Candidiasis asociada a biopelículas

The number of biomedical devices (intravascular catheters, heart valves, joint replacements, etc.) that are implanted in our hospitals has increased exponentially in recent years. Candida species are pathogens which are becoming more significant in these kinds of infections. Candida has two forms of development: planktonic and in biofilms. A biofilm is a community of microorganisms which adhere to a surface and are enclosed by an extracellular matrix. This form of development confers a high resistance to the antimicrobial agents. This is the reason why antibiotic treatments usually fail and biomedical devices may have to be removed in most cases. Unspecific adhesion mechanisms, the adhesion-receptor systems, and an intercellular communication system called quorum sensing play an essential role in the development of Candida biofilms. In general, the azoles have poor activity against Candida biofilms, while echinocandins and polyenes show a greater activity. New therapeutic strategies need to be developed due to the high morbidity and mortality and high economic costs associated with these infections. Most studies to date have focused on bacterial biofilms. The knowledge of the formation of Candida biofilms and their composition is essential to develop new preventive and therapeutic strategies.     

Guía de práctica clínica para el diagnóstico y tratamiento de la apoplejía hipofisaria

Classic pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by acute hemorrhage and/or infarction of the pituitary gland. PA is considered a neuroendocrinological emergency. However, there is no consensus about the best options for PA diagnosis and management.ObjectiveTo develop a clinical practice guideline with a number of recommendations for diagnosis and treatment of patients with PA based on the medical evidence available, in order to help clinicians involved in their care.MethodsThe clinical guideline for diagnosis and treatment of pituitary apoplexy issued in 2006 by the Neuroendocrinology Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) and the British Clinical Practice Guideline published in 2011 were taken as the basis. The text has been adapted to the format used in most international medical journals. For this, after updated medical literature, the quality of evidence and the strength of the recommendations were evaluated using the system proposed by the Agency for Health Care Policy and Research (AHCPR).ConclusionsDiagnosis of pituitary apoplexy should be considered in all patients with acute severe headache with or without neuro-ophthalmic signs. Patients with PA must undergo a complete history and physical examination. All patients with suspected pituitary apoplexy should have urgent blood samples drawn to test electrolytes, renal function, liver function, coagulation screen, complete blood count, and basal levels of pituitary and peripheral hormones, and to rule out adrenocorticotropic hormone (ACTH) deficiency. Formal visual field assessment should be performed when the patient is clinically stable. Magnetic resonance imaging (MRI) is the imaging test of choice to confirm diagnosis. Indications for empirical urgent corticosteroid therapy in patients with PA include hemodynamic instability, impaired consciousness, reduced visual acuity, and severe visual field defects. In patients with these severe neuro-ophthalmic signs, surgery should be considered. Surgery should preferably be performed within seven days of the onset of symptoms. Patients with mild and stable signs may be managed conservatively with careful monitoring. Treatment and long-term follow-up of patients with PA should be conducted by a multidisciplinary team consisting, amongst others, of an experienced pituitary neurosurgeon, an ophthalmologist, and an endocrinologist.     

Bloom of Gymnodinium catenatum in Bahía Santiago and Bahía Manzanillo, Colima, Mexico

Gymnodinium bloom events are of concern, since they produce toxins, which have unfavorable consequences to marine ecosystems, human health and the economy. This report describes the physico-chemical conditions that were present during the algal bloom event on May 2010 in Bahía Manzanillo and Bahía Santiago, Colima, Mexico. For this, seawater nutrient analysis, phytoplankton counts, identification, and toxicity tests were undertaken. Nutrients in seawater were determined using colorimetric techniques, the higher concentrations (8.88 microM DIN, 0.78 microM PO4 and 24.34 microM SiO2) were related with upwelling waters that promoted the algal bloom that began after registering the year lowest sea-surface temperature, favoring the rapid growth of G. catenatum (up to 1.02 x 10(7) cells/L). Phytoplankton counting was carried out using sedimentation chambers and cells enumerated on appropriated area. The bloom persisted in the bays for approximately two weeks and was associated with toxicity (determined with HPLC) in local oysters (1525.8 microg STXeq/100g), and in phytoplankton (10.9 pg STXeq/cells) samples. Strong variations in cell toxicity (1.4 to 10.9pg STXeq/cells), most likely reflected the availability of inorganic nutrients. The toxin profile of the phytoplankton samples consisted of 11 toxins and resembled those recorded for several strains of G. catenatum isolated from other coastal areas of Mexico.     

Guía clínica de manejo de la diabetes insípida y del síndrome de secreción inapropiada de hormona antidiurética en el postoperatorio de la cirugía hipofisaria

Changes in water metabolism and regulation of vasopressin (AVP) or antidiuretic hormone (ADH) are common complications of pituitary surgery. The scarcity of studies comparing different treatment and monitoring strategies for these disorders and the lack of prior clinical guidelines makes it difficult to provide recommendations following a methodology based on grades of evidence. This study reviews the pathophysiology of diabetes insipidus and inappropriate ADH secretion after pituitary surgery, and is intended to serve as a guide for their diagnosis, differential diagnosis, treatment, and monitoring.     

Características y factores asociados a caídas en pacientes con enfermedad cerebrovascular

Objectiveto asses the characteristics and factors associated with falls during hospitalisation among elderly stroke patients.Material and methodswe studied 1,410 subjects (60.1% female), aged 65 years and older (80.6 ± 6.9 years), admitted to a geriatric stroke unit between 2000 and 2003. We recorded demographic, clinical and functional variables and evaluated the characteristics and management of falls. The variables showing an association with falls in bivariate analyses were subsequently included in a multivariate logistic regression analysis.Resultsthe incidence rate of falls was 10.49% in 115 patients. The variables showing statistical association (p < 0.05) with falls were age (78.7 vs 80.8) and gender (10.5% male vs 6.6% female), arm strength (2.8 vs 2.3), leg strength (3.2 vs 2.6) and being classified in the group with moderate stroke (47.8%) compared with patients without falls (29.3%). Falls were more frequent in patients with depression (13% vs 7%) and delirium (27% vs 6%). The variables that remained significant in the multivariate logistic regression model for falls were: delirium (OR = 4.691 [2.930-7.511]), mild stroke (OR: 0.347 [0.154-0.782]), age (OR = 0.958 [0.929-0.987]), depression (OR = 1.760[1.095-2.828]), arm strength (OR = 1.233 [1.058-1.438]), and Barthel Index prior to the fall (OR = 1.013 [1.002-1.024]).Conclusionspatients with falls are younger, with a higher previous functional status and with lesser neurological severity on admission. The presence of depression and delirium are frequently associated.     

Impact factor of Revista Iberoamericana de Micología

The impact factor is a bibliometric indicator published annually in the Journal Citation Reports, and widely regarded as a quality ranking of the journals included in this database. The problem with this indicator is that the impact factor of several journals not listed in the Science Citation Index database is largely unknown. The aim of this study was to analyze the 2001 national and international impact factor of Revista Iberoamericana de Micología. The National impact factor of Revista Iberoamericana de Micología was obtained by adding the number of cites in 2001 from a total of 87 Spanish medical journals of greater scientific quality. Also, bibliographical references from Spanish journals indexed in the 2001 Journal Citation reports database have been included to determine the international impact factor of this analyzed journal. Revista Iberoamericana de Micología received a total of 62 cites from published articles in 1999 to 2001, coming from 20 different journals, being their self-citation index 10.1%. The journal with the highest number of cites to Revista Iberoamericana de Micología was Journal of Clinical Microbiology, with 12 cites (19.3%). According to this findings the national and international impact factor of Revista Iberoamericana de Micología was 0.266 and 0.606, respectively. The impact factor of Revista Iberoamericana de Micología, although not included in the Science Citation Index database, was higher than other Journal Citation Reports. Moreover, Revista Iberoamericana de Micología received most of its citations from high impact factor journals included in the Journal Citation Reports database. These data support the international recognition of the scientific level of the journal.     

Anfotericina B liposomal: farmacología clínica,farmacocinética y farmacodinamia

Liposomal amphotericin B is a lipid formulation of the antifungal drug amphotericin B with some distinguishing characteristics in its pharmacological behavior that entail some clinical differences of great interest. The significant improvement in the systemic and renal tolerability is one of them. This fact is related to the great stability of the liposome, promoted by its negative charge, the presence of cholesterol and the remarkable thermo-stability of the remaining lipids that compose it. In this situation, amphotericin B seems to be released from the liposome not spontaneously but when the liposome binds to the ergosterol in the fungal cell membrane. For this reason, there is almost no free amphotericin B in plasma or tissues, although it seems that its availability is greater when there is fungal infection. As a consequence, when the pharmacokinetic behavior is studied, the concentration and availability of liposomal amphotericin B are very high, and its volume of distribution is reduced in comparison with the other formulations.