Artículos de revista (Fac. Medicina)
Permanent URI for this collectionhttps://hdl.handle.net/10171/70259
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- Study on the compatibility of a treated effluent from automobile industry with conventional municipal activated sludge process(Springer Nature, 2024) Peñas-Esteban, F.J. (Francisco Javier); Vitas, A.I. (Ana Isabel)The on-site-treated effluent from an automobile manufacturing company is discharged into the public sewage system for further treatment. However, the upgrade of the treatment plant to reduce the effluent pollutant load led to the discharge limit for phenols being occasionally exceeded. The concern of the water authority prompted a study to investigate whether the toxicity of phenols could affect the performance of the receiving municipal wastewater treatment plant. To this end, mixtures of the industrial effluent and synthetic municipal wastewater were tested in a laboratory-scale activated sludge system. The bioreactor was fed with increasing ratios of the industrial wastewater in the combined influent (from 10 to 50%) over 7 months. No significant differences were observed in the system performance fed only with the synthetic wastewater (during the acclimation stage) or with the industrial wastewater. The bioreactor achieved average removal efficiencies of 70% for phenols even when half of the combined influent was the industrial wastewater. Bearing in mind the question of phenols, an important drawback was the high uncertainty in their determination by the conventional phenol index method due to the matrix effect. To overcome this a spectrophotometric procedure based on the serial dilutions of each pair of influent and effluent samples has been developed. Although strong microbial selection was observed by the changing bioreactor environment, the industrial effluent was found to be fully compatible with further treatment by conventional activated sludge process.
- Cross contamination of Escherichia coli O157:H7 in fresh-cut leafy vegetables: Derivation of a food safety objective and other risk management metrics(Elsevier, 2023) Sin Autoridad; Díez-Leturia, M. (María); González, D. (David); Vitas, A.I. (Ana Isabel); Pérez-Rodríguez-Urrutia, F. (Fernando)In the present study, the cross contamination and distribution of Escherichia coli O157:H7 was investigated in fresh-cut lettuce by simulating a commercial process at a pilot plant scale with different initial inoculum levels. A deterministic approach was used to derive a potential Food Safety Objective (FSO) for the studied pathogen. The experimental outcomes, together with literature data, were used to develop a probabilistic exposure model for E. coli O157:H7 to elucidate potential risk management metrics, i.e., Performance Objectives (POs) and a Performance Criterion (PC) at specific process steps within the food chain of fresh-cut leafy vegetables. The proposed FSO was estimated to be −6.0 log CFU/g for E. coli O157:H7 at consumption. The experimental results indicated that the pathogen could cross contaminate most of the samples in a lot at the different contamination levels tested (1-7 log CFU/g) resulting in a homogeneous distribution of E. coli O157:H7 in fresh-cut lettuce after processing. Based on the modelling results, the average concentration estimated as PO in unprocessed lettuce should be −5.8 log CFU/g to meet the proposed FSO. On the other hand, the PO established after washing and packaging (processed lettuce) showed a lower value, with −6.8 log CFU/g E. coli O157:H7. Reduction levels during the washing or disinfection step estimated as the PC should be > 2.9 log CFU/g. The establishment of PC for the washing step, assisted by the use of disinfection process indicators (e.g., generic E. coli), could be considered as a suitable measure to reach the FSO in fresh-cut leafy vegetables. The suggested POs and PC would help food businesses and authorities to establish safety targets and corrective actions to reduce the number of potentially contaminated lettuce lots on the market, thus reducing the number of E. coli O157:H7 infections.
- Clonal Complexes 23, 10, 131 and 38 as Genetic Markers of the Environmental Spread of Extended-Spectrum β-Lactamase (ESBL)-Producing E. coli(MDPI, 2022) Pérez-Etayo, L. (Lara); González, D. (David); Vitas, A.I. (Ana Isabel)In accordance with the global action plan on antimicrobial resistance adopted by the World Health Assembly in 2015, there is a need to develop surveillance programs for antimicrobial resistant bacteria. In this context, we have analyzed the clonal diversity of Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) isolated from aquatic environments and human and food samples in Spain, with the aim of determining possible clonal complexes (CCs) that act as markers of the potential risk of transmission of these resistant bacteria. The phylogenetic groups, sequence types (STs) and CCs were determined by different Polymerase Chain Reaction (PCR) and Multilocus Sequence Typing (MLST) techniques. Phylogroup A was prevalent and was mainly present in food and water strains, while human strains were mostly associated with phylogroup B2. According to the observed prevalence in the different niches, CC23 and CC10 are proposed as markers of phylogroups A and C, related with the spread of blaCTX-M1 and blaCTX-M15 genes. Similarly, CC131 and CC38 could be associated to the dissemination of pathogenic strains (phylogroups B2 and D) carrying mainly blaCTX-M14 and blaCTX-M15 genes. Some strains isolated from wastewater treatment plants (WWTPs) showed identical profiles to those isolated from other environments, highlighting the importance that water acquires in the dissemination of bacterial resistance. In conclusion, the detection of these genetic markers in different environments could be considered as an alert in the spread of ESBL.
- Antibacterial Activity of Kaolin–Silver Nanomaterials: Alternative Approach to the Use of Antibiotics in Animal Production(MDPI, 2021) Pérez-Etayo, L. (Lara); González, D. (David); Leiva, J. (José); Díez-Leturia, M. (María); Sin Autoridad; Vitas, A.I. (Ana Isabel)According to the search for alternatives to replace antibiotics in animal production suggested in the antimicrobial resistance action plans around the world, the objective of this work was to evaluate the bactericidal effect of kaolin–silver nanomaterial for its possible inclusion as an additive in animal feed. The antibacterial activity of the C3 (kaolin–silver nanomaterial) product was tested against a wide spectrum of Gram-negative and Gram-positive bacteria (including multidrug resistant strains) by performing antibiograms, minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC), as well as growth inhibition curves against seven strains causing infections in animals. The C3 product generated inhibition halos in all the tested strains, and a higher activity against Gram-negative bacteria was found, with MBC values ranged from 7.8 µg/mL (P. aeruginosa) to 15.6 µg/mL (E. coli and Salmonella). In contrast, it was necessary to increase the concentration to 31.3 µg/mL or 250 µg/mL to eliminate 99.9% of the initial population of S. aureus ATCC 6538 and E. faecium ATCC 19434, respectively. Conversely, the inhibition growth curves showed a faster bactericidal activity against Gram-negative bacteria (between 2 and 4 h), while it took at least 24 h to observe a reduction in cell viability of S. aureus ATCC 6538. In short, this study shows that the kaolin–silver nanomaterials developed in the framework of the INTERREG POCTEFA EFA183/16/OUTBIOTICS project exhibit antibacterial activity against a wide spectrum of bacteria. However, additional studies on animal safety and environmental impact are necessary to evaluate the effectiveness of the proposed alternative in the context of One Health.
- Highlighting the interplay of microRNAs from Leishmania parasites and infected-host cells(Cambridge University Press, 2021) Carrera-Silva, E.A. (Eugenio Antonio); Ali-Hassanzadeh, M. (Mohammad); Ghani, E. (Esmaeel); Karimazar, M. (Mohammadreza); Mansouri, R. (Reza); Barazesh, A. (Afshin); Nguewa, P.A. (Paul Alain); Rashidi, S. (Sajad)Leishmania parasites, the causative agents of leishmaniasis, are protozoan parasites with the ability to modify the signalling pathway and cell responses of their infected host cells. These parasite strategies alter the host cell environment and conditions favouring their replication, survival and pathogenesis. Since microRNAs (miRNAs) are able to post-transcriptionally regulate gene expression processes, these biomolecules can exert critical roles in controlling Leishmania-host cell interplay. Therefore, the identification of relevant miRNAs differentially expressed in Leishmania parasites as well as in infected cells, which affect the host fitness, could be critical to understand the infection biology, pathogenicity and immune response against these parasites. Accordingly, the current review aims to address the differentially expressed miRNAs in both, the parasite and infected host cells and how these biomolecules change cell signalling and host immune responses during infection. A deep understanding of these processes could provide novel guidelines and therapeutic strategies for managing and treating leishmaniasis.
- Nutritional and culinary habits to empower families (n-CHEF): a feasibility study to increase consumption and home cooking of plant-based foods(Cambridge University Press, 2024) Simonin, L. (Luca); Goñi, L. (Leticia); Kury-Guzman, I. (Isabella); Ruiz-Canela, M. (Miguel); Martín‐Calvo, N. (Nerea); Rovayo, A. (Anacristina)Objective: To analyse the feasibility and acceptability of a culinary nutritional intervention aimed at increasing plant-based foods consumption in the context of the Mediterranean diet in parent-child dyads. Design: The Nutritional and Culinary Habits to Empower Families (n-CHEF) is a 9-month feasibility study that included four culinary nutritional workshops (two face to face, two online) led by a chef and a dietitian-nutritionist. These workshops combined cooking with plant-based foods, with nutritional advice and experimental activities. The main outcomes were retention, quality of the intervention (monitoring workshops, acceptability and perceived impact) and changes in dietary and cooking habits. Setting: Parent-child dyads, Spain. Participants: Parent-child (aged 10-14 years) dyads. Results: Fifteen parent-child dyads were recruited, of which thirteen were retained during the 6-month follow-up. All but one parent-child dyads attended the four workshops. The overall assessment of the workshops was positive, although the online workshops were rated lower than the face to face. In general, parent-child dyads reported benefits in terms of nutrition and cooking aspects. Parents significantly increased their adherence to the Mediterranean diet, but non-significant changes were observed in children. However, children increased their consumption of vegetables and legumes and reduced snacks and ready meals. Parents also changed some of their culinary habits and increased their confidence in cooking at home. Conclusions: The n-CHEF showed that the culinary nutritional intervention had good levels of recruitment, retention and acceptability among parent-child dyads. In addition, dietary and culinary knowledge and habits can be improved, although further studies are needed to know the long-term effects in larger populations.
- Impact of a longitudinal course on medical professionalism on the empathy of medical students(Elsevier, 2024) García-del-Barrio, L. (Loreto); Rodriguez-Diez, M.C. (María Cristina); Arbea, L. (Leire); Diez-Goñi, N. (Nieves); Gea, A. (Alfredo); Pereira, J. (José)Objective: Medical education should enhance empathy. We examined, using self-assessment instruments and standardized patients (SPs), the impact on empathy, of a multi-year intervention (years 4–6 of medical training) that uses reflective learning approaches. Methods: 241 final-year medical students participated; 110 from the 2018 graduation class (non-intervention group) and 131 from the 2019 graduation class (intervention group). Participants completed two self-reported empathy questionnaires – the Jefferson Scale of Empathy-Students (JSE-S) and the Interpersonal Reactivity Index (IRI) – and a personality questionnaire, the NEO Five-Factor Inventory. Additionally, SPs in a simulated station assessed participants’ empathy with two patient-reported instruments: the Consultation and Relational Empathy (CARE) scale and the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). Results: Empathy scores were significantly higher in the intervention group compared to the non-intervention group when assessed by the SP (p < 0.001). No differences were found in self-reported questionnaires between the two groups. Conclusion: A longitudinal, multi-year reflection-based intervention enhanced empathy amongst medical students as assessed by SPs, but not when assessed by student self-reported measures. Practice Implications: Multi-year reflective learning interventions during clinical training nurture empathy in medical students. Assessments completed by SPs or patients may enhance the evaluation of empathy.
- Predicted vitamin D levels and risk of depression in the SUN Project: A prospective cohort study(Elsevier, 2024) Martinez-Gonzalez, M.A. (Miguel Ángel); Pons-Izquierdo, J.J. (Juan José); Bes-Rastrollo, M. (Maira); Silva-Sabiao, T. (Thaís) da; Cardoso-Carraro, J.C. (Julia Cristina); Sanchez-Villegas, A. (Almudena); Valer-Martínez, A. (Ana); Sayon-Orea, C. (Carmen)The current study aimed to investigate the association between predicted vitamin D status and depression in a prospective Spanish cohort of university graduates. The SUN Project is a dynamic cohort study designed to investigate multiple aspects of health and lifestyle. Participants were asked to complete a comprehensive questionnaire consisting of 556 items, that included a validated food-frequency questionnaire. Participants initially free of depression were classified as incident cases if they reported a medical diagnosis of depression during follow-up. Serum vitamin D levels were predicted by a previously validated equation. Vitamin D deficiency was defined as vitamin D levels below 20 ng/mL. Cox models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). We included 15,175 Spanish university graduates [mean (SD) age: 36.9 year (11.5)] followed-up for a median of 12.7 years. Among 192,976 person-years of follow-up, we identified 753 incident cases of depression. Participants with vitamin D deficiency had a 27% higher risk of depression as compared to those with vitamin D sufficiency (HR: 1.27, 95% CI: 1.09–1.48; p = 0.002) after adjusting for potential confounders. Furthermore, a significant effect modification by female sex was observed with higher depression risks associated with vitamin D deficiency in women than in men (p for interaction = 0.034). In educated middle-aged Spanish adults, we observed a direct association between vitamin D deficiency and the risk of depression, that was stronger among women.
- Macronutrient quality and its association with micronutrient adequacy in children(Elsevier, 2024) Martinez-Gonzalez, M.A. (Miguel Ángel); García-Blanco, L. (Lorena); Zazpe, I. (Itziar); Martín‐Calvo, N. (Nerea); De-la-O-Pascual, V. (Víctor); Fabios, E. (Elise)Background & aims: The double burden of malnutrition compels us to reconsider macronutrients from a diet quality perspective. The Macronutrient Quality Index (MQI) has been designed to reflect overall macronutrient quality and is based on three sub-indexes: the carbohydrate quality index (CQI), the healthy plate protein quality index (HPPQI) and the fat quality index (FQI). Nutritional adequacy is an essential aspect of diet quality that should be captured by reliable dietary indexes. Methods: We analyzed the association between the Macronutrient Quality Index (MQI) and micronutrient adequacy. Participants were children aged 4 and 5 years, recruited in the SENDO cohort. Baseline information was collected through a self-administered online questionnaire, which included information on sociodemographic, dietary, and lifestyle variables. Dietary information was obtained using a 147-item validated semi-quantitative food frequency questionnaire. Participants were categorized into tertiles based on their MQI score. We evaluated the intake of 20 micronutrients and assessed the probability of micronutrient adequacy using the Estimated Average Requirement cut-off point. Results: Children in the highest tertile of MQI had 0.33-fold lower odds (95%CI 0.17e0.66) of having 3 inadequate micronutrient intakes than their peers in the lowest tertile, after adjusting for potential confounders. The adjusted proportions of children with inadequate intake of 3 micronutrients were 18%, 14% and 11% in the first, second, and third tertiles of MQI respectively. The MQI appears to be capable of capturing nutrient adequacy in children, although our results suggest that a modified MQI, with eggs and dairy products weighted positively, might be more adequate for the pediatric population.
- Association between pre-conceptional carbohydrate quality index and the incidence of gestational diabetes: the SUN cohort study(Cambridge University Press on behalf of The Nutrition Society, 2023) Martinez-Gonzalez, M.A. (Miguel Ángel); Bes-Rastrollo, M. (Maira); Santiago, S. (Susana); Fernández-González, E. (Elena); Suescun-Elizalde, D. (David); Gea, A. (Alfredo); Basterra-Gortari, F.J. (Francisco Javier)The aim of the study was to investigate the association between pre-gestational carbohydrate quality index (CQI) and the incidence of gestational diabetes mellitus (GDM). Data from the ‘Seguimiento Universidad de Navarra’ (SUN) cohort were used, which includes 3827 women who notified at least one pregnancy between December 1999 and December 2019. We used a validated semicuantitative 136-item FFQ to evaluate dietary exposures at baseline and at 10-year follow-up. The CQI was defined by four criteria: glycaemic index, whole-grain/total-grain carbohydrate, dietary fibre intake and solid/total carbohydrate ratio. We fitted generalised estimating equations with repeated measurements of the CQI to assess its relationship with incident GDM. A total of 6869 pregnancies and 202 new cases of incident GDM were identified. The inverse association between the global quality of carbohydrate and the development of GDM was not statistically significant: OR the highest v. the lowest CQI category: 0·67, 95 % CI (0·40, 1·10), Pfor trend = 0·10. Participants at the highest CQI category and with daily carbohydrate amounts ≥50 % of total energy intake had the lowest incidence of GDM (OR = 0·29 (95 % CI (0·09, 0·89)) compared with those with the lowest quality (lowest CQI) and quantity (≤40 %). Further studies are needed to overcome the limitations of our study. Those studies should jointly consider the quality and the quantity of dietary carbohydrates, as the quality might be of importance, especially in women with a higher intake of carbohydrates.