Outcome of Human Parainfluenza Virus infection in allogeneic stem cell transplantation recipients: possible impact of ribavirin therapy.

BACKGROUND: This retrospective study focused on analyzing community-acquired respiratory virus (CARV) infections, in particular human parainfluenza virus (hPIV) after allogeneic stem cell transplant (allo-SCT) in adults recipients. It aimed to assess the impact of ribavirin treatment, clinical characteristics, and risk factors associated with lower respiratory tract disease (LRTD) progression and all-cause mortality. PATIENTS AND METHODS: The study included 230 allo-SCT recipients diagnosed with hPIV between December 2013 and June 2023. Risk factors for the development of LRTD, disease severity, and mortality were analyzed. Ribavirin treatment was administered at physician discretion in 61 out of 230 cases (27%). RESULTS: Risk factors for LRTD progression in multivariate analysis were corticosteroids > 30 mg/day (Odds ratio (OR) 3.5, 95% Confidence Interval (C.I.) 1.3-9.4, p = 0.013), fever at the time of hPIV detection (OR 3.89, 95% C.I. 1.84-8.2, p < 0.001), and absolute lymphocyte count (ALC) < 0.2 × 109/L (OR 4.1, 95% C.I. 1.42-11.9, p = 0.009). In addition, the study found that ribavirin therapy significantly reduced progression to LRTD [OR 0.19, 95% C.I. 0.05-0.75, p = 0.018]. Co-infections (OR 5.7, 95% C.I. 1.4-23.5, p = 0.015) and ALC < 0.2 × 109/L (OR 17.7, 95% C.I. 3.6-87.1, p < 0.001) were independently associated with higher day + 100 after hPIV detection all-cause mortality. There were no significant differences in all-cause mortality and infectious mortality at day + 100 between the treated and untreated groups. CONCLUSION: ALC, corticosteroids, and fever increased the risk for progression to LRTD while ribavirin decreased the risk. However, mortality was associated with ALC and co-infections. This study supports further research of ribavirin therapy for hPIV in the allo-HSCT setting.

Coupling the pretreatment and hydrolysis of lignocellulosic biomass by the expression of beta-xylosidases.

Thermochemical pretreatment and enzymatic hydrolysis are the areas contributing most to the operational costs of second generation ethanol in lignocellulosic biorefineries. The improvement of lignocellulosic enzyme cocktails has been significant in the recent years. Although the needs for the reduction of the energy intensity and chemical consumption in the pretreatment step are well known, the reduction of the severity of the process strongly affects the enzymatic hydrolysis yield. To explore the formulation requirements of the well known cellulolytic cocktail from Myceliophthora thermophila on mild pretreated raw materials, this cocktail was tested on steam exploded corn stover without acid impregnation. The low hemicellulose yield and significant accumulation of xylobiose compared with the standard pretreated material obtained with dilute acid impregnation evidenced a clear limitation in the conversion of xylan to xylose. In order to complement the beta-xylosidase limitation, a selection of enzymes was expressed and tested in this fungus. A controlled expression of xylosidases from Aspergillus nidulans, Aspergillus fumigatus, and Fusarium oxysporum allowed recovering hemicellulose yields reached with standard acid treated material. The results underline the need of parallel development of the pretreatment process with the optimization of the formulation of the enzymatic cocktails.

Gastric necrosis secondary to strangulated giant paraesophic hiatal hernia.

Asymptomatic giant hiatal hernia comprises a relatively common disease, mostly presented in women with 50 years onwards. The therapeutic approach remains controversial in recent years. Under the latest SAGES`revision, all the symptomatic hernias must be repaired, but the symptomatic hiatal hernia definition isn`t even now established. We present the case os a A 67 - year old woman with an asymptomatic hiatal hernia, that is admitted to our hospital owing to toracic and abdominal pain. This pain was related with food intake for 6 months. The patient presents a clear worsening in the last 24 hours, with no other asociated symptomatology. Suspecting an incarcerated hiatal hernia with stomach perforation, the patient is taken to theatre for a laparotomy during the early hours. An atypic gastrectomy of the greater curvature with a gastropexy is performed with fixation to the anterior abdominal wall. The surgery is completed with a feeding jejunostomy. The Manegement of giant paraesophagic hernias, still remains as one of the challenge of the esophageal surgeons.

Are any specific respiratory viruses more severe than others in recipients of allogeneic stem cell transplantation? A focus on lower respiratory tract disease.

In the general population, influenza virus, respiratory syncytial virus, and SARS-CoV-2 are considered the most severe community-acquired respiratory viruses (CARVs). However, allogeneic stem cell transplant (allo-SCT) recipients may also face severe courses from other CARVs. This retrospective study compared outcomes of various CARV lower respiratory tract diseases (LRTD) in 235 adult allo-SCT recipients, excluding co-infection episodes. We included 235 adults allo-SCT recipients experiencing 353 CARV LRTD consecutive episodes (130 rhinovirus, 63 respiratory syncytial virus, 43 influenza, 43 human parainfluenza virus, 23 human metapneumovirus, 19 Omicron SARS-CoV-2, 17 common coronavirus, 10 adenovirus and 5 human bocavirus) between December 2013 and June 2023. Day 100 overall survival ranged from 78% to 90% without significant differences among CARV types. Multivariable analysis of day 100 all-cause mortality identified corticosteroid use of >1 to <30 mg/d [Hazard ratio (HR) 2.45, p = 0.02) and ≥30 mg/d (HR 2.20, p = 0.015) along with absolute lymphocyte count <0.2 × 109/L (HR 5.82, p < 0.001) and number of CARV episodes as a continuous variable per one episode increase (HR 0.48, p = 0.001) as independent risk factors for all-cause mortality. Degree of immunosuppression, rather than intrinsic CARV virulence, has the most significant impact on mortality in allo-SCT recipients with CARV-LRTD.

Surgical resident training program to perform laparoscopic bariatric procedures: Are safety and postoperative outcomes compromised? / Realización de procedimientos bariátricos por residentes de cirugía general. ¿Compromete la efectividad de la intervención y los resultados postoperatorios?

INTRODUCTION: Laparoscopic bariatric procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB) are technically demanding and require a long learning curve. Little is known about whether surgical resident (SR) training programs to perform these procedures are safe and feasible. This study aims to evaluate the results of our SR training program to perform LRYGB. METHODS: We designed a retrospective study including patients with LRYGB between January 2014 and December 2018, comparing SR results to experienced bariatric surgeons (EBS). In our country, SR have a five-year surgical formative period, and in the fourth year they are trained for 6 months in our bariatric surgery unit, from January to June. In the beginning, they perform different steps of this procedure, to finally complete an LRYGB. We collected demographic data, comorbidities, intraoperative outcomes, and postoperative complications and outcomes after a one-year follow-up. RESULTS: Two hundred and eight patients were eligible for inclusion: 67 in group I (SR), and 141 in group II (EBS). Both groups were comparable. There was no statistically significant difference in operating time (166.45min in group I vs. 156.69min in group II; P=0.156). Conversion to open surgery, hospital stay, postoperative complications, and short-term outcomes had no significant differences between the two groups. There was no mortality registered during this period. CONCLUSION: Implementation of LRYGB stepwise learning as part of an SR training program is safe, and results are comparable to EBS, without loss of efficiency. Therefore, it is feasible to train SR in bariatric surgery under EBS supervision.

Simultaneous Complex Incisional Hernia Repair and Bariatric Surgery for Obese Patients: a Case Series of a Single-Center Early Experience.

Purpose: Obesity is associated with recurrence of complex incisional hernia repair (CIHR). Bariatric procedure during CIHR can improve recurrence rates without increasing morbidity. This study aimed to describe our results after CIHR in patients with obesity, in which a simultaneous bariatric procedure was performed. Materials and Methods: We performed a retrospective observational study including patients who underwent surgery between January 2014 and December 2018, with a complex incisional hernia (CIH) according to the Slater classification and body mass index (BMI) ≥35. CIHR was the main indication for surgery. We collected demographic data, comorbidities, CIH classification according to the European Hernia Society, type of bariatric procedure, postoperative morbidity using the Dindo-Clavien classification, and short-term results. Computed tomography (CT) is performed preoperatively. Results: Ten patients were included in the study (7 women). The mean BMI was 43.63±4.91 kg/m2. The size of the abdominal wall defect on CT was 8.86±3.93 cm. According to the European Hernia Society classification, all CIHs were W2 or higher. Prosthetic repair of the CIH was selected. Onlay, sublay, preperitoneal, and inlay mesh placement were performed twice each, as well as one modified component separation technique and one transversus abdominis release. Gastric leak after sleeve gastrectomy was the only major complication. Short-term outcomes included one recurrence, and % total weight loss was 24.04±8.03 after 1-year follow-up. Conclusion: The association of bariatric procedures during CIHR seems to be feasible, safe, and could be an option for surgical treatment in selected patients.

Systemic Oxidative Stress and Visceral Adipose Tissue Mediators of NLRP3 Inflammasome and Autophagy Are Reduced in Obese Type 2 Diabetic Patients Treated with Metformin.

Obesity is a low-grade inflammatory condition affecting a range of individuals, from metabolically healthy obese (MHO) subjects to type 2 diabetes (T2D) patients. Metformin has been shown to display anti-inflammatory properties, though the underlying molecular mechanisms are unclear. To study whether the effects of metformin are mediated by changes in the inflammasome complex and autophagy in visceral adipose tissue (VAT) of obese patients, a biopsy of VAT was obtained from a total of 68 obese patients undergoing gastric bypass surgery. The patients were clustered into two groups: MHO patients and T2D patients treated with metformin. Patients treated with metformin showed decreased levels of all analyzed serum pro-inflammatory markers (TNFα, IL6, IL1ß and MCP1) and a downwards trend in IL18 levels associated with a lower production of oxidative stress markers in leukocytes (mitochondrial ROS and myeloperoxidase (MPO)). A reduction in protein levels of MCP1, NFκB, NLRP3, ASC, ATG5, Beclin1 and CHOP and an increase in p62 were also observed in the VAT of the diabetic group. This downregulation of both the NLRP3 inflammasome and autophagy in VAT may be associated with the improved inflammatory profile and leukocyte homeostasis seen in obese T2D patients treated with metformin with respect to MHO subjects and endorses the cardiometabolic protective effect of this drug.

Effect of Roux-en-Y Bariatric Bypass Surgery on Subclinical Atherosclerosis and Oxidative Stress Markers in Leukocytes of Obese Patients: A One-Year Follow-Up Study.

Little is known about the mechanisms underlying the cardioprotective effect of Roux en-Y gastric bypass (RYGB) surgery. Therefore, the aim of the present study was to investigate whether weight loss associated with RYGB improves the oxidative status of leukocytes and ameliorates subclinical atherosclerotic markers. This is an interventional study of 57 obese subjects who underwent RYGB surgery. We determined biochemical parameters and qualitative analysis of cholesterol, leukocyte and systemic oxidative stress markers -superoxide production, glutathione peroxidase 1 (GPX1), superoxide dismutase (SOD) activity and protein carbonylation-, soluble cellular adhesion molecules -sICAM-1 and sP-selectin-, myeloperoxidase (MPO) and leukocyte-endothelium cell interactions-rolling flux, velocity and adhesion. RYGB induced an improvement in metabolic parameters, including hsCRP and leukocyte count (p < 0.001, for both). This was associated with an amelioration in oxidative stress, since superoxide production and protein carbonylation were reduced (p < 0.05 and p < 0.01, respectively) and antioxidant systems were enhanced (GPX1; p < 0.05 and SOD; p < 0.01). In addition, a significant reduction of the following parameters was observed one year after RYGB: MPO and sICAM (p < 0.05, for both), sPselectin and pattern B of LDL particles (p < 0.001, for both), and rolling flux and adhesion of leukocytes (p < 0.05 and p < 0.01, respectively). Our results suggest that patients undergoing RYGB benefit from an amelioration of the prooxidant status of leukocytes, metabolic outcomes, and subclinical markers of atherosclerosis.

A New Therapeutic Application of Platelet-Rich Plasma to Chronic Breast Wounds: A Prospective Observational Study.

The aim of this study was to investigate the usefulness of platelet-rich plasma (PRP) treatment for chronic wounds (CWs) of the breast. A prospective study was performed in 23 patients with CW of the breast who were treated with PRP. The procedure was repeated until the wound was closed completely. The study included patients with a history of breast cancer (n = 8) and patients without cancer (n = 15). The treatment with PRP was successful in all cases and observed in ≤4 weeks in 82.6% (19/23) of patients. The patients without breast cancer showed significantly less time for wound closure than the patients with a history of breast cancer. Moreover, a greater number of PRP treatments were necessary to achieve wound closure in patients undergoing conservative breast treatment. No patients had complications associated with the application of PRP. Conclusions: To the best of our knowledge, this is the first study to reveal that PRP treatment for CWs of the breast is safe, simple, useful and well-tolerated by patients.

A New Management Technique for Symptomatic Haematomas Following Therapeutic Vacuum-Assisted Biopsy.

The aim of this study was to investigate the efficacy of the vacuum-assisted biopsy (VAB) system in evacuating symptomatic haematomas after VAB excision of benign breast lesions. We retrospectively analysed the data of eight patients with symptomatic and large haematomas who were treated with VAB evacuation between 10 and 14 days after VAB excision. Only one case underwent the procedure 24 h after VAB excision, due to the patient reporting intense pain, which was relieved after application of the technique, even though it had to be done twice. This new clinical application of the VAB system for evacuating symptomatic breast haematomas was successful in all the cases in the present study. No technique-related complications were observed. Conclusions: To the best of our knowledge, this is the first study to reveal that VAB evacuation of symptomatic haematomas is safe, effective, quick and well-tolerated by patients.

Nivel de conocimientos y capacidad para el autocuidado en personas en tratamiento con hemodiálisis y su relación con la calidad de vida / Level of knowledge and self-care capacity in individuals undergoing hemodialysis and its relationship with quality of life

Introducción:Determinar el grado de conocimientos que tie-nen los pacientes en hemodiálisis sobre su enfermedad y trata-miento, valorar su capacidad para hacerse el autocuidado y su relación con la calidad de vida relacionada con la salud.Material y Método: Se realizó un estudio descriptivo y trans-versal en dos unidades de diálisis. Se estudiaron 31 pacien-tes en hemodiálisis con edad media de 67,2±14 años (71% hombres). Se estudió nivel de conocimientos sobre la enfermedad y tra-tamiento, capacidad de autocuidado y calidad de vida (lámi-nas COOP/WONCA). Se recogieron, además, variables socio-demográficas, clínicas, comorbilidad y grado de dependencia.Resultados: El 9,7% de los pacientes eran laboralmente acti-vos. El 16,1% no tenía formación, 38,7% básica, 32,3% secun-daria y 12,9% universitaria. El 61% tenía un grado de conoci-mientos alto sobre su enfermedad y tratamiento, el 32% medio y el 7% bajo.El 52 % de los pacientes mostraron alta capacidad para el au-tocuidado y el 48% media. El 3,2% de los pacientes presentaba dependencia severa, moderada el 22,6%, leve el 6,5%, siendo autónomos el 67,7%.La puntuación media en el cuestionario de calidad de vida fue de 24,06±6,5 puntos.Encontramos relación significativa entre el grado de conocimien-tos con edad (0,384, p<0,05) y nivel formativo (0,464, p<0,01).Conclusiones: Los pacientes presentan un alto nivel de cono-cimiento sobre su enfermedad y tratamiento, alto grado de autonomía y capacitación para el autocuidado, siendo los más jóvenes y con mayor nivel formativo, los que muestran mejores resultados, sin que estas variables tengan relación con la cali-dad de vida (AU)

Introduction:To determine the level of knowledge that hemodialysis patients have about their disease and treatment, assess their ability for self-care, and examine its relationship with health-related quality of life.Material and Method:A descriptive, cross-sectional study was conducted in two dialysis units. Thirty-one hemodialysis patients were studied, with a mean age of 67.2±14 years (71% male). The study assessed the level of knowledge about the disease and treatment, self-care ability, and quality of life (using COOP/WONCA charts). Additionally, sociodemographic, clinical, comorbidity, and dependence variables were collected.Results: 9.7% of the patients were employed. 16.1% had no formal education, 38.7% had basic education, 32.3% had secondary education, and 12.9% had a university education. 61% had a high level of knowledge about their disease and treatment, 32% had a moderate level, and 7% had a low level.52% of the patients demonstrated a high capacity for self-care, while 48% showed a moderate capacity. 3.2% of the patients exhibited severe dependence, 22.6% moderate dependence, 6.5% mild dependence, and 67.7% were autonomous. The average score on the quality-of-life questionnaire was 24.06±6.5 points. A significant relationship was found between the level of knowledge and age (0.384; p<0.05) and educational level (0.464; p<0.01).Conclusions: Patients exhibit a high level of knowledge about their disease and treatment, along with a high degree of autonomy and self-care capabilities. Younger patients and those with higher education levels show better results, although these variables do not appear to be directly related to quality of life (AU)

Zygomatic bone graft for oral-antral communication closure and implant placement.

The roots of molar and premolar maxillary teeth are often very close to the floor of the maxillary sinus. As a result, extraction of these teeth can leave an oral-antral communication or lead to a fistula that requires treatment. A woman with an oral-antral communication secondary to extraction of a maxillary molar is presented. The communication was closed by means of a bone graft harvested from the wall of the sinus (zygomatic bone). After 3 months, 2 dental implants were placed, one in the pterygoid area and the other with parasinusal angulation. Rehabilitation followed in the form of a screw-retained, fixed prosthesis 3 months after implant placement. There have been no complications after 1 year of follow-up. This surgical technique allowed closure of an oral-antral communication produced by molar extraction through placement of a zygomatic bone graft and subsequent placement of 2 dental implants.

A new method for the prevention of skin laceration during vacuum-assisted breast biopsy.

OBJECTIVE: To describe a new technique to prevent skin laceration during ultrasound-guided vacuum-assisted breast biopsy with the insertion of a spinal needle between the mass and the skin. METHODS: The study includes 118 patients with 118 breast imaging-reporting and data system Category 3 masses located very close to the skin or areola, which were excised using the mammotome system with a spinal needle inserted just above the site of insertion of the probe. RESULTS: The mean distance between the most superficial portion of the mass to the under surface of the overlying skin was 1.3 ± 0.4 mm. The average procedure time was 13.5 ± 4.2 min. A complete excision was achieved in 100% of the cases, and the procedure was well tolerated by all the patients. No patient experienced serious adverse events such as a skin laceration. CONCLUSION: This is the first study to prevent skin laceration during vacuum assisted breast biopsy. Advances in knowledge: The method described in this study is simple, safe and well tolerated by patients.

Realización de procedimientos bariátricos por residentes de cirugía general. ¿Compromete la efectividad de la intervención y los resultados postoperatorios? / Surgical resident training program to perform laparoscopic bariatric procedures: Are safety and postoperative outcomes compromised?

Introducción: El objetivo de este estudio es evaluar los resultados de nuestro programa de formación de residentes para la realización de bypass gástrico laparoscópico en Y de Roux (BGLYR). Material y métodos: Estudio retrospectivo en el que se incluyeron pacientes a los que se les realizó un BGLYR en nuestro centro durante el período comprendido entre enero de 2014 y diciembre de 2018. Los residentes de cuarto año de nuestro centro realizaron progresivamente distintos pasos de la intervención siempre tutorizados por cirujanos bariátricos expertos (CBE). Se compararon los resultados obtenidos en las intervenciones en las que el residente ha realizado algún paso o la totalidad del BGLYR (grupo I), con aquellas realizadas en su totalidad por CBE (grupo II). Se analizaron datos demográficos de los pacientes, comorbilidades, resultados intraoperatorios, morbimortalidad postoperatoria y resultados al año de la intervención. Resultados: Se incluyeron 208 pacientes en el estudio, 67 en el grupo I y 141 en el grupo II. Ambos grupos fueron comparables. No se objetivaron diferencias significativas en el tiempo operatorio (166,45min en el grupo I vs. 156,69min en el grupo II; p=0,156). La conversión a cirugía abierta, la estancia hospitalaria y la morbilidad postoperatoria tampoco presentaron diferencias estadísticamente significativas. No hubo mortalidad durante este período. Los resultados tras el primer año fueron similares en ambos grupos. Conclusiones: La realización de distintos procedimientos del BGLYR por residentes es segura y no compromete la efectividad ni los resultados postoperatorios, siempre que se realice bajo la supervisión de un CBE. (AU)

Introduction: Laparoscopic bariatric procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB) are technically demanding and require a long learning curve. Little is known about whether surgical resident (SR) training programs to perform these procedures are safe and feasible. This study aims to evaluate the results of our SR training program to perform LRYGB. Methods: We designed a retrospective study including patients with LRYGB between January 2014 and December 2018, comparing SR results to experienced bariatric surgeons (EBS). In our country, SR have a five-year surgical formative period, and in the fourth year they are trained for 6 months in our bariatric surgery unit, from January to June. In the beginning, they perform different steps of this procedure, to finally complete an LRYGB. We collected demographic data, comorbidities, intraoperative outcomes, and postoperative complications and outcomes after a one-year follow-up. Results: Two hundred and eight patients were eligible for inclusion: 67 in group I (SR), and 141 in group II (EBS). Both groups were comparable. There was no statistically significant difference in operating time (166.45min in group I vs. 156.69min in group II; P=0.156). Conversion to open surgery, hospital stay, postoperative complications, and short-term outcomes had no significant differences between the two groups. There was no mortality registered during this period. Conclusion: Implementation of LRYGB stepwise learning as part of an SR training program is safe, and results are comparable to EBS, without loss of efficiency. Therefore, it is feasible to train SR in bariatric surgery under EBS supervision. (AU)

[Value of Aspergillus galactomannan antigen detection in the diagnosis and follow-up of invasive aspergillosis in hematological patients]. / Valor de la detección del antígeno galactomanano de Aspergillus en el diagnóstico y seguimiento de la aspergilosis invasora en pacientes hematologícos.

Serum galactomannan detection is considered to be a useful test for early diagnosis and follow-up of invasive aspergillosis. From February to September 2002, adult patients hospitalized in our Hematology Unit for receiving intensive chemotherapy and/or hematopoietic stem cell transplant were prospectively studied. We analyzed a total of 760 samples obtained from 100 patients. Eleven patients (11%) having a positive result (OD index >1.5 ng/ml) in two consecutive Platelia Aspergillus tests were considered galactomannan-positive cases. On the other hand, 12 patients (12%) were diagnosed of proven or probable invasive aspergillosis. Sensitivity (66.6%), specificity (95.5%), positive predictive value (72.7%) and negative predictive value (96.7%) were comparable to those of larger series. Galactomannan positivity allowed also to anticipate invasive aspergillosis diagnosis (from two to 17 days before radiographic findings and from two to 15 days before mycological culture). Moreover, kinetics of antigenemia could be useful for assessing therapeutic response. Once accepted galactomannan test as a diagnostic criterium for invasive aspergillosis knowing potential causes of false positive results is of paramount importance.

[What is "coping"?]. / Qué es el afrontamiento?

The objective of this article is to analyze the concept of confrontation, especially how cancer patients apply it as related to their disease. To this end, the authors study empirical evidence from patients who are undergoing treatment for cancer. The authors evaluate the uses, attributes, antecedents and consequences of the concept of confrontation. Furthermore, the authors present different conceptual and operational definitions of confrontation.

[Analysis of NIC interventions in a neonatal intensive care unit]. / Análisis de las intervenciones NIC en una unidad de cuidados intensivos neonatales.

INTRODUCTION: The aim of the study was to describe and analyze the nursing interventions NIC developed in the clinical practice by specialized nurses in a Neonatal Intensive Care Unit (NICU). MATERIAL AND METHODS: Descriptive study in the Neonatal Intensive Care Unit of University Complex Hospital of León. The study population included all the neonates admitted in the Neonatal Intensive Care Unit from 1 march to 30 november of 2011. Database was created with the statistical program Epi Info where NIC interventions were collected between the selected by the panel of experts. RESULTS: We collected a sum of 283 records of 44 neonates admitted with an average weight of 1705.5 gr and 14.3 days of age. Nurses have performed a total of 8861 NIC interventions. The highest percentage of interventions (47,1%) belong to the complex physiological domain, followed by the basic physiological (17,7%). We found 40,1%; 30,6% and 29,1% interventions in the early, late and night shifts. CONCLUSIONS: The highest percentage of interventions belong to the complex physiological domain although we can conclude that in the nursing clinical practice the solution of problems not only depend of interventions in that area but other areas such as family key intervention in the neonatal care.

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