Urinary tract infections are one of the most common health problems and entail a high consumption of health system resources. Due to the increase in global antibiotic resistances in recent years, it ...is increasingly common to find uropathogens with multiple resistance mechanisms, including quinolone-resistant bacteria, broad-spectrum β-lactamase producers and carbapenemase producers. In this scenario, the role of fosfomycin has gained considerable importance, given its spectrum of activity against multidrug resistant microorganisms (Gram-positive and Gram-negative), becoming an attractive alternative therapy. Regarding the use of fosfomycin in complicated urinary tract infections, there is increasing clinical experience with patients with infections caused by multidrug resistant bacteria, those with recurrent urinary tract infection and special populations such as those with kidney transplants. Randomized comparative studies and series are underway, which will provide greater evidence. Nevertheless, more studies are needed to confirm the enormous potential of fosfomycin in complicated urinary tract infection in the era of multiresistance.
•Chagas disease, caused by Trypanosoma cruzi, is a global problem with an increasing impact on public health.•Trypanosoma cruzi reactivation may occur in immunosuppressed patients, so it should be ...taken into account in the screening and differential diagnosis of patients from endemic areas.•Only benznidazole and nifurtimox have been approved for use in the treatment of patients with Chagas disease, a current worldwide health problem.•There is dearth of available information on benznidazole dosage and the levels achieved in cerebrospinal fluid.
There is little published data on benznidazole dosing, or levels in cerebrospinal fluid. In this report, we describe the clinical course of an immunosuppressed patient with Chagas central nervous system involvement. He was treated successfully with larger benznidazole doses than are recommended, in order to reach therapeutically effective concentrations in the brain.
Current tissue engineering technology focuses on developing simple tissues, whereas multilayered structures comprising several tissue types have rarely been described. We developed a highly ...biomimetic multilayered palate substitute with bone and oral mucosa tissues using rabbit cells and biomaterials subjected to nanotechnological techniques based on plastic compression. This novel palate substitute was autologously grafted in vivo, and histological and histochemical analyses were used to evaluate biointegration, cell function, and cell differentiation in the multilayered palate substitute. The three-dimensional structure of the multilayered palate substitute was histologically similar to control tissues, but the ex vivo level of cell and tissue differentiation were low as determined by the absence of epithelial differentiation although cytokeratins 4 and 13 were expressed. In vivo grafting was associated with greater cell differentiation, epithelial stratification, and maturation, but the expression of cytokeratins 4, 13, 5, and 19 at did not reach control tissue levels. Histochemical analysis of the oral mucosa stroma and bone detected weak signals for proteoglycans, elastic and collagen fibers, mineralization deposits and osteocalcin in the multilayered palate substitute cultured ex vivo. However, in vivo grafting was able to induce cell and tissue differentiation, although the expression levels of these components were always significantly lower than those found in controls, except for collagen in the bone layer. These results suggest that generation of a full-thickness multilayered palate substitute is achievable and that tissues become partially differentiated upon in vivo grafting.
•Community-onset multidrug-resistant (MDR) infections are increasing.•Clinical and economic burden of community-onset MDR infections were evaluated.•Community-onset MDR infections had longer hospital ...stay and higher costs.•Multidrug resistance was related to sicker patients and thus to worse outcomes.•Multidrug resistance could be a marker of more complicated and expensive admissions.
To analyze the clinical and economic burden of community-acquired (CA) or community-onset healthcare-associated (COHCA) multidrug-resistant (MDR) infections requiring hospitalization.
Case-control study. Adults admitted with CA or COHCA MDR infections were considered cases, while those admitted in the same period with non-MDR infections were controls. The matching criteria were source of infection and/or microorganism. Primary outcome was 30-day clinical failure. Secondary outcomes were 90-day and 1-year mortality, hospitalization costs and resource consumption.
194 patients (97 cases and 97 controls) were included. Multivariate analysis identified age (odds ratio OR, 1.07, 95% confidence interval CI, 1.01–1.14) and SOFA score (OR, 1.45, CI95%, 1.15–1.84) as independent predictors of 30-day clinical failure. Age (hazard ratio HR 1.09, 95%CI, 1.03–1.16) was the only factor associated with 90-day mortality, whereas age (HR 1.06, 95%CI, 1.03–1.09) and Charlson Index (HR 1.2, 95%CI, 1.07–1.34) were associated with 1-year mortality. MDR group showed longer hospitalization (p<0.001) and MDR hospitalization costs almost doubled those in the non-MDR group. MDR infections were associated with higher antimicrobial costs.
Worse economic outcomes were identified with community-onset MDR infections. MDR was associated with worse clinical outcomes but mainly due to higher comorbidity of patients in MDR group, rather than multidrug resistance.
This study was performed on 50 human embryos and fetuses between 7 and 17 weeks of development. Reichert's cartilage is formed in the second pharyngeal arch in two segments. The longer cranial or ...styloid segment is continuous with the otic capsule; its inferior end is angulated and is situated very close to the oropharynx. The smaller caudal segment is in contact with the body and greater horn of the hyoid cartilaginous structure. No cartilage forms between these segments. The persistent angulation of the inferior end of the cranial or styloid segment of Reichert's cartilage and its important neurovascular relationships may help explain the symptomatology of Eagle's syndrome.
In April 2015, the Spanish National Health System (SNHS) developed a national strategic plan for the diagnosis, treatment, and management of hepatitis C virus (HCV). Our aim was to analyze the impact ...of this on human immunodeficiency virus (HIV)-infected patients included in the HERACLES cohort during the first 6 months of its implementation. The HERACLES cohort (NCT02511496) was set up in March 2015 to evaluate the status and follow-up of chronic HCV infection in patients co-infected with HIV in the south of Spain. In September 2015, the data were analyzed to identify clinical events (death, liver decompensation, and liver fibrosis progression) and rate of treatment implementation in this population. The study population comprised a total of 3474 HIV/HCV co-infected patients. The distribution according to liver fibrosis stage was: 1152 F0–F1 (33.2 %); 513 F2 (14.4 %); 641 F3 (18.2 %); 761 F4 (21.9 %); and 407 whose liver fibrosis was not measured (12.3 %). During follow-up, 248 patients progressed by at least one fibrosis stage 7.1 %; 95 % confidence interval (CI): 6.3–8 %. Among cirrhotic patients, 52 (6.8 %; 95 % CI: 5.2–8.9 %) developed hepatic decompensation. In the overall population, 50 patients died (1.4 %; 95 % CI: 1.1–1.9 %). Eight hundred and nineteen patients (23.56 %) initiated interferon (IFN)-free treatment during follow-up, of which 47.8 % were cirrhotic. In our study, during 6 months of follow-up, 23.56 % of HIV/HCV co-infected patients included in our cohort received HCV treatment. However, we observed a high incidence of negative short-term outcomes in our population.
The situation of the Catalan language in higher education is a significant indicator of its linguistic use in the academic world as well as the students‘ linguistic formation and the graduate ...students‘ specific communication skills in Catalan. Regardless of what is pointed out in the Law of use of the Valencian language and the European Charter for Regional or Minority Languages (point 879), the Universitat Politècnica de València’s linguistic policy regarding the teaching in Valencian and the teaching of Valencian for specific purposes has suffered a drastic reduction compared to previous years; thus it can be asserted that such a language policy is against what is established normatively by a higher stage of proceeding which has outstanding consequences concerning the standardisation of Valencian in higher education. Keywords: Catalan, language policy, higher education, teaching and learning, teaching in Catalan, teaching of Catalan for specific purposes
Ceftolozane-tazobactam is currently the most active antipseudomonal agent, including multidrug-resistant extensively drug-resistant strains. Tazobactam provides additional activity against many ...extended-spectrum beta-lactamases Enterobacterales. Ceftolozane-tazobactam is formally approved for complicated urinary tract infection, complicated intra-abdominal infection, and hospital-acquired and ventilator-associated bacterial pneumonia. The clinical and microbiological success is over 70-80% in many series. However, resistant mutants to ceftolozane-tazobactam have been already described. Combination therapies with colistin or meropenem could be among the strategies to avoid the resistance emergence.
This paper deals with terminology teaching in the administration field in Catalan language in the context of the specialisation subjects that are offered in the Public Administration Management ...Degree of the Universitat Politècnica de València (Polytechnic University of Valencia). In this sense, we start from the idea that in order to develop a good system for the teaching of terminological units, previous descriptive studies are required regarding the lexical and specialised combinations which allow us to get to know which aspects are the most problematic and thus, to direct teaching to their resolution. Firstly, we analyse the environment and teaching audience, since this fact presents some tendencies which will determine the teaching and learning methods. On the other hand, in order to be able to anticipate and solve other previous problems we must also analyse learnerś needs, taking into account that this is all about learning a minority language of social and professional restricted access. Finally, we have outlined three different phases in the teaching-learning terminology process, as well as the type of activities that have to be performed to achieve terminologic competence in the administrative and terminology field of the abovementioned subjects.
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