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Introduction: Hospital-wide SARS-CoV-2 seroprevalence is rarely explored and can identify areas of unexpected risk. We determined the seroprevalence against SARS-CoV-2 in all health care workers (HCW) at a hospital., Methods: Cross-sectional study (14-27/04/2020). We determined SARS-CoV-2 IgG by ELISA in all HCW including external workers of a teaching hospital in Madrid. They were classified by professional category, working area, and risk for SARS-CoV-2 exposure., Results: Among 2919 HCW, 2590 (88,7%) were evaluated. The mean age was 43.8 years (SD 11.1), and 73.9% were females. Globally, 818 (31.6%) workers were IgG positive with no differences for age, sex or previous diseases. Of these, 48.5% did not report previous symptoms. Seropositivity was more frequent in high- (33.1%) and medium- (33.8%) than in low-risk areas (25.8%, p=0.007), but not for hospitalization areas attending COVID-19 and non-COVID-19 patients (35.5 vs 38.3% p>0.05). HWC with a previous SARS-CoV2 PCR-positive test were IgG seropositive in 90.8%. By multivariate logistic regression analysis seropositivity was significantly associated with being physicians (OR 2.37, CI95% 1.61-3.49), nurses (OR 1.67, CI95% 1.14-2.46), nurse assistants (OR 1.84, CI95% 1.24-2.73), HCW working at COVID-19 hospitalization areas (OR 1.71, CI95% 1.22-2.40), non-COVID-19 hospitalization areas (OR 1.88, CI95% 1.30-2.73), and at the Emergency Room (OR 1.51, CI95% 1.01-2.27)., Conclusions: Seroprevalence uncovered a high rate of infection previously unnoticed among HCW. Patients not suspected of having COVID-19 as well as asymptomatic HCW may be a relevant source for nosocomial SARS-CoV-2 transmission., (Copyright © 2020 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Background: It has been established that the genomic background of Mycobacterium tuberculosis may influence disease progression, in particular for the Beijing family and the Latin American and Mediterranean (LAM)/RD Rio strains. The purpose of this study was to evaluate the prevalence of the LAM/RD Rio genotype in cases of tuberculosis from Mexico and their drug susceptibility profile., Methods: Two hundred eighteen M. tuberculosis isolates were screened by 43-spacer spoligotyping. The LAM/RD Rio genotype was confirmed by multiplex PCR, and the drug susceptibility testing was carried out in solid Löwenstein-Jensen media., Results: Among the LAM strains identified, 24 (63.1%) were confirmed as M. tuberculosis RD Rio . All RD Rio strains shared the RD174 deletion, that was associated with isoniazid resistance (p=0.0264)., Conclusions: We documented for the first time the isolation of the LAM/RD Rio genotype in pulmonary cases of tuberculosis in Mexico, and we found resistance to the first-line anti-tuberculosis drug isoniazid in these strains., (Copyright © 2020 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Hospital-wide SARS-CoV-2 seroprevalence is rarely explored and can identify areas of unexpected risk. We determined the seroprevalence against SARS-CoV-2 in all health care workers (HCW) at a hospital., Methods: Cross-sectional study (14-27/04/2020). We determined SARS-CoV-2 IgG by ELISA in all HCW including external workers of a teaching hospital in Madrid. They were classified by professional category, working area, and risk for SARS-CoV-2 exposure., Results: Among 2919 HCW, 2590 (88,7%) were evaluated. The mean age was 43.8 years (SD 11.1), and 73.9% were females. Globally, 818 (31.6%) workers were IgG positive with no differences for age, sex or previous diseases. Of these, 48.5% did not report previous symptoms. Seropositivity was more frequent in high- (33.1%) and medium- (33.8%) than in low-risk areas (25.8%, p=0.007), but not for hospitalization areas attending COVID-19 and non-COVID-19 patients (35.5 vs 38.3% p>0.05). HWC with a previous SARS-CoV2 PCR-positive test were IgG seropositive in 90.8%. By multivariate logistic regression analysis seropositivity was significantly associated with being physicians (OR 2.37, CI95% 1.61-3.49), nurses (OR 1.67, CI95% 1.14-2.46), nurse assistants (OR 1.84, CI95% 1.24-2.73), HCW working at COVID-19 hospitalization areas (OR 1.71, CI95% 1.22-2.40), non-COVID-19 hospitalization areas (OR 1.88, CI95% 1.30-2.73), and at the Emergency Room (OR 1.51, CI95% 1.01-2.27)., Conclusions: Seroprevalence uncovered a high rate of infection previously unnoticed among HCW. Patients not suspected of having COVID-19 as well as asymptomatic HCW may be a relevant source for nosocomial SARS-CoV-2 transmission., (Copyright © 2020 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: It has been established that the genomic background of Mycobacterium tuberculosis may influence disease progression, in particular for the Beijing family and the Latin American and Mediterranean (LAM)/RD Rio strains. The purpose of this study was to evaluate the prevalence of the LAM/RD Rio genotype in cases of tuberculosis from Mexico and their drug susceptibility profile., Methods: Two hundred eighteen M. tuberculosis isolates were screened by 43-spacer spoligotyping. The LAM/RD Rio genotype was confirmed by multiplex PCR, and the drug susceptibility testing was carried out in solid Löwenstein-Jensen media., Results: Among the LAM strains identified, 24 (63.1%) were confirmed as M. tuberculosis RD Rio . All RD Rio strains shared the RD174 deletion, that was associated with isoniazid resistance (p=0.0264)., Conclusions: We documented for the first time the isolation of the LAM/RD Rio genotype in pulmonary cases of tuberculosis in Mexico, and we found resistance to the first-line anti-tuberculosis drug isoniazid in these strains., (Copyright © 2020 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Heart failure (HF) with recovered ejection fraction (EF) is emerging as a different HF subtype. There is little information about his clinical profile in hospitals that are not a reference., Methods: We analysed characteristics and prognosis in patients with recovered HF followed prospectively in the HF Unit of a non-tertiary hospital., Results: A total of 431 patients with HF with reduced EF were followed (median 50 months, 79.3% males, mean age 70.3±12.2years). Of the patients, 26.9% (N 116) recovered EF, mainly in the first year of follow-up (76.7%). Compared with patients that did not recovered EF in the follow-up, they were younger, rate of ischemic origin of cardiomyopathy was less frequent and presented less comorbidity. Mortality was lower in patients with recovered HF (survival median of 85.2±2.1 vs. 74.2±1.9 months [log-rank χ 2 11.5, P=0.001], hazard ratio 0.37, 95% confidence interval [CI]: 0.21-0.67, P=0.002). Aetiology of deaths was not mainly secondary to HF. Younger age of 68 years (odds ratio [OR] 0-98, 95% CI: 0.96-0,99; P=0.025), ischemic origin (OR 1.12, 95% CI: 1.01-1.21; P=0.003) and use of aldosterone antagonists (OR 1.89, 95% CI: 1.09-3.26; P=0.023) were the variables independently associated to normalisation of EF., Conclusion: HF with recovered EF is a frequent phenomenon. It has a more favourable clinical course, prognosis and basal characteristics than HF with persistent reduced EF. Further studies are needed to identify natural history and optimal medications for HF-recovered patients., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Background: HIV-immigrant use of health services and related cost has hardly been analysed. We compared resource utilisation patterns and direct health care costs between Spanish and immigrant HIV-infected patients., Methods: All HIV-infected adult patients treated during the years 2003-2005 (372 patients) in this hospital were included. We evaluated the number of out-patient, Emergency Room (ER) and Day-care Unit visits, and number and length of admissions. Direct costs were analysed. We compared all variables between immigrant and Spanish patients., Results: Immigrants represented 12% (n=43) of the cohort. There were no differences in the number of out-patient, ER, and day-care hospital visits per patient between both groups. The number of hospital admissions per patient for any cause was higher in immigrant than in Spanish patients, 1.3 (4.4) versus 0.9 (2.7), P=.034. A high proportion of visits, both for the immigrant (45.1%) and Spanish patients (43.0%), took place in services other than Infectious Diseases. Mean unitary cost per patient per admission, out-patient visits and ER visits were similar between groups. Pharmacy costs per year was higher in Spanish patients than in immigrants (7351.8 versus 7153.9 euros [year 2005], P=.012). There were no differences in the total cost per patient per year between both groups. The global distribution of cost was very similar between both groups; almost 75% of the total cost was attributed to pharmacy in both groups., Conclusions: There are no significant differences in health resource utilisation and associated costs between immigrant and Spanish HIV patients., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Tuberculosis (TB) is an infectious disease affecting people from all ages all over the world. It is estimated that one third of the world population lives infected with the causal agent: Mycobacterium tuberculosis. Despite availability and systematic administration of BCG vaccine in endemic areas, TB transmission remains elusive to control, partly because BGC efficacy has been shown to have wide variability (0-80%). Such variability in protection is attributed to factors including: the BCG strain used for immunization, pre-existing exposure to environmental saprophytic Mycobacterium species, and host genetic factors. In this context, efforts regarding to re-engineering BCG vaccines with the ability to prevent latent TB reactivation, providing long lasting protection, and devoid from collateral effects in immunosuppressed people are urgent. In this work we review the actual molecular «gene-by-gene» strategies aimed at generating BCG alternatives, and discuss the urgent necessity of high throughput technology methods for a rational design for a new TB vaccine., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Introduction: Acute cholecystitis treatment may initially be surgical or conservative with subsequent surgery; we reviewed the cases found in our centre, including their treatment and outcome., Material and Methods: We conducted a retrospective study of treatment in 178 patients with acute cholecystitis during one year. We evaluated variables associated with patient characteristics, as well as clinical data, diagnostic tests, treatment and outcome., Results: The majority (70.2%) was treated conservatively (group A), and 29.8% were operated on in the first 72 h (group B). In group A, 96 patients were treated with antibiotics, 15 with antibiotic therapy and cholecystectomy, and 12 with antibiotics and ERCP. In group B urgent laparoscopic cholecystectomy was performed in 60.4%, and 35.8% had open cholecystectomy. In group A, admission time was 11 days, with satisfactory progress in 79.2%, mortality rate of 5.6% and 10.7% of readmissions. In group B, operation time was 111 +/- 43 min, a mean of 8.7 days hospital stay, and 68% of cases did not require further treatment after surgery. Outcome was satisfactory in all but 7, there was no mortality in this group. We had a return rate of 2%., Conclusions: A significant proportion of conservative treatment was carried out at the expense of emergency surgery, although in absolute numbers conservative treatment seems to have a higher rate of complications, mortality and hospitalisation time.

Objective: To assess the results of percutaneous transparieto-hepatic dilation of benign biliary stenosis achieved over a period of 5 years., Design: A retrospective study to assess the technique, complications and the clinical, analytical and radiology results., Patients: Data was gathered on 13 patients diagnosed in our Hospital between the years 2002 and 2006 with benign biliary stenosis and who had been treated using percutaneous dilation. Patients diagnosed with malignant disease and those who had a prosthesis were excluded. Seven of the patients had received a liver transplant. One patient had an endoscopic dilation on two occasions, with the stenosis persisting., Results: A clinical and radiological improvement was observed in 60% of the cases, and an analytical improvement in 69% (61% normal). Re-stenosis occurred in 30% of the cases, of which 50% were rescue support using re-dilation. The complications presented (30.7%) were resolved conservatively. No significant differences were observed between the transplanted and the non-transplanted groups., Conclusions: Transparieto-hepatic dilation of benign biliary stenosis is a fairly safe technique and has a high rate of resolution in the medium term, and avoids the use of surgery in 75% of patients. The results need to be confirmed in larger samples., (Copyright 2009 AEC. Published by Elsevier Espana. All rights reserved.)

Introduction: The Bogota bag technique is a reliable method for open abdominal closure. The aim of this study was to describe our experience with this technique., Material and Method: We retrospectively evaluated our experience with the Bogota Bag technique between January 2000 and March 2006. Descriptive statistical techniques were applied and percentages and means were calculated., Results: The Bogota bag technique was applied in 12 patients. The technique was the preferred closure system to prevent abdominal compartment syndrome in 11 patients (91.66%) and was required to treat abdominal compartment syndrome in one patient (8.34%). No complications occurred in relation to placement or withdrawal of the Bogota bag. There were no intestinal fistulas or intra-abdominal abscesses. The mean length of hospital stay was 46.33 days and the mean length of stay in the intensive care unit was 16.58 days. The survival rate was 41.66%., Conclusions: In our experience, the Bogota bag is a useful technique and is the preferred closure system to prevent or treat abdominal compartment syndrome. The high mortality rates described are due to the underlying diseases leading to open abdominal closure and not directly to the Bogota bag technique itself.

Mycobacterium tuberculosis is the single most deadly microorganism worldwide. A third of the world population is thought to have latent tuberculosis and approximately 2 million people die of the disease each year. Short and closely supervised treatment regimens are needed, but it is also essential to develop new strategies to ensure prompt diagnosis of the disease. In particular, cheap methods are needed to tackle tuberculosis from a population perspective. The present article reviews the advances in immunology and molecular strategies for epidemiological diagnosis and monitoring of tuberculosis patients.

Background and Objective: There is scant data comparing the incidence of pneumonia in the community and in the human immunodeficiency virus (HIV) population in highly active antiretroviral therapy (HAART) era., Patients and Method: Prospective study during 18 months. Data were obtained by the means of the electronic clinical record. Incidence rate was compared between HIV positive and negative patients., Results: There were 529 pneumonia episodes in global population (n = 220,000), 1.6 cases/1000 person-year. HIV-infected patients (n = 170) suffered 12 episodes of pneumonia; 46 cases/1000 person-year (relative risk = 29.3, 95% confidence interval, 16.34-51.4; p < 0.01). HIV infected patients with pneumonia have a lower CD4 count (mean 434 versus 230 cells/ml; p = 0.04), higher viral load (4.1 versus 3.2 log copies/ml; p = 0.07) and received antiretroviral treatment in a similar proportion compared to HIV without pneumonia (62 versus a 66.7%, p = 0.5)., Conclusions: Pneumonia in HIV infected patients may be about 30 times more frequent than general population in HAART era. Prevention measures should be reinforced.