Analysis of the urine microbiological results and its impact on the protocol of the prophylaxis of the urology department in our area

Objetivos: Analizar cuáles son los microorganismos más frecuentemente aislados en los urinocultivos realizados en nuestro centro hospitalario. Estudiar el antibiograma de dichos gérmenes para definir cuál es la mejor profilaxis preoperatoria en la cirugía urológica en nuestro medio. Material y métodos: Se realizó un análisis retrospectivo de todos los urinocultivos de pacientes adultos recogidos en el Servicio de Microbiología de nuestro hospital durante el año 2015. La identificación y estudio de sensibilidad de los microorganismos aislados se realizó mediante el sistema automático Vitek 2 (BioMèrieux), seleccionando los antibióticos en función del microorganismo aislado. Se estudió el antibiograma comparándolo con las sugerencias recogidas en la última actualización de las Guías Europeas de Urología sobre infecciones urológicas, que recomiendan ampliamente el empleo de fluorquinolonas, cotrimoxazol, aminopenicilinas/betalactamasas y cefalosporinas en la cirugía limpia-contaminada, la más frecuente en nuestra actividad quirúrgica. Resultados: Se estudió un total de 11.987 muestras de orina, de las cuales 3.457 (28%) fueron positivas en la detección de microorganismos. Los más frecuentes aislados fueron Escherichia coli (46%%), Klebsiella pneumoniae (14%) y Enterococcus faecalis (11%). En el análisis de los antibiogramas se detectaron resistencias superiores al 30% en E.coli frente a los antibióticos recomendados en las Guías de referencia. De igual forma, E. faecalis, otro de los uropatógenos más frecuentes es intrínsecamente resistente a cefalosporinas. Conclusión: El empleo de guías clínicas con grados de recomendación es de vital importancia en la patología infecciosa urológica, debiéndose adecuar al entorno microbiológico de cada área. En nuestro caso, inferimos que tanto el empleo de amoxicilina-clavulánico como fosfomicina se perfilan como la mejor opción para la profilaxis preoperatoria en pacientes de bajo riesgo así, como para el manejo empírico en casos de infección urinaria.Object: To analyze which are the more often microorganism isolated in the urine cultures in our hospital. To study the antibiogram to define which is the best preoperative prophylaxis in our urological surgeries. Material and methods: We retrospective reviewed consecutive urine culture samples assembled in adult patients in the Service of Microbiology in our hospital during 2015. The identification and study of sensibility of the isolated microorganisms was realized by means of the automatic system Vitek 2 (BioMèrieux), selecting the antibiotics according to the isolated microorganism. The antibiogram was studied comparing the suggestions gathered in the last update of the European Guides of Urología in urological infections, that recommend employment extensively: fluoroquinolones, cotrimoxazole, aminopenicillins / beta-lactamases and cephalosporins in the clean-contaminated, most frequent surgery in our daily surgical practice. Results: In total 11.987 urine samples were evaluated, 3.457 (28%) were positive. The most frequent micro-organisms isolated were Escherichia coli (46%), Klebsiella pneumoniae (14%) and Enterococcus faecalis (11%). In the antibiogram analysis resistances was detected up to 30% in E. coli, opposite to the antibiotics recommendations in the Guides of reference. Even, E. faecalis, another of the most frequent uropathogens is intrinsically resistant to cefalosporins. Conclusions: The use of clinical guides with grade of recommendation it is of vital importance in the urological infection pathology, and they should be adapted to the microbiological environment of each area. In our case, we infer that the use of Amoxicillin-clavulanic and Fosfomycin are outlined like the best option for preoperative prophylaxis in low risk patients and for empirical handling in cases of urine infection

Atmospheric effects on extensive air showers observed with the Surface Detector of the Pierre Auger Observatory

Atmospheric parameters, such as pressure (P), temperature (T) and density, affect the development of extensive air showers initiated by energetic cosmic rays. We have studied the impact of atmospheric variations on extensive air showers by means of the surface detector of the Pierre Auger Observatory. The rate of events shows a ~10% seasonal modulation and ~2% diurnal one. We find that the observed behaviour is explained by a model including the effects associated with the variations of pressure and density. The former affects the longitudinal development of air showers while the latter influences the Moliere radius and hence the lateral distribution of the shower particles. The model is validated with full simulations of extensive air showers using atmospheric profiles measured at the site of the Pierre Auger Observatory.Comment: 24 pages, 9 figures, accepted for publication in Astroparticle Physic

Update on the correlation of the highest energy cosmic rays with nearby extragalactic matter

Data collected by the Pierre Auger Observatory through 31 August 2007 showed evidence for anisotropy in the arrival directions of cosmic rays above the Greisen-Zatsepin-Kuz'min energy threshold, \nobreak{$6\times 10^{19}$eV}. The anisotropy was measured by the fraction of arrival directions that are less than $3.1^\circ$ from the position of an active galactic nucleus within 75 Mpc (using the V\'eron-Cetty and V\'eron $12^{\rm th}$ catalog). An updated measurement of this fraction is reported here using the arrival directions of cosmic rays recorded above the same energy threshold through 31 December 2009. The number of arrival directions has increased from 27 to 69, allowing a more precise measurement. The correlating fraction is $(38^{+7}_{-6})$, compared with $21$ expected for isotropic cosmic rays. This is down from the early estimate of $(69^{+11}_{-13})$. The enlarged set of arrival directions is examined also in relation to other populations of nearby extragalactic objects: galaxies in the 2 Microns All Sky Survey and active galactic nuclei detected in hard X-rays by the Swift Burst Alert Telescope. A celestial region around the position of the radiogalaxy Cen A has the largest excess of arrival directions relative to isotropic expectations. The 2-point autocorrelation function is shown for the enlarged set of arrival directions and compared to the isotropic expectation.Comment: Accepted for publication in Astroparticle Physics on 31 August 201

Operations of and Future Plans for the Pierre Auger Observatory

Technical reports on operations and features of the Pierre Auger Observatory, including ongoing and planned enhancements and the status of the future northern hemisphere portion of the Observatory. Contributions to the 31st International Cosmic Ray Conference, Lodz, Poland, July 2009.Comment: Contributions to the 31st ICRC, Lodz, Poland, July 200

Salt Reduction Initiatives around the World – A Systematic Review of Progress towards the Global Target

Objective To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025. Methods A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework. Results A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt. Conclusion The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake

Measurement of the Depth of Maximum of Extensive Air Showers above 10^18 eV

We describe the measurement of the depth of maximum, Xmax, of the longitudinal development of air showers induced by cosmic rays. Almost four thousand events above 10^18 eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106 +35/-21) g/cm^2/decade below 10^(18.24 +/- 0.05) eV and (24 +/- 3) g/cm^2/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm^2. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.Comment: Accepted for publication by PR

The Fluorescence Detector of the Pierre Auger Observatory

The Pierre Auger Observatory is a hybrid detector for ultra-high energy cosmic rays. It combines a surface array to measure secondary particles at ground level together with a fluorescence detector to measure the development of air showers in the atmosphere above the array. The fluorescence detector comprises 24 large telescopes specialized for measuring the nitrogen fluorescence caused by charged particles of cosmic ray air showers. In this paper we describe the components of the fluorescence detector including its optical system, the design of the camera, the electronics, and the systems for relative and absolute calibration. We also discuss the operation and the monitoring of the detector. Finally, we evaluate the detector performance and precision of shower reconstructions.Comment: 53 pages. Submitted to Nuclear Instruments and Methods in Physics Research Section