José Ángel García Rodríguez

Tratamiento de las infecciones fúngicas en pacientes con neoplasias hematológicas

La Asociación Española de Hematologı́a y Hemoterapia (AEHH) y la Sociedad Española de Quimioterapia (SER) publicaron en el año 2002 el primer Documento de Consenso sobre Profilaxis y Tratamiento de las Infecciones Fúngicas en el Paciente Oncohematológico. Desde entonces se ha producido una serie de avances importantes en aspectos determinantes de la elección del tratamiento antifúngico. Estos progresos incluyen: a) la introducción de pautas de profilaxis con triazoles (posaconazol, voriconazol) activos frente a Aspergillus spp.; b) el desarrollo de técnicas más sensibles para el diagnóstico de la infección fúngica invasiva como detección del antı́geno galactomanano (AGA), la detección del glucano o el empleo de la tomografı́a computarizada (TC) torácica de alta resolución; c) la introducción en terapéutica de nuevos antifúngicos activos frente Aspergillus spp. (posaconazol, anidulafungina, micafungina), y d) la creciente experiencia clı́nica en el manejo de la infección fúngica invasiva, procedente de los ensayos de fase III y de estudios poscomercialización. En su conjunto, estos adelantos justifican que, 5 años después de la primera publicación, los miembros de ambas sociedades que participaron en la elaboración del primer consenso hayan revisado y actualizado las recomendaciones a la luz de los nuevos conocimientos. En el presente documento se describen sólo las indicaciones y pautas de tratamiento antifúngico empı́rico o definitivo. Las indicaciones y pautas de profilaxis, por su extensión, se exponen en otro documento. Las recomendaciones se han definido de

Conferencia de ConsensoTratamiento de las infecciones fúngicas en pacientes con neoplasias hematológicasTreatment of fungal infections in patients with hematologic neoplasia

La Asociación Española de Hematologı́a y Hemoterapia (AEHH) y la Sociedad Española de Quimioterapia (SER) publicaron en el año 2002 el primer Documento de Consenso sobre Profilaxis y Tratamiento de las Infecciones Fúngicas en el Paciente Oncohematológico. Desde entonces se ha producido una serie de avances importantes en aspectos determinantes de la elección del tratamiento antifúngico. Estos progresos incluyen: a) la introducción de pautas de profilaxis con triazoles (posaconazol, voriconazol) activos frente a Aspergillus spp.; b) el desarrollo de técnicas más sensibles para el diagnóstico de la infección fúngica invasiva como detección del antı́geno galactomanano (AGA), la detección del glucano o el empleo de la tomografı́a computarizada (TC) torácica de alta resolución; c) la introducción en terapéutica de nuevos antifúngicos activos frente Aspergillus spp. (posaconazol, anidulafungina, micafungina), y d) la creciente experiencia clı́nica en el manejo de la infección fúngica invasiva, procedente de los ensayos de fase III y de estudios poscomercialización. En su conjunto, estos adelantos justifican que, 5 años después de la primera publicación, los miembros de ambas sociedades que participaron en la elaboración del primer consenso hayan revisado y actualizado las recomendaciones a la luz de los nuevos conocimientos. En el presente documento se describen sólo las indicaciones y pautas de tratamiento antifúngico empı́rico o definitivo. Las indicaciones y pautas de profilaxis, por su extensión, se exponen en otro documento. Las recomendaciones se han definido de

Risk Factors Associated with Colonization by Pneumococci with Reduced Susceptibility to Fluoroquinolones in Adult Outpatients

ABSTRACT We developed a case-control study in order to identify risk factors associated with pharyngeal colonization by Streptococcus pneumoniae with reduced susceptibility to fluoroquinolones (ciprofloxacin MIC, ≥4 μg/ml). A total of 400 patients were studied for colonization by quinolone-nonsusceptible S. pneumoniae (QNSP) isolates and risk factors for this colonization. Isolate susceptibility was determined by the agar dilution method. Forty patients were colonized by QNSP (case patients), and 360 patients were not colonized by QNSP (control patients). The MIC range of ciprofloxacin for QNSP isolates was 4 to 8 μg/ml. No isolates were resistant to levofloxacin and moxifloxacin. Risk factors significantly associated with QNSP colonization, according to univariate analysis, were recent hospitalizations (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.6 to 7.2; P < 0.01) and prior exposure to fluoroquinolones (OR, 6.04; 95% CI, 3.0 to 12.0; P < 0.01). Other factors such as chronic obstructive pulmonary disease (OR, 1.94; 95% CI; 0.7 to 5.0), prior exposure to penicillins (OR, 1,68; 95% CI, 0.8 to 3.3) and prior exposure to macrolides (OR 2; 95% CI, 0.6 to 6.2) were more frequent among patients colonized with QNSP, but there was no statistical significance. Multivariate analysis showed that exposure to fluoroquinolones was the only independent factor associated with colonization by QNSP (OR, 4.2; 95% CI, 1.8 to 9.4; P < 0.01). Throat colonization by QNSP is becoming frequent, though most of these isolates (all the isolates in this case) remain susceptible to newer fluoroquinolones. Previous treatment with fluoroquinolones seems to be the main risk factor associated with colonization by QNSP.

Raman laser spectrometer optical head: flight model performance verification

In the framework of the ESA’s Aurora Exploration Programme and, in particular, of the ExoMars mission, the Raman Laser Spectrometer (RLS) will be in charge of performing out planetary Raman spectroscopy for the first time. The instrument is located inside the Rover at the Analytical Drawer (ALD) and will analyze powdered samples obtained from the Martian subsurface in order to determine the geochemistry content and elemental composition of the minerals under study. After the RLS instrument successful qualification, the Flight Model (FM) development and the acceptance verification activities started. Among the different units RLS is composed on, i.e. its three main units that are interconnected by optical fibers and electrical harness, iOH (Internal Optical Head), SPU (Spectrometer Unit) and ICEU (Instrument control and Excitation Unit) which also contains the Raman excitation laser diode, iOH FM information can be found in this paper. RLS iOH unit is in charge of focusing the Raman excitation signal onto the sample, receiving the Raman signal emitted by the sample and focusing this signal in the output optical fiber that is directly connected to SPU unit. As for the rest of RLS instrument FM subunits, and before their final assembly and system level tests, RLS iOH FM exhaustive and complete characterization process was carried out, not only at room conditions but also at relevant environmental conditions: vacuum condition along the operational temperature range with acceptance margins (from -50 to 8ºC). In this paper, and after to carry out the RLS iOH FM proper integration and alignment process, the activities accomplished during the performance verification and the obtained results are reported on

Embolismo paradójico como causa de trombosis precoz de fístula arteriovenosa para hemodiálisis

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Parametric DC and noise measurements in a unified test & characterization software tool framework

Testing and characterization are fundamental tasks in any semiconductor manufacturing or circuit development activity. These activities call for flexible, yet efficient tools that allow for automated execution. This paper describes the development of an independent Testing Development Environment (TDE) as a platform for designing testing and characterization procedures for use in a production line setting. The proposed platform supports DC, parametric, and noise measurement capabilities in a modular, designer customizable library of testing functions. The platform structure, customization protocols, and I/O formats are discussed, along with the process of populating its function library with procedures for evaluating passive and active devices with diverse requirements and formats. Over four dozen testing procedures have been added to the tool. User-level interactions are used to illustrate the easiness of use and flexibility of this platform.