[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Effects of antibiotic administration delay and inadequacy upon the survival of septic shock patients.

OBJECTIVE: To assess how antibiotic administration delay and inadequacy influence survival in septic shock patients. DESIGN: A prospective, observational cohort study was carried out between September 2005 and September 2010. SCOPE: Patients admitted to the ICU of a third level hospital. PATIENTS: A total of 342 septic shock patients INTERVENTIONS: None VARIABLES OF INTEREST: The time to antibiotic administration (difference between septic shock presentation and first administered dose of antibiotic) and its adequacy (in vitro susceptibility testing of isolated pathogens) were determined. RESULTS: ICU and hospital mortality were 26.4% and 33.5%, respectively. The median delay to administration of the first antibiotic dose was 1.7h. Deceased patients received antibiotics significantly later than survivors (1.3±14.5h vs. 5.8±18.02h; P=.001). Percentage drug inadequacy was 12%. Those patients who received inadequate antibiotics had significantly higher mortality rates (33.8% vs. 51.2%; P=.03). The coexistence of treatment delay and inadequacy was associated to lower survival rates. CONCLUSIONS: Both antibiotic administration delay and inadequacy exert deleterious effects upon the survival of septic shock patients, independently of their characteristics or severity.

Isolation and characterization of Streptococcus parauberis from vacuum-packaging refrigerated seafood products.

Streptococcus parauberis is known as an etiological agent of mastitis in cows and for producing streptococcosis in farmed fish, although its presence in foods has seldom been reported. In this work, two bacterial isolates were recovered from a spoiled vacuum-packaged refrigerated seafood product. Both isolates were identified by 16S rRNA gene sequencing, exhibiting 99% homology with respect to S. parauberis. Both isolates were also characterized by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Genetic analysis revealed the clonal homogeneity of the isolates and their grouping together with other S. parauberis strains in a different cluster with respect to Streptococcus uberis strains. Proteomic analysis by MALDI-TOF MS allowed for the identification of five mass peaks in the range of 2200-6000 m/z that resulted to be specific to the species S. parauberis and allowed its rapid and direct identification with respect to other pathogenic and spoilage bacteria potentially present in seafood and other food products. This study represents, to our knowledge, the first report of S. parauberis in seafood in general and in vacuum-packed food products in particular. Moreover, it provides a rapid method based on MALDI-TOF MS for the identification of S. parauberis.

Activación y determinación de parámetros cinéticos de la plasmina humana y Ovis aries / Activation and comparative kinetics of Ovis aries plasmin with human plasmin

Objetivo. Comparar las cinéticas y activaciones, unificar las purificaciones y determinar las secuencias de los terminales-N de los plasminógenos Ovis aries y humano. Materiales y métodos. Los plasminógenos fueron purificados por el mismo método: cromatografías de afinidad e intercambio iónico, activados con urocinasa, la secuencia de los terminales-N se realizó por el método de Edman Resultados. La afinidad de la plasmina Ovis aries por el sustrato cromogénico fue de 0.45 mM, 11.8 veces mayor que la afinidad de la plasmina humana (5.3 mM). Conclusiones. Se confirma y unifica el método de purificación de los plasminógenos del plasma, para todos los mamíferos. La alta afinidad de la plasmina Ovis aries confirma una mayor afinidad de las plasminas animales por el sustrato cromogénico, en comparación con la plasmina humana.

[External validation of the Risk Quantification of Early Outcome after Lung Transplantation scale]. / Validación externa de la escala Risk Quantification of Early Outcome After Lung Transplantation.

OBJECTIVE: To validate the "Risk Quantification of Early Outcome After Lung Transplantation" (RQLT) scale in a cohort of lung transplantation patients. DESIGN: The parameters included in the RQLT scale were recorded prospectively. PATIENT: A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008. MAIN VARIABLES OF INTEREST: This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test. RESULTS: The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58. CONCLUSIONS: The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients.

[Discrepancies between the clinical and pathological diagnosis in lung transplant early mortality]. / Discrepancias entre el diagnóstico clínico y el diagnóstico anatomopatológico en la mortalidad temprana del trasplante pulmonar.

OBJECTIVE: To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al. MATERIAL AND METHODS: Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups. RESULTS: The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6+/-4.52 days) and patients from the group with no discrepancy (15.42+/-8.99). CONCLUSION: The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100%.

[Evaluation of the pre-operative exercise capacity as survival marker in the lung transplant recipients]. / Valoración de la capacidad preoperatoria al ejercicio como factor predictivo de supervivencia en enfermos sometidos a trasplante pulmonar.

OBJECTIVE: To make an independent evaluation of the capacity for exercise as a predictive factor in lung transplant recipients. DESIGN: Retrospective study. SCOPE: Lung transplant unit of the Intensive Care Unit (ICU) of a university hospital. PATIENTS: We analyzed 132 lung transplants in a total of 130 patients. The patients were monitorized up to June 18, 2005 or their death. VARIABLES OF INTEREST: An evaluation was made of their pre-operative exercise capacity with the 6-minute walking test (6MWT). Long-term survival in relationship with the walking test value was also assessed. The survival curves were estimated using the Kaplan-Meier method. Comparison between curves was made with the Log-Rank methods and the hazard ratios were estimated by Cox regression. RESULTS: The association between mortality and the walking test value showed a hazard ratio of 0.99 (95% CI: 0.99-1.00) per metric unit (meter), (p = 0.282). The patients were classified according to the distance covered in the 4 groups: group 1 (distance covered less than 100 meters), group II (distance covered between 101-200 meters), group III (distance covered between 201 and 300 meters) and group IV (distance greater than 301 meters). No significant differences were found when comparing the survival curves of the four groups (p = 0.709). The multivariant analysis also did not show any statistical significance. CONCLUSIONS: We do not believe that the distance covered in the 6MWT conducted in the study protocol in the lung transplant candidates is useful as a marker to predict long-term mortality in patients undergoing lung transplant.