Non-thyroidal illness syndrome and its relationship with mortality risk in critically ill children.

Introduction: Non-thyroidal illness syndrome (NTIS) is considered to be associated with adverse outcomes in critically ill children.The hypothesis that thyroid hormones and inflammatory markers are associated with increased prediction of mortality risk scores is tested in this paper. Methods: A prospective observational study was set up in a pediatric intensive care unit (PICU). One hundred and three patients were included. NTIS was defined as a low free triiodothyronine (FT3) value for the patient's age. Thyroid hormones levels and inflammatory markers were determined at admission: FT3, FT4 (free thyroxine), TSH (thyroid-stimulating hormone), rT3 (reverse triiodothyronine), CRP (C-reactive protein) and PCT (Procalcitonin). They were compared between children with a pediatric risk of mortality score PRISM-III >75th percentile (group A, n= 25) and the rest (group B, n = 78). Results: A FT4 value lower than 16.6 pmol/L showed an area under the curve (AUC) of 0.655 (0.56-0.78, p = 0.02), with 76% sensitivity and 61.5% specificity to detect a high risk of mortality. A multiple regression analysis revealed that a FT4 lower than 16.6 pmol/L [OR: 4.92 (1.60-18.19), p = 0.009] and having NTIS [OR: 6.04 (1.45-27.93), p = 0.016] could predict a high risk of mortality. Conclusions: In unselected critically ill children, FT4 and FT3 values at admission could be used as a good predictor of a high mortality risk. We have not achieved a predictive model that combines hormones with inflammatory markers.

Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies.

Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p = 0.013), but with a higher probability of needing second-line therapy compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p = 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p = 0.011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p < 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG.    Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment. What is Known: • Steroids plus intravenous immunoglobulin, compared with intravenous immunoglobulin alone for multi-system inflammatory syndrome (MIS-C) might reduce the need for hemodynamic support and the duration of fever, but the certainty of the evidence is low. What is New: • Intravenous immunoglobulin, steroids, and their combination for MIS-C may have different outcomes. • In this study, intravenous immunoglobulin increased the probability of discharge over time, steroids reduced persistent fever, while combination therapy reduced the need for second-line treatments.

Seroconversion panels demonstrate anti-SARS-CoV-2 antibody development after administration of the mRNA-1273 vaccine.

Seroconversion panels are an important tool for investigating antibody responses in acute and chronic phases of disease and development of serological assays for viral diseases including COVID-19. Globally it is anticipated that vaccines against SARS-CoV-2 will facilitate control of the current pandemic. The two COVID-19 seroconversion panels analyzed in this study were obtained from healthcare workers with samples collected before vaccination with the mRNA-1273 vaccine (Moderna) and after the first and second doses of the vaccine. Panel samples were tested for antibodies to SARS-CoV-2 (IgG). Individual subjects with a positive response for anti-SARS-CoV2 IgG in their pre-vaccination samples showed a significantly enhanced response to the first vaccination. In older subjects, lower immunological responses to the first injection were observed, which were overcome by the second injection. All subjects in the study were positive for anti-SARS-CoV-2 IgG after the second dose of vaccine.

Niveles de actividad física y su relación entre la distribuciónpor sexo y programa académico en una universidad / Levels of Physical Activity and Its Relation Between the Distribution by Sex and Academic Program in a University / Níveis de atividade física e a relação entre gênero e programa acadêmico em uma Universidade

Resumen El objetivo del estudio1 fuerelacionar los niveles de actividad física identificados en estudiantes universitarios con su género y el programa académico al cual pertenece. Lametodología de corte transversal con diseño de muestreo aleatorio simple estratificado sin remplazamiento, con tamaño de muestra de 329 personas, se evaluaron por encuesta probabilística mediante el Cuestionario Internacional de Actividad Física versión corta. Se utilizó el programa de Excel para la tabulación de los datos y el software estadístico R-project, para obtenergráficos BoxPlot, y prueba Chi2, asimismo el análisis de correspondencias para la representación de datos multivariados.Los resultados fueron que el 65,7 % del estudiantado se encuentra en un nivel bajo, el 19,8 % en moderado, 14,6 % en alto. La prevalencia de niveles bajos en hombre fue de 55.6 % y en mujeres de 70.6 %. Estadísticamente, el nivel de actividad física depende del género del estudiante (p<0,05) obteniendo menor nivel las mujeres. El nivel de actividad física depende también del programa de pregrado que curse el estudiante (p<0,05), adquiriendo mayores niveles, los que estudian Licenciatura en Educación Física.En conclusión, la mayor parte del estudiantado universitario se encuentra en el margen de sedentarismo, con mayor prevalencia en mujeres y programas académicos con pocas prácticas de movimiento humano, por esta razón se sugiere incentivar estrategias que promuevan la realización de actividad física regular. Independientemente de que existan programas como fisioterapia, cuyo objeto de estudio este enfocado al movimiento humano.

Abstract The purpose of the study was to relate the levels of physical activity identified in university students with their gender and the academic program to which they belong. The cross-sectional methodology with stratified simple random sampling design without replacement, with a sample size of 329 students, was evaluated by probabilistic surveys using the International Physical Activity Questionnaire short version. The Excel program was used to tabulate the data and the statistical software R-project to obtain BoxPlot graphics and Chi2 test, as well as the correspondence analysis for multivariate data representation. The results were that 65.7% of the students are at a low level, 19.8% on a moderate level, 14.6% in a high level of physical activity. The prevalence of low levels of physical activity in men was 55.6% and in women 70.6%. Statistically, the level of physical activity depends on the student's gender (p <0.05), with women obtaining a lower level of physical activity. The level of physical activity also depends on the undergraduate program that the student studies (p <0.05), acquiring higher levels of physical activity those who study Bachelor of Physical Education. In conclusion, most of the university students are in the margin of sedentarism, with a higher prevalence in women and academic programs with few human movement practices. For this reason, it is suggested to encourage strategies that promote the performance of a regular physical activity, independently of the existence of programs, such as Physiotherapy whose object of study is focused on human movement.

Resumo O objetivo do estudo foi relacionar os níveis de atividade física identificados em universitários de acordo com seu gênero e o programa acadêmico a que pertencem. A metodologia foi transversal, com delineamento amostral aleatório simples estratificado sem reposição, com amostra de 329 escolares, avaliada por questionário probabilístico, utilizando o Questionário Internacional de Atividade Física, versão curta. Foi utilizado o programa Excel para obtenção dos gráficos BoxPlot, e teste Chi2O para tabulação dos dados e o software estatístico R-project, bem como a análise de correspondência para a representação de dados multivariados. Os resultados mostram que 65,7% dos estudantes estão em um nível baixo, 19,8% num nível moderado e 14,6% num alto nível de atividade física. A prevalência de baixos níveis de atividade física nos homens foi de 55,6% e nas mulheres de 70,6%. Estatisticamente, o nível de atividade física depende do gênero do estudante (p <0,05), as mulheres obtiveram um menor nível de atividade física. E o nível de atividade física depende do curso de graduação que cursa o estudante (p <0,05), adquirindo níveis mais elevados de atividade física daqueles que estudam bacharelado em Educação Física. Em conclusão, a maioria dos universitários estão à margem do sedentarismo, com maior prevalência em mulheres e programas acadêmicos com poucas práticas de movimento humano, por isso sugere-se incentivar estratégias que promovam a realização de atividade física regular. Independentemente de existirem programas como Fisioterapia, cujo objeto de estudo é focado no movimento humano.

Comparison of the effect of three different protein content enteral diets on serum levels of proteins, nitrogen balance, and energy expenditure in critically ill infants: study protocol for a randomized controlled trial.

BACKGROUND: Nutritional support is essential in the care of critically ill children since malnutrition in this population is associated with increased morbidity and mortality. Injury in patients admitted to pediatric intensive care units (PICU) results in a catabolic state and augmented protein breakdown, leading to a negative protein balance. Current recommendations about protein prescription in the PICU are fundamentally based on expert opinions, and the minimum threshold is 1.5 g/kg per day of protein, although protein needs could be higher in certain subgroups of patients. The main objectives of the present study are to examine whether the administration of a protein-enriched infant formula increases the serum levels of total proteins, albumin, prealbumin, transferrin, and retinol and improves nitrogen balance and to analyze the effect of the high-protein diet on energy expenditure. A secondary objective is to register possible secondary effects of the protein-enriched diet. METHODS: A multicenter prospective randomized controlled trial (RCT) will be performed in three hospitals. Patients meeting inclusion criteria will be randomly allocated to one of three enteral feeding formulae with different protein contents. Blood and urine test, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry will be performed at the beginning of the nutrition regimen and at 24 h, 72 h and 5-7 days after initiation. The sample size for this trial is estimated to be 90 participants (about 30 participants in each group). The data analysis will be by intention to treat. DISCUSSION: This RCT will provide new data about the amount of protein needed to improve levels of serum protein and nitrogen balance, a surrogate of protein balance, in critically ill infants receiving enteral nutrition. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03901742 . Registered April 1, 2019 - Retrospectively registered.

[Selection and implantation of yeast strains of genus Saccharomyces at a winery regulated by Appellation Contrôlée "Chacolí de Vizcaya/Bizkaiko Txakolina"]. / Selección e implantación de cepas de levadura del género Saccharomyces en la producción de vinos de la Denominación de Origen (DO) Chacolí de Vizcaya/Bizkaiko Txakolina.

The white wine Chacolía de Vizcaya/Bizkaiko Txakolina is characteristic from The Basque Country region and regulated under Appellation Contrôlée standards (BOPV 14/6/94). The objective of this study was the identification and selection of autochthonous yeast strains, to improve the conditions used to maintain the typical characteristics of this region wines. Yeasts identified as Saccharomyces bayanus isolated around these fields from 1996 to 1998, were subjected to a selective procedure based on enological characteristics and fermentative behaviour. Three of the selected strains were used to inoculate, at winery scale, two grape juice varieties accepted by the Appellation Contrôlée (Hondarrabi Zuri and Folle Blanche). The inoculated strains on the respective vinifications was followed by restriction fragment length polymorphism of mitochondrial DNA (REAmt) method with AluI enzyme, due to their specificity, short outcome, and technological simplicity compared with other molecular typing methods such as: chromosomal karyotyping analyzed by pulsed field gel electrophoresis, Random Amplified Polymorphic DNA-PCR (RAPD-PCR) and restriction fragment length polymorphism using the infrequently cutting enzyme SfiI (REA infrequent). This study demonstrated that strains with different phenotypic traits could show indistinguishable restriction patterns with REAmt, but could be discriminated using other typing methods such as RAPD-PCR, which although showing low reproducibility could be used as complementary to REAmt. Our results demonstrate that in spite of using autochthonous selected strains, the inoculation of musts with a particular strain do not guarantee its predominance and driving fermentation features. Of all yeast strains studied, strain no. 2 showed the best results in sensory testing and at the implantation process. Therefore, it could be used with commercial purposes for the production of Chacolí de Vizcaya/Bizkaiko Txakolina, especially when using musts from Folle Blanche.

Genes and molecules involved in Aspergillus fumigatus virulence.

Aspergillus fumigatus causes a wide range of diseases that include mycotoxicosis, allergic reactions and systemic diseases (invasive aspergillosis) with high mortality rates. Pathogenicity depends on immune status of patients and fungal strain. There is no unique essential virulence factor for development of this fungus in the patient and its virulence appears to be under polygenetic control. The group of molecules and genes associated with the virulence of this fungus includes many cell wall components, such as beta-(1-3)-glucan, galactomannan, galactomannanproteins (Afmp1 and Afmp2), and the chitin synthetases (Chs; chsE and chsG), as well as others. Some genes and molecules have been implicated in evasion from the immune response, such as the rodlets layer (rodA/hyp1 gene) and the conidial melanin-DHN (pksP/alb1 gene). The detoxifying systems for Reactive Oxygen Species (ROS) by catalases (Cat1p and Cat2p) and superoxide dismutases (MnSOD and Cu, ZnSOD), had also been pointed out as essential for virulence. In addition, this fungus produces toxins (14 kDa diffusible substance from conidia, fumigaclavin C, aurasperon C, gliotoxin, helvolic acid, fumagilin, Asp-hemolysin, and ribotoxin Asp fI/mitogilin F/restrictocin), allergens (Asp f1 to Asp f23), and enzymatic proteins as alkaline serin proteases (Alp and Alp2), metalloproteases (Mep), aspartic proteases (Pep and Pep2), dipeptidyl-peptidases (DppIV and DppV), phospholipase C and phospholipase B (Plb1 and Plb2). These toxic substances and enzymes seems to be additive and/or synergistic, decreasing the survival rates of the infected animals due to their direct action on cells or supporting microbial invasion during infection. Adaptation ability to different trophic situations is an essential attribute of most pathogens. To maintain its virulence attributes A. fumigatus requires iron obtaining by hydroxamate type siderophores (ornitin monooxigenase/SidA), phosphorous obtaining (fos1, fos2, and fos3), signal transductional falls that regulate morphogenesis and/or usage of nutrients as nitrogen (rasA, rasB, rhbA), mitogen activated kinases (sakA codified MAP-kinase), AMPc-Pka signal transductional route, as well as others. In addition, they seem to be essential in this field the amino acid biosynthesis (cpcA and homoaconitase/lysF), the activation and expression of some genes at 37 degrees C (Hsp1/Asp f12, cgrA), some molecules and genes that maintain cellular viability (smcA, Prp8, anexins), etc. Conversely, knowledge about relationship between pathogen and immune response of the host has been improved, opening new research possibilities. The involvement of non-professional cells (endothelial, and tracheal and alveolar epithelial cells) and professional cells (natural killer or NK, and dendritic cells) in infection has been also observed. Pathogen Associated Molecular Patterns (PAMP) and Patterns Recognizing Receptors (PRR; as Toll like receptors TLR-2 and TLR-4) could influence inflammatory response and dominant cytokine profile, and consequently Th response to infec tion. Superficial components of fungus and host cell surface receptors driving these phenomena are still unknown, although some molecules already associated with its virulence could also be involved. Sequencing of A. fumigatus genome and study of gene expression during their infective process by using DNA microarray and biochips, promises to improve the knowledge of virulence of this fungus.

Molecular genotyping methods and computerized analysis for the study of Salmonella enterica.

Salmonella enterica is widely recognized as a major cause of foodborne diseases in humans and animals and has been isolated from environmental sources in increasing numbers worldwide. Conventional typing methods such as serotyping and phage typing have been and still are the mainstay in descriptive epidemiology of this microorganism. Nevertheless, limitations on the availability of phage reagents circumscribes the performance of such technique in reference laboratories. The resolving power of epidemiological typing has been expanded during recent years through the molecular analysis of microbial DNA. The broader availability of the reagents and equipment is accelerating their generalized use in clinical and public health laboratories. Important differences in the performance criteria of the genotyping techniques (typability, reproducibility, stability, and discriminatory power) and the convenience criteria (flexibility, accessibility, and ease of use) exist between them, and there is no ideal typing system for universal use. Most of these powerful strain-discriminative techniques are based on comparison of electrophoretic patterns or fingerprints, for which computer-assisted strategies and software packages have been developed to help in construction and analysis of microbial databases. Several initiatives, such as PulseNet (http://www.cdc.gov/pulsenet) or Harmony (http://www.phls.org.uk/inter/harmony), have arisen during recent years for international construction of such fingerprinting databases, which will allow the rapid detection of new strains and the spread of pathogenic clones of bacteria through different regions or countries. Nevertheless, complete consensus has not yet been achieved on the techniques to use or the criteria for interpretation of the results, but these goals may be reached soon.

Typing fungal isolates: molecular methods and computerized analysis.

Infections caused by fungi (mycoses) are increasingly reported in many countries owing to greater life expectancy associated with an increase in quality of medical and surgical procedures, as well as the emergence of diseases or infections that affect the immune system such as AIDS. Nosocomial outbreaks of fungal infections are sometimes reported, and typing is then necessary to find the reservoirs, analyze the modes of transmission, study the antifungal susceptibility patterns, and investigate the susceptibility of the host. In addition, the food industry is increasingly demanding typing methods that could help in selection of the best fungal strains, in order to incorporate them in the productive chains and augment the quality and security of food. This is the case for Saccharomyces cerevisiae in the wine industry: the selection and characterization of indigenous or autochthonous strains is an important objective for the production of high-quality certified wines.Several genotyping methods are now widely used for strain delineation of medically or economically important microorganisms belonging to the kingdom Fungi. Most molecular typing methods are comparable to those already described for bacteria, although the peculiarities of their nucleic acids increase the number of available methods. Although typing procedures based on the analysis of nucleic acid sequences have been developed, most genotyping methods currently in use are electrophoretically based, and the procedures include the visual comparison of nucleic acid band profiles or their reading with the help of computerized software. Here we describe some of the most frequently used genotyping methods for fungi, based on polymerase chain reactions (PCR), the isolation of chromosomal or mitochondrial DNA, and their restriction using endonuclease enzymes. The latter methods are exclusive for typing eukaryotic organisms and are based on the expected polymorphism obtained from the separation of large chromosomes using pulsed-field gel electrophoresis (PFGE) and the restriction of mitochondrial or chromosomal DNA. More sophisticated methods, such as those that combine endonuclease restriction with hybridization, are also available, although their use is less extensive and is limited mostly to research laboratories.

Development of a multiplex PCR technique for detection and epidemiological typing of salmonella in human clinical samples.

We have developed a multiplex PCR assay for Salmonella detection and epidemiological typing. Six sets of primers were designed to detect the major Salmonella serotypes and phage types in Spain. An internal amplification control was designed in order to detect PCR inhibition. The different amplification profiles obtained allowed us to detect Salmonella bacteria and to distinguish the clinically prevalent Salmonella enterica serotypes Enteritidis, Typhimurium and subspecies I serotype 4,5,12:i:-. Using this method, we could detect a specific band for DT104 and U302 phage types in Salmonella serotype Typhimurium. Salmonella enterica serotype Hadar and other C2 serogroup strains showed two specific band profiles. In the validation stage, the assay was reproducible for all serotypes studied, apart from some C2 serogroup strains. When the technique was applied to clinical stool specimens, the prevalent serotypes Enteritidis and Typhimurium were detected with a sensitivity of 93%, specificity of 100%, and efficiency of 98%. Also, a low PCR inhibition rate (8%) was obtained. The overall agreement of the multiplex PCR with conventional culture-based techniques was 95% for Salmonella typing using Cohen's kappa index.

Detection of a Salmonella enterica serovar California strain spreading in spanish feed mills and genetic characterization with DNA microarrays.

We performed an epidemiological study on Salmonella isolated from raw plant-based feed in Spanish mills. Overall, 32 different Salmonella serovars were detected. Despite its rare occurrence in humans and animals, Salmonella enterica serovar California was found to be the predominant serovar in Spanish feed mills. Different typing techniques showed that isolates of this serovar were genetically closely related, and comparative genomic hybridization using microarray technology revealed 23 S. enterica serovar Typhimurium LT2 gene clusters that are absent from serovar California.