Percolation-intercropping strategies to prevent dissemination of phytopathogens on plantations.

Phytophthora is one of the most aggressive and worldwide extended phytopathogens that attack plants and trees. Its effects produce tremendous economical losses in agronomy and forestry since no effective fungicide exists. We propose to combine percolation theory with an intercropping sowing configuration as a non-chemical strategy to minimize the dissemination of the pathogen. In this work, we model a plantation as a square lattice where two types of plants are arranged in alternating columns or diagonals, and Phytophthora zoospores are allowed to propagate to the nearest and next-to-nearest neighboring plants. We determine the percolation threshold for each intercropping configuration as a function of the plant's susceptibilities and the number of inoculated cells at the beginning of the propagation process. The results are presented as phase diagrams where crop densities that prevent the formation of a spanning cluster of susceptible or diseased plants are indicated. The main result is the existence of susceptibility value combinations for which no spanning cluster is formed even if every cell in the plantation is sowed. This finding can be useful in choosing a configuration and density of plants that minimize damages caused by Phytophthora. We illustrate the application of the phase diagrams with the susceptibilities of three plants with a high commercial value.

[Findings in brainstem auditory evoked potentials in patients under 2 years of age with a history of intraventricular haemorrhage]. / Hallazgos en los potenciales evocados auditivos del tallo cerebral en pacientes menores de 2 años con antecedente de hemorragia intraventricular.

INTRODUCTION: There are few studies that describe the results of auditory pathway assessment in patients with a history of intraventricular haemorrhage (IVH) during the early years of life. Hypoacusis can occur from the earliest stages of IVH. Brainstem auditory evoked potentials (BAEPs) are a useful tool for diagnosing auditory pathway disorders in early childhood. The aim of the present study was to describe the BAEPs findings in patients under 2 years of age with a history of IVH. PATIENTS AND METHODS: We conducted a retrospective observational study in patients under 2 years of age with a history of IVH referred to our hospital for BAEPs over a period of three years. Patients with genetic syndromes associated with hypoacusis were excluded. BAEPs were used to evaluate the presence or absence of any bioelectrical response and latencies of waves I, III and V, as well as of the intervals I-III, III-V and I-V, and also their morphology, amplitude, synchrony and reproducibility. A descriptive analysis was carried out with the calculation of frequencies and percentages. RESULTS: A total of 122 patients were included. Fifty-one per cent of them had a history of Grade I IVH; 42%, Grade II; and 7%, Grades III or IV. A bioelectrical response was obtained in 243 auditory pathways (99.6%). The morphology was found to be altered in 6.2% of the auditory pathways, while amplitudes were decreased in 2.5% of those tested. Latencies for waves I and III were found to be prolonged in 2% and for wave V in 3.6% of patients. The hearing threshold was normal in 64.8%, and 35.2% of cases presented hypoacusis. CONCLUSIONS: The prevalence of hypoacusis was high in the sample analysed. Systematic follow-up using BAEPs is recommended in order to detect and treat problems in the auditory pathway in patients with IVH in a timely manner.

TITLE: Hallazgos en los potenciales evocados auditivos del tallo cerebral en pacientes menores de 2 años con antecedente de hemorragia intraventricular.Introducción. Existen pocos estudios que describan los resultados de la evaluación de la vía auditiva en pacientes con antecedente de hemorragia intraventricular (HIV) durante los primeros años de vida. La hipoacusia puede presentarse desde los grados iniciales de la HIV. Los potenciales evocados auditivos del tallo cerebral (PEATC) son una herramienta útil para diagnosticar alteraciones de la vía auditiva en la infancia temprana. El objetivo del presente estudio fue describir los hallazgos en los PEATC en pacientes menores de 2 años con antecedente de HIV. Pacientes y métodos. Es un estudio observacional retrospectivo realizado en pacientes menores de 2 años con antecedente de HIV enviados a nuestro hospital para la realización de PEATC en un período de tres años. Se excluyó a pacientes con síndromes genéticos asociados a hipoacusia. A través de los PEATC se evaluó la presencia o la ausencia de respuesta bioeléctrica y latencias de las ondas I, III y V, así como de los intervalos I-III, III-V y I-V, además de su morfología, amplitud, sincronía y la replicabilidad. Se realizó un análisis de tipo descriptivo con cálculo de frecuencias y porcentajes. Resultados. Se incluyó a un total de 122 pacientes. El 51% de ellos tenía antecedente de HIV de grado I; el 42%, de grado II; y el 7%, de grados III o IV. La respuesta bioeléctrica se obtuvo en 243 vías auditivas (99,6%). La morfología se encontró alterada en el 6,2% de las vías auditivas, mientras que las amplitudes estuvieron disminuidas en el 2,5% de las evaluadas. Las latencias para las ondas I y III se encontraron prolongadas en el 2%, y, para la onda V, en el 3,6% de los pacientes. El umbral auditivo fue normal en el 64,8%, y el 35,2% de los casos presentó hipoacusia. Conclusiones. La prevalencia de la hipoacusia fue alta en la muestra analizada. Se recomienda realizar el seguimiento mediante PEATC de forma sistemática con la finalidad de detectar y atender oportunamente problemas de la vía auditiva en pacientes con HIV.

Patterns and outcomes of switching direct oral anticoagulants in non-valvular atrial fibrillation: A real-world experience from Spain.

AIMS: The aim is to evaluate a management program for direct oral anticoagulants (DOACs) in non-valvular atrial fibrillation (NVAF) patients according to their profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal prospective study in a cohort of patients attended in daily clinical practice in a regional hospital in Spain with 3-year a follow-up plan for patients initiating dabigatran, rivaroxaban or apixaban between JAN/2012-DEC/2016. METHODS: We analyzed 490 episodes of treatment (apixaban 2.5 9.4%, apixaban 5 21.4%, dabigatran 75 0.6%, dabigatran 110 12,4%, dabigatran 150 19.8%, rivaroxaban 15 17.8% and rivaroxaban 20 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban switched to other DOACs or changed dosing. RESULTS: Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding were 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke and age were independent predictors of stroke/TIA. Concurrent platelet inhibitors, male gender and age were independent predictors of BE. CONCLUSION: This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profile.

Oral desensitization as a useful treatment in 2-year-old children with cow's milk allergy.

BACKGROUND: Limited published evidence shows oral desensitization to be a potential intervention option for cow's milk protein (CMPs) allergy. OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of oral desensitization in 2-year-old children with cow's milk allergy, as a treatment alternative to elimination diet. METHODS: A total of 60 children aged 24-36 months with IgE-mediated allergy to CMPs were included in this multi-center study and were randomized into two groups. Thirty children (group A: treatment group) began oral desensitization immediately, whereas the remaining 30 (group B: control group) were kept on a milk-free diet and followed-up for 1 year. RESULTS: After 1-year follow-up period, 90% of the children in group A had become completely tolerant vs. 23% of the children in group B. In group A, cow's milk skin reactivity and serum-specific IgE to milk and casein decreased significantly from the initial assessment, whereas group B showed no significant change after 1 year of follow-up. Twenty-four patients (80%) developed some reaction during the treatment period: 14 children developed moderate reaction (47%) and 10 mild reaction (33%). The most common manifestations were urticaria-angioedema, followed by cough. CONCLUSIONS AND CLINICAL RELEVANCE: In this study, oral desensitization was found to be effective in a significant percentage of 2-year-old children with cow's milk allergy. Oral desensitization appears to be efficacious as an alternative to elimination diet in the treatment of 2-year-old children with cow's milk allergy. The side-effect profile appears acceptable but requires further study.

[Randomized experimental study to evaluate the effectiveness of the Flebitis Zero project in Navarre].

BACKGROUND: Phlebitis is one of the most frequent complications in peripheral venous catheters. The aim was to compare the frequency of phlebitis before and after the implementation of the Flebitis Zero project, in order to ascertain its effectiveness and what factors were associated with this complication. METHODS: Randomized pre-post intervention (Flebitis Zero project) study performed in the Hospital Universitario de Navarra (Pamplona, Spain) between 2015 and 2019. The intervention consisted of training of professionals along with the implementation of measures in order to lower the incidence of complications associated with the peripheral venous catheters. The control group (CG) was selected prior the intervention and the Intervention Group (IG) in the subsequent five years. RESULTS: The study included 656 patients, 96 (14.6%) in the CG and 569 in the IG. Lower frequency of complications (49.0 vs 37.1%; p<0.001), especially accidental PVC exit (18.8 vs 8.1%), and of phlebitis (13.5 vs 11.8%). The intervention and the use of fully reinforced dressings were associated to happening of phlebitis. The implantation of the Flebitis Zero project prevented the occurrence of phlebitis (OR = 0.78; IC95%: 0.42-0.86; p = 0.042). CONCLUSION: The implementation of the measures used in the Phlebitis Zero project was associated with a significant reduction of the complications linked to the use of the peripheral venous catheters; the frequency of phlebitis dropped, although nowhere near the recommended level.

Site-bond percolation solution to preventing the propagation of Phytophthora zoospores on plantations.

We propose a strategy based on the site-bond percolation to minimize the propagation of Phytophthora zoospores on plantations, consisting in introducing physical barriers between neighboring plants. Two clustering processes are distinguished: (i) one of cells with the presence of the pathogen, detected on soil analysis, and (ii) that of diseased plants, revealed from a visual inspection of the plantation. The former is well described by the standard site-bond percolation. In the latter, the percolation threshold is fitted by a Tsallis distribution when no barriers are introduced. We provide, for both cases, the formulas for the minimal barrier density to prevent the emergence of the spanning cluster. Though this work is focused on a specific pathogen, the model presented here can also be applied to prevent the spreading of other pathogens that disseminate, by other means, from one plant to the neighboring ones. Finally, the application of this strategy to three types of commercially important Mexican chili plants is also shown.

[Development of a program of nutritional education and valuation of the change of healthful nourishing habits in a population of students of Obligatory Secondary Education]. / Desarrollo de un programa de educación nutricional y valoración del cambio de hábitos alimentarios saludables en una población de estudiantes de Enseñanza Secundaria Obligatoria.

INTRODUCTION: Adolescence is a critical period for the acquisition and configuration of healthy dietary habits and lifestyle for the young future, which will likely persist throughout the adulthood. Paediatric and juvenile obesity is a public health problem which control necessarily implies prevention and nutritional education. OBJECTIVES: To evaluate the nutritional status of the adolescents and determine the proportion with overweight or obesity, and to establish a Nutritional Intervention Programme and analyse the improvement in the pattern of dietary habits among the adolescents. METHODS: The study has been carried out in a population of 372 Obligatory Secondary Education (OSE) students from the Institute of Secondary Education of Gandía (Valencia). RESULTS: 37.8% of the adolescents have improved the level of their diet quality. Those consuming a high quality diet have increased from 30.0% to 58.6%. Also significant is the number of students that have taken up having breakfast and those having discontinued taking industrial bakery with this meal. The decrease in the number of adolescents going to fast food places and of those that have discontinued eating candies regularly is statistically significant. The data from the KIDMED index show that 47.4% (p < 0.001) of de the students have improved the quality of their diet and in none of them it has worsened. DISCUSSION: Before starting the programme, 30% of the students followed a high quality diet comparable to the traditional Mediterranean Diet, and after the education programme, this percentage increased to 58.6%. Forty-seven point four percent of overweighed or obese students receiving the Nutritional Education and Intervention have improved their diet quality and the percentage of those following a high quality diet varied from 28.9% to 71.0%.

Oral desensitization in children with cow's milk allergy.

INTRODUCTION: Current treatment of food allergies consists of the elimination of the offending food from the diet. Desensitization or tolerance induction can be an alternative for those children who have not achieved tolerance spontaneously. We propose a cow's milk desensitization protocol carried out in an outpatient setting over a 9-10 week period. PATIENTS AND METHOD: Eighteen children older than 4 years with cow's milk protein allergy confirmed by open oral challenge with milk underwent a desensitization protocol beginning with 0.05 mL of cow's milk, reaching 1 mL on the first day, and increasing the dosage weekly until a dose of 200-250 mL of milk taken once a day was tolerated. RESULTS: By the end of the desensitization protocol, 16 of the 18 patients tolerated 200-250 mL of cow's milk in a single daily dose. The median length of the process was 14 weeks (interquartile range, 11-17 weeks). One patient withdrew due to recurrent symptoms with 2 mL and another reached a tolerance of 40 mL of milk a day. During the program, 11 children (68.75%) presented symptoms that were generally mild but which increased the length of the protocol. At the time of writing, the 16 patients who completed the program continue to tolerate milk, 13 of them for more than a year. CONCLUSIONS: Tolerance of cow's milk was achieved in 16 out of 18 patients who took part in this study. One patient only tolerated 40 mL, which prevents the risk of reactions caused by the inadvertent intake of the food substance; 1 patient is still on a milk-free diet. We believe this cow's milk desensitization protocol to be effective and reasonably safe.

Safety and immunogenicity of a combined hepatitis B virus-Haemophilus influenzae type B vaccine comprising a synthetic antigen in healthy adults.

The combined HB-Hib vaccine candidate Hebervac HB-Hib (CIGB, La Habana), comprising recombinant HBsAg and tetanus toxoid conjugate synthetic PRP antigens has shown to be highly immunogenic in animal models. A phase I open, controlled, randomized clinical trial was carried out to assess the safety and immunogenicity profile of this bivalent vaccine in 25 healthy adults who were positive for antibody to HBsAg (anti-HBs). The trial was performed according to Good Clinical Practices and Guidelines. Volunteers were randomly allocated to receive the combined vaccine or simultaneous administration of HB vaccine Heberbiovac-HB and Hib vaccine QuimiHib (CIGB, La Habana). All individuals were intramuscularly immunized with a unique dose of 10 microg HBsAg plus 10 microg conjugated synthetic PRP. Adverse events were actively recorded after vaccine administration. Total anti-HBs and IgG anti-PRP antibody titers were evaluated using commercial ELISA kits at baseline and 30 days post-vaccination. The combined vaccine candidate was safe and well tolerated. The most common adverse reactions were local pain, febricula, fever and local erythema. These reactions were all mild in intensity and resolved without medical treatment. Adverse events were mostly reported during the first 6-72 hours post-vaccination. There were no serious adverse events during the study. No severe or unexpected events were either recorded during the trial. The combined vaccine elicited an anti-HBs and anti-PRP booster response in 100% of subjects at day 30 of the immunization schedule. Anti-HBs and anti-PRP antibody levels had at least a two-fold increase compared to baseline sera. Even more, anti-HBs antibody titer showed a four-fold increase in 100% of volunteers in the study group. The results indicate that the combined HB-Hib vaccine produces increased antibody levels in healthy adults who have previously been exposed to these two antigens. To our knowledge, this is the first demonstration of safety and immunogenicity for a combined vaccine comprising recombinant HBV and synthetic Hib antigens. The present results support phase I-II clinical trial in the target population, two months old healthy infants.

Hallazgos en los potenciales evocados auditivos del tallo cerebral en pacientes menores de 2 años con antecedente de hemorragia intraventricular / Findings in brainstem auditory evoked potentials in patients under 2 years of age with a history of intraventricular haemorrhage

Introducción: Existen pocos estudios que describan los resultados de la evaluación de la vía auditiva en pacientes con antecedente de hemorragia intraventricular (HIV) durante los primeros años de vida. La hipoacusia puede presentarse desde los grados iniciales de la HIV. Los potenciales evocados auditivos del tallo cerebral (PEATC) son una herramienta útil para diagnosticar alteraciones de la vía auditiva en la infancia temprana. El objetivo del presente estudio fue describir los hallazgos en los PEATC en pacientes menores de 2 años con antecedente de HIV. Pacientes y métodos: Es un estudio observacional retrospectivo realizado en pacientes menores de 2 años con antecedente de HIV enviados a nuestro hospital para la realización de PEATC en un período de tres años. Se excluyó a pacientes con síndromes genéticos asociados a hipoacusia. A través de los PEATC se evaluó la presencia o la ausencia de respuesta bioeléctrica y latencias de las ondas I, III y V, así como de los intervalos I-III, III-V y I-V, además de su morfología, amplitud, sincronía y la replicabilidad. Se realizó un análisis de tipo descriptivo con cálculo de frecuencias y porcentajes. Resultados: Se incluyó a un total de 122 pacientes. El 51% de ellos tenía antecedente de HIV de grado I; el 42%, de grado II; y el 7%, de grados III o IV. La respuesta bioeléctrica se obtuvo en 243 vías auditivas (99,6%). La morfología se encontró alterada en el 6,2% de las vías auditivas, mientras que las amplitudes estuvieron disminuidas en el 2,5% de las evaluadas. Las latencias para las ondas I y III se encontraron prolongadas en el 2%, y, para la onda V, en el 3,6% de los pacientes. El umbral auditivo fue normal en el 64,8%, y el 35,2% de los casos presentó hipoacusia. Conclusiones: La prevalencia de la hipoacusia fue alta en la muestra analizada. Se recomienda realizar el seguimiento mediante PEATC de forma sistemática con la finalidad de detectar y atender oportunamente problemas...(AU)

Introduction: There are few studies that describe the results of auditory pathway assessment in patients with a history of intraventricular haemorrhage (IVH) during the early years of life. Hypoacusis can occur from the earliest stages of IVH. Brainstem auditory evoked potentials (BAEPs) are a useful tool for diagnosing auditory pathway disorders in early childhood. The aim of the present study was to describe the BAEPs findings in patients under 2 years of age with a history of IVH. Patients and methods: We conducted a retrospective observational study in patients under 2 years of age with a history of IVH referred to our hospital for BAEPs over a period of three years. Patients with genetic syndromes associated with hypoacusis were excluded. BAEPs were used to evaluate the presence or absence of any bioelectrical response and latencies of waves I, III and V, as well as of the intervals I-III, III-V and I-V, and also their morphology, amplitude, synchrony and reproducibility. A descriptive analysis was carried out with the calculation of frequencies and percentages. Results: A total of 122 patients were included. Fifty-one per cent of them had a history of Grade I IVH; 42%, Grade II; and 7%, Grades III or IV. A bioelectrical response was obtained in 243 auditory pathways (99.6%). The morphology was found to be altered in 6.2% of the auditory pathways, while amplitudes were decreased in 2.5% of those tested. Latencies for waves I and III were found to be prolonged in 2% and for wave V in 3.6% of patients. The hearing threshold was normal in 64.8%, and 35.2% of cases presented hypoacusis.Conclusions: The prevalence of hypoacusis was high in the sample analysed. Systematic follow-up using BAEPs is recommended in order to detect and treat problems in the auditory pathway in patients with IVH in a timely manner.(AU)

Phase I clinical trial in healthy adults of a nasal vaccine candidate containing recombinant hepatitis B surface and core antigens.

BACKGROUND: The nasal vaccine candidate (NASVAC), comprising hepatitis B virus (HBV) surface (HBsAg) and core antigens (HBcAg), has been shown to be highly immunogenic in animal models. METHODS: A phase I double-blinded, placebo-controlled randomized clinical trial was carried out in 19 healthy male adults with no serologic markers of immunity/infection to HBV. This study was aimed at exploring the safety and immunogenic profile of nasal co-administration of both HBV recombinant antigens. The trial was performed according to Good Clinical Practice guidelines. Participants ranged in age from 18 to 45 years and were randomly allocated to receive a mixture of 50 microg HBsAg and 50 microg HBcAg or 0.9% physiologic saline solution, as a placebo, via nasal spray in a five-dose schedule at 0, 7, 15, 30, and 60 days. A total volume of 0.5 ml was administered in two dosages of 125 microl per nostril. Adverse events were actively recorded 1 h, 6 h, 12 h, 24 h, 48 h, 72 h, 7 days and 30 days after each dose. Anti-HBs and anti-HBc titers were evaluated using corresponding ELISA kits at days 30 and 90. RESULTS: The vaccine candidate was safe and well tolerated. Adverse reactions included sneezing (34.1%), rhinorrhea (12.2%), nasal stuffiness (9.8%), palate itching (9.8%), headache (9.8%), and general malaise (7.3%). These reactions were all self-limiting and mild in intensity. No severe or unexpected events were recorded during the trial. The vaccine elicited anti-HBc seroconversion in 100% of subjects as early as day 30 of the immunization schedule, while a seroprotective anti-HBs titer (>or=10 IU/l) was at a maximum at day 90 (75%). All subjects in the placebo group remained seronegative during the trial. CONCLUSION: The HBsAg-HBcAg vaccine candidate was safe, well tolerated and immunogenic in this phase I study in healthy adults. To our knowledge, this is the first demonstration of safety and immunogenicity for a nasal vaccine candidate comprising HBV antigens.

Pandemia y atencion ambulatoria pediatrica de alta complejidad en un hospital publico. Experiencia de un modelo de atención con uso de telemedicina en niños/as con nutrición parenteral domiciliaria / Pandemic and highly complex pediatric outpatient care in a public hospital. Experience of a care model with the use of telemedicine in children with home parenteral nutrition

Introducción: Los pacientes que reciben nutrición parenteral domiciliaria (NPD) en seguimiento desde el Hospital requieren un monitoreo que debió modificarse por la pandemia por SARS-CoV-2. Objetivo: Valorar la utilización y el impacto en los resultados, de estrategias alternativas a la atención presencial de pacientes con NPD, empleando telemedicina, durante el inicio de la pandemia por SARS-CoV-2, comparándolas con las prácticas habituales previas. Materiales y métodos: Estudio analítico descriptivo retrospectivo que analizó el monitoreo, la evolución y las complicaciones de pacientes con NPD asistidos en el Hospital en el período previo a la pandemia (1/4/2019 y 31/3/2019) y durante su primer año (1/4/2020 a 31/3/2021), basado en la revisión de historias clínicas y bases de datos de complicaciones. Resultados: Las características demográficas, diagnósticos, procedencia y provisión de la NPD fueron similares en los dos períodos. Durante el período de la pandemia se redujeron en forma significativa el número de controles presenciales y aumentaron los realizados por telemedicina en forma sincrónica (con una modalidad pautada previamente), y los controles por profesionales locales. La participación de los cuidadores en los procedimientos de administración de la NPD aumentó en pandemia. Las tasas de complicaciones, re-internaciones, el número de inicios y suspensiones de tratamiento fueron similares en ambos períodos. Conclusiones: En pandemia fue posible implementar y monitorizar la NPD utilizando telemedicina sin observar afectación significativa de la evolución, las complicaciones de la enfermedad y del tratamiento. El seguimiento mediante telemedicina sincrónica resultó útil y se incorporará como una herramienta más al monitoreo habitual sin reemplazarlo

Introduction: Patients receiving home parenteral nutrition (HPN) under follow-up from the Hospital require monitoring that had to be modified due to the SARSCoV-2 pandemic. Objective: To assess the use and the impact on the results of other care strategies for patients with HPN, using telemedicine, during the beginning of the SARS CoV2 pandemic, compared with previous usual practices.Materials and methods: Retrospective descriptive analytical study that analyzed the monitoring, evolution and complications of patients with HPN assisted in the Hospital, in the period before pandemic ( 4/1/2019 to 3/31/2020) and during the first year of SARS CoV-2 pandemic (4/1/2020 to 3/31/2021), according to data obtained from medical records and databases. Results: demographic characteristics, diagnoses, place of residence and HPN provision were similar in both periods. During the pandemic period, the number of face-to-face controls were significantly reduced and those carried out by telemedicine synchronously, and by local professionals increased. The participation of caregivers in the administration procedures of the HPN increased in the pandemic period. The rates of complications, readmissions, number of initiations and suspensions of home treatment were similar in both periods. Conclusions: It was possible to implement and monitor HPN during pandemic. The evolution and complications of the disease and treatment were not significantly affected. Synchronous telemedicine follow-up was successfully useful and will be incorporated as another tool to regular monitoring

Estudio experimental aleatorizado para la evaluación de la efectividaddel proyecto Flebitis Zero en Navarra / Randomized experimental study to evaluate the effectiveness of the Flebitis Zero project in Navarre

Fundamento:La flebitis es una de las complicaciones más frecuentes en los catéteres venosos periféricos (CVP). El objetivo fue comparar la frecuencia de flebitis previa y tras la implantación del proyecto Flebitis Zero, para conocer la efectividad del mismo y los factores relacionados con dicha complicación.Material y métodos:Estudio aleatorizado de comparación pre-post intervención (proyecto Flebitis Zero) realizado en el Hospital Universitario de Navarra (Pamplona, España) entre 2015 y 2019. La intervención consistió en la formación del personal y en la implementación de medidas que permitan disminuir la incidencia de complicaciones de los catéteres venosos periféricos. El grupo control (GC) se seleccionó antes de la puesta en marcha del proyecto Flebitis Zero, y el grupo intervención (GI) a lo largo de los cinco años posteriores.Resultados:Se incluyeron 656 pacientes, 96 en el GC (14,6%) y 569 en el GI. En el GI se observó menor frecuencia de complicaciones (49 vs 37,1%; p<0,001), especialmente salida accidental del dispositivo (18,8 vs 8,1%), y de flebitis (13,5 vs 11,8%). La intervención y el uso de apósitos totalmente reforzados se asociaron a la no aparición de flebitis La instauración del proyecto Flebitis Zero fue un factor protector de flebitis (OR = 0,78; IC95%: 0,42-0,86; p = 0,042).Conclusiones:La implantación de las medidas trabajadas con el proyecto Flebitis Zero se asociaron a una reducción significativa de las complicaciones asociadas al uso de los catéteres venosos periféricos; la frecuencia de flebitis disminuyó, pero lejos aún de los niveles recomendados.(AU)

Background: Phlebitis is one of the most frequent complications in peripheral venous catheters. The aim was to compare the frequency of phlebitis before and after the implementation of the Flebitis Zero project, in order to ascertain its effectiveness and what factors were associated with this complication.Methods: Randomized pre-post intervention (Flebitis Zero project) study performed in the Hospital Universitario de Navarra (Pamplona, Spain) between 2015 and 2019. The intervention consisted of training of professionals along with the implementation of measures in order to lower the incidence of complications associated with the peripheral venous catheters. The control group (CG) was selected prior the intervention and the Intervention Group (IG) in the subsequent five years. Results: The study included 656 patients, 96 (14.6%) in the CG and 569 in the IG. Lower frequency of complications (49.0 vs 37.1%; p<0.001), especially accidental PVC exit (18.8 vs 8.1%), and of phlebitis (13.5 vs 11.8%). The intervention and the use of fully reinforced dressings were associated to happening of phlebitis. The implantation of the Flebitis Zero project prevented the occurrence of phlebitis (OR= 0.78; IC95%: 0.42-0.86; p= 0.042). Conclusion: The implementation of the measures used in the Phlebitis Zero project was associated with a significant reduction of the complications linked to the use of the peripheral venous catheters; the frequency of phlebitis dropped, although nowhere near the recommended level.(AU)

Long-Term Outcomes of Intestinal and Multivisceral Transplantation at a Single Center in Argentina.

BACKGROUND: Intestinal failure (IF) patients received parenteral nutrition (PN) as the only available therapy until intestinal transplantation (ITx) evolved as an accepted treatment. The aim of this article is to report the long-term outcomes of a series of ITx performed in pediatric and adult patients at a single center 9 years after its creation. PATIENTS AND METHODS: This is a retrospective analysis of the ITx performed between May 2006 and January 2015. Diagnoses, pre-ITx mean time on PN, indications for ITx, time on the waiting list for types of ITx, mean total ischemia time, and warm ischemia time, time until PN discontinuation, incidence of acute and chronic rejection, and 5-year actuarial patient survival are reported. RESULTS: A total of 42 patients received ITx; 80% had short gut syndrome (SG); the mean time on PN was 1620 days. The main indication for ITx was lack of central venous access followed by intestinal failure-associated liver disease (IFALD) and catheter-related infectious complications. The mean time on the waiting list was 188 days (standard deviation, ±183 days). ITx were performed in 26 children and 14 adults. In all, 32 procedures were isolated ITx (IITX); 10 were multiorgan Tx (MOT; 3 combined, 7 multivisceral Tx (MVTx), 1 modified MVTx and 2 with kidney); 2 (4.7 %) were retransplantations: 1 IITx, 1 MVTx, and 5 including the right colon. Thirteen patients (31%) received abdominal rectus fascia. All procedures were performed by the same surgical team. Total ischemia time was 7:53 ± 2:04 hours, and warm ischemia time was 40.2 ± 10.5 minutes. The mean length of implanted intestine was 325 ± 63 cm. Bishop-Koop ileostomy was performed in 67% of cases. In all, 16 of 42 Tx required early reoperations. The overall mean follow-up time was 41 ± 35.6 months. The mean time to PN discontinuation after Tx was 68 days (P = .001). The total number of acute cellular rejection (ACR) episodes until the last follow-up was 83; the total number of grafts lost due to ACR was 4; and the total graft lost due to chronic rejection was 3. At the time of writing, the overall 5-year patient survival is 55% (65% for IITx vs 22% for MOT; P = .0001); 60% for pediatric recipients vs 47% for adults (P = NS); 64% when the indication for ITx was SG vs 25% for non-SG (P = .002). CONCLUSIONS: At this center, candidates with SG, in the absence of IFALD requiring IITx, showed the best long-term outcomes, independent of recipient age. A multidisciplinary approach is mandatory for the care of intestinal failure patients, to sustain a rehabilitation and transplantation program over time.

Determination of carbaryl, carbofuran and methiocarb in cucumbers and strawberries by monoclonal enzyme immunoassays and high-performance liquid chromatography with fluorescence detection. An analytical comparison.

Carbaryl, carbofuran and methiocarb are three of the most important N-methylcarbamate pesticides. In the present work, the application of laboratory-developed monoclonal antibody-based enzyme-linked immunosorbent assays (ELISAs) to the determination of these compounds in fruits and vegetables is described. Cucumbers and strawberries were spiked with the three carbamates at 10, 50 and 200 ppb. After extraction and clean-up, samples were analyzed by immunoassay and by HPLC with post-column derivatization and fluorescence detection (US Environmental Protection Agency Method 531.1). Results obtained by ELISA correlated well with those obtained by HPLC, both in terms of accuracy and precision. Recoveries were in the 60-90% range by ELISA and in the 50-90% range by HPLC, depending on the particular combination of commodity, pesticide, and fortification level under consideration. ELISAs were also applied to the analysis of non-purified sample extracts with excellent results: recoveries close to 100% were obtained, while maintaining similar precision values. This approach avoids the use of solid-phase extraction columns, saves time, and considerably increases the sample throughput. Results clearly indicate that the developed immunoassays may be suitable for the quantitative and reliable determination of carbaryl, carbofuran and methiocarb in fruits and vegetables even without including clean-up steps. These considerations make these ELISAs very useful analytical tools for monitoring and regulatory programs, without the need of complex and expensive instrumentation.

Heterologous production of bacteriocins by lactic acid bacteria.

Over the last two decades, bacteriocins produced by lactic acid bacteria (LAB) have been the subject of considerable research and industrial interest due to their potential as food biopreservatives. The development of heterologous expression systems for such antimicrobial compounds may offer a number of advantages over native systems, such as facilitating the control of bacteriocin gene expression or achieving higher production levels. In addition, the heterologous production by food-grade LAB offers an attractive method for overcoming some of the adverse situations that may affect the effectiveness of some bacteriocins in food systems. Construction of multibacteriocinogenic strains or acquisition of antimicrobial properties by industrial strains are further objectives that can be achieved through the use of heterologous gene expression systems. The development of new biotechnological tools and recent advances in LAB genetics account for the escalating number of studies dealing with heterologous production of bacteriocins by such hosts. This paper reviews the literature published on the subject and compares the different experimental strategies that have been used up to the present for this purpose.

Monoclonal enzyme immunoassay for the analysis of carbaryl in fruits and vegetables without sample cleanup.

The N-methylcarbamate pesticide carbaryl is one of the most important insecticides used worldwide. In the present work, the validation of a monoclonal antibody-based enzyme immunoassay (ELISA) for the determination of this compound in fruits and vegetables is described. The immunoassay is a competitive heterologous ELISA in the antibody-coated format, with an I(50) value for standards in buffer of 101.0 +/- 26.9 ng/L and with a dynamic range between 31.6 and 364.0 ng/L. For recovery studies, peppers, cucumbers, strawberries, tomatoes, potatoes, oranges, and apples were spiked with carbaryl at 10, 50, and 200 ppb. After liquid extraction, analyses were performed by ELISA on both extracts purified on solid-phase extraction (SPE) columns and crude, nonpurified extracts. Depending on the crop and the fortification level, recoveries in the 59.0--120.0% range were obtained for purified samples and in the 70.0--137.7% range for crude extracts. The carbaryl immunoassay performance was further validated with respect to high-performance liquid chromatography (HPLC) with postcolumn derivatization and fluorescence detection (EPA Method 531.1). Samples were spiked with carbaryl at several concentrations and analyzed as blind samples by ELISA and HPLC after SPE cleanup. The correlation between methods was excellent (y = 1.04x + 0.71, r(2) = 0.992, n = 33), with HPLC being more precise than ELISA (mean coefficients of variation of 5.2 and 12.0%, respectively). The immunoassay was then applied to the analysis of nonpurified extracts of the same samples. Results also compared very well with those obtained by HPLC on purified samples (y = 1.28x - 0.59, r(2) = 0.987, n = 33) while maintaining similar precision. Therefore, the developed immunoassay is a suitable method for the quantitative and reliable determination of carbaryl in fruits and vegetables even without sample cleanup, which saves time and money and considerably increases sample throughput.

Study of the reaction of complexation of penicillin V with cobalt(II) in methanolic medium.

As shown by spectrophotometry, two specific complexes with stoichiometry 1:1 and 2:1 are formed when penicillin V reacts with cobalt(II) in a methanolic medium. Stability constants are determined at 20 degrees , as well as the molar absorptivities at 510 nm. The results obtained are: log beta(1:1) = 1.67 +/- 0.01 l.mole(-1) and log beta(2:1) = 5.76 +/- 1.01 l(2).mole(-2), (1:1) = 13.62 +/- 0.73 and (2:1) = 12.95 +/- 0.61 l.mole(-1).cm(-1).

Influence of osteoarticular pathology (OAP) on the quality of life of elderly people.

BACKGROUND: In elderly people the concept of quality of life includes health status, ability to perform daily tasks and social activities, financial position, emotional status and absence of aches and pains. OBJECTIVE: To evaluate the degree of incapacity related to osteoarticular pathology (OAP), one of the most common diseases among old people, and to ascertain to what extent this affects their quality of life. DESIGN: The sample was made up of 59 men (76.1+/-8.1 years) and 104 women (79.7+/-6.2 years) from a geriatric home depending on the Generalitat Valenciana (Spain). Data obtained from the individual clinical histories and personal interviews made it possible to evaluate their: global health status, ability to perform daily tasks and social activities, food intake and the quality of the geriatric home. In addition, body mass index (BMI), arm muscle area (AMA) and arm fat area (AFA) were estimated. RESULTS: The number of chronic diseases, drug consumption, and values of the fat-mass indicators (BMI and AFA) were significantly higher (p<0.05) in people with OAP (61% of women and 25% of men of the sample), and their global health status and manual ability were significantly worse (p<0.05) than that of the other residents. Both groups (with and without OAP) obtained similar scores (p>0.05) on all indicators of quality of life evaluated, and only the catering services was disliked by the majority of the residents. CONCLUSIONS: From a subjective point of view, OAP does not seem to affect the quality of life of people suffering from it, except insofar as it diminishes their manual ability.

Identification of cocaine in cocaine-lidocaine mixtures ("rock cocaine") and other illicit cocaine preparations using derivative absorption spectroscopy.

A rapid second-derivative procedure for distinguishing cocaine and other local anesthetics is described. This technique appeared to be particularly useful in the detection of cocaine in binary mixtures. It is of great value in forensic toxicology, resolving cocaine-lidocaine, cocaine-procaine, cocaine-tetracaine, and cocaine-benzocaine mixtures, for which zero-order UV spectroscopy fails.