Physical inactivity and sedentary lifestyle are an emerging individual, familiar and social public health problem. The aim of this work was to validate a new questionnaire to know the attitude ...towards physical activity and other habits in adolescents.
The Delphi method was used. It was developed in three phases: an initial phase of selection of the panel of experts, an exploratory phase in two rounds of voting using a Likert scale of 1 to 5, and statistical and qualitative analysis of the experts' contributions. The criteria for the choice of items were: average >3.5 and factor V of Aiken ≥0.7. Reliability was assessed with the Cronbach alpha coefficient. A pilot test was carried out to assess the understanding of the instrument.
21 experts agreed to participate. Their participation was 100% in the first round and 95.2% in the second one. Seven items did not meet the criteria. The final questionnaire included 93 questions and 11 dimensions: data of the student, father, mother, physical activity in the educational center, transportation, free time, psychosocial aspects of physical activity, attitude towards physical activity, food, other habits and health perception. A Cronbach's alpha of 0.974 was obtained.
The results support the reliability and validity of the questionnaire. The Delphi method proved to be a useful technique for the proposed objective.
Describir los factores de riesgo cardiovascular de la población intervenida por arteriesclerosis grave de miembros inferiores.
Se ha realizado un estudio observacional durante un período de dos años, ...comprendido entre enero de 1999y diciembre del 2000, con 330 pacientes intervenidos por enfermedad ateroesclerótica grave de miembros inferiores, con isquemia crítica.
La edad media fue de 74,78 ± 10,35 años; la edad de las mujeres fue mayor (78,88 ± 10,45 años) que la de los hombres (73,7 ± 10,07) (p < 0,0001), con una distribución por sexos de 261 hombres (79,1%) y 69 mujeres (20,9%). Si analizamos el porcentaje de pacientes obesos (índice de masa corporal ≥ 30), observamos unaprevalencia del 12,2% de obesidad. El 37,4% de la población (n = 123) presentaba hipertensión arterial y sólo fue tratado el 63,4%. El 59,9% (n = 178) de la población del estudio mostraba dislipemia. Los niveles medios de glucosa plasmática fueron de 121,9 ± 55,8mg/dL; el 42,4% (n = 140) de la población padecía diabetes mellitus y todos eran diabéticos de tipo 2. El 35,2% de los pacientes de nuestro estudio manifestaba dolor en reposo (estadio clínico III) y el 64,8% mostraba lesiones tróficas y/o gangrena, en correspondencia con el estadio IV de Fontaine. A los pacientes con isquemia crónica de miembros inferiores se les intervino quirúrgicamente –en un intento de revascularizar los tejidos isquémicos– una media de 2,2 ± 1,7 veces.
Los pacientes con isquemia crítica de miembros inferiores presentan una alta prevalencia de factores de riesgo cardiovascular infratratados. El tipo de cirugía depende del estadio clínico.
To describe the cardiovascular risk factors of a population secondary to severe atherosclerosis in limbs.
An observational study was performed during two years, from January 1999 to December 2000, with 330 patients with surgery secondary to critical ischemia of legs.
The mean age was 74.78 ± 10.35 years, with a higher age in females (78.88 ± 10.45 years) than males (73.70 ± 10.07) (p < 0,0001), with 261 males (79.1%) and 69 females (20.9%). Frequency of obese patients (body mass index > 30) was 12.2%. A total of 37.4% had high blood pressure, and only 63.4% were treated. 59.9% (n = 178) of the population had dyslipemia. Average glucose levels were 121.9 ± 55.8mg/dL, a total of 42.4% (n = 140) had diabetes mellitus, all people had diabetes mellitus type 2. A 35.2% of patients had pain on rest (III stage) and a 64,8% had trophic lessons (Fontaine stage IV). Patients with this disease received and average of 2.2 ± 1.7 surgeries.
Patients with critical ischemia of limbs had a high prevalence of cardiovascular risk factors without pharmacological treatment. Type of surgery was related with the type of lesion.
Microbiological diagnosis of osteoarticular infections (OI) is crucial for a successful treatment. A prospective multicenter study including 262 synovial fluids with suspicion of acute OI was ...performed between July 2021 and October of 2022. BioFire Joint Infection Panel multiplex-PCR test was performed and results were compared with conventional cultures of synovial fluid specimens. In total, 136 microorganisms were detected, and fourteen samples were positive for more than one microorganism. In monomicrobial infections (n = 87) agreement with culture was 69%. In 26 samples, the multiplex PCR yield an additional positive result when culture result was negative. It helped in the detection of fastidious microorganisms as K. kingae and N. gonorrhoeae. This multiplex PCR has proven to be a useful technique that can be used for patients with high suspicion of acute OI in a rapid and automated manner.
Background. Concerns have arisen regarding the optimal antifungal regimen for Candida parapsilosis bloodstream infection (BSI) in view of its reduced susceptibility to echinocandins. Methods. The ...Prospective Population Study on Candidemia in Spain (CANDIPOP) is a prospective multicenter, population-based surveillance program on Candida BSI conducted through a 12-month period in 29 Spanish hospitals. Clinical isolates were identified by DNA sequencing, and antifungal susceptibility testing was performed by the European Committee on Antimicrobial Susceptibility Testing methodology. Predictors for clinical failure (all-cause mortality between days 3 to 30, or persistent candidemia for ≥72 hours after initiation of therapy) in episodes of C. parapsilosis species complex BSI were assessed by logistic regression analysis. We further analyzed the impact of echinocandin-based regimen as the initial antifungal therapy (within the first 72 hours) by using a propensity score approach. Results. Among 752 episodes of Candida BSI identified, 200 (26.6%) were due to C. parapsilosis species complex. We finally analyzed 194 episodes occurring in 190 patients. Clinical failure occurred in 58 of 177 (32.8%) of evaluable episodes. Orotracheal intubation (adjusted odds ratio AOR, 2.81; P = .018) and septic shock (AOR, 2.91; P = .081) emerged as risk factors for clinical failure, whereas early central venous catheter removal was protective (AOR, 0.43; P = .040). Neither univariate nor multivariate analysis revealed that the initial use of an echinocandin-based regimen had any impact on the risk of clinical failure. Incorporation of the propensity score into the model did not change this finding. Conclusions. The initial use of an echinocandin-based regimen does not seem to negatively influence outcome in C. parapsilosis BSI.
Summary
Philadelphia‐chromosome acute lymphoblastic leukaemia (Ph+ ALL) is a subgroup of ALL with very high risk of treatment failure. We report here the results of the Sociedad Española de ...Hematología y Oncología Pediátricas (SEHOP/SHOP) in paediatric Ph+ ALL treated with intermediate‐dose imatinib concurrent with intensive chemotherapy. The toxicities and outcome of these patients were compared with historical controls not receiving imatinib. Patients with Ph+ ALL aged 1–18 years were enrolled in three consecutive ALL/SHOP trials (SHOP‐94/SHOP‐99/SHOP‐2005). In the SHOP‐2005 trial, imatinib (260 mg/m2 per day) was given on day‐15 of induction. Allogeneic haematopoietic stem‐cell transplantation (HSCT) from a matched related or unrelated donor was scheduled in first complete remission (CR1). Forty‐three patients were evaluable (22 boys, median age 6·8 years, range, 1·2–15). Sixteen received imatinib whereas 27 received similar chemotherapy without imatinib. Seventeen of 27 and 15 of 16 patients in the non‐imatinib and imatinib cohort, respectively, underwent HSCT in CR1. With a median follow‐up of 109 and 39 months for the non‐imatinib and imatinib cohorts, the 3‐year event‐free survival (EFS) was 29·6% and 78·7%, respectively (P = 0·01). These results show that, compared to historical controls, intermediate dose of imatinib given concomitantly with chemotherapy and followed by allogeneic HSCT markedly improved early EFS in paediatric Ph+ ALL.
Summary Objective To assess the current clinical features and determinants of outcome of Candida tropicalis bloodstream infection (BSI). Methods A population-based surveillance on Candida BSI was ...conducted from May 2010 to April 2011 in 29 Spanish hospitals. Antifungal susceptibility testing (EUCAST methodology) was centrally performed. The characteristics and outcome of C. tropicalis BSI episodes were compared with those due to other species. Results Fifty-nine out of 752 episodes (7.8%) were due to C. tropicalis (annual incidence: 0.62 cases per 100,000 population). Resistance to fluconazole and voriconazole was found in 23.2% and 26.8% of isolates. Breakthrough BSI occurred in 10.5% of episodes. Risk factors for C. tropicalis BSI were age (odds ratio OR: 1.01; P -value = 0.05), underlying leukaemia (OR: 4.77; P -value = 0.001) and chronic lung disease (OR: 2.62; P -value = 0.002). There were no differences in clinical failure (persistent BSI for ≥72 h after initiation of therapy and/or 30-day all-cause mortality) between C. tropicalis (39.6%) and non- C. tropicalis groups (45.6%). The appropriateness of antifungal therapy or the fluconazole MIC values had no significant impact on outcome, whereas early central venous catheter removal exerted a protective effect. Conclusions C. tropicalis BSI was associated with advanced age, haematological malignancy and respiratory comorbidity. We found no correlation between the unexpectedly high resistance rate to azoles observed and outcome.
There is little information about carbapenemase-producing (CP) Citrobacter spp. We studied the molecular epidemiology and microbiological features of CP Citrobacter spp. isolates collected in Spain ...(2013-15).
In total, 119 isolates suspected of being CP by the EUCAST screening cut-off values were analysed. Carbapenemases and ESBLs were characterized using PCR and sequencing. The genetic relationship among Citrobacter freundii isolates was studied by PFGE.
Of the 119 isolates, 63 (52.9%) produced carbapenemases, of which 37 (58.7%) produced VIM-1, 20 (31.7%) produced OXA-48, 12 (19%) produced KPC-2, 2 (3.2%) produced NDM-1 and 1 (1.6%) produced VIM-2; 9 C. freundii isolates co-produced VIM-1 plus OXA-48. Fourteen isolates (22.2%) also carried ESBLs: 8 CTX-M-9 plus SHV-12, 2 CTX-M-9, 2 SHV-12 and 2 CTX-M-15. Fifty-seven isolates (90.5%) were C. freundii, 4 (6.3%) were Citrobacter koseri, 1 (1.6%) was Citrobacter amalonaticus and 1 (1.6%) was Citrobacter braakii. By EUCAST breakpoints, eight (12.7%) of the CP isolates were susceptible to the four carbapenems tested. In the 53 CP C. freundii analysed by PFGE, a total of 44 different band patterns were observed. Four PFGE clusters were identified: cluster 1 included eight isolates co-producing VIM-1 and OXA-48; blaVIM-1 was carried in a class 1 integron (intI-blaVIM-1-aacA4-dfrB1-aadA1-catB2-qacEΔ1/sul1) and blaOXA-48 was carried in a Tn1999.2 transposon.
We observed the clonal and polyclonal spread of CP Citrobacter spp. across several Spanish geographical areas. Four species of Citrobacter spp. produced up to five carbapenemase types, including co-production of VIM-1 plus OXA-48. Some CP Citrobacter spp. isolates were susceptible to the four carbapenems tested, a finding with potential clinical implications.
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