Background
Fluconazole‐resistant Candida parapsilosis is a matter of concern.
Objectives
To describe fluconazole‐resistant C. parapsilosis genotypes circulating across hospitals in Spain and Rome and ...to study their azole‐resistance profile associated with ERG11p substitutions.
Patients/Methods
We selected fluconazole‐resistant C. parapsilosis isolates (n = 528 from 2019 to 2023; MIC ≥8 mg/L according to EUCAST) from patients admitted to 13 hospitals located in five Spanish cities and Rome. Additionally, we tested voriconazole, posaconazole, isavuconazole, amphotericin B, micafungin, anidulafungin and ibrexafungerp susceptibility.
Results
Of the 53 genotypes found, 49 harboured the Y132F substitution, five of which were dominating city‐specific genotypes involving almost half the isolates. Another genotype involved isolates harbouring the G458S substitution. Finally, we found two genotypes with the wild‐type ERG11 gene sequence and one with the R398I substitution. All isolates were fully susceptible/wild‐type to amphotericin B, anidulafungin, micafungin and ibrexafungerp. The azole‐resistance patterns found were: voriconazole‐resistant (74.1%) or voriconazole‐intermediate (25.2%), posaconazole‐resistant (10%) and isavuconazole non‐wild‐type (47.5%). Fluconazole‐resistant and voriconazole non‐wild‐type isolates were likely to harbour substitution Y132F if posaconazole was wild type; however, if posaconazole was non‐wild type, substitution G458S was indicated if isavuconazole MIC was >0.125 mg/L or substitution Y132F if isavuconazole MIC was ≤0.125 mg/L.
Conclusions
We detected a recent clonal spread of fluconazole‐resistant C. parapsilosis across some cities in Spain, mostly driven by dominating city‐specific genotypes, which involved a large number of isolates harbouring the Y132F ERG11p substitution. Isolates harbouring substitution Y132F can be suspected because they are non‐susceptible to voriconazole and rarely posaconazole‐resistant.
Choroidal thickness (CT) has been evaluated as a marker of systemic inflammation in ankylosing spondylitis (AS). This study evaluates the CT of AS patients before and after 6 months of biological ...treatment.
This longitudinal multicenter study evaluated CT in 44 AS patients. The correlations between CT and C-reactive protein (CRP) with disease activity indices were calculated. The concordance between CT and CRP was determined. We assessed factors associated with response to treatment. Clinically important improvement was defined as a decrease in Ankylosing Spondylitis Disease Activity Score of 1.1 points or greater.
Forty-four eyes in patients aged 18 to 65 years were included. Mean CT values were significantly higher at baseline than after 6 months of treatment (baseline: 355.28 ± 80.46 μm; 6 months: 341.26 ± 81.06 μm; p < 0.001). There was a 95% concordance between CT and CRP at baseline and 6 months. Clinically important improvement was associated with lower baseline CT and age as independent factors (odds ratios, 0.97 95% confidence interval, 0.91-0.93; p = 0.009 and 0.81 95% confidence interval, 0.7-0.95; p = 0.005), with baseline CT of less than 374 μm (sensitivity 78%, specificity 78%, area under the curve 0.70, likelihood ratio 3.6).
Choroidal thickness decreased significantly after 6 months of biological treatment in all treatment groups. Choroidal thickness and CRP had a 95% concordance. A high CT was associated with a risk of biological treatment failure. Choroidal thickness can be considered a useful biomarker of inflammation and a factor associated with response to treatment in AS.
The literature on fiscal policies is paying increasing attention to the impact of the composition of public expenditures on long-term economic growth. Public policy endogenous growth models recommend ...to change the composition of public expenditures to items considered productive expenditures. In this sense, European institutions are encouraging the rise in the share of productive outlays like public investments, R&D, and active labor market policies, among others. The article analyzes whether these recommendations are followed by European Union countries and whether a convergence to a new pattern of public finances with a higher share of those items considered productive expenditures by European institutions is arising.
Purpose
To compare the clinical prognosis among selected white dot syndromes (WDS) (birdshot chorioretinopathy (BRC), multifocal choroiditis, serpiginous choroidopathy (SC), and others) and to ...identify risk factors of poor visual prognosis.
Methods
Retrospective longitudinal cohort study including 84 patients (143 affected eyes) diagnosed with WDS between 1982 and July 2017, followed up until loss of follow-up or December 2017, and recruited from three Uveitis Clinics (Madrid Community, Spain). Our main outcome measures were temporary or permanent moderate (corrected visual acuity in the Snellen scale < 20/50) or severe (< 20/200) vision losses, and development of new ocular complications. Incidence rates (IR) of the main outcome measures were estimated per 100 eye-years. Bivariate and multivariate Cox robust regression models analyzed the association of demographic- and clinical-related variables with vision loss.
Results
SC exhibited the greatest IR of vision loss, even in the multivariate models. Previous events of vision loss, presence of choroidal neovascularization, and cataracts exhibited worse visual prognosis. Monotherapy with immunosuppressive drugs but not combine therapy was also associated with higher IR of visual loss. Regarding new ocular complications, BRC showed the highest IR of epiretinal membrane and macular edema.
Conclusions
SC presents the worst visual prognosis. Some ocular manifestations can identify patients with WDS at risk of a worse clinical evolution.
We have been monitoring the antifungal resistance in Candida parapsilosis isolates collected from inpatients at Madrid metropolitan area hospitals for the last 3 years. The study aimed to elucidate ...the presence of fluconazole-resistant C. parapsilosis genotypes in Madrid. From January 2019 to December 2021, a total of 354 C. parapsilosis isolates (
= 346 patients) from blood (76.6%) or intraabdominal samples were collected and genotyped using species-specific microsatellite markers. Antifungal susceptibilities to amphotericin B, the triazoles, micafungin, anidulafungin, and ibrexafungerp were performed according to EUCAST E.Def 7.3.2; the
gene was sequenced in fluconazole-resistant isolates. A total of 13.6% (
= 48/354) isolates (one per patient) were found to be resistant to fluconazole and non-wild-type to voriconazole but fully susceptible to ibrexafungerp. Resistant isolates were mostly sourced from blood (
= 45/48, 93.8%) and were detected in five hospitals. Two hospitals accounted for a high proportion of resistant isolates (
= 41/48). Resistant isolates harbored either the Y132F ERG11p amino acid substitution (
= 43) or the G458S substitution (
= 5). Isolates harboring the Y132F substitution clustered into a clonal complex involving three genotypes (one genotype accounted for
= 39/43 isolates) that were found in four hospitals. Isolates harboring the G458S substitution clustered into another genotype found in a fifth hospital. C. parapsilosis genotypes demonstrating resistance to fluconazole have been spreading across hospitals in Madrid, Spain. Over the last 3 years, the frequency of isolation of such isolates and the number of hospitals affected is on the rise.
In the last three decades, a remarkable degree of progress has occurred in the study of gender within anthropology. Gendered Anthropology offers a thought-provoking, lively examination of current ...debates focusing on sex and gender, race, ethnicity, politics and economics and provides insights which are still too often lacking in mainstream anthropology. Gendered Anthropology will be of particular value to undergraduates and lecturers in social anthropology and gender studies.
Mobilizing Company Members' Full Innovative Potential Velasco, Eva; Zamanillo, Ibon; Del Valle, Teresa Garcia
Human factors and ergonomics in manufacturing & service industries,
11/2013, Letnik:
23, Številka:
6
Journal Article
Abstract
Objectives
We prospectively monitored the epidemiology and antifungal susceptibility of Candida spp. from blood cultures and intra-abdominal samples in patients admitted to hospitals in the ...Madrid area.
Methods
Between 2019 and 2021, we prospectively collected incident isolates one per species, patient and compartment (blood cultures versus intra-abdominal samples) from patients admitted to any of 16 hospitals located in Madrid. We studied the antifungal susceptibilities to amphotericin B, triazoles, micafungin, anidulafungin and ibrexafungerp following the EUCAST E.Def 7.3.2 procedure.
Results
A total of 2107 Candida spp. isolates (1895 patients) from blood cultures (51.7%) and intra-abdominal samples were collected. Candida albicans, the Candida glabrata complex, the Candida parapsilosis complex, Candida tropicalis and Candida krusei accounted for 96.9% of the isolates; in contrast, Candida auris was undetected. Fluconazole resistance in Candida spp. was higher in blood cultures than in intra-abdominal samples (9.1% versus 8.2%; P > 0.05), especially for the C. parapsilosis complex (16.6% versus 3.6%, P < 0.05), whereas echinocandin resistance tended to be lower in blood cultures (0.5% versus 1.0%; P > 0.05). Resistance rates have risen, particularly for fluconazole in blood culture isolates, which increased sharply in 2021. Ibrexafungerp showed in vitro activity against most isolates. Species distributions and resistance rates varied among hospitals.
Conclusions
Whereas no C. auris isolates were detected, fluconazole-resistant C. parapsilosis isolates have been spreading across the region and this has pulled up the rate of fluconazole resistance. In contrast, the rate of echinocandin resistance continues to be low.
We previously conducted a multicenter surveillance study on
epidemiology and antifungal resistance in Madrid (CANDIMAD study; 2019-2021), detecting an increase in fluconazole-resistant
. We here ...present data on isolates collected in 2022. Furthermore, we report the epidemiology and antifungal resistance trends during the entire period, including an analysis per ward of admission.
spp. incident isolates from blood cultures and intra-abdominal samples from patients cared for at 16 hospitals in Madrid, Spain, were tested with the EUCAST E.Def 7.3.2 method against amphotericin B, azoles, micafungin, anidulafungin, and ibrexafungerp and were molecularly characterized. In 2022, we collected 766
sp. isolates (686 patients; blood cultures, 48.8%).
was the most common species found, and
was undetected. No resistance to amphotericin B was found. Overall, resistance to echinocandins was low (0.7%), whereas fluconazole resistance was 12.0%, being higher in blood cultures (16.0%) mainly due to fluconazole-resistant
clones harboring the Y132F-R398I ERG11p substitutions. Ibrexafungerp showed
activity against the isolates tested. Whereas
was the dominant species in most hospital wards, we observed increasing
proportions in blood. During the entire period, echinocandin resistance rates remained steadily low, while fluconazole resistance increased in blood from 6.8% (2019) to 16% (2022), mainly due to fluconazole-resistant
(2.6% in 2019 to 36.6% in 2022). Up to 7 out of 16 hospitals were affected by fluconazole-resistant
. In conclusion, rampant clonal spreading of
fluconazole-resistant genotypes is taking place in Madrid.
The European Union has recently been putting the emphasis on the need to change the composition of public expenditures to what, according to the public policies endogenous models, is considered as a ...high quality of public finances-that is, a higher share of productive expenditures. These recommendations are the same for all the EU member states. Joined to the fiscal requirements arisen from the Maastricht Treaty and the Stability and Growth Pact, EU authorities are promoting a one-size-fits-all fiscal policy model. Our paper analyzes the differences existing in the composition of public expenditures in the European Union. If this composition is significantly different, that would mean that in the European Union there are differences in the national preferences about the role-size of public expenditures, some that would not allow the implementation of a single model of public sector and fiscal policy.
