Effect of passively aerated biological pretreatment on different biomasses with diverse lignocellulosic fiber profiles.

Passively aerated biological pretreatment was applied to four different lignocellulosic biomasses with varying fiber content profiles: sugar beet pulp (SBP), brewery bagasse (BB), rice husk (RH), and orange peel (OP). In order to analyze the organic matter solubilization yield at 24 and 48 h, different percentages of activated sewage sludge (2.5-10%) were utilized as inoculum. The OP achieved the best organic matter solubilization yield in terms of soluble chemical oxygen demand (sCOD) and dissolved organic carbon (DOC) at 2.5% inoculation and 24 h: 58.6% and 20%, respectively, since some total reducing sugars (TRS) consumption was identified after 24 h. On the contrary, the worst organic matter solubilization yield was obtained with RH, the substrate with the highest lignin content among the tested, with percentages of 3.6% and 0.7% in terms of sCOD and DOC respectively. In fact, it could be considered that this pretreatment was not successful with RH. The optimum inoculation proportion was 7.5% (v/v) except for the OP (2.5% (v/v)). Finally, due to the counterproductive organic matter consumption at longer pretreatment durations, the optimal time for BB, SBP, and OP was 24 h.

Impacto en el patrón de atención en cirugía de cabeza y cuello y las medidas sanitarias adoptadas durante los primeros 150 días de la era COVID-19 / Impact on the pattern of care in Head and Neck Surgery and the regional and institutional policy changes adopted during the first 150 days of the COVID-19 era

Resumen Introducción: La pandemia COVID-19 generó una reestructuración en la atención quirúrgica mundialmente debido a su alta transmisibilidad y la inherente limitación de los recursos humanos y materiales disponibles. Objetivo: Describir el impacto de la pandemia COVID-19 en el Equipo de Cirugía Cabeza y Cuello del Complejo Asistencial Barros Luco Trudeau (CABL) en su ejecución clínico-quirúrgica y la secuenciación organizada de las medidas sanitarias aplicadas a lo largo del tiempo durante los primeros 150 días de iniciada la pandemia en Chile. Materiales y Método: Realizamos una revisión retrospectiva de los pacientes sometidos a cirugía y/o evaluados ambulatoriamente durante el período COVID-19 comprendido entre el 3 de marzo y el 31 de julio de 2020, comparado con el mismo intervalo de tiempo de 2019. Características clínicas y medidas sanitarias empleadas durante este período fueron sintetizadas. Resultados: Detectamos un descenso del 64% en atención ambulatoria y un descenso del 58% en la carga quirúrgica, comparado con el año 2019. Durante el período COVID-19 de 2020, un total de 61 pacientes fueron sometidos a intervención quirúrgica. La principal indicación de cirugía fue cáncer en un 75,4% (46). No se reportaron pacientes contagiados por COVID-19 en los 14 días siguientes a la hospitalización. Se discuten las consideraciones perioperatorias empleadas y restricciones nacionales/institucionales sanitarias. Conclusión: La crisis sanitaria mundial secundaria al COVID-19 generó una reducción en las atenciones ambulatorias y cirugías realizadas por Equipo de Cabeza y Cuello CABL. A pesar de las restricciones sanitarias, organizamos estratificadamente la atención para preservar la resolución de casos críticos no diferibles en cabeza y cuello.

Introduction: The COVID-19 pandemic generated a restructuring of surgical care worldwide due to the disease's high transmissibility and the inherent limitation of available human and material resources. Aim: The study's aim was to describe the impact of the COVID-19 pandemic on the head and neck surgery team at Complejo Asistencial Barros Luco Trudeau (CABL) in clinical-surgical execution and organization of sanitary sequencing measures implemented over time during the first 150 days after the pandemic started in Chile. Materials and Method: We performed a retrospective review of patients undergoing surgery or outpatient evaluation during the COVID-19 period from 03-03-2020 to 07-31-2020, compared to the same time interval in 2019. Clinical characteristics and sanitary measures used during this period were synthesized. Results: We detected a 64% decrease in outpatient care and a 58% decrease in surgical load from 2019. During the COVID-19 period of 2020, a total of 61 patients underwent surgical intervention. The main indication for surgery was cancer, in 75.4% of patients (46). COVID-19 was not reported in any patients in the 14 days following hospitalization. We discussed the perioperative considerations used and the national/institutional sanitary restrictions. Conclusions: The global health crisis to COVID-19 generated a reduction in outpatient care and surgeries performed by the CABL head and neck team. Despite health restrictions, we organized care stratified to preserve critical head and neck non-deferrable cases.

Hypertensive and HLA-B27 negative uveitis: Disease course and complications.

PURPOSE: To perform a retrospective analysis on patients with HLA-B27 negative hypertensive acute anterior uveitis. Aqueous humor samples were obtained on which a polymerase chain reaction (PCR) test was performed. The patients were then classified into 3 groups depending on whether they were positive for cytomegalovirus (CMV) or herpesvirus (HSV-VZV) or negative for both. MATERIAL AND METHODS: Different variables were collected in successive visits (baseline, 3, 6, and 12 months). The variables were age, sex, visual acuity, intraocular pressure (IOP), cells in the anterior chamber, retro-keratic precipitates, hypotensive treatment, glaucoma or retina surgery, corneal transplantation, and central thickness of the retinal nerve fiber layer. RESULTS: The sample was 36 patients, with a mean age of 59.78 ± 15.26 years. The mean baseline IOP value was 40 ± 10.42 mmHg in the CMV group compared to 23.8 ± 10.4 mmHg in the HSV-VZV, and 22.65 ± 9.9 mmHg in the negative group. The baseline frequency of retro-keratic precipitates, hypotensive treatment, glaucoma surgery, and corneal transplantation was higher in CMV positives. At one year, the loss of retinal nerve fiber layer and glaucoma surgery was greater in the negative group. In the 3 groups, there was a direct and positive correlation between IOP and inflammation in the anterior chamber. Being 0.94 (P = .05) for the positive for CMV, 0.24 (P = .75) in that of HSV-VZV, and 0.98 (P = .17) in the negative group. CONCLUSIONS: HLA-B27 negative hypertensive acute anterior uveitis with CMV positive has a more aggressive initial presentation. However, after one year, the glaucomatous damage is less than in the negative group. In hypertensive acute anterior uveitis, when inflammation in anterior chamber is controlled then IOP is also controlled.

[Moods in critical care units: emotions and moral duties of care providers]. / États d'âme en réanimation COVID-19 : des émotions aux devoirs moraux des acteurs du soin.

The Covid-19 pandemic instills emotions that can be understood in the pathological sense of mental disorder and/or in the heuristic sense of a moral dimension. So what about this distinction in critical care and resuscitation services where caregivers are at the forefront of events? What to do with emotions? The objective of this work is to pose a medico-psychological and ethical perspective on these questions, starting from the hypothesis that emotions have a specific use during the pandemic. The first step will be to show that anguish and fear, although different from an epistemological point of view, arise from the same historical place, which is the discourse of the medical world with death. The awareness of the inevitable makes share the same need of the caregiver and the citizen of a psychic economy which will lead to differentiating two possible reactions to emotions: one to face up and one to come to terms with. This psychic interlacing, inherent to the pandemic context, calls for critical care on a moral dimension related to the issue of abandonment of the human person and the poorly understood notion of "mass death". An answer to this difficulty would be found in the concept of "being-caregiver-close" but its application also supposes an ethical reflection on the outlets and the personal virtues.

Public health response to an outbreak of SARS-CoV2 infection in a Barcelona prison.

An outbreak of SARS-CoV2 infection in a Barcelona prison was studied. One hundred and forty-eight inmates and 36 prison staff were evaluated by rt-PCR, and 24.1% (40 prisoners, two health workers and four non-health workers) tested positive. In all, 94.8% of cases were asymptomatic. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. There were no deaths. Generalised screening and the isolation and evaluation of the people infected were key measures. Symptom-based surveillance must be supplemented by rapid contact-based monitoring in order to avoid asymptomatic spread among prisoners and the community at large.

Hypertensive and HLA-B27 negative uveitis: Disease course and complications. / Evolución y complicaciones en pacientes con uveítis hipertensivas HLA-B27 negativas.

PURPOSE: To perform a retrospective analysis on patients with HLA-B27 negative hypertensive acute anterior uveitis. Aqueous humor samples were obtained on which a polymerase chain reaction (PCR) test was performed. The patients were then classified into 3 groups depending on whether they were positive for cytomegalovirus (CMV) or herpesvirus (HSV-VZV) or negative for both. MATERIAL AND METHODS: Different variables were collected in successive visits (baseline, 3, 6, and 12 months). The variables were age, sex, visual acuity, intraocular pressure (IOP), cells in the anterior chamber, retro-keratic precipitates, hypotensive treatment, glaucoma or retina surgery, corneal transplantation, and central thickness of the retinal nerve fiber layer. RESULTS: The sample was 36 patients, with a mean age of 59.78±15.26 years. The mean baseline IOP value was 40±10.42mmHg in the CMV group compared to 23.8±10.4mmHg in the HSV-VZV, and 22.65±9.9mmHg in the negative group. The baseline frequency of retro-keratic precipitates, hypotensive treatment, glaucoma surgery, and corneal transplantation was higher in CMV positives. At one year, the loss of retinal nerve fiber layer and glaucoma surgery was greater in the negative group. In the 3 groups, there was a direct and positive correlation between IOP and inflammation in the anterior chamber. Being 0.94 (P=.05) for the positive for CMV, 0.24 (P=.75) in that of HSV-VZV, and 0.98 (P=.17) in the negative group. CONCLUSIONS: HLA-B27 negative hypertensive acute anterior uveitis with CMV positive has a more aggressive initial presentation. However, after one year, the glaucomatous damage is less than in the negative group. In hypertensive acute anterior uveitis, when inflammation in anterior chamber is controlled then IOP is also controlled.

Patients with non-tuberculous mycobacteria in respiratory samples: a 5-year epidemiological study.

OBJECTIVE: This study describes the characteristics of patients with positive cultures of non-tuberculous mycobacteria (NTM) in respiratory samples and determines the risk factors that predispose for a reinfection with different NTM species. METHODS: Patients with NTM isolates in respiratory samples between 2013 and 2017 were studied. Additionally, risk factors and comorbidities of reinfected patients were analyzed.. RESULTS: The study was focused on the 280 patients with NTM isolation (28 were reinfected with at least another species). Mycobacterium avium was the main isolated species. 68% were men. Median age was 73.2. Most remarkable risk factors were: tobacco, COPD and bronchiectasis. Bronchiectasis turned out to be a statistically significant risk factor for reinfection. Only 12 patients (12.4%) were treated. CONCLUSIONS: NTM were mainly identified in elderly patients. The most frequent comorbidities were COPD and smoking, whereas the most frequent species was M. avium. Previous bronchiectasis was a predisposing factor for reinfection.

PTH como predictor de hipocalcemia postiroidectomía total / PTH as a predictor of hypocalcemia after total thyroidectomy

Resumen Objetivo: Evaluar la asociación entre el valor de PTH medido a las 6 h posoperatorias de los pacientes sometidos a una tiroidectomía total, y la presentación de hipocalcemia en las primeras 24 h posoperatorias. Materiales y Método: Estudio analítico retrospectivo que utiliza una base de datos de 173 pacientes operados de tiroidectomía total entre enero de 2016 a diciembre de 2018 en el Hospital Militar de Santiago (HMS). Se revisaron datos demográficos y perioperatorios. Se utilizó curva ROC para evaluar la asociación entre PTH e hipocalcemia en nuestros pacientes. Resultados: 106 pacientes que cumplen criterios de inclusión. Promedio de PTH 30,5 (1,4-169), 58% presentó hipocalcemia, solo 17 pacientes fueron sintomáticos. PTH promedio en pacientes sintomáticos fue de 7,8 pg/ml. Curva ROC con área bajo la curva de 0,83 (0,75-0,92). Considerando valores útiles para la práctica clínica, una PTH menor a 6,3 (valor más bajo en nuestro laboratorio), tiene sensibilidad de 97%. El valor 18 de PTH (límite inferior del rango de normalidad del laboratorio) se obtiene 88,89% de sensibilidad con 66,07% de especificidad. Y con un valor de 47 pg/ml, se obtiene con un 91% de especificidad para predecir pacientes que no tendrían hipocalcemia. Conclusión: Con un valor de PTH disminuido bajo su valor normal, se puede decir que el riesgo de tener hipocalcemia es sobre el 80%, por lo que se debería iniciar tratamiento profiláctico y desistir del alta. En cambio, para definir un valor superior sobre el cual dar de alta precoz con seguridad, faltan más estudios.

Aim: To evaluate the association between PTH (parathormone) value measured at 6 hours postoperatively of patients submitted to total thyroidectomy, and the presentation of hypocalcemia in the first 24 hours. Materials and Method: Retrospective study of 173 patients with total thyroidectomy between January 2016 to December 2018 in HMS. Demographic and perioperative data were reviewed. The ROC curve was used to evaluate the association between PTH and hypocalcemia in our patients. Results: 106 patients meet inclusion criteria. Average of PTH 30.5 (1.4-169), 58% presented hypocalcemia, 17 patients were symptomatic. ROC curve with area under the curve of 0.83 (0.75-0.92) was obtained considering useful values for clinical practice, a PTH less than 6.3 (lowest value in our laboratory), has 97% sensitivity to predict hypocalcemia. If we use the value 18 we obtain 88.89% sensitivity with 66.07% specificity. And with a value of 47, it is obtained with 91% specificity to predict patients who would not have hypocalcemia Conclusion: With a PTH value decreased below its normal value, it can be said that the risk of having hypocalcemia is over 80%, so that prophylactic treatment should be initiated. To define a value on which to register early with security, more study is needed.

[Association between major depression and arterial hypertension in a Colombian population]. / Asociación entre depresión mayor e hipertensión arterial en una población colombiana.

INTRODUCTION: A third of hypertensive patients have major depression, a relationship that is associated with a worse prognosis. The objective of the study was to estimate the association between depression and high blood pressure, as well as to establish the possible bidirectionality of the conditions. MATERIALS AND METHODS: Retrospective cohort study. People between 18 and 65 years old with high blood pressure, depression or use of medications for their management were included. To analyze the antecedent, a comorbidity model was performed. A bivariate analysis was performed and then a multivariate logistic regression. The association was estimated using the Chi-square test and the odds ratios that were crude and adjusted to the other variables included in the analysis. The Hosmer-Lemeshow test was used to assess the goodness of fit. SPSS® v.21 was used as the statistical package. RESULTS: A total of 1,721 people were included in the study. The prevalence of depression in patients with and without hypertension was 17.4 and 12.6%, respectively, with a 43% risk of hypertension in people with depression. In patients with depression, it preceded the diagnosis of hypertension in 64.8% of cases and in hypertensive patients, 22.2% were later diagnosed with depression. The association between high blood pressure and major depression remained significant after adjusting for the other risk factors. CONCLUSIONS: Depression was found as a risk factor for high blood pressure, with a 2-way risk relationship between depression and high blood pressure.

Is it possible to eliminate hepatitis C from the prisons of Catalonia, Spain, in 2021?

AIM: Predict the elimination of chronic hepatitis C in Catalan prisons. MATERIAL AND METHOD: We analyzed the trend of the prevalence of HCV-RNA and anti-hepatitis C treatments prescribed in Catalonia in the period 2002-2016. Using linear exponential smoothing from the historical values in the time series, we estimate the time required to eliminate hepatitis C as a public health problem in prisons (prevalence of hepatitis C virus RNA<1%). RESULTS: A total of 1264 treatments were administered by 12/31/2016. The prevalence of hepatitis C virus RNA was 31.2% in 2002, decreasing to 8.81% in 2016. We estimate that prevalence will reach 0-0.5% in 5 years (second half 2021; 95% CI: 2019-2025). DISCUSSION: Appropriate actions can eliminate hepatitis C infection in prisoners. We estimate that by 2021 hepatitis C infection will no longer be a public health problem in Catalonia prisons.

Reconstrucción microquirúrgica de cabeza y cuello en paciente pediátrico / Micro-surgical reconstruction of the head and neck in a pediatric patient

OBJETIVO: Realizar un análisis retrospectivo de pacientes pediátricos sometidos a reconstrucciones con injertos libres microvasculares del territorio maxilofacial en el Hospital Luis Calvo Mackenna entre los años 2014 y 2018. MATERIALES Y MÉTODO: Se realizó un análisis de los casos reconstruidos entre los años indicados. RESULTADOS: Un total de 11 pacientes fueron incluidos en la muestra, 7 hombres y 4 mujeres. El rango de edad de los pacientes fue entre 3 a 17 años (media 10,1). Siete colgajos de fíbula, 3 dorsales y 1 anterolateral de muslo fueron utilizados para reconstrucción. La tasa de éxito de los colgajos fue de un 100%. Discusión: Se realizó una discusión de los colgajos y sus principales indicaciones en pediatría y se compararon los resultados de la revisión con los casos reportados. CONCLUSIÓN: El estudio preoperatorio, una adecuada planificación, la rehabilitación de la oclusión dentaria, la reconstrucción simétrica y mantener el contorno facial deben ser objetivos de la reconstrucción.

AIM: Carry out a retrospective analysis of pediatric patients undergoing reconstructions with free micro-vascular grafts of the maxillofacial territory at the Luis Calvo Mackenna Hospital during the years 2014 and 2018. MATERIALS AND METHOD: Retrospective analysis of the cases reconstructed during the years 2014 and 2018 was made. RESULTS: A total of 11 patients were included in the sample, 7 men and 4 women. The age range of the patients was between 3 to 17 years (mean 10.1 years) . Seven Fibula flaps, 3 dorsal and 1 anterolateral thigh flaps were used for reconstruction. The success rate of the flaps was 100%. DISCUSSION: A discussion of the flaps and their main indications in pediatrics was made and the results of the review were compared with the cases reported. CONCLUSION: The pre-operative study, adequate planning, the rehabilitation of the dental occlusion, the symmetry reconstruction and maintaining the facial contour must be objective of the reconstruction.

LDL cholesterol-lowering therapies: emphasis on proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.

Atherosclerotic cardiovascular disease is the leading cause of death all over the world. Its etiopathogenesis involves many correlated processes, with hypercholesterolemia being one of the main risk factors. Several large clinical trials have established the association between low-density lipoprotein cholesterol (LDL-C) levels and cardiovascular events. With the aim to take control over high LDL-C levels, several drugs with different targets in the cholesterol pathway have been developed. Statins are the cornerstone of pharmacological lipid-lowering treatment, although they are not always successful in attaining the recommended LDL-C levels. Therefore, newer and more potent therapies have been developed, being prominent among them ezetimibe and especially the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Recent trials with these new therapies have reaffirmed the theory of 'the lower, the better' when it comes to LDL-C levels, and 'the earlier, the better' when it comes to atherosclerotic physiopathology.

Dual versus triple antithrombotic therapy: is there a role for direct oral anticoagulants in arterial thrombosis?

The number of patients receiving dual antiplatelet therapy with an additional indication for long-term oral anticoagulation has substantially increased over time. This population is facing an unacceptable risk of bleeding events, particularly among elderly individuals, who are especially vulnerable to complications. Further strategies to minimize this bleeding risk, including various drug combinations, different dosage regimens and even numerous attempts to find the appropriate duration of the treatment, have been evaluated in a multitude of randomized control trials. Moreover, the recent incorporation of the direct oral anticoagulants (DOACs) to the therapeutic armamentarium may represent an alternative to treat such patients, since they have demonstrated to be noninferior to the classic vitamin K antagonists and with lower bleeding rates. The aim of this review is to summarize the most recent literature on the use of DOACs in patients with an indication for dual antiplatelet therapy (mostly subjects with coronary artery disease) and also an established indication for chronic anticoagulation (chiefly individuals with nonvalvular atrial fibrillation). The role of DOACs in ischemic heart disease alone is also discussed.

Spinach consumption ameliorates the gut microbiota and dislipaemia in rats with diet-induced non-alcoholic fatty liver disease (NAFLD).

Non-alcoholic fatty liver disease (NAFLD) is defined as the accumulation of fat in liver cells, which causes serious health consequences. Animal and human studies suggest that the gut microbiota plays a role in the pathogenesis of NAFLD. Here, we investigated whether spinach consumption could ameliorate high-fat-diet-induced disturbances in certain intestinal bacterial groups and products derived from their metabolism, such as short-chain fatty acids (SCFAs) and microbial phenolic catabolites. Attention is also paid to blood lipids and glucose. In the study, a rat model of high-fat-diet-induced NAFLD was used. There were six experimental groups: NC (normal diet), NB (normal diet + 2.5% spinach), NA (normal diet + 5% spinach), HC (high-fat diet), HB (high-fat diet + 2.5% spinach) and HA (high-fat diet + 5% spinach). The rats consumed these diets for five weeks, and after that, they were sacrificed and plasma, urine, intestinal content, faeces and liver samples were taken. Biochemical parameters were analyzed in plasma, phenolic catabolites were quantified in the faeces, urine, plasma and liver by UPLC-ESI-MS/MS, and the analysis of the microbiota and SCFAs in the intestinal content was performed by qPCR and GLC. Consumption of a high-fat diet caused NAFLD and dislipaemia and altered the gut microbiota and the pattern of SCFAs and phenolic gut microbial catabolites. Supplementation with spinach partially ameliorated some alterations induced by the high-fat diet, in particular by increasing the Lactobacillus counts, reducing the fasting glucose and total and LDL-cholesterol and preventing excess liver cholesterol accumulation, thereby improving the values of the steatosis biomarkers.

Pulmonary histiocytosis: beyond Langerhans cell histiocytosis related to smoking. / Histiocitosis pulmonar: más allá de la histiocitosis de células de Langerhans relacionada con el tabaco.

OBJECTIVE: To review the imaging findings for the different types of pulmonary histiocytosis. In particular, in addition to the well-known pulmonary Langerhans cell histiocytosis related to smoking and its possible appearance in nonsmokers, we focus on non-Langerhans cell histiocytosis in Rosai-Dorfman disease and Erdheim-Chester disease. We also review the etiopathogenesis, histology, clinical presentation, and treatment of pulmonary histiocytosis. CONCLUSION: Langerhans cell histiocytosis, Rosai-Dorfman disease, and Erdheim-Chester disease are idiopathic diseases in which the proliferation and infiltration of histiocytes is the histologic finding that confirms the diagnosis. Langerhans cell histiocytosis manifests as nodules and cysts that spare the costophrenic angles; it typically appears in smokers. Although it is uncommon in nonsmokers, Langerhans cell histiocytosis should also be considered in nonsmokers treated with chemotherapy and radiotherapy in whom cavitated nodules appear and should be included in the differential diagnosis together with metastatic disease and opportunistic infections. Rosai-Dorfman disease and Erdheim-Chester disease present with less specific thoracic findings such as adenopathies, interstitial thickening, and pleural effusion. In Erdheim-Chester disease, the characteristic extrathoracic manifestations are usually key for the diagnosis.

Alpha 1 antitrypsin distribution in an allergic asthmatic population sensitized to house dust mites.

BACKGROUND AND OBJECTIVE: Severe alpha1 antitrypsin deficiency has been clearly associated with pulmonary emphysema, but its relationship with bronchial asthma remains controversial. Some deficient alpha 1 antitrypsin (AAT) genotypes seem to be associated with asthma development. The objective of this study was to analyze the distribution of AAT genotypes in asthmatic patients allergic to house dust mites (HDM), and to asses a possible association between these genotypes and severe asthma. METHODS: A cross-sectional cohort study of 648 patients with HDM allergic asthma was carried out. Demographic, clinical and analytical variables were collected. PI*S and PI*Z AAT deficient alleles of the SERPINA1 gene were assayed by real-time PCR. RESULTS: Asthma was intermittent in 253 patients and persistent in 395 patients (246 mild, 101 moderate and 48 severe). One hundred and forty-five asthmatic patients (22.4%) with at least one mutated allele (S or Z) were identified. No association between the different genotypes and asthma severity was found. No significant differences in all clinical and functional tests, as well as nasal eosinophils, IgA and IgE serum levels were observed. Peripheral eosinophils were significantly lower in patients with the PI*MS genotype (p = 0.0228). Neither association between deficient AAT genotypes or serum ATT deficiency (AATD) and development of severe asthma, or correlation between ATT levels and FEV1 was observed. CONCLUSION: In conclusion, the distribution of AAT genotypes in HDM allergic asthmatic patients did not differ from those found in Spanish population. Neither severe ATTD or deficient AAT genotypes appear to confer different clinical expression of asthma.