Tobramycin Systemic Absorption in Lung Transplant Recipients Treated With Inhaled Tobramycin: A Cohort Study.

Inhaled tobramycin treatment has been associated with nephrotoxicity in some case reports, but limited data are available about serum levels and its possible systemic absorption in lung transplant recipients (LTR). We conducted a single-center, observational and retrospective study of all adult (>18 years old) LTR treated with inhaled tobramycin for at least 3 days between June 2019 and February 2022. Trough serum levels were collected and >2 µg/mL was considered a high drug level. The primary outcome assessed the presence of detectable trough levels, while the secondary outcome focused on the occurrence of acute kidney injury (AKI) in individuals with detectable trough levels. Thirty-four patients, with a median age of 60 years, were enrolled. The primary indications for treatment were donor bronchial aspirate bacterial isolation (18 patients) and tracheobronchitis (15 patients). In total, 28 patients (82%) exhibited detectable serum levels, with 9 (26%) presenting high levels (>2 µg/mL). Furthermore, 9 patients (26%) developed acute kidney injury during the treatment course. Median trough tobramycin levels were significantly elevated in invasively mechanically ventilated patients compared to non-ventilated individuals (2.5 µg/mL vs. 0.48 µg/mL) (p < 0.001). Inhaled tobramycin administration in LTRs, particularly in those requiring invasive mechanical ventilation, may result in substantial systemic absorption.

Evaluating silicosis risk: Assessing dust constitution and influence of water as a primary prevention measure in cutting and polishing of silica agglomerates, granite and marble.

An increasing number of silicosis cases have been reported related to the use of silica agglomerates. Many studies agree on the severity of this disease, which often presents with severe clinical forms in young workers and after a short latency period. Are there differences in the composition of dust generated by cutting and polishing with silica agglomerates versus granite and marble? Does the use of water injection reduce the risk associated with the use of these materials? We carried out a comparative observational-analytical study, measuring the concentration of dust generated during different machining operations on three different materials: granite, marble, and silica agglomerates. The effect of water injection on dust generation was evaluated. Personal sampling pumps were used, connected to a cyclone with polyvinyl chloride filters. The flow rate of the pumps was adjusted using a piston flowmeter. Measurements with a cascade impactor were made to assess the size distribution of respirable crystalline silica particles within the respirable fraction. In addition, environmental measurements with a spectrometer were made. 10 tests were carried out on granite and silica agglomerates for each procedure. In the case of marble, with very low silica content, only 2 tests of each type were carried out. Duration of each measurement was between 6 and 25 min. Cleaning times were set for each of the operations. The amount of dust collected in the respirable fraction was 70.85, 32.50 and 35.78 mg/m3 for dry cutting; 6.50, 3.75 and 3.95 mg/m3 for wet cutting; and 21.35, 13.68 and 17.50 mg/m3 for dry polishing, for granite, marble, and silica agglomerates respectively. Dry procedures in marble, silica agglomerates and granite showed higher dust concentration of particles smaller than 0.5 µm. Silica agglomerates showed higher concentrations of respirable crystalline silica particles than granite and marble, mainly with dry procedures. The greater production of small particles in dry and wet procedures with silica agglomerates shows that water injection is an insufficient preventive measure.

Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study.

COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a frequent complication in the intensive care unit (ICU). However, little is known about this life-threatening fungal superinfection in solid organ transplant recipients (SOTRs), including whether targeted anti-mold prophylaxis might be justified in this immunosuppressed population. We performed a multicentric observational retrospective study of all consecutive ICU-admitted COVID-19 SOTRs between August 1, 2020 and December 31, 2021. SOTRs receiving antifungal prophylaxis with nebulized amphotericin-B were compared with those without prophylaxis. CAPA was defined according the ECMM/ISHAM criteria. Sixty-four SOTRs were admitted to ICU for COVID-19 during the study period. One patient received antifungal prophylaxis with isavuconazole and was excluded from the analysis. Of the remaining 63 SOTRs, nineteen (30.2%) received anti-mold prophylaxis with nebulized amphotericin-B. Ten SOTRs who did not receive prophylaxis developed pulmonary mold infections (nine CAPA and one mucormycosis) compared with one who received nebulized amphotericin-B (22.7% vs 5.3%; risk ratio 0.23; 95%CI 0.032-1.68), but with no differences in survival. No severe adverse events related to nebulized amphotericin-B were recorded. SOTRs admitted to ICU with COVID-19 are at high risk for CAPA. However, nebulized amphotericin-B is safe and might reduce the incidence of CAPA in this high-risk population. A randomized clinical trial to confirm these findings is warranted.

Smoking in hospitalized patients. A great opportunity. / Tabaquismo en pacientes hospitalizados. Una gran oportunidad.

The objective of this study is to describe the characteristics of smokers admitted to different medical and surgical services in a university hospital and the perception of patients regarding the need for a specialized intervention. The sample comprises a total of 307 patients (mean age of 59.4 years), being 40% (n = 123) non-smokers, 42.7% (n = 131) ex-smokers, and 17.3% (n = 53) smokers. The average consumption of smokers was 22.2 cigarettes / day and the severity of nicotine dependence evaluated with the Fagerström test exceeded 5 points in more than half of the sample. On the other hand, 77.7% had made at least one previous attempt to quit tobacco use. Almost the entire sample (89.9%) of smokers and ex-smokers considered it necessary to develop tobacco treatment programs during hospitalization. Finally, the importance of the hospital context is argued as an opportunity to address the cessation of smoking. The data obtained in this study will allow focusing more appropriately on the management of these patients and optimizing resources.

El objetivo de este estudio es conocer las características de los fumadores ingresados en diferentes servicios médicos y quirúrgicos en un hospital universitario y la percepción de los pacientes respecto a la necesidad de una intervención especializada. La muestra comprende un total de 307 pacientes (edad media de 59,4 años), siendo un 40% (n = 123) no fumadores, 42,7% (n = 131) exfumadores, y un 17,3% (n = 53) fumadores. El consumo medio de los fumadores era de 22,2 cigarrillos/día y la gravedad de la dependencia a la nicotina evaluado con el test de Fagerström sobrepasaba los 5 puntos en más de la mitad de la muestra. Por otra parte, el 77,7% había realizado al menos un intento previo de abandono del consumo de tabaco. Casi la totalidad de la muestra (89,9%) de los fumadores y ex fumadores consideraba necesario desarrollar programas de tratamiento del tabaquismo en la hospitalización. Finalmente se argumenta la importancia del contexto hospitalario como oportunidad para abordar la cesación del hábito tabáquico. Los datos obtenidos en el presente estudio permitirán enfocar más adecuadamente el manejo de estos pacientes y optimizar los recursos.

Achalasia and mycobacterium goodii pulmonary infection.

Achalasia is a common adult disorder that rarely manifests in children and infrequently can be associated with pulmonary nontuberculous mycobacteria infections. We describe here the first case of Mycobacterium goodii pulmonary infection associated with achalasia in a pediatric patient. Heller myotomy with Dor fundoplication and 12 months of treatment with ciprofloxacin and doxycycline resulted in complete clinical and radiologic improvement.