 years; BMI: 38 Kg/m2) were studied in single-night sessions. The differences between the two groups were not significant. For most patients studied in "made to order" sessions, all sleep stages were recorded and readings were taken in supine position. REM sleep was not recorded, however, for 26% of the patients in this group. No significant differences between the double- and single-session groups were found for apnea (51 versus 62), maximum oxygen desaturation (72% versus 75%) and effective CPAP level (9 versus 10 cm H2O). These data suggest that both study methods are equally useful for evaluating OSAS severity and for prescribing effective CPAP treatment. We discuss, however, the need to arrange for two-night studies in the minority of patients for whom no REM sleep recordings become available during a single session.
Asunto(s)
Polisomnografía/métodos , Síndromes de la Apnea del Sueño/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva , Síndromes de la Apnea del Sueño/terapia , Sueño REMAsunto(s)
Cefotaxima/uso terapéutico , Resistencia a las Cefalosporinas , Cefalosporinas/uso terapéutico , Meningitis Neumocócica/tratamiento farmacológico , Streptococcus pneumoniae/efectos de los fármacos , Antibacterianos/uso terapéutico , Cefotaxima/efectos adversos , Cefotaxima/farmacología , Cefalosporinas/efectos adversos , Cefalosporinas/farmacología , Quimioterapia Combinada/uso terapéutico , Humanos , Lactante , Masculino , Vancomicina/uso terapéuticoRESUMEN
OBJECTIVE: To investigate if the addition of vancomycin and gentamicin to the irrigating solutions during phacoemulsification with lens implantation reduces the incidence of positive postoperative intraocular cultures. DESIGN: Two-part double-masked, placebo-controlled, randomized clinical trial. PATIENTS: In the preliminary study, intracameral antibiotic concentrations were measured immediately after surgery (in 10 eyes) and 2 hours after surgery (in 10 eyes) in patients treated with antibiotics. In the primary study, 120 eyes underwent uncomplicated surgery. The treatment group and the placebo group were composed of 60 eyes each. INTERVENTION: The treatment group received vancomycin, 20 micrograms/mL, and gentamicin, 8 micrograms/mL, in the irrigating fluid. The placebo group received only irrigating fluid. All patients in the primary study underwent anterior chamber aspiration following surgery, and culturing was performed 2 hours later. MAIN OUTCOME MEASURE: Identification and quantification of positive cultures in thioglycolate broth and chocolate agar. RESULTS: In the preliminary study, the half-life of both intraocular antibiotics was less than 2 hours. In the primary study, intraocular aspirates yielded positive cultures in 3 specimens (5.0%) in the antibiotic-treated group and in 7 specimens (12.0%) in the placebo group. CONCLUSIONS: Although we found a higher rate of positive postoperative cultures in the placebo group (odds ratio = 2.51), 2 hours of contact between the antibiotic solution and bacteria did not produce results that reached statistical significance (P =.18) to support adding vancomycin and gentamicin to the irrigating solutions during phacoemulsification. Further studies are needed to evaluate the clinical implications of using antibiotics in irrigating solutions.