Comparing BIS Monitoring vs. Clinical Assessment for Deep Sedation in the ICU: Effects on Delirium Reduction and Sedative Drug Doses - A randomized trial.

BACKGROUND: Sedative overdoses pose a delirium risk among Intensive Care Unit (ICU) patients, with potential mitigation through the use of a processed EEG monitor (BIS) to guide depth of sedation. RESEARCH QUESTION: Can BIS-guided deep sedation (RASS -4, -5) reduce sedative dosage and increase delirium-free and coma-free (DFCF) days? STUDY DESIGN AND METHODS: A randomized controlled trial was conducted in a tertiary mixed ICU, enrolling patients requiring deep sedation for >8 hours. Patients were randomly assigned to either the Clinical Assessment (CA) or BIS groups (BIS range of 40-60). Both groups utilized a BIS sensor, while the CA group's screen remained covered. After deep sedation, BIS sensors were removed, and delirium was assessed twice daily by researchers blinded to the randomization. The primary outcome was the number of DFCF days within 14 days after deep sedation. Additionally, we compared doses of sedative drugs and BIS values during deep sedation. RESULTS: Ninety-nine patients were included in the study. We found no significant difference in DFCF (p=0.1) between CA and BIS arms, but propofol doses were significantly lower in the BIS group (CA group 1.77 mg/kg/hr [95% CI 1.60, 1.93] vs. BIS group 1.44 mg/kg/hr [95% CI 1.04, 1.83]; p=0.03). During deep sedation, the CA group spent 46% of the total hours (95% CI 35, 57%) with BIS values below 40, whereas the BIS group spent 32% (95% CI 25, 40%), (p=0.03). Subgroup analysis focusing on patients sedated for more than 24 hours revealed an increase in DFCF in the BIS group (CA group median of 1 day [IQR 0, 9] vs. BIS group 8 days [IQR 0, 13]; p=0.04). INTERPRETATION: BIS-guided deep sedation did not improve DFCF days but reduced sedative drug use. In patients requiring sedation for more than 24 hours, it showed an improvement in DFCF days.

A microphysiological system for handling graphene related materials under flow conditions.

The field of nanotechnology has developed rapidly in recent decades due to its broad applications in many industrial and biomedical fields. Notably, 2D materials such as graphene-related materials (GRMs) have been extensively explored and, as such, their safety needs to be assessed. However, GRMs tend to deposit quickly, present low stability in aqueous solutions, and adsorb to plastic materials. Consequently, traditional approaches based on static assays facilitate their deposition and adsorption and fail to recreate human physiological conditions. Organ-on-a-chip (OOC) technology could, however, solve these drawbacks and lead to the development of microphysiological systems (MPSs) that mimic the microenvironment present in human tissues. In light of the above, in the present study a microfluidic system under flow conditions has been optimised to minimise graphene oxide (GO) and few-layer graphene (FLG) adsorption and deposition. For that purpose, a kidney-on-a-chip was developed and optimised to evaluate the effects of exposure to GO and FLG flakes at a sublethal dose under fluid flow conditions. In summary, MPSs are an innovative and precise tool for evaluating the effects of exposure to GRMs and other type of nanomaterials.

MoS2 2D materials induce spinal cord neuroinflammation and neurotoxicity affecting locomotor performance in zebrafish.

MoS2 nanosheets belong to an emerging family of nanomaterials named bidimensional transition metal dichalcogenides (2D TMDCs). The use of such promising materials, featuring outstanding chemical and physical properties, is expected to increase in several fields of science and technology, with an enhanced risk of environmental dispersion and associated wildlife and human exposures. In this framework, the assessment of MoS2 nanosheets toxicity is instrumental to safe industrial developments. Currently, the impact of the nanomaterial on the nervous tissue is unexplored. In this work, we use as in vivo experimental model the early-stage zebrafish, to investigate whether mechano-chemically exfoliated MoS2 nanosheets reach and affect, when added in the behavioral ambient, the nervous system. By high throughput screening of zebrafish larvae locomotor behavioral changes upon exposure to MoS2 nanosheets and whole organism live imaging of spinal neuronal and glial cell calcium activity, we report that sub-acute and prolonged ambient exposures to MoS2 nanosheets elicit locomotor abnormalities, dependent on dose and observation time. While 25 µg mL-1 concentration treatments exerted transient effects, 50 µg mL-1 ones induced long-lasting changes, correlated to neuroinflammation-driven alterations in the spinal cord, such as astrogliosis, glial intracellular calcium dysregulation, neuronal hyperactivity and motor axons retraction. By combining integrated technological approaches to zebrafish, we described that MoS2 2D nanomaterials can reach, upon water (i.e. ambient) exposure, the nervous system of larvae, resulting in a direct neurological damage.

Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis.

OBJECTIVE: To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock. DESIGN: Retrospective cohort study. SETTING: Two intensive care units in Argentina. PATIENTS: Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24h of the AKI diagnosis. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis. RESULTS: 80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC=0.52, p=0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60-0.83; p=0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57-0.80; p=0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%. CONCLUSIONS: urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.

A sportomics soccer investigation unveils an exercise-induced shift in tyrosine metabolism leading to hawkinsinuria.

Tyrosine metabolism has an intense role in the synthesis of neurotransmitters. Our study used an untargeted, sportomics-based analysis of urine samples to investigate changes in metabolism during a soccer match in 30 male junior professional soccer players. Samples were collected before and after the match and analyzed using liquid chromatography and mass spectrometry. Results showed significant changes in tyrosine metabolism. Exercise caused a downregulation of the homogentisate metabolites 4-maleylacetoacetate and succinylacetone to 20% (p = 4.69E-5) and 16% (p = 4.25E-14), respectively. 4-Hydroxyphenylpyruvate, a homogentisate precursor, was found to be upregulated by 26% (p = 7.20E-3). The concentration of hawkinsin and its metabolite 4-hydroxycyclohexyl acetate increased ~six-fold (p = 1.49E-6 and p = 9.81E-6, respectively). Different DOPA metabolism pathways were also affected by exercise. DOPA and dopaquinone increased four-to six-fold (p = 5.62E-14 and p = 4.98E-13, respectively). 3-Methoxytyrosine, indole-5,6-quinone, and melanin were downregulated from 1 to 25%, as were dopamine and tyramine (decreasing to up to 5% or 80%; p= 5.62E-14 and p = 2.47E-2, respectively). Blood TCO2 decreased as well as urinary glutathione and glutamate (40% and 10% respectively) associated with a two-fold increase in pyroglutamate. Our study found unexpected similarities between exercise-induced changes in metabolism and the inherited disorder Hawkinsinuria, suggesting a possible transient condition called exercise-induced hawkinsinuria (EIh). Additionally, our research suggests changes in DOPA pathways may be involved. Our findings suggest that soccer exercise could be used as a model to search for potential countermeasures in Hawkinsinuria and other tyrosine metabolism disorders.

Epidemiologic characteristics and clinical features of patients with monkeypox virus infection from a hospital in Peru between July and September 2022.

OBJECTIVES: Monkeypox (Mpox) recent outbreak has changed in terms of predominant transmission route and typical presentation. Describing current epidemiological and clinical characteristics is crucial to identifying cases and halting transmission. METHODS: An observational study was conducted at a Peruvian tertiary-level hospital and included all individuals with Mpox virus infection between July 01 and September 03, 2022. RESULTS: Among 205 confirmed cases, 99% (202/205) were men, 94% (192/205) were men who have sex with men or bisexual, and 66% (136/205) were living with HIV. Regarding sexual behavior, 87% (179/205) had a sexual encounter 21 days before consultation, although only 8% (17/205) identified sexual contact with a Mpox confirmed case; 65% (133/205) had sexual intercourse with casual partners, 55% (112/205) reported a last sexual partner unknown, and 21.5% (44/205) continued having sexual intercourse with symptoms. Systemic symptoms were fever (162/205, 79%), malaise (123/205, 60%), headache (119/205, 58%), fatigue (105/205, 52%), and lymphadenopathy (111/205, 54%). The distribution of skin lesions was generalized (166/205, 81%), located in the anogenital area (160/205, 78%), polymorphic (174/205, 85%), and it was the first symptom identified in 46% (94/205) of cases. Overall, 10% (21/205) required hospitalization, of whom 85.7% (18/205) have HIV infection. Complications included bacterial superinfection (n = 18), proctitis (n = 6), balanitis (n = 4), and necrosis of skin lesions (n = 3). CONCLUSION: In 2022, Mpox mainly affects men who have sex with men and People living with HIV/AIDS. It presents with skin lesions localized to the anogenital area and can lead to severe complications requiring hospitalization.

Mpox in people with advanced HIV infection: a global case series.

BACKGROUND: People living with HIV have accounted for 38-50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm3). METHODS: A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm3 or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive. FINDINGS: We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30-43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117-291) cells per mm3, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm3 and 94 (25%) with 100-200 cells per mm3. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm3 than in those with more than 300 cells per mm3, including necrotising skin lesions (54% vs 7%), lung involvement (29% vs 0%) occasionally with nodules, and secondary infections and sepsis (44% vs 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. Among people with CD4 counts of less than 200 cells per mm3, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance. INTERPRETATION: A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. FUNDING: None.

Alactic base excess is an independent predictor of death in sepsis: A propensity score analysis.

PURPOSE: Alactic base excess (ABE) is a novel biomarker defined as the sum of lactate and standard base excess and estimates the renal capability of handling acid-base disturbances in sepsis. The objective of this study is to see if ABE is an independent predictor of mortality in septic patients with and without renal dysfunction. MATERIALS AND METHODS: We retrospectively studied 1178 patients with sepsis and septic shock. Patients were divided according to ABE values: 1) negative ABE (<-3 mmol/L); 2) neutral ABE (≥ - 3 and < 4 mmol/L); and 3) positive ABE (≥4 mmol/L). The effect of ABE on mortality was evaluated using Cox regression weight by inverse probability weighting (IPWT) analysis after propensity score assessment. Additionally, we performed a stratified analysis in patients with GFR > 60 mL/min/1.73 m2. RESULTS: Negative ABE patients had higher mortality than patients with neutral ABE (adjusted HR 1.43; 95%CI 1.02-2.01). Also, in patients with GFR > 60 mL/min/1.73 m2 (n = 493), we observed higher mortality in patients with negative ABE (adjusted HR 2.43; 95%CI 1.07-5.53). CONCLUSIONS: Negative ABE is an independent predictor of in-hospital mortality in septic patients with and without renal dysfunction.

Evaluation of the discrimination and calibration of predictive scores of mortality in ECMO for patients with COVID-19.

BACKGROUND: The criteria for the selection of COVID-19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID-19. We also performed a cost-benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID-19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021. MATERIALS AND METHODS: We evaluated the discrimination (C-statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V-V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy-Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure. RESULTS: We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8-15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67-0.94]) and calibration (calibration-in-the-large 0.5 [95%CI -1.4 to 0.3]; calibration slope 2.2 [95%CI 0.7/3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100 000 in patients older than 45 years with a PRESET > 10. CONCLUSION: The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource-demanding and highly invasive organ support.

Anaerobic Threshold in Stand-up Paddle: Comparison Between Direct and Alternative Methods.

ABSTRACT: Balikian, P, Gomes de Araujo, G, Prado, ES, Ryan Geraldes, AA, Marinho de Lima, AH, and Mendes, EV. Anaerobic threshold in stand-up paddle: comparison between direct and alternative methods. J Strength Cond Res 36(7): 1896-1900, 2022-The purpose of this study was to test the validity of alternative protocols, mean velocity during 30 minutes of continuous effort (V30min) and critical velocity (CV), to estimate the anaerobic threshold in stand-up paddle (SUP). Eight athletes performed: 3 maximal efforts at 400-, 500-, and 800-m distances to determine CV values, using the distance-time relationship; 3 efforts at 85, 90, and 100% of maximal 500-m effort to determine the velocity related to 3.5 mmol·L-1 of lactate, assumed as the onset of blood lactate accumulation (OBLA) and; a 30-minute continuous effort to determine the V30min. All evaluations were separated by 48 hours, with the athletes using their own boards and paddles in the water. No differences were observed between the OBLA (2.35 ± 0.13 m·s-1) and alternative methods (CV: 2.42 ± 0.20 m·s-1; p = 0.10 and V30min: 2.32 ± 0.13 m·s-1; p = 0.63). Although strong correlations were observed between the OBLA and alternative methods (CV: r = 0.84 and V30min: r = 0.94), the limits of agreement were higher in CV (±0.23 m·s-1) than V30min (±0.08 m·s-1). These results demonstrate that both the CV and V30min are valid to estimate the OBLA. In view of the specificity of SUP and the high levels of agreement, the use of the V30min is recommended to prescribe training intensities.

Sportomics suggests that albuminuria is a sensitive biomarker of hydration in cross combat.

We have been using sportomics to understand hypermetabolic stress. Cross Combat (CCombat) has recently been initiated as a high-intensity functional training method inspired by CrossFit. We used a CCombat session to induce metabolic stress and evaluated its effects on hydration and kidney function. Blood samples were collected from 16 elite-level professional male athletes engaged in training sessions over a 96-h protocol. Blood myoglobin increased by ~ 3.5-fold (119 ± 21 to 369 ± 62 nmol/L; p = .001) in response to the protocol, returning to the pre-exercise level within 48 h. Furthermore, D-dimer levels increased from 6.5 ± 0.6 to 79.4 ± 21.3 µmol/L (p < .001) in response to exercise decreasing during recovery with high variability among the studied athletes. Albuminemia and creatininemia increased ~ 10% and cystatin C increased ~ 240% (1.7 ± 0.1 to 5.7 ± 0.5 mg/L; p < .001; effect size = 2.4) in response to the protocol. We measured albuminuria (HuA) to assess kidney permeability to albumin caused by exercise. HuA increased ~ 16-fold (0.16 ± 0.03 to 2.47 ± 0.41 µmol/L; p < .001; effect size = 1.4) in response to exercise, dropping and reaching basal levels during 48 h. Here, we suggest that microalbuminuria can be used as an early, sensitive, easy, and inexpensive biomarker to evaluate hydration status changes during intensive exercise, decreasing chronic impairment in renal function.

Insuficiencia respiratoria y hemoptisis en paciente con dengue: Hemorragia alveolar difusa como presentación inusual de dengue grave / Respiratory insufficiency and hemoptysis in a patient with dengue: Diffuse alveolar hemorrhage as an unusual presentation of severe dengue

Introducción: La infección por el virus del dengue es una enfermedad endémica en ciertas regiones del Perú. La mayoría de estos casos se clasifican como dengue sin signos de alarma y la mortalidad reportada es menor de 1%. Sin embargo, existen ciertas condiciones asociadas a la enfermedad que podrían incrementar la mortalidad. Reporte de caso: Se presenta el caso de una paciente mujer de 48 años procedente de área endémica de esta infección con cuadro clínico y hallazgos laboratoriales compatibles con enfermedad por dengue con signos de alarma. Durante la hospitalización, cursa con hemoptisis e insuficiencia respiratoria produciendo su posterior fallecimiento. Conclusión: Es importante reconocer la hemorragia alveolar difusa como parte del compromiso respiratorio por dengue y diferenciarlo de otras posibilidades infecciosas y no infecciosas para poder brindar el manejo adecuado de forma temprana.

Background: Dengue virus infection is an endemic disease in some regions of Peru. Most of these cases are classified as dengue without warning signs and the reported mortality is less than 1%. However, there are certain conditions associated with the disease that could increase mortality. We Case report:present the case of a 48-year-old female patient from a dengue endemic area with clinical and laboratory compatible with dengue disease with warning signs. During hospitalization, she presents hemoptysis and respiratory insufficiency, leading to death. It is important to recognize diffuse alveolar Conclusion:hemorrhage as part of dengue respiratory manifestations and to differentiate it from other infectious and non-infectious possibilities in order to provide appropriate and early management.

Different dehydration levels and their impact on blood ammonia, cognitive-motor performance, and muscle damage in acclimated runners.

BACKGROUND: Prolonged exercise in the heat can promote dehydration, which could impair ammonia metabolism, cognitive-motor performance, and muscle damage. However, exercise heat acclimation induces physiological adaptations that improve performance, metabolism, and cellular protection. This study aimed to evaluate different dehydration levels and their impact on blood ammonia, cognitive-motor performance, and muscle damage after a race in the heat in acclimated runners. METHODS: Sixteen male amateur endurance runners performed a half marathon race. After the race, the runners were divided into two groups according to their percentage body mass change (Δ% BM): Δ% BM less than 3% (G1%; N.=8) and Δ% BM greater than or equal to 3% (G3%; N.=8). Hydration status, biochemical parameters, and cognitive-motor performance were assessed before and after the race. RESULTS: Blood ammonia concentrations were increased in both G1% (before: 46±26 µmol/L; after: 118±22 µmol/L) and G3% (before: 41±15 µmol/L; after: 108±15 µmol/L) groups. There was an early increase in all markers of muscle damage (creatine kinase [CK], lactate dehydrogenase [LDH], aspartate aminotransferase [AST], and alanine aminotransferase [ALT]) in both groups, but only LDH was greater in the G3% group than in the G1% group. Cognitive-motor performance did not differ between groups. CONCLUSIONS: Dehydration up to ~4% BM loss does not affect blood ammonia concentrations and cognitive-motor performance in acclimated runners. The results also suggest that exercising in the heat induces the early appearance of several markers of muscle damage in acclimated runners regardless of hydration status.

Prevalence of protective haplotypes of the SLCO1B1 gene for statin transport in Mexican populations.

Aim: To evaluate the genetic distribution of the rs4149056 and rs2306283 variants in the SLCO1B1 gene in Mexican Mestizo (admixed) and Native American groups. Materials & methods: We recruited 360 volunteers who were qPCR-genotyped with TaqMan probes. Results: Allele and genotype frequencies are reported. Among the expected rs4149056-rs2306283 haplotypes, T-A (42.35-58.47%) was the most prevalent which relates to the normal activity of the OATP1B1 transporter. This was followed by the T-G haplotype associated with further statin transport and cholesterol reduction (32.49-43.76%). Conclusion: Based on these SLCO1B1 gene variants, we confirmed that a minimum fraction of the Mexican study populations would be at risk from decreasing simvastatin transport and the development of statin-induced myopathy.

Lay abstract The clinical response to statins, mainly atorvastatin and simvastatin, can be modified by interindividual variability including variations in the SLCO1B1 gene. This gene, that encodes the statin transporter OATP1B1, helps to regulate the cholesterol levels in the blood and is responsible for the presence of adverse drug reactions related to the statin consumption, such as muscular sickness. This study analyzes the distribution of the SLCO1B1 gene variants rs4149056 and rs2306283 in geographically dispersed samples of the two main populations in Mexico: two Mestizo (admixed) populations and three Native American groups. We found that the genetic combinations of T­A and T­G for the two SLCO1B1 gene variants ­ associated with normal or efficient activity of the transporter OATP1B ­ were predominant in all of the study population. Therefore, the SLCO1B1 gene variability suggests that a majority of the Mexican population will respond favorably to simvastatin and have a low risk of developing associated muscular complications.

Caffeine decreases ammonemia in athletes using a ketogenic diet during prolonged exercise.

OBJECTIVES: Both exercise and a ketogenic (low-carbohydrate) diet favor glycogen depletion and increase ammonemia, which can impair physical performance. Caffeine supplementation has been routinely used to improve exercise performance. Herein, the effect of xanthine was evaluated on ammonemia in cyclists who were placed on a ketogenic diet and engaged in prolonged exercise. METHODS: Fourteen male cyclists followed a ketogenic diet for 2 d before and during the experimental trial. The cyclists were assigned to either the caffeine- (CEx; n = 7) or placebo-supplemented (LEx; n = 7) group. Blood samples were obtained during cycling and the recovery periods. RESULTS: The CEx group showed a significant decrease (up to 25%) in blood ammonia at 60, 90, and 120 min after beginning exercise compared with the LEx group. A higher concentration of apparent blood urea was observed in the LEx group than in the CEx group at 60 to 90 min of exercise (~10%). In addition, a significant increase in blood glucose levels was evident at 30 min of exercise (~28%), and an increase in blood lactate levels was visible during the first 30 to 60 min of exercise (~80%) in the CEx group. CONCLUSIONS: Our results suggest that the consumption of caffeine might attenuate the increase in ammonemia that occurs during exercise.

Influenza season 2019. Analysis of 143 hospitalized patients.

Influenza infection is a latent public health problem, affecting millions of people throughout the world, which imposes high morbidity and economic burden on the region. In Argentina, influenza-associated mortality is estimated at 6/100 000 person-years, and is higher among men = 65 years old. The knowledge of the baseline characteristics and outcomes of hospitalized patients is crucial for public health officials planning interventions to address local outbreaks. Thus, in this retrospective, single-center study, performed in a highcomplexity university hospital, we aimed to analyze clinical characteristics, image findings, and laboratory variables of patients with laboratory-confirmed influenza requiring hospitalization in our hospital during 2019. Cases were confirmed by real-time reverse transcription-polymerase chain reaction. One hundred and forty-three patients with influenza were hospitalized during the study period; 141 (98.6%) were infected with influenza virus type A, including 88 (61.5%) with the H1N1 subtype. The median age was 71 years (IQR 60- 82), 111 (77.6%) were older than 70 years, and 126 (88.1%) had at least one coexisting illness; 56 (39.1%) patients required intensive care unit, 16 (11.1%) invasive mechanical ventilation, and 6 (4.1%) died during hospitalization. In this study, in-hospital mortality was similar to that reported in previous series of non-pandemic influenza, even though the majority of the cases in this study were older than 70 years and had at least one coexisting illness.

La influenza es un problema latente de salud pública que afecta a millones de personas en todo el planeta e impone una alta morbilidad y carga económica para la región. En Argentina, la mortalidad asociada a la influenza se estima en 6/100 000 personas-año y es mayor entre los hombres mayores de 65 años. El conocimiento de las características clínicas y la evolución de los pacientes hospitalizados es fundamental para planificar el abordaje de los brotes locales. En este estudio retrospectivo, realizado en un hospital universitario de alta complejidad, nuestro objetivo fue analizar las características clínicas, los hallazgos de imágenes y las variables de laboratorio en 143 pacientes con influenza confirmada por laboratorio que requirieron hospitalización durante 2019. Los casos fueron confirmados mediante la reacción en cadena de la polimerasa con transcripción inversa en tiempo real. El 98.6% (n: 141) estaban infectados por influenza tipo A y 61.5% (n: 88) correspondía al subtipo H1N1. La mediana de edad fue 71 años (IQR 60-82), el 77.6% (n: 111) tenía más de 70 años y el 88.1% (n: 126) al menos una enfermedad coexistente. El 39.1% (n: 56) requirió internación en unidad de cuidados intensivos, el 11.1% (n: 16) ventilación mecánica invasiva y seis pacientes (4.1%) fallecieron durante la hospitalización. En este estudio, la mortalidad hospitalaria fue similar a la publicada en series previas de influenza no pandémica, aunque la mayoría de los pacientes eran mayores de 70 años y presentaban al menos una enfermedad coexistente.

Influenza season 2019. Analysis of 143 hospitalized patients / Temporada de influenza 2019. Análisis de 143 pacientes hospitalizados

Abstract Influenza infection is a latent public health problem, affecting millions of people throughout the world, which imposes high morbidity and economic burden on the region. In Argentina, influenza‐associ ated mortality is estimated at 6/100 000 person‐years, and is higher among men ≥ 65 years old. The knowledge of the baseline characteristics and outcomes of hospitalized patients is crucial for public health officials planning interventions to address local outbreaks. Thus, in this retrospective, single-center study, performed in a high-complexity university hospital, we aimed to analyze clinical characteristics, image findings, and laboratory variables of patients with laboratory-confirmed influenza requiring hospitalization in our hospital during 2019. Cases were confirmed by real-time reverse transcription-polymerase chain reaction. One hundred and forty-three patients with influenza were hospitalized during the study period; 141 (98.6%) were infected with influenza virus type A, including 88 (61.5%) with the H1N1 subtype. The median age was 71 years (IQR 60- 82), 111 (77.6%) were older than 70 years, and 126 (88.1%) had at least one coexisting illness; 56 (39.1%) patients required intensive care unit, 16 (11.1%) invasive mechanical ventilation, and 6 (4.1%) died during hospitalization. In this study, in-hospital mortality was similar to that reported in previous series of non-pandemic influenza, even though the majority of the cases in this study were older than 70 years and had at least one coexisting illness.

Resumen La influenza es un problema latente de salud pública que afecta a millones de personas en todo el planeta e impone una alta morbilidad y carga económica para la región. En Argentina, la mortalidad asociada a la influenza se estima en 6/100 000 personas-año y es mayor entre los hombres mayores de 65 años. El conocimiento de las características clínicas y la evolución de los pacientes hospitalizados es fundamental para planificar el abordaje de los brotes locales. En este estudio retrospectivo, realizado en un hospital universitario de alta complejidad, nuestro objetivo fue analizar las características clínicas, los hallazgos de imágenes y las variables de laboratorio en 143 pacientes con influenza confirmada por laboratorio que requirieron hospitalización durante 2019. Los casos fueron confirmados mediante la reacción en cadena de la polimerasa con transcripción inversa en tiempo real. El 98.6% (n: 141) estaban infectados por influenza tipo A y 61.5% (n: 88) correspondía al subtipo H1N1. La mediana de edad fue 71 años (IQR 60-82), el 77.6% (n: 111) tenía más de 70 años y el 88.1% (n: 126) al menos una enfermedad coexistente. El 39.1% (n: 56) requirió internación en unidad de cuidados intensivos, el 11.1% (n: 16) ventilación mecánica invasiva y seis pacientes (4.1%) fallecieron durante la hospitalización. En este estudio, la mortalidad hospitalaria fue similar a la publicada en series previas de influenza no pandémica, aunque la mayoría de los pacientes eran mayores de 70 años y presentaban al menos una enfermedad coexistente.

Comparative analysis of Rhipicephalus tick salivary gland and cement elementome.

Rhipicephalus spp. (Acari: Ixodidae) ticks are obligate hematophagous arthropods, which constitute a model for the study of vector-host interactions. The chemical composition or elementome of salivary glands (SG) and cement provides information relevant for the study of protein-based complex multifunctional tissues with a key role in tick biology. In this study, we characterized the elementome of cement cones in Rhipicephalus sanguineus collected from naturally infested dogs and in SG and cement of R. bursa collected from experimentally infested rabbits at different feeding stages. The elementome was characterized using scanning electron microscopy (SEM) combined with energy dispersive X-ray spectroscopy (EDS). The results showed the identification of up to 14 chemical elements in the cement, and suggested tick/host-driven differences in the cement elementome between tick species and between SG and cement within the same species. By still unknown mechanisms, ticks may regulate cement elementome during feeding to affect various biological processes. Although these analyses are preliminary, the results suggested that N is a key component of the cement elementome with a likely origin in SG/salivary proteins (i.e., Glycine (C2H5NO2)-rich superfamily member proteins; GRPs) and other tick/host-derived components (i.e. NAPDH). Future research should be focused on tick elementome and its functional implications to better understand cement structure and function.