Unliganded progesterone receptor-mediated targeting of an RNA-containing repressive complex silences a subset of hormone-inducible genes.

A close chromatin conformation precludes gene expression in eukaryotic cells. Genes activated by external cues have to overcome this repressive state by locally changing chromatin structure to a more open state. Although much is known about hormonal gene activation, how basal repression of regulated genes is targeted to the correct sites throughout the genome is not well understood. Here we report that in breast cancer cells, the unliganded progesterone receptor (PR) binds genomic sites and targets a repressive complex containing HP1γ (heterochromatin protein 1γ), LSD1 (lysine-specific demethylase 1), HDAC1/2, CoREST (corepressor for REST [RE1 {neuronal repressor element 1} silencing transcription factor]), KDM5B, and the RNA SRA (steroid receptor RNA activator) to 20% of hormone-inducible genes, keeping these genes silenced prior to hormone treatment. The complex is anchored via binding of HP1γ to H3K9me3 (histone H3 tails trimethylated on Lys 9). SRA interacts with PR, HP1γ, and LSD1, and its depletion compromises the loading of the repressive complex to target chromatin-promoting aberrant gene derepression. Upon hormonal treatment, the HP1γ-LSD1 complex is displaced from these constitutively poorly expressed genes as a result of rapid phosphorylation of histone H3 at Ser 10 mediated by MSK1, which is recruited to the target sites by the activated PR. Displacement of the repressive complex enables the loading of coactivators needed for chromatin remodeling and activation of this set of genes, including genes involved in apoptosis and cell proliferation. These results highlight the importance of the unliganded PR in hormonal regulation of breast cancer cells.

Acute Appendicitis: Epidemiological, Clinical, Surgical, and Post-surgical Characteristics in a Honduran General Hospital.

BACKGROUND: Acute appendicitis is a common surgical emergency worldwide, yet data specific to Central America, including Honduras, are limited. This study aimed to investigate the epidemiological, clinical, surgical, and post-surgical characteristics of acute appendicitis in a Honduran general hospital. METHODS: A descriptive, quantitative, non-experimental, cross-sectional study was conducted at the Mario Catarino Rivas Hospital in San Pedro Sula, Honduras. The study sample consisted of 100 patients admitted with acute appendicitis from January to April 2022. Data on demographic factors, surgical interventions, appendicitis phases, appendix location, and laboratory findings were collected and analyzed. RESULTS: The mean age of the participants was 28.5 years, with a slight male predominance (52%). Timely surgical intervention was performed in 95% of cases within the first 12 hours. The gangrenous phase was observed in 30% of patients, followed by the perforated (24%), edematous (24%), and suppurative (22%). Retrocecal appendicitis accounted for the majority of cases (66%). Moderate leucocytosis (46%) and severe leucocytosis (39%) were associated with acute appendicitis severity. A higher neutrophil percentage was indicative of complicated appendicitis. Computed tomography was underutilized, with only one patient undergoing the examination. CONCLUSION: This study provides valuable insights into Honduras' epidemiological, clinical, and surgical characteristics of acute appendicitis. Early surgical intervention and laboratory findings, such as leukocyte count and neutrophil percentage, can aid in assessing disease severity. Further research is warranted to understand the unique aspects of acute appendicitis in Central America and optimize patient management. This study highlights the need for multi-centre studies and long-term follow-up to enhance our understanding of appendicitis in similar populations.

Maine organic dairy producers' receptiveness to seaweed supplementation and effect of Chondrus crispus on enteric methane emissions in lactating cows.

Introduction: There is a growing interest in utilizing seaweed in ruminant diets for mitigating enteric methane (CH4) emissions while improving animal health. Chondrus crispus is a red seaweed that grows in the Gulf of Maine (United States) and has shown to suppress CH4 production in vitro. Organic dairy producers in Maine are currently feeding seaweed due to herd health promoting benefits. However, large-scale adoption depends on technical and financial factors, as well as validation from pilot studies. Methods: A survey was developed to identify barriers and drivers towards the adoption of CH4-reducing algal-based feeds. Concurrently, a randomized complete block design study was conducted to investigate the effect of C. crispus on enteric CH4 emissions and milk production in a typical Maine organic dairy farm. Twenty-two organically certified Holstein and Jersey cows averaging 29 ± 6.8 kg of milk/d and 150 ± 69 days in milk, were blocked and randomly assigned to a control diet without C. crispus (0CC), or with 6% [dry matter (DM) basis] C. crispus (6CC). Samples were collected on the last week of the 2-wk covariate period, and wk 3, 5, 8, and 10 after initiation of treatments for a total of 12 weeks. Gaseous emissions were measured using a GreenFeed unit. Data were analyzed using the MIXED procedure of SAS with repeated measures over time. Results: All survey respondents (n = 35; 54% response rate) were familiar with seaweeds as feed, and 34% were already users. Producers who were willing to pay 0.64 USD/cow/d on average for a CH4-reducing algal-based feed, also stated the need for co-benefits in terms of cattle health and performance as a requirement for adoption. Feeding 6CC decreased enteric CH4 production by 13.9% compared with 0CC (401 vs. 466 g/d). Further, milk yield (mean = 27.1 kg/d), CH4 intensity (mean = 15.2 g of CH4/kg of energy corrected milk), and concentrations and yields of milk fat and true protein were not affected by treatments. Discussion: Producer receptiveness to CH4-reducing algal-based feeds will not only be dependent on purchase price, but also on co-benefits and simplicity of integration into existing feed practices. Feeding C. crispus at 6% of the diet DM decreased CH4 production in dairy cows by 13.9% without negative effects on milk yield and composition. Identifying the bioactive compounds in C. crispus is critical to understand the effect of this red seaweed on mitigating enteric CH4 emissions in dairy cows.

Meta-analysis of the effects of chemical and microbial preservatives on hay spoilage during storage.

A meta-analysis was performed to evaluate the effects of chemical (50 articles) and microbial (21 articles) additives on hay preservation during storage. Multilevel linear mixed-effects models were fit with response variables calculated as predicted differences (Δ) between treated and untreated samples. Chemical preservatives were classified into five groups such as propionic acid (PropA), buffered organic acids (BOA), other organic acids (OOA), urea, and anhydrous ammonia (AA). Moderators of the models included preservative class (PC), forage type (FT; grass, legumes, and mixed hay), moisture concentration (MC), and application rate (AR). Dry matter (DM) loss during storage was affected by PC × FT (P = 0.045), PC × AR (P < 0.001), and PC × MC (P = 0.009), relative to the overall effect of preservatives (-0.37%). DM loss in PropA-treated hay was numerically reduced to a greater extent in grasses (-16.2), followed by mixed hay (-1.76), but it increased (+2.2%) in legume hay. Increasing AR of PropA resulted in decrease in DM loss (slope = -1.34). Application of BOA, OOA, PropA, and AA decreased visual relative moldiness by -22.1, -29.4, -45.5, and -12.2 percentage points, respectively (PC; P < 0.001). Sugars were higher in treated grass hay (+1.9) and lower in treated legume hay (-0.8% of DM) relative to their untreated counterparts (P < 0.001). The application of all preservatives resulted in higher crude protein (CP) than untreated hay, particularly urea (+7.92) and AA (+5.66% of DM), but PropA, OOA, and BOA also increased CP by 2.37, 2.04, and 0.73 percentage points, respectively. Additionally, preservative application overall resulted in higher in vitro DM digestibility (+1.9% of DM) relative to the untreated hay (x¯=58.3%), which increased with higher AR (slope = 1.64) and decreased with higher MC (slope = -0.27). Microbial inoculants had small effects on hay spoilage because the overall DM loss effect size was -0.21%. Relative to untreated (x¯=4.63% DM), grass hay preserved more sugars (+1.47) than legumes (+0.33) when an inoculant was applied. In conclusion, organic acid-based preservatives prevent spoilage of hay during storage, but their effectiveness is affected by FT, MC, and AR. Microbial inoculants had minor effects on preservation that were impaired by increased MC. Moreover, legume hay was less responsive to the effects of preservatives than grass hay.

Storing hay that has not been properly dried to a moisture concentration (MC) below 20% can lead to the growth of undesirable microbes, such as molds, that decrease the nutritive value of the hay and compromise animal performance and health. Hay preservatives such as propionic acid (PropA), buffered organic acids (BOA), other organic acids (OOA), urea, anhydrous ammonia (AA), and microbial inoculants have been commonly applied to high moisture (>20%) hay to reduce microbial growth during hay storage. The present study compiled the results of 62 published articles on hay preservatives and performed a quantitative analysis (meta-analysis) to determine the effect of preservative treatment on dry matter (DM) loss, moldiness, bale heating, nutritional composition, and DM digestibility, and their interactions with forage type, application rate, and bale moisture. Organic acid-based preservatives (PropA, BOA, and OOA) were effective at reducing DM loss, moldiness, bale maximum temperature, and insoluble nitrogen, and at preserving sugars and DM digestibility during storage to different extents. Microbial inoculants had small effects on the prevention of hay spoilage, and were negatively affected by the increase of hay MC. Legume hay was less responsive to the effects of preservatives than grass hay during storage.

Candida lusitaniae: Biology, Pathogenicity, Virulence Factors, Diagnosis, and Treatment.

The incidence of fungal infections is increasing at an alarming rate and has posed a great challenge for science in recent years. The rise in these infections has been related to the increase in immunocompromised patients and the resistance of different species to antifungal drugs. Infections caused by the different Candida species, especially Candida albicans, are one of the most common mycoses in humans, and the etiological agents are considered opportunistic pathogens associated with high mortality rates when disseminated infections occur. Candida lusitaniae is considered an emerging opportunistic pathogen that most frequently affects immunocompromised patients with some comorbidity. Although it is a low-frequency pathogen, and the mortality rate of C. lusitaniae-caused candidemia does not exceed 5%, some isolates are known to be resistant to antifungals such as amphotericin B, 5-fluorocytosine, and fluconazole. In this paper, a detailed review of the current literature on this organism and its different aspects, such as its biology, possible virulence factors, pathogen-host interaction, diagnosis, and treatment of infection, is provided. Of particular interest, through Blastp analysis we predicted possible virulence factors in this species.

Trends in Reproductive Indicators of Green and Hawksbill Sea Turtles over a 30-Year Monitoring Period in the Southern Gulf of Mexico and Their Conservation Implications.

Long-term monitoring programs of species at risk are efficacious tools to assess population changes, evaluate conservation strategies, and improve management practices to ensure populations reach levels at which they can fulfill their ecological roles. For sea turtles, annual nesting beach surveys are the most accessible method to estimating the population abundance and reproductive output, especially when these are done in primary nesting sites. However, little data exist on the long-term assessment of these parameters. Here, we present the trends of the nest abundance, female size, hatching, and emergence success of hawksbill (Eretmochelys imbricata) and green (Chelonia mydas) turtles at key nesting beaches in the southern Gulf of Mexico over 31 years (from 1990 to 2021). The nest abundance showed an increasing trend in both species as a result of the sustained protection and conservation effort, but there was no significant temporal trend in the annual female size, clutch size, hatching, and emergence success. However, these indicators showed decreasing mean values over the last decade and should be closely monitored. We suggest these decreases link to the combined effects of ocean warming and anthropogenic pressures affecting the sea turtle foraging grounds. Aside from protecting key nesting sites, protecting and restoring crucial foraging habitats should be an immediate priority requiring international cooperation.

Agreement between two scales used for assessing risk classification for thromboembolic events and the requirement of postpartum pharmacological prophylaxis / Concordancia entre dos escalas para evaluar la clasificación del riesgo de eventos tromboembólicos y el requerimiento de profilaxis farmacológica en el posparto.

Objectives: To determine agreement in assessing the need for postpartum pharmacological prophylaxis between the scale of the Royal College of Obstetricians and Gynaecologists and the Colombian guideline scale in a Level IV institution in Bogota, Colombia. Material and methods: Diagnostic agreement study assembled on a cross-sectional study. The included population consisted of pregnant women with 24 or more weeks of pregnancy admitted between March 1 and April 30 of 2021 to a high complexity private institution in Bogotá, Colombia, for labor induction, in active labor, for elective cesarean section, or who required urgent cesarean section. Convenience sampling was used. Measured variables included demographics, risk factors, risk classification and pharmacological prophylaxis according to the two scales. The prevalence of risk factors for each scale was estimated and agreement regarding prophylaxis indication between the two scales was measured using the weighted kappa value. Results: Overall, 320 patients were included. According to the scale of the Royal College Obstetricians and Gynaecologists, 54.7 % patients were classified as low risk, 42.5 % as intermediate risk and 2.8 % as high risk. The Colombian scale classified 80 % of patients as low risk, 17.2 % as intermediate risk, 2.2 % as high risk, and 0.6 % as very high risk. The weighted kappa value for agreement regarding the indication was 0.47 (95 % CI: 0.38-0.56). Conclusions: Agreement between the two scales to determine the need for postpartum pharmacological prophylaxis is moderate. Risk classification criteria for the Colombian scale should be validated in a second cohort. Moreover, the predictive ability of the Colombian guideline tool should be assessed at different cut-off points in terms of the consequences of false positive and false negative results.

Objetivos: establecer la concordancia para evaluar el requerimiento de profilaxis farmacológica en el puerperio entre la escala del Royal College Obstetricians and Gynaecologists y la escala de la guía colombiana en una institución de cuarto nivel en Bogotá, Colombia. Materiales y métodos: estudio de concordancia diagnóstica ensamblado sobre un estudio transversal. Se incluyeron mujeres embarazadas con 24 o más semanas de gestación que ingresaron para inducción de trabajo de parto, en trabajo de parto activo, para cesárea electiva, o que requirieron cesárea de urgencia, hospitalizadas entre el 1 de marzo y 30 de abril de 2021 en una institución privada de alta complejidad en Bogotá, Colombia. Se realizó un muestreo por conveniencia. Se midieron variables demográficas, factores de riesgo, clasificación del riesgo y profilaxis farmacológica según las dos escalas. Se calculó la prevalencia de los factores de riesgo por cada escala y la concordancia en la indicación de la profilaxis entre las dos escalas por medio del valor de kappa ponderado. Resultados: se incluyeron 320 pacientes. La escala del Royal College Obstetricians and Gynaecologists clasificó al 54,7 % de las pacientes en riesgo bajo, riesgo intermedio al 42,5 % y riesgo alto al 2,8 %. La escala colombiana clasificó al 80 % de las pacientes en riesgo bajo, 17,2 % riesgo intermedio, 2,2 % riesgo alto y 0,6 % con riesgo muy alto. El valor kappa ponderado para la concordancia para indicación fue de 0,47 (IC 95 %: 0,38-0,56). Conclusiones: la concordancia de las dos escalas para definir requerimiento de profilaxis farmacológica en el posparto tiene un acuerdo moderado. Se considera es necesario validar los criterios de clasificación del riesgo de la escala colombiana en una segunda cohorte, además evaluar la capacidad predictiva de la herramienta de la guía colombiana en diferentes puntos de corte en términos de las consecuencias de falsos positivos y negativos.

Diagnosis of tuberous sclerosis complex in adulthood: A case report.

Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder. TSC consists of a wide variety of clinical manifestations, with neurological and dermatological symptoms being the most frequent. This study aims to describe the clinical characteristics and management of a pregnant patient incidentally diagnosed with TSC.

Co-evolution of the branch site and SR proteins in eukaryotes.

Serine-arginine-rich (SR) proteins are essential for splicing in metazoans but are absent in yeast. By contrast, many fungi have SR protein homologs with variable arginine-rich regions analogous to the arginine-serine-rich (RS) domain in metazoans. The density of RS repeats in these regions correlates with the conservation of the branch site signal, providing evidence for an ancestral origin of SR proteins and indicating that the SR proteins and the branch site co-evolved.

A combination of Lactobacillus buchneri and Pediococcus pentosaceus extended the aerobic stability of conventional and brown midrib mutants-corn hybrids ensiled at low dry matter concentrations by causing a major shift in their bacterial and fungal community.

We evaluated the effects of applying a combination inoculant to four corn hybrids harvested at high moisture on their nutritive value and microbial populations. The treatment design was the factorial combination of corn hybrids ensiled with (INO) and without (CON) inoculant. The hybrids were TMF2R737 (MCN), F2F817 (MBR), P2089YHR (PCN), and PI144XR (PBR), ensiled at dry matter (DM) concentrations of 30.5%, 26.3%, 31.1%, and 31.5%, respectively; MBR and PBR were brown midrib mutants (BMR). The inoculant contained Lactobacillus buchneri and Pediococcus pentosaceus (4 × 105 and 1 × 105 cfu/g of fresh corn). The experiment had a complete randomized design with treatments replicated six times. Corn was treated or not with inoculant, packed into 7.6 L bucket silos, and stored for 100 d. At d 0, the relative abundance (RA, %) of Enterobacteriaceae was lower in PBR vs. the other hybrids [51.3 vs. x¯ = (average of) 58.4] and in the case of fungi, incertae sedis (i.s.) Tremellales and Mucoraceae were more and less abundant, respectively, in conventional hybrids vs. BMRs (x¯= 25.8 vs. x¯ = 13.9 and x¯ = 3.64 vs. x¯ = 7.52; P < 0.04). After ensiling, INO had higher LAB (9.3 vs. 7.1 log cfu/g of fresh corn) and acetic acid (3.44% vs. 1.32% of DM) and lower yeast (3.1 vs. 4.6) and molds (1.5 vs. 3.0), and also extended the aerobic stability (582 vs. 111 h) but decreased DM recovery (95.6% vs. 97.4%) vs. CON (P < 0.02). Inoculation reduced bacterial phylogenetic diversity (6.75 vs. 14.4) but increased fungal observed taxonomical units (46 vs. 20) vs. CON (P < 0.01). Also, a higher relative abundance (RA) for Lactobacillaceae (99.2% vs. 75.7%) and lower for Enterobacteriaceae (0.28 vs. 9.93) was observed due to inoculation (P < 0.001). For fungi, INO had a lower RA compared to CON for Monascaceae (12.6 vs. 44.7) and increased i.s. Tremellales (8.0 vs. 1.2) and i.s. Saccharomycetales (6.4% vs. 0.3%; P < 0.006). Inoculation changed the diverse bacterial community found in the phyllosphere across hybrids to a taxonomically uneven one dominated by Lactobacillaceae. In the case of fungi, INO application increased the fungal diversity at d 100 mainly by reducing the dominance of Monascaceae vs. CON. In conclusion, the INO treatment overwhelmed the disparate microbial populations found across BMR and conventional hybrids ensiled at low DM concentrations and ensured a significant concentration of acetic acid that modified fungal populations and in turn extended the aerobic stability of all hybrids.

Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article.

The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.

[Factors associated to death in patients hospitalized due to COVID-19]. / Factores asociados a defunción en pacientes hospitalizados por COVID-19.

BACKGROUND: SARS-CoV-2 virus was notified by the World Health Organization in January 2020 as a global emergency, due to its intense transmission, and clinical picture, that is aggravated in susceptible people. OBJECTIVE: To describe the factors associated with death in COVID-19 and pneumonia patients hospitalized in a thirdlevel center. MATERIAL AND METHODS: An undivided case-control study was carried out. It was conducted an interview to obtain general information; from the medical record were collected hospitalization data, radiological images, laboratory parameters, and treatments used. It was used descriptive statistics. Student's t, Mann-Whitney U, and chi-squared were used to identify variables associated with death, and models of adjusted binary logistic regression to propose which variables of the patient's history, clinical parameters and treatments explained the death. RESULTS: We treated 5339 patients with suspicion of COVID-19: 3117 positive (59%), 1029 hospitalized due to pneumonia, and 513 deaths (16.46%). For the analysis, 1110 patients were taken, 399 death cases were selected and 357 controls discharged due to improvement. The average age was 57.8 years; 59% were male. CONCLUSIONS: The variables associated with mortality were: patients older than 40 years, chest radiography image > 50% involvement, intubation, lactic dehydrogenase > 500, C-reactive protein > 10, and organ failure; variables associated with improvement were: stay in the intensive care unit, use of broad spectrum parenteral antibiotics, steroids, and use of the anticoagulant enoxyheparin. Sex, diabetes, and comorbidities did not show significant association.

INTRODUCCIÓN: el SARS-CoV-2 fue notificado por la Organización Mundial de la Salud en enero de 2020 como emergencia mundial debido a su intenso contagio y cuadro clínico, que se agrava en personas susceptibles. OBJETIVO: describir factores asociados a defunción en pacientes con COVID-19 y neumonía hospitalizados en tercer nivel. MATERIAL Y MÉTODOS: estudio de casos y controles no pareado. Se obtuvo información general mediante entrevista; del expediente se tomaron datos de hospitalización, imágenes radiológicas, parámetros de laboratorio y tratamientos. Se empleó estadística descriptiva, t de student, U de Mann-Whitney y chi cuadrada para identificar variables asociadas a defunción, y modelos de regresión logística binaria ajustada para proponer variables de antecedentes del paciente, parámetros clínicos y tratamientos que explicaran la defunción. RESULTADOS: atendimos 5339 pacientes sospechosos de COVID-19: 3117 positivos (59%), 1029 hospitalizados por neumonía y 513 defunciones (16.46%). Para el análisis, se tomaron 1110, se seleccionaron 399 casos de defunción y 357 controles egresados por mejoría. La edad promedio fue 57.8 años; 59% fueron hombres. CONCLUSIONES: las variables asociadas a mortalidad fueron: mayores de 40 años, radiografía de tórax > 50% de afectación, intubación, deshidrogenasa láctica > 500, proteína C reactiva > 10 e insuficiencia orgánica; las asociadas a mejoría: estancia en unidad de cuidados intensivos, uso de antibióticos parenterales de amplio espectro, esteroides y anticoagulante enoxiheparina. El sexo, la diabetes y las comorbilidades no mostraron asociación.

Applied science facilitates the large-scale expansion of protected areas in an Amazonian hot spot.

Meeting international commitments to protect 17% of terrestrial ecosystems worldwide will require >3 million square kilometers of new protected areas and strategies to create those areas in a way that respects local communities and land use. In 2000-2016, biological and social scientists worked to increase the protected proportion of Peru's largest department via 14 interdisciplinary inventories covering >9 million hectares of this megadiverse corner of the Amazon basin. In each landscape, the strategy was the same: convene diverse partners, identify biological and sociocultural assets, document residents' use of natural resources, and tailor the findings to the needs of decision-makers. Nine of the 14 landscapes have since been protected (5.7 million hectares of new protected areas), contributing to a quadrupling of conservation coverage in Loreto (from 6 to 23%). We outline the methods and enabling conditions most crucial for successfully applying similar campaigns elsewhere on Earth.

Behavioural activation in nursing homes to treat depression (BAN-Dep): study protocol for a pragmatic randomised controlled trial.

INTRODUCTION: Depression is a common disorder among older people living in residential aged care facilities. Several trials have demonstrated the effectiveness of behavioural therapies in treating depressive symptoms in older adults living in the community and in residential aged care. Behavioural Activation is demonstrably effective even when delivered by non-specialists (staff without formal psychological training), although strategies for adapting its use in residential aged care facilities are yet to be explored. This study will determine whether training residential care staff in the use of a structured Behavioural Activation programme is more effective at decreasing depressive symptoms among older residents than internet-based training about depression recognition and management alone. METHOD AND ANALYSIS: The behavioural activation in nursing homes to treat depression (BAN-Dep) trial is a pragmatic two-arm parallel clustered randomised controlled trial. It will recruit 666 residents aged 60 or older from 100 residential aged care facilities, which will be randomly assigned to the Behavioural Activation or control intervention. Staff in both treatment groups will be encouraged to complete the Beyondblue Professional Education to Aged Care e-learning programme to improve their recognition of and ability to respond to depression in older adults. Selected staff from intervention facilities will undergo additional training to deliver an 8-module Behavioural Activation programme to residents with subthreshold symptoms of depression-they will receive ongoing Mental support from trained Behavioural Activation therapists. Outcome measures will be collected by blind research officer at baseline and after 3, 6 and 12 months. The Patient Health Questionnaire-9 is the primary outcome measure of the study. ETHICS AND DISSEMINATION: The trial will comply with the principles of the Declaration of Helsinki for Human Rights and is overseen by the University of Western Australia (reference RA/4/20/4234) and Melbourne Health (reference number HREC/18/MH/47) Ethics Committees. The results of this research project will be disseminated through publications and/or presentations in a variety of media to health professionals, academics, clinicians and the public. Only de-identified group data will be presented. TRIAL REGISTRATION: ACTRN12618000634279.

Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review.

BACKGROUND: In adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters. AIM: Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters. METHODS: A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion. RESULTS: Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the 'On the CUSP: Stop Blood Stream Infections' national programme. CONCLUSIONS: Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.

Alkalization of dissolving cellulose pulp with highly concentrated caustic at low NaOH stoichiometric excess.

We present a quantitative study, using Raman spectroscopy combined with multivariate data analysis, to determine the degree of activation of softwood sulphite dissolving cellulose pulp by aqueous sodium hydroxide. We have chosen industrially relevant conditions, including low stoichiometric ratio of NaOH/Anhydroglucose Unit (AGU)<2 and highly concentrated caustic (≥45% w/w [NaOH]). A design of experiments is used to investigate the effects of simultaneous variation of a set of key parameters on the degree of activation (i.e. transformation to alkali cellulose, denoted as DoA): (a) the NaOH/AGU stoichiometric ratio, denoted (r); (b) the concentration of NaOH, denoted [NaOH]; (c) temperature, denoted (T); and (d) reaction time, denoted (t). Solid-state 13C CP/MAS NMR spectroscopy was applied to investigate the reproducibility of the experiments and to select the range for (t). According to the model, (r) is found to have a statistically significant effect on DoA (increasing from DoA=6-30% at the lowest (r)=0.8, to DoA=48-87% at the highest (r)=1.8), together with [NaOH]. The influence of [NaOH] depends strongly on (r). The other studied variables are found to be insignificant in the model and has a complicated influence on the activation. In particular, (T) is found to be unimportant in the studied range (30-60°C), but increasing (t) from 5 to 25min shows a positive influence on DoA, depending on both (r) and [NaOH]. A mercerisation mechanism that is controlled by diffusion is proposed to explain these phenomena.

Mechanical power measurement during mechanical ventilation of SARS-CoV-2 critically ill patients. A cohort study / Medición del poder mecánico durante ventilación mecánica en pacientes críticamente enfermos con SARS-CoV-2, Estudio de cohorte

Abstract Introduction: The ventilator-induced lung injury (VILI) depends on the amount of energy per minute transferred by the ventilator to the lung measured in Joules, which is called mechanical power. Mechanical power is a development variable probably associated with outcomes in ventilated patients. Objective: To describe the value of mechanical power in patients with SARS-CoV-2 infection and ventilated for other causes and its relationship between days of mechanical ventilation, length of stay in the intensive care unit (ICU), and mortality. Methods: A multicenter, analytical, observational cohort study was conducted in patients with SARS-CoV-2 infection who required invasive mechanical ventilation and patients ventilated for other causes for more than 24 hours. Results: The cohort included 91 patients on mechanical ventilation in three tertiary care centers in the city of Pereira, Colombia. The average value of the mechanical power found was 22.7 ± 1 Joules/ min. In the subgroup of patients with SARS-CoV-2 infection, the value of mechanical power was higher 26.8 ± 9 than in the subgroup of patients without a diagnosis of SARS-CoV-2 infection 18.2 ± 1 (p <0.001). Conclusions: Mechanical power is an important variable to consider during the monitoring of mechanical ventilation. This study found an average value of mechanical power of 22.7 ± 1 Joules/min, being higher in patients with SARS-CoV-2 infection related to longer days of mechanical ventilation and a longer stay in the ICU.

Resumen Introducción: La lesión pulmonar inducida por la ventilación mecánica (LPIVM) depende, entre otras variables, de la cantidad de energía -medida en Joules- por unidad de tiempo transferida desde el ventilador al paciente, también llamada poder mecánico. El poder mecánico es una variable de desarrollo, posiblemente asociada a los desenlaces en pacientes sometidos a ventilación. Objetivo: Describir el valor del poder mecánico en pacientes con infección por SARS-CoV-2 y ventilados por otras causas y la relación entre días de ventilación mecánica, estancia en la UCI y mortalidad. Métodos: Estudio multicéntrico, analítico y observacional de cohorte realizado en pacientes con diagnóstico de infección por SARS-CoV-2 que requirieron soporte ventilatorio mecánico invasivo y pacientes ventilados por otras causas, durante más de 24 horas. Resultados: La cohorte incluyó 91 pacientes que recibieron ventilación mecánica en 3 centros de tercer nivel de la ciudad de Pereira, Colombia. El valor promedio del poder mecánico obtenido fue 22,7 ± 1 Joules/min. En el grupo de pacientes con infección por SARS-CoV-2 el valor obtenido fue mayor (26,8 ± 9), comparado con el grupo de pacientes sin infección por SARS-CoV-2 (18,2 ± 1) (p <0,001). Conclusiones: El poder mecánico es una variable importante a tener en cuenta en el monitoreo de la ventilación mecánica. El presente estudio encontró un valor promedio de poder mecánico de 22,7±1 Joules/min, siendo mayor en los pacientes con infección por SARS-CoV-2 en relación con más días de ventilación mecánica y estancia en UCI más prolongada.

Rabdomiolisis causada por ejercicio

Introduction: rhabdomyolysis is a clinical and paraclinical syndrome characterized by the presence of skeletal muscle necrosis that leads to the consequent release of intracellular muscle components with a variable clinical presentation and complications that put life at risk such as acute kidney injury. Methods: we present a case report of a patient with rhabdomyolysis with severe elevation of muscle enzymes and secondary acute kidney injury who was subsequently documented (initial Total CK 189,000 u/L) after extreme physical activity (CrossFit), who developed multiple complications and the need for support in the Intensive Care Unit (ICU) with satisfactory outcome. Results: Patient with kidney failure, receiving renal therapy with a favorable evolution and survival at discharge from the intensive care unit of a third-level hospital in the city of Pereira, Risaralda, Colombia. Conclusions: Rhabdomyolysis is a clinical and paraclinical syndrome characterized by the presence of skeletal muscle necrosis. The main cause is severe direct traumatic injury or crushes injuries; however, other conditions such as infections, intoxication, muscle ischemia, neuroleptic malignant syndrome, malignant hyperthermia, metabolic disorders, and genetic pathologies can also cause it, and particularly, extended rest, immobilization or strenuous exercise. The clinical presentation and complications are variable.

Introducción: la rabdomiólisis es un síndrome clínico y paraclínico caracterizado por la presencia de necrosis del músculo esquelético que lleva a la liberación de componentes musculares intracelulares, con una presentación clínica variable y complicaciones que ponen en riesgo la vida,como la insuficiencia renal aguda. Métodos: presentamos un caso clínico de un paciente con rabdomiólisis con elevación severa de enzimas musculares y lesión renal aguda secundaria que posteriormente se documentó (CK Totalinicial189.000u/L) luego de actividad física extrema (CrossFit), quien desarrolló múltiples complicaciones y la necesidad de apoyo en la Unidad de Cuidados Intensivos (UCI) con evolución satisfactoria. Resultados: Paciente con insuficiencia renal, que recibe terapia renal con una evolución favorable y supervivencia al egreso de la unidad de cuidados intensivos de un hospital de tercer nivel de la ciudad de Pereira, Risaralda, Colombia. Conclusiones: La rabdomiólisis es un síndrome clínico y paraclínico caracterizado por la presencia de necrosis del músculo esquelético. La causa principal son las lesiones traumáticas directas severas o las lesiones por aplastamiento; sin embargo, otras condiciones como las infecciones, la intoxicación, la isquemia muscular, el síndrome neuroléptico maligno, la hipertermia maligna, los trastornos metabólicos y las patologías genéticas también pueden causarla, y en particular, el reposo prolongado, la inmovilización o el ejercicio extenuante. La presentación clínica y las complicaciones son variables.

Concordancia entre dos escalas para evaluar la clasificación del riesgo de eventos tromboembólicos y el requerimiento de profilaxis farmacológica en el posparto / Agreement between two scales used for assessing risk classification for thromboembolic events and the requirement of postpartum pharmacological prophylaxis

RESUMEN Objetivos: Establecer la concordancia para evaluar el requerimiento de profilaxis farmacológica en el puerperio entre la escala del Rojal College Obstetricians and Gynaecologists y la escala de la guía colombiana en una institución de cuarto nivel en Bogotá, Colombia. Materiales y métodos: Estudio de concordancia diagnóstica ensamblado sobre un estudio transversal. Se incluyeron mujeres embarazadas con 24 o más semanas de gestación que ingresaron para inducción de trabajo de parto, en trabajo de parto activo, para cesárea electiva, o que requirieron cesárea de urgencia, hospitalizadas entre el 1 de marzo y 30 de abril de 2021 en una institución privada de alta complejidad en Bogotá, Colombia. Se realizó un muestreo por conveniencia. Se midieron variables demográficas, factores de riesgo, clasificación del riesgo y profilaxis farmacológica según las dos escalas. Se calculó la prevalencia de los factores de riesgo por cada escala y la concordancia en la indicación de la profilaxis entre las dos escalas por medio del valor de kappa ponderado. Resultados: Se incluyeron 320 pacientes. La escala del Royal College Obstetricians and Gynaecologists clasificó al 54,7 % de las pacientes en riesgo bajo, riesgo intermedio al 42,5 % y riesgo alto al 2,8 %. La escala colombiana clasificó al 80 % de las pacientes en riesgo bajo, 17,2 % riesgo intermedio, 2,2 % riesgo alto y 0,6 % con riesgo muy alto. El valor kappa ponderado para la concordancia para indicación fue de 0,47 (IC 95 %: 0,38-0,56). Conclusiones: La concordancia de las dos escalas para definir requerimiento de profilaxis farmacológica en el posparto tiene un acuerdo moderado. Se considera es necesario validar los criterios de clasificación del riesgo de la escala colombiana en una segunda cohorte, además evaluar la capacidad predictiva de la herramienta de la guía colombiana en diferentes puntos de corte en términos de las consecuencias de falsos positivos y negativos.

ABSTRACT Objectives: To determine agreement in assessing the need for postpartum pharmacological prophylaxis between the scale of the Royal College of Obstetricians and Gynaecologists and the Colombian guideline scale in a Level IV institution in Bogota, Colombia. Material and methods: Diagnostic agreement study assembled on a cross-sectional study. The included population consisted of pregnant women with 24 or more weeks of pregnancy admitted between March 1 and April 30 of 2021 to a high complexity private institution in Bogotá, Colombia, for labor induction, in active labor, for elective cesarean section, or who required urgent cesarean section. Convenience sampling was used. Measured variables included demographics, risk factors, risk classification and pharmacological prophylaxis according to the two scales. The prevalence of risk factors for each scale was estimated and agreement regarding prophylaxis indication between the two scales was measured using the weighted kappa value. Results: Overall, 320 patients were included. According to the scale of the Royal College Obstetricians and Gynaecologists, 54.7 % patients were classified as low risk, 42.5 % as intermediate risk and 2.8 % as high risk. The Colombian scale classified 80 % of patients as low risk, 17.2 % as intermediate risk, 2.2 % as high risk, and 0.6 % as very high risk. The weighted kappa value for agreement regarding the indication was 0.47 (95 % CI: 0.38-0.56). Conclusions: Agreement between the two scales to determine the need for postpartum pharmacological prophylaxis is moderate. Risk classification criteria for the Colombian scale should be validated in a second cohort. Moreover, the predictive ability of the Colombian guideline tool should be assessed at different cut-off points in terms of the consequences of false positive and false negative results.

Mechanical ventilation in SARS-CoV-2 patients: state of art / Ventilación mecánica en pacientes con SARS - CoV-2: estado del arte

Abstract CoVID-19-associated infection leads to a pathology of yet unknown clinical behavior, confronting the clinician with various challenges. An extensive search was conducted based on review articles on SARS-CoV-2 infection and studies including mechanical ventilation management strategies in order to complete this narrative review. Evidenced-based treatment for SARS-CoV2 infection is still in the works. We have some tools from our knowledge from past experiences indicating that a step-wise management approach should be used, without neglecting other joint therapeutic measures for improved clinical outcomes of a condition with a high mortality. The current recommendations indicate that patients with severe acute respiratory failure due to SARS-CoV-2 should be managed with protective mechanical ventilation measures. No strong evidence is yet available on the individualization of mechanical ventilation therapy according to phenotypes.

Resumen La infección asociada a COVID-19 produce una patología de comportamiento aún desconocido, planteándole diversos desafíos al clínico. Para esta revisión narrativa se llevó a cabo una extensa búsqueda basada en artículos de revisión sobre la infección por SARS-CoV-2 y estudios que incluían estrategias de manejo con ventilación mecánica. El tratamiento basado en evidencia para la infección por SARS-CoV2 todavía está en desarrollo. Tenemos algunas herramientas basadas en nuestros conocimientos de experiencias en el pasado que indican que se debe usar un abordaje escalonado, sin descuidar otras medidas terapéuticas conjuntas para mejorar los desenlaces clínicos de una condición con una elevada mortalidad. Las actuales recomendaciones indican que los pacientes con falla respiratoria aguda por SARS-CoV-2 deben manejarse con medidas de protección con ventilación mecánica. Aún no tenemos una sólida evidencia sobre la individualización del tratamiento con ventilación mecánica, de acuerdo a los distintos fenotipos.