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Objective: To measure the benefits of a physical exercise program in a community, through the modifications in quality of life, and perimenopausal-menopausal women physical condition., Setting: The participants were recruited in PC consultations from two health centers in Molina de Segura (Murcia)., Participants: Women between 40 and 70 years old, or under 40 of age diagnosed with early menopause., Design: Quasi-experimental study, non-randomized, controlled, open and single-center with 2 parallel branches to study., Intervention: Experimental group: ACTIVA Bone Health Program for six months., Control: inactive., Main Measurements in Both Groups: The SF 36 questionnaire was used to measure the Quality of life., Physical Condition: Aerobic condition, flexibility, balance and strength measured with the mile, flamenco, flexibility box tests, and throwing the medicine ball, respectively. Physical activity level through the GPPAQ Questionnaire. Sociodemographic variables were collected and the adherence to the program was measured., Results: The quality of life improved in the intervention group compared to the control group, except «Body Pain» dimension (p = 0.412). As regards the intragroup level, all dimensions showed significant improvement except both «Physical Function» (p = 0.263) and «Body Pain» (p = 0.136). The physical capacities that benefited most were aerobic fitness, strength and balance., Conclusions: The Active Bone Health Physical Exercise Program piloting showed benefits on participants' physical and mental quality of life. In addition, it has been shown that performing a specific physical exercise for premenopausal-menopausal women improves their physical condition., (Copyright © 2021 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Within Mycoplasma genus, M. pneumoniae, M. genitalium, M. hominis or U. urealyticum are the main species that have been traditionally linked to infectious processes. However, there are many other species involved in these conditions and that are, frequently, unfamiliar to healthcare professionals. The aim of this review is to identify all Mycoplasma genus species that have been isolated in human beings and to determine their involvement in infectious pathology., (©The Author 2021. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

The crisis in the health system caused by COVID-19 has left some important humanitarian deficits on how to care for the sick in their last days of life. The humanization of the dying process has been affected in three fundamental aspects, each of which constitutes a medical and ethical duty necessary. In this study, I analyze why dying accompanied, with the possibility of saying goodbye and receiving spiritual assistance, constitutes a specific triad of care and natural obligations that should not be overlooked - even in times of health crisis - if we do not want to see human dignity violated and violated some fundamental rights derived from it.

Fungal diseases, including those caused by (multi)drug-resistant fungi, still represent a global public health concern. Information on the susceptibility of these microorganisms to antifungal agents must be quickly produced to help clinicians initiate appropriate antifungal therapies. Unfortunately, antifungal susceptibility tests are not as developed or widely implemented as antibacterial tests, being similar in design, accuracy and reproducibility, but also laborious and slow. In this article, we review the methods of in vitro susceptibility testing, both reference (CLSI and EUCAST), commercial and new methods based on proteomics (MALDI-TOF MS) and in the detection of resistance genes by nucleic acid amplification techniques. In addi-tion, we discuss the newly established clinical breakpoints, as well as the epidemiological cut-off points, which constitute a new category that can help in the early identification of isolates that have acquired resistance mechanisms. We also discuss the advantages and limitations of each of the methods studied. Therefore, we can conclude that, although there has been much progress in studies of in vitro susceptibility testing to antifungals, there are still limitations in its application in the daily routine of microbiology labo-ratories, although it seems that the future is promising with the new technologies based on proteomics and nucleic acid amplification. Supplement information: This article is part of a supplement entitled «SEIMC External Quality Control Programme. Year 2016», which is sponsored by Roche, Vircell Microbiologists, Abbott Molecular and Francisco Soria Melguizo, S.A. © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosasy Microbiología Clínica. All rights reserved., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Objective: Acinetobacter baumannii infections have increased over time becoming a significant issue. Consequently, those applications that allow to predict the evolution of an outbreak and the relevance of the different control methods, are very important. The design of mathematical models plays a central role in this topic., Methods: Development of a deterministic mathematical model based on ordinary differential equations whose variables and parameters are defined upon the basis of knowledge of the epidemiology and characteristics of A. baumannii. This model is analyzed from a qualitative point of view and, also, its computational implementation is derived., Results: Several simulations were obtained developed from different initial conditions. The qualitative analysis of these simulations provides formal evidence of most effective control measures., Conclusions: The implementation of the computational model is an extremely useful tool in terms of managing A. baumannii outbreaks. There is mathematical proof of the fact that the observance of efficient hygiene and screening rules reduces the number of infected patients.

Objective: To know the most relevant epidemiological features of Clostridium difficile infection (CDI) between 2005- 2014 in the province of Salamanca (Spain)., Methods: Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Detection was performed according to standard methodology., Results: 2.6% of stool samples analyzed for detection of C. difficile toxins (9,103) were positive. The average prevalence was 6.8 cases per 100,000 people per year. The mean age was 65 ± 21.4 years and the median 70 years. 59% of cases occurred in patients over 64 years, with an average prevalence of 16.5 (4 times higher than the 15-64 group). Most cases (86.4%) occurred in hospitalized patients, and the group of over 64 had the highest percentage of hospital CDI, with 55%., Conclusions: A significant increase in the number of requests and in the prevalence of CDI over the decade studied is observed, and prevalence rates were significantly lower than those of other studies. The percentage of CDI increased significantly in both inpatient and community. Age and hospitaliza-tion were risk factors for developing CDI. After the introduc-ion of a molecular detection technique in 2014, the prevalence increased, being 2.5 times higher than 2013.

Objective: In Spain there are not many updated population studies about salmonellosis, despite being one of the most common etiologies of acute gastroenteritis (AGEs) caused by bacteria in the world. The aim of the study was to know the most relevant epidemiological features of AGEs produced by Salmonella spp. between 2005 and 2014 in Salamanca (Spain)., Methods: Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Culture, isolation, identification and serotyping were performed according to standard methodology., Results: Salmonella was isolated in 1,477 patients, representing 47.7% of all positive stool cultures and 53.3% of all income bacterial AGE. The average prevalence was 42.1 cases/100,000 people per year. The mean age was 23 ± 28 years and the median 7 years. 40.2% of all isolates occurred in children under 5 years, with an average prevalence of 45.1 cases/ 10,000 people per year. Overall, the most frequently isolated serotype was S. Typhimurium with 57%, followed by S. Enteritidis with 35.8%., Conclusions: The prevalence of Salmonella decreased over time. The group aged 0-4 years had the highest rate throughout the period. However, Salmonella produced the highest percentage of hospitalizations for bacterial AGE. In recent years, S. Typhimurium serotype has replaced S. Enteritidis serotype and predominates in younger patients. It is observed under-reporting of cases of salmonellosis produced in Salamanca despite being mandatory notification of these since 2007.

Although the WHO original target date for the global eradication of poliomyelitis was the year 2000 -thanks to vaccination and institutional, public and private, resources for that purpose-, in 2013 the disease remained endemic in three countries, Afghanistan, Pakistan and Nigeria, and some cases were described in five others. The circulation of wild type 1 poliovirus in Israel, Gaza and the West Bank and the cases in Syria were a wakeup call, as at that time there were polioviruses derived from the oral vaccine that are still circulating among the human population and can cause the development of the disease. Travelling "from" and "to" endemic areas are factors to consider in poliovirus exportation and in its spread when it reaches areas with poor immunogenicity. Wars, terrorism, intolerance, lack of culture and proliferation of anti-vaccine groups and the rise of the anti-vaccination movement are important factors in the maintenance and expansion of the virus and in the "non-vaccination" against it. Based on the international situation to date, the Emergency Committee of WHO met in May 2014 to address the problem. It is still necessary to enhance the knowledge of the disease and its agent. In the first case to perform a differential diagnosis of flaccid paralysis and to continue vaccination programs, and in the second case to keep studying and looking for the poliovirus in environmental samples, which is a model for the study of many other viruses., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Noma is an aggressive orofacial gangrenous pathology that damages hard and soft tissues of the mouth and the face. Throughout the centuries it has been present around the globe, but nowadays it has practically disappeared from developed countries and mainly affects children from the most disadvantaged places, especially in Africa. Noma disease is a multifactorial process; malnutrition, debilitating diseases (bacterial or viral systemic diseases, HIV-associated immunosuppression, etc.) and intraoral infections are some of the factors implied. The characteristic tissue necrosis is produced by a polymicrobial infection. Fusobacterium necrophorum, Prevotella intermedia, Prevotella melaninogenica, Fusobacterium nucleatum, Bacteroides fragilis, Bacillus cereus, Trueperella pyogenes, spyrochetes, etc, are some of the species that have been isolated from the affected areas. Without treatment, noma is lethal in a short period of time, and the patients that survive show severe sequelae that hinder their life and interpersonal relationships. The aim of this paper is to unify the existing information and to promote wider knowledge and awareness among the population.

Introduction: Although in past decades, Acinetobacter baumanni infections have been sporadically identified in hospitals, nowadays the nosocomial infections due to this pathogen have notably increased. Its importance is due to its multidrug- resistance, morbidity and mortatility in healthcare settings. Consequently, it is important to predict the evolution of these outbreaks in order to stablish the most efficient control measures. There are several experimental studies shown that the compliance with hand and environmental hygiene and the efficient management of the healthcare work help to control the evolution of these outbreaks. The goal of this work is to formally proof these experimental results by means of the analysis of the results provided by the model., Methods: A stochastic mathematical model based on cellular automata was developed. The variables and parameters involved in it have been identified from the knowledge of the epidemiology and main characteristics of Acinetobacter infections., Results: The model provides several simulations from different initial conditions. The analysis of these results proofs in a formal way that the compliance with hand and environmental hygiene and an efficient plannification of the work of healtcare workers yield a decrease in the colonized patients. Moreover, this is the unique model proposed studying the dynamics of an outbreak of A. baumanni., Conclusions: The computational implementation of the model provides us an efficient tool in the management of outbreaks due to A. baumanni. The analysis of the simulations obtained allows us to obtain a formal proof of the behaviour of the measures for control and prevention.

In 2011 we celebrated the 150th anniversary of the discovery of anaerobic bacteria by Louis Pasteur. The interest of the biomedical community on such bacteria is still maintained, and is particularly focused on Clostridium difficile. In the past few years important advances in taxonomy have been made due to the genetic, technological and computing developments. Thus, a significant number of new species related to human infections have been characterised, and some already known have been reclassified. At pathogenic level some specimens of anaerobic microflora, that had not been isolated from human infections, have been now isolated in some clinical conditions. There was emergence (or re-emergence) of some species and clinical conditions. Certain anaerobic bacteria have been associated with established infectious syndromes. The virulence of certain strains has increased, and some hypotheses on their participation in certain diseases have been given. In terms of diagnosis, the routine use of MALDI-TOF has led to a shortening of time and a cost reduction in the identification, with an improvement directly related to the improvement of data bases. The application of real-time PCR has been another major progress, and the sequencing of 16srRNA gene and others is currently a reality for several laboratories. Anaerobes have increased their resistance to antimicrobial agents, and the emergence of resistance to carbapenems and metronidazole, and multi-resistance is a current reality. In this situation, linezolid could be an effective alternative for Bacteroides. Fidaxomicin is the only anti-anaerobic agent introduced in the recent years, specifically for the diarrhoea caused by C.difficile. Moreover, some mathematical models have also been proposed in relation with this species., (Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

The anaerobic bacteria resistance to antibiotics is increasing, and even has appeared against the most active of those, like metronidazol and carbapenems. This fact forces to make and periodical sensibility tests -at least in the most aggressive and virulent species, in cases that they are isolated from life locations and in the absence of therapeutic response- to check the local sensibility and to establish suitable empiric therapies, all based on multicentric studies carried out in order to this or well to check the activity of new antibiotics. For the laboratory routine, the easiest sensibility method is the E-test/MIC evaluator. Another alternative is microdilution, that's only normalized for Bacteroides. There are preliminary facts that allow the use of disc diffusion method in some species of Bacteroides and Clostridium. For the temporal and multicentric studies, the procedure is dilution in agar plate, the reference method., (Copyright © 2014 Elsevier España, S.L. All rights reserved.)

Since 1978, when the first test tube baby, Louis Brown, was born, thousands of children have been born every year through in vitro fertilization. Many families keep attending fertility clinics in order to receive some treatment for their infertility problems and have a child. Children born in this way are worthy human beings. Their parents love them and devote themselves to their children admirably, showing real parental love. However, does this loving kindness justify, from an ethical point of view, any way of desiring and having a son or daughter? Is it really an act of human love to long for a child and satisfy this desire using artificial methods? Is it equally human and worthy to wish them choosing in vitro fertilization than to wish them through an intimate and loving relationship, in which the child emerges as a result of interpersonal donation? I answer these questions by analyzing the ethics proposal formulated by Rhonheimer and Carrasco de Paula. In short, only the intimate and loving sexual union between a man and a woman -as long as it is unconditional love- may be the dignity cause of the existence of a human being. And such union and unconditional requirement are absent in vitro fertilization.

This work deals with the study of the use of mathematical models to simulate the spreading of infectious diseases. There is no doubt about the importance of the use of computational tools that allow the health staff to model and predict the spreading of an infectious disease. Using such tools one can establish and simulate disease control strategies. The development of such technologies is a multidisciplinary issue; in this sense, the mathematical algorithms -that must be computationally implemented- play a central role. The main goal of this work is to highlight among health community the increasing importance of the use of mathematical models for epidemic disease spreading. Consequently, the main features of such models are introduced and their classification is stated taking into account the behavior, the basic population unit or the mathematical objects used. An exhaustive search of related papers through the most important databases (Medline and Web of Science) are performed. The main conclusion obtained from this work is the central role that mathematical models can play in the simulation of epidemic spreading; moreover,some ideas about the future research are stated.

The antibiotic resistance is one of the greatest challenges of the international health community. The study of antibiotic resistance must be a multidisciplinary task and, in this sense, the main goal of this work is to analyze the role that Mathematical Modeling can play in this scenario. A qualitative and cuantitative analysis of the works published in the scientific literature is done by means of a search in the most important databases: MEDLINE, SCOPUS and ISI Web of Science. Consequently, there are few papers related to our topic but the existing works have been published in high-quality and impact international journals. Moreover, we can state that mathematical models are a very important and useful tool to analyze and study both the treatments protocols for resistance prevention and the assesment of control strategies in hospital environtment, or the prediction of the evolution of diseases due to resistant strains.

A review of some antibacterial products is done motivated by the serious situation arisen by the antimicrobial resistance in bacteria. The attention is focus on those drugs with suitable antimicrobial properties that have prospects to be commercialized in the next years because of they are undergoing a clinical development phase (I, II, III). The search for these antibacterial products has been done by an exhaustive study of conference proceedings and web pages of international congresses on chemotherapy, infectious diseases and new antimicrobial drugs. Some of the new antibacterial products acts on known targets, and they belong to already used families. Furthermore, the great majority acts against the gram-positive bacterium. There is also some limited-spectrum antimicrobial drug whose use would minimize the adverse biological effects.

In this article I discuss briefly a proposal for the recovery of the essential content of the concept of human nature through the careful attention to ethics which must be received by a terminal ill person in the last phase of life. I propose palliative medicine as a way to rescue the human mind in the life of dying patients to whom the fullness of nature and human dignity belongs. It's about recovering the original medical ethos through the exercise of the virtues through which staff can be trained to recognize the weak, the sick, miserable, the dispossessed are important, are worthy of medicine, used for science: are human and quite valid.

This review offers succinct, precise, and complete information based on the available data concerning new anaerobic bacterial species involved in infectious diseases in humans. All hitherto undescribed species, those not previously implicated in clinical conditions, those with confirmed implication in human disease that have not been characterized, and those that have undergone taxonomic changes are considered to be "new"., (Copyright 2008 Elsevier España, S.L. All rights reserved.)

Since its inception, the cinema has constantly provided a reflection of infectious diseases because of their omnipresence in life and their importance to individuals and society. Few infectious diseases escape its eye, to the extent that the cinema constitutes an authentic treatise on these phenomena. The cinema is a very valuable educational resource, able to supplement classical teaching methods and to encourage critical thinking among students. The enormous flow of information, images, sounds, consequences, situations, and points of view that it provides should not be wasted and can be of great use, both in the spread of ideas and in training in infectious diseases and clinical microbiology.

The aim of this study was to determine the prevalence of the microorganisms causing uncomplicated acute urinary tract infections in the community and their susceptibility to cefixime and another six antimicrobials in frequent use in Spain. In 1998, we conducted an open, prospective study of 1,000 consecutive patients in five large provincial capitals who had positive urine culture, met the inclusion criteria, and were referred to the microbiology laboratory for urinalysis on an outpatient basis. The procedures for sample collection, transportation, laboratory techniques and the evaluation criteria were the same in all cases. The prevalence of the microorganisms found was similar to that published in the last few years by authors of various studies in Spain. Escherichia coli was the most frequently isolated bacteria (82.67% of the Gram-negative bacteria). The decrease in susceptibility of the isolates to the antimicrobials most empirically used was confirmed in these infections at the general practitioner's. Therefore, it is suggested that cefixime, an oral cephalosporin with the greatest activity against these microorganisms, is useful.

Meropenem is a beta-lactamic carbapenem derived from thienamycin and is structurally characterized by the presence of a beta-methyl group in position C1 which confers stability to the molecule versus renal dehydropeptidase 1 (DHP-1), thereby making the coadministration of an enzyme inhibitor unnecessary. Its esterochemical configuration of the lateral chain in C2 (dimethyl carbomoilpyrrolidenethium) increases the activity versus gram negative bacteria (enterobacteria and pseudomonas) and moreover, may explain the reduction in the proconvulsive effect observed in imipenem/cilastatin. Meropenem has great bactericide power and has a very wide spectrum of activity depending on it low molecular weight and zwiterionic structure, stability versus almost all the clinically important beta-lactamases and high affinity for the PBPs. It covers gram positive aerobes (Staphylococcus aureus, coagulase negative staphylococci, streptococci including Streptococcus pneumoniae resistant to penicillin, Enterococcus faecalis, Rhodococcus equi, Listeria monocytogenes) and gram negative bacteria (enterobacteria, P. aeruginosa, Acinetobacter, Aeromonas, Plesiomonas, Vibrio, Haemophilus influenzae, Neisseria, Moraxella) and anaerobes (Bacteroides, Prevotella, Porphyromonas, Fusobacterium, Clostridium, Peptostreptococcus, and Propionibacterium acnes), being more active than imipenem versus gram negatives: P. aeruginosa (2-4-fold), enterobacteria (2-32-fold) and H. influenzae (4-8-fold) and less active versus the gram positives (enterococci, streptococci and staphylococci). Meropenem has no activity on Enterococcus faecium, S. aureus resistant to methycillin, Stenotrophomonas maltophilia and other genera producers of chromosomic methalo-beta-lactamases (carbapenemases). Resistance may be due to impermeability given the loss of the OprD porin (OprD2 in enterobacteria and P. aeruginosa) loss of different membrane proteins (Proteus mirabilis, Proteus rettgeri, Enterobacter cloacae, Enterobacter aerogenes), modifications of the PBPs (gram positive) and the production of carbapenemases (chromosomic methalo-beta-lactamases).

The authors submit an experimental model for bacterial translocation (administering OF-1 mice Zymosan intra-peritoneally at a dose of 1 mg/kg weight). The existence is confirmed of this new mechanism of infection (0% of translocation in control groups, as against 80% in the trial group -p < 0.001). The bacteria in the translocated organs coincide with those present in the fecal flora of the experimental animal. This study is the point of departure for subsequent research to study the physiopathological mechanisms of the phenomenon, which will enable us subsequently to reach better preventive and/or therapeutic decisions.

Aim: To study the resistance to strains of H. influenzae simultaneously isolated during 1990 in 10 Spanish cities with this being the second multicentric study carried out in Spain., Methods: Three hundred eight strains of H. influenzae were consecutively isolated with less than 50% being from the respiratory tract. The sensitivity by microdilution in supplement Isosensitest was studied., Results: Thirty-five percent of the strains were producers of beta-lactamase which predominate among those isolated in systemic infections and specially among those from Madrid (58.78%) and Barcelona (61.8%). The strains producing beta-lactamase were more resistant to all the antimicrobials than the non producers. Five point two percent of the strains were resistant to ampicillin by non enzymatic mechanisms. Resistance to chloramphenicol is frequent (28.6%) especially among strains producing beta-lactamase, strains of ocular origin and ORL (46%) and systemic infections (74.3%). The distribution is irregular, being more frequent in Seville (66.7%) and not detectable in Barcelona. Resistance to tetracycline is also usually linked to the production of beta-lactamase and not necessarily to that of chloramphenicol. Resistance to cotrimoxazole is the most frequent (67.5%) specially in Valladolid (87.5%). Resistance to cefaclor is of 60.7% being the most frequent among those isolated from ocular processes and ORL. Only 28 strains (9.1%) were sensitive to all the antimicrobials tested. Thirty-nine percent were multiresistant., Conclusions: The authors found a slight increase in the high resistance detected in 1986. This increase was not uniform in all of Spain being significant in Madrid with producers of beta-lactamase, in Seville to chloramphenicol, to tetracycline in Bilbao and cotrimoxazole in Valencia.

Prognostic factors of pyriform sinus carcinomas were studied in 122 patients. The 5-year determinate survival was 25.8%. Factors that implied a bad prognosis were an advanced local and nodal stage, and the degree of differentiation. At variance, alcohol and tobacco abuse, age, previous tracheostomy, involvement of surgical margins and local complications had not any prognostic significance.

Campylobacter pylori has been associated with the etiology of gastritis and duodenal ulcer. It has been shown that several drugs, among them a variety of antimicrobials, eliminate C. pylori from gastric mucosa at least for a time, resulting in an improvement of the patients' symptoms. The activity of 16 antimicrobials (ampicillin, cefazolin, cefuroxime, cefotaxime, imipenem, aztreonam, tigemonam, erythromycin, vancomycin, nalidixic acid, colistin , norfloxacin, ciprofloxacin, difloxacin, ofloxacin and perfloxacin) was tested against 30 clinical isolates of C. pylori. The antimicrobials showing the highest activity were ampicillin, imipenem and ciprofloxacin, followed by cefazolin, cefuroxime, cefotaxime, aztreonam, tigemonam, erythromycin and difloxacin. Nalidixic acid, colistin and vancomycin were virtually ineffective against C. pylori.

The use of semiautomatic methods for identification and study of bacterial sensitivity to antimicrobials is increasingly widespread in clinical Microbiology. In the present study, the evaluation of a new micromethod (Sen-SIR, BBL) for the identification and determination of bacterial sensitivity is reported. 115 clinical isolates of enterobacteria, 10 strains of Acinetobacter calcoaceticus and 57 gram positive cocci, previously identified as belonging to the geni Staphylococcus and Streptococcus were evaluated. In gram negative organisms, the concordance with classical identification methods was 98.4%. In gram positive organisms, the concordance was lower only for the differentiation between group D streptococci and enterococci. The observed sensitivities were similar to those seen with the disk method, except basically for Morganella morganii and Proteus vulgaris. This method is quick, simple and reliable; thus, it can represent an alternative to classical identification methods.