Care of patients on home parenteral nutrition during the first year of the COVID-19 pandemic: Management of central line-associated bloodstream infections.

BACKGROUND AND AIM: The aim of this study was to analyze central line-associated bloodstream infections (CLABSI) in home parenteral nutrition (HPN) patients assisted by an interdisciplinary team during the first year of the COVID-19 pandemic in Argentina. METHODS: Longitudinal, retrospective and analytical study of patients on HPN for ≥90 days during 2020. Data collection included age (adults >18 years, pediatric ≤18 years), gender, diagnosis, type of catheter, number of lumens, venous access, days on HPN, infusion modality and number of CLABSI-associated events. In COVID-19 cases, number of patients, disease progression, mortality rate and microorganisms involved were analyzed. RESULTS: A total of 380 patients were included, 120 (31.6%) pediatric and 260 (68.4%) adult patients. Median age was 44.50 years (10; 62.25). Twelve patients (3.15% of the total) had COVID-19; of these, two pediatric and seven adult patients had no complications, and three adults died of COVID-19 pneumonia. The diagnoses observed were benign chronic intestinal failure (CIF, n = 311), grouped into short bowel (n = 214, 56.3%), intestinal dysmotility (n = 56, 14.7%), intestinal fistula (n = 20, 5.3%), and extensive small bowel mucosal disease (n = 21, 5.5%); malignant tumors (n = 52, 13.7%); other (n = 17, 4.4%). Total catheter days were 103,702. Median days of PN duration per patient were 366 (176.2, 366). The types of catheters used were tunneled (317 patients, 83.4%); peripherally inserted central (PICC) line (55 patients, 14.5%) and ports (8 patients; 2.1%). A total of 111 CLABSI was registered, with a prevalence of 1.09/1000 catheter days (adult, 0.86/1000 days; pediatric, 1.51/1000 days). The microorganisms identified in infectious events were Gram + bacteria (38, 34.5%); Gram-bacteria (36, 32%); mycotic (10, 9%); polymicrobial (4, 3.6%); negative culture and signs/symptoms of CLABSI (23, 20.3%). The odds ratio between pediatric and adult patients was 2.29 (1.35, 3.90). CONCLUSION: The rate of CLABSI during the COVID-19 pandemic was within the ranges reported by international scientific societies. The risk of CLABSI was higher in pediatric patients, and mortality rate in COVID-19 infected patients was higher than in the general population.

Antioxidant and Anti-Inflammatory Properties of Probiotic Candidate Strains Isolated during Fermentation of Agave (Agave angustifolia Haw).

Agave species are a source of diverse products for human use, such as food, fiber, and beverages, which include mezcal, a distilled beverage produced by spontaneous fermentation. Agave is an excellent source of high amounts of sugars, minerals, and phenolic compounds, which favor the growth of lactic acid bacteria (LAB) and yeast communities. In this work, 20 promising LAB strains with probiotic characteristics were isolated from the agave fermentation stage in mezcal production. The strains belonged to Lactobacillus plantarum (15), Lactobacillus rhamnosus (2), Enterococcus faecium (2), and Lactococcus lactis (1). These isolates were characterized for their resistance under gastrointestinal conditions, such as lysozyme, acid pH, and bile salts. In addition, the adherence of these LABs to human intestinal epithelial cells (Caco-2 and HT-29 cells) was tested in vitro and their antioxidant and immunomodulatory profile was determined using cellular models. Lactobacillus rhamnosus LM07 and Lactobacillus plantarum LM17 and LM19 strains were selected for their antioxidant properties, and their capacities in an oxidative stress model in intestinal epithelial cells IECs (Caco-2 and HT-29 cells) in the presence of hydrogen peroxide were evaluated. Interestingly, Lactobacillus rhamnosus LM07 and Lactobacillus plantarum LM17 and LM19 strains showed anti-inflammatory properties in TNF-α-stimulated HT-29 cells. Subsequently, bacterial strains exhibiting antioxidant and anti-inflammatory properties were tested in vivo in a mouse model with dinitrobenzene sulfonic acid (DNBS)-induced chronic colitis. Weight loss, intestinal permeability, and cytokine profiles were measured in mice as indicators of inflammation. One of the selected strains, Lactobacillus plantarum LM17, improved the health of the mice, as observed by reduced weight loss, and significantly decreased intestinal permeability. Altogether, our results demonstrate the potential of LAB (and lactobacilli in particular) isolated from the agave fermentation stage in mezcal production. Lactobacillus rhamnosus LM07 and Lactobacillus plantarum LM17 strains represent potential candidates for developing new probiotic supplements to treat inflammatory bowel disease (IBD).

Fast and accurate medication identification.

Much of the AI work in healthcare is focused around disease prediction in clinical settings, which is an important application that has yet to deliver in earnest. However, there are other fundamental aspects like helping patients and care teams interact and communicate in efficient and meaningful ways, which could deliver quadruple-aim improvements. After heart disease and cancer, preventable medical errors are the third leading cause of death in the United States. The largest subset of medical errors is medication error. Providing the right treatment plan for patients includes knowledge about their current medications and drug allergies, an often challenging task. The widespread growth of prescribing and consuming medications has increased the need for applications that support medication reconciliation. We show a deep-learning application that can help reduce avoidable errors with their attendant risk, i.e., correctly identifying prescription medication, which is currently a tedious and error-prone task. We demonstrate prescription-pill identification from mobile images in the NIH NLM Pill Image Recognition Challenge dataset. Our application recognizes the correct pill within the top-5 results at 94% accuracy, which compares favorably to the original competition winner at 83.3% for top-5 under comparable, though not identical configurations. The Institute of Medicine claims that better use of information technology can be an important step in reducing medication errors. Therefore, we believe that a more immediate impact of AI in healthcare will occur with a seamless integration of AI into clinical workflows, readily addressing the quadruple aim of healthcare.

Pielonefritis xantogranulomatosa secundaria a litiasis obstructiva en un paciente pediátrico / Pyelonephritis Xanthogranulomatous Secundary to Obstructive Lithiasis in Pediatric Patient

Introducción La pielonefritis xantogranulomatosa (XGPN), es una enfermedad inflamatoria crónica del parénquima renal, de rara presentación en pediatría. Su etiología es multifactorial comenzando con un proceso obstructivo del tracto urinario por litiasis e infección hasta el daño renal crónico. Su diagnóstico se logra por sospecha clínica, estudio imagenológico e histopatológico, lo que require tratamiento definitivo en la mayoría con nefrectomía simple. Materiales y métodos Paciente masculino de 4 años de edad con infección de la vía urinaria y dilatación de pelvis y uréter causada por cálculos que genera un proceso inflamatorio crónico y destrucción del parénquima renal. Sin respuesta clínica a tratamiento antibiótico quien requirió manejo en unidad de cuidados intensivos y nefrectomía. Discusión Se presenta entre la cuarta a sexta década de vida, con reportes de caso en edad pediátrica. Cursa con fiebre, dolor abdominal y masa palpable. Puede presentar en cambio de cursar con leucocitosis, anemia y piuria. Estudio radiológico de XGPN se puede apreciar de forma focal o difusa. A la histopatología se evidencia necrosis tisular crónica con macrófagos espumosos en su interior entremezclados con células inflamatorias. El tratamiento definitivo requiere nefrectomía de unidad renal disfuncional. Conclusiones Se presenta el caso de paciente pediátrico con XGPN por obstrucción urinaria litiásica; entidad de baja frecuencia en ese grupo poblacional, requiere una adecuada correlación clínico-imagenológica e histológica para lograr el diagnóstico final y puede ser tratado con manejo médico y quirúrgico.

Introduction Xanthogranulomatous pyelonephritis (XGPN) is a chronic inflammatory disease of the renal parenchyma, rare in pediatrics. Etiology is multifactorial ranging from an obstructive urinary tract process through lithiasis and infection generating chronic kidney amage. Its diagnosis is achieved by clinical suspicion, imaging and histopathology, which requires definitive treatment in the majority with simple nephrectomy Materials and Methods A 4-year-old male patient with urinary tract infection and dilation of the pelvis and ureter caused by calculus that generate a chronic inflammatory process and destruction of the renal parenchyma. No clinical response to antibiotic treatment that required management and intensive care unit and nephrectomy. Discussion It occurs between the fourth and sixth decade of life, with case reports in pediatric age. Patients have fever, abdominal pain and palpable mass. They can occur with leukocytosis, anemia and pyuria. Radiological study of XGPN can be seen in focal or diffuse form. Histopathology looks a chronic tissue necrosis with foamy macrophages and inflammatory cells. Definitive treatment requires nephrectomy of damaged renal unit. Conclusions We report the case of pediatric patients with XGPN due to urinary obstruction of the lithiasis; Low frequency entity in this population group, requires an adequate clinical-imaging and histological correlation to achieve final diagnosis and can be treated with medical and surgical management.

Radioablación por laparoscopia de masas renales pequeñas en pacientes octogenarios: técnica paso a paso / Laparoscopic Radioablation of Small Renal Masses in Octogenarian Patients: Step by Step Technique

El hallazgo incidental de tumores renales T1a se ha incrementado en la última década.1 La cirugía preservadora de nefronas sigue siendo el gold standard de manejo en pacientes con tumores renales pequeños, con resultados oncológicamente equiparables a la nefrectomía radical y reduciendo el impacto negativo en la función renal.2,3 La ablación por radiofrecuencia (RFA), es una alterativa mínimamente invasiva cuya técnica causa la destrucción del tumor mediante el calentamiento.4,5 Puede ser realizada mediante cirugía abierta o laparoscópica y por vía percutánea guiada por tomografía axial o ecografía. La evidencia sustancial indica que la RFA de tumores renales pequeños es efectiva en la erradicación tumoral completa.6­8

The incidental finding of T1a kidney tumors has increased in the last decade.1 Surgery nephron-preserving remains the gold standard of management in patients with small renal tumors, with results oncologically comparable to radical nephrectomy and reducing the negative impact on renal function.2,3 Radio Frequency Ablation (RFA) is a minimally invasive alterative technique whose technique causes tumor destruction by heating.4,5 It can be performed by open or laparoscopic surgery and percutaneously guided by axial tomography or ultrasound. Substantial evidence indicates that RFA of small renal tumors is effective in complete tumor eradication.6-8

Human Mesenchymal Stromal Cells Improve Cardiac Perfusion in an Ovine Immunocompetent Animal Model.

BACKGROUND: Mesenchymal stromal cells (MSCs) hold considerable promise in the treatment of ischemic heart disease. Most preclinical studies of MSCs for acute myocardial infarction (AMI) have been performed either in syngeneic animal models or with human cells in xenogeneic immunodeficient animals. A preferable pre-clinical model, however, would involve human MSCs in an immunocompetent animal. METHODS: AMI was generated in adult sheep by inducing ischemia reperfusion of the second diagonal branch. Sheep (n = 10) were randomized to receive an intravenous injection of human MSCs (1 × 10(6) cells/kg) or phosphate buffered saline. Cardiac function and remodeling were evaluated with echocardiography. Perfusion scintigraphy was used to identify sustained myocardial ischemia. Interaction between human MSCs and ovine lymphocytes was assessed by a mixed lymphocyte response (MLR). RESULTS: Sheep receiving human MSCs showed significant improvement in myocardial perfusion at 1 month compared with baseline measurements. There was no change in ventricular dimensions in either group after 1 month of AMI. No adverse events or symptoms were observed in the sheep receiving human MSCs. The MLR was negative. CONCLUSION: The immunocompetent ovine AMI model demonstrates the clinical safety and efficacy of human MSCs. The human cells do not appear to be immunogenic, further suggesting that immunocompetent sheep may serve as a suitable pre-clinical large animal model for testing human MSCs.

Abordando las enfermedades respiratorias agudas en niños con un Enfoque Ecológico en la Comunidad / Addressing acute respiratory diseases in children with an ecological approach in the Community

Objetivos: Disminuir los episodios de enfermedad respiratoria aguda (ERA) en las familias, mediante un enfoque modificado del modelo ecológico de Morelatto para identificar y trabajar colectivamente determinantes que influyen en la salud respiratoria de niños y niñas. Materiales y Métodos: Durante el proceso se realizaron actividades encaminadas a prevenir las principales causas de ERA basadas en el modelo transteórico del comportamiento con el fin de generar cambios conductuales en las familias. Para ello se creó una escala de valoración del riesgo de ERA como instrumento de medición de la efectividad de las actividades realizadas, otorgándole a cada familia un puntaje antes y después de la intervención para determinar si hubo disminución del mismo. Resultados: Las actividades realizadas conducen a cambios evidenciados en las prácticas cotidianos de las madres y sus familias, reflejadas en la escala de valoración de riesgos a partir de la disminución de conductas que favorecen la enfermedad respiratoria aguda y sus complicaciones en la primera infancia afiliada a la FAR -Génesis. Conclusiones: Una menor exposición a eventos y complicaciones de la ERA en miembros de grupos familiares de la FAR -Génesis puede contribuir a mejorar la resiliencia y disminuir la vulnerabilidad socioeconómica de las familias afectadas regularmente por la ERA sus complicaciones.

Objectives: To reduce acute respiratory disease (ARD) in children under six years of age. An ecological model approach modified by Morelatto guided community actions to identify and improve respiratory health determinants. Materials and Methods: During this process activities were implemented to change behaviors at the family level, regarding respiratory health practices according to the trans theoretical model of behavior. A risk scoring scale was used as a tool to track change in respiratory health related practices. Results: Project activities lead to behavioral changes in daily practices related ot ARD in mothers and their families, traced through the risk scoring scale. This approach allowed a participatory intervention of determinants related to ARD at different levels to improve respiratory health of children under six years of age. Conclusions: Fewer episodes and complications of respiratory disease among households may improve resilience and reduce socioeconomic vulnerability of families previously exposed to frequent events and complications of acute respiratory disease.

Ischemia-induced model of diastolic dysfunction in sheep.

BACKGROUND: Ischemic heart failure with normal ejection fraction (HFNEF) is an increasingly recognized entity that carries similar morbidity and mortality than low ejection fraction heart failure. Animal models of diastolic dysfunction mimicking this condition are lacking and are essential for the development of therapeutic strategies. METHODS AND RESULTS: Eight Corriedale sheep, 18 ± 5 months old, were included in the study. Basal echocardiography and myocardial perfusion evaluation (SPECT) was performed. Acute myocardial infarction (AMI) was made by occlusion (90 min) and reperfusion of the second diagonal branch of the anterior descending coronary artery. Two months after AMI, echocardiography and SPECT evaluation were performed prior to sacrifice. Basal and 2 months echocardiography showed similar fractional shortening and ventricular dimensions in each animal except for an increase in left atrial diameter. No mitral regurgitation was evidenced. SPECT imaging and pathology confirmed infarction in the apical, apico-anterior, and apico-septal segments. CONCLUSION: A novel model of ischemia-induced diastolic dysfunction with preserved ventricular thickness and ejection fraction is described. This model opens the possibility of testing therapeutic options for patients with this condition.

Incidência da automedicação em graduandos de Enfermagem / Incidence of self-medication in nursing students

Objetivo - Abordar a automedicação entre graduandos de Enfermagem, associado aos problemas de saúde. Objetivou-se uma avaliação da incidência, conhecimento dos medicamentos e os fatores de risco. Métodos - Trata-se de uma pesquisa de campo de caráter quantitativo, realizado com 89 graduandos de Enfermagem de uma universidade particular de São Paulo, Universidade Paulista (UNIP), que responderam o questionário, caracterizando o perfil e a prática da automedicação. Resultados - Mostrou-se que esta prática ocorre em 65,17% dos graduandos de Enfermagem, 43,82% costumam indicar medicamentos a outras pessoas, a droga prevalente de uso são os analgésicos, anti-inflamatórios, antibióticos e antitérmicos justificando seu uso pelo conhecimento da patologia acometida, 52,81% fazem uso sob orientação própria, 86,51% não apresentaram qualquer tipo de reação adversa pelo uso da automedicação e 86,52% acreditam que a automedicação pode mascarar doenças. Conclusão - Este estudo evidenciou que a prática da automedicação foi elevada entre os graduandos, sendo necessária uma abordagem sobre a temática e explicitar aos graduandos os fatores de risco e a necessidade de avaliação e prescrição médica, fundamentado no código de ética profissional.

Objective - To cover self-medication among nursing graduates, associated to health problems. The study aimed at the evaluation of the incidence, knowledge of the medications and risk factors. Methods - It is a search of quantitative character, performed with 89 nursing graduates from a private university in São Paulo, University Paulista (UNIP), who answered the questionnaire, characterizing the profile and practical the self-medication. Results - It has been found that this practice occurs with 65,17% of the nursing graduates, 43,82% indicate medicaments to others people, the prevalent drug of use is the analgesics, anti-inflammatory, antibiotics and antipyretics justifying its use by knowledge of the pathology involved, 52,81% they use under the guidance itself, 86,51% did not show any adverse reaction by the use of self-medication and 86,52% believe that self-medication can mask illnesses. Conclusion - This study it evidenced that the practical one of self-medication was elevated between the graduates, being necessary to approach the topic and explain to the graduates the risk factors and the need for a medical evaluation and prescription, based on the professional ethics code.

Embriología del desarrollo de los bronquios y el parénquima pulmonar / Embryology of development of the bronchi and lung parenchyma

Las malformaciones congénitas de aparato respiratorio son un extenso número de patologías que oscilan en gravedad dependiendo del momento embriológico en que se dio el fallo y cuales mecanismos fueron afectados. En la revisión se profundiza en patologías congénitas como el secuestro broncopulmonar y la malformación adenomatoide quística...

El Factor de impacto / Impact factor

Introducción: La tendencia a evaluar las revistas de la literatura científica y biomédica existe desde hace aproximadamente 80 años, tiempo durante el cual los métodos para ello han ido cambiando, hasta llegar a lo que hoy se conoce como el factor de impacto, una medida del número promedio de veces en las cuales los trabajos publicados son citados hasta dos años después de su publicación. Objetivo: Mostrar cómo ha sido la historia del factor de impacto, su definición y su papel dentro del campo de la investigación, así como la controversia que ha generado, y lo relacionado con el uso y el abuso que se le ha dado. Método: Revisión narrativa sobre el tema. Desarrollo: Creado en 1960 por Irving H. Sher y Eugene Garfield, anualmente la Revista de Reporte de Citaciones (Journal Citation Report [JCR]), del Instituto Thomson Reuters, ofrece una serie de herramientas para evaluar el factor de impacto. Así, el de una revista para el 2009 es igual a A/B. Donde A es el número de veces que los artículos pub licados en los años 2007 y 2008 fueron citados en revistas indexadas durante el año 2009 y B es el número de artículos publicados entre 2007 y 2008...

Introduction: The evaluation of medical and scientific journals during the past 80 years has been an important tendency in research. During this time evaluation methods have changed, arriving to what is known today as the impact factor. Objective: To show the impact factor's history, its definition and its role within the field of research, as well as the controversy it has generated in relation to its use vs. abuse. Method: Narrative review. Development: The impact factor was created in 1960 by Irving H. Sher and Eugene Garfield, and is published annually in the Journal of Citation Report (JCR) of the Thomson Reuters Institute, which offers a range of tools for its assessment. It is a measure of the average number of times published papers are cited up to two years after publication. Thus the impact factor 2009 for a journal is equal to A/B, where A is the number of times articles published in 2007- 2008 were cited in indexed journals during 2009, and B the number of articles published in 2007-2008...

Staining procedure of cartilage and skeleton in adult bats and rodents / Procedimiento de transparentación para evidenciar cartílago y esqueleto en murciélagos y roedores adultos

Transparency technique to demonstrate cartilage and skeleton has been used from years 70. This consists basically of the muscle digestion through an enzyme (trypsine), and the staining of cartilage and skeleton using alcian blue and alizarin red on specimens previously fixed to formalin. This technique can be used to study the state of the cartilage and the bones in different stages of the development and to observe abnormalitys. Also it can be used to demonstrate museum specimen skeleton preserved in liquid. In this article is showed the application of this technique for the first time in rodents and adult bats, besides some annotations to optimize the procedure.

La técnica de transparentación para evidenciar cartílago y esqueleto ha sido empleada desde los años 70. Esta consiste básicamente en la digestión de músculo a través de una enzima (tripsina), y la tinción del cartílago y el esqueleto usando azul de alcian y rojo de alizarina sobre especímenes previamente fijados en formol. Esta técnica puede emplearse para estudiar el estado del cartílago y los huesos en diferentes etapas del desarrollo y poder observar anormalidades. También puede ser utilizada para evidenciar el esqueleto en especimenes de museo preservados en líquido. En este artículo se muestra la aplicación de esta técnica por primera vez en roedores y murciélagos adultos, además de algunas anotaciones para optimizar el procedimiento.