Adenosine plasma level in patients with paroxysmal or persistent atrial fibrillation and normal heart during ablation procedure and/or cardioversion.

The mechanism of atrial fibrillation (AF) in patients with normal heart remains unclear. While exogenous adenosine can trigger AF, nothing is known about the behavior of endogenous adenosine plasma level (APL) at the onset of AF and during ablation procedure. Ninety-one patients (68 with paroxysmal AF: 40 males, 66 ± 16 years; 23 with persistent AF: 14 males, 69 ± 11 years) and 18 controls were included. Among paroxysmal patients: i) medical therapy alone was performed in 45 cases and ablation procedure in 23. AF was spontaneously resolutive in 6 cases; ii) 23 underwent ablation procedure and blood was collected simultaneously in a brachial vein and in the left atrium; 17 were spontaneously in sinus rhythm while 6 were in sinus rhythm after direct current cardioversion. Among persistent patients: i) in 17 patients, blood samples were collected in a brachial vein before and after direct current cardioversion; ii) in 6 patients, blood samples were collected simultaneously in a brachial vein and in left atrium before and after cardioversion during ablation procedure. CV-APL was higher in patients with persistent AF vs patients with paroxysmal AF (median [range]: 0.9[0.6-1.1] vs 0.7[0.4-1.1] µM; p < 0.001). In patients with paroxysmal AF, LA-APL increased during the AF episode (0.95[0.85-1.4] vs 2.7[1.5-7] µM; p = 0.03) and normalized in sinus rhythm after DCCV. In patients with persistent AF, LA-APL was higher than CV-APL (1.2[0.7-1.8] vs 0.9[0.6-1.1] µM; p < 0.001), and both normalized in sinus rhythm (CV-APL: 0.8[0.6-1.1] vs 0.75[0.4-1] µM; p = 0.03), (LA-APL: 1.95[1.3-3] vs 1[0.5-1.15] µM; p = 0.03). The occurrence of AF is associated with a strong increase of APL in the atrium. The cause of this increase needs further investigations.

Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida.

BACKGROUND: Inappropriate testing for Clostridiodes difficile infection (CDI) increases health care onset cases and contributes to overdiagnosis and overtreatment of patients in a community health care system. METHODS: An electronic smart order set for the testing of CDI was created and implemented to improve the appropriateness of testing. A retrospective review of patients who were tested for CDI, pre and post, was conducted to determine if inappropriate stool testing for CDI decreased post-implementation of the order set. RESULTS: 224 patients were tested for CDI during the study period with the post-implementation period having a higher proportion of patients who met appropriate testing criteria defined by presence of diarrhea (80.5% vs 61.3%; P = .002). The rate of inappropriate CDI stool testing decreased from 31.1% to 11.0% after implementation (P < .001). A higher proportion of CDI patients were readmitted within 30 days of discharge (54.2% vs 33.0%; P = 0.001) during the post-implementation period. CONCLUSIONS: There was a significant reduction in inappropriate CDI testing following the implementation of the order set. There was an observed increase in the proportion of patients who underwent recent gastrointestinal surgery which may have contributed to the increase in 30-day readmission rates during the post-implementation period.

A retrospective study on 198 mpox cases in South Florida: Clinical characteristics and outcomes with focus on human immunodeficiency virus status.

BACKGROUND: Men who have sex with men (MSM) and persons living with human immunodeficiency virus (PLWH) were disproportionately affected by global mpox outbreak in 2022. In this retrospective review, we describe epidemiology and clinical characteristics of mpox infection in South Florida with a focus on human immunodeficiency virus (HIV) status. METHODS: This was a retrospective observational study of 198 adult patients with confirmed diagnosis of mpox between 01 January 2020, and 10 September 2022, in two large health systems in South Florida. A descriptive analysis was performed to summarize demographic, clinical and laboratory characteristics, and outcomes of the patients. RESULTS: Young male patients and PLWH were disproportionately represented among patients with mpox. HIV positive patients were less likely to have adenopathy and myalgia and were more likely to have oral or facial lesions. 22.7% of studied patients were diagnosed with one or more concurrent STI at the time of mpox diagnosis. CONCLUSIONS: We suggest screening for sexually transmitted infections and HIV for patients diagnosed with mpox. We suggest prompt consultation or referral to infectious disease specialist if needed for the patients who are diagnosed with mpox especially in the severely immunocompromised host.

Distinct Clinical Presentations and Outcomes of Hospitalized Adults with the SARS-CoV-2 Infection Occurring during the Omicron Variant Surge.

The COVID-19 Omicron variant has imposed a tremendous burden on healthcare services. We characterized the types of the Omicron variant-associated hospitalizations and their associations with clinical outcomes. Consecutive adults hospitalized with COVID-19 during the Omicron variant surge period of 1-14 January 2022, were classified into one of three groups based on their clinical presentations on admission: Group 1-primary COVID-19; Group 2-extrapulmonary manifestations of COVID-19; and Group 3-incidental COVID-19. Of the 500 patients who were hospitalized, 51.4% fell into Group 1, 16.4% into Group 2, and 32.2% into Group 3. The patients in Groups 1 and 2 were older, with higher proportions of comorbidities than patients in Group 3. The Group 1 patients had the highest mortality rate (15.6%), followed by Group 2 (8.5%), and Group 3 (0.6%), with adjusted odds ratios (OR) of 22.65 (95% confidence interval [CI], 2.75-239.46; p = 0.004) and 10.95 (95% CI, 1.02-117.28; p = 0.048), respectively, compared to Group 3. Those in Group 1 showed a greater utilization of intensive care services (15.9%), followed by Group 2 (10.9%), and Group 3 (2.5%), with adjusted ORs of 7.95 (95% CI, 2.52-25.08; p < 0.001) and 5.07 (95% CI, 1.34-19.15; p = 0.017), respectively, compared to Group 3. The patients in Groups 1 and 2 had longer hospitalization stays than the patients in Group 3 (p < 0.001 and p = 0.002, respectively). Older age (≥65 years) was an independent factor associated with longer hospital stays (OR = 1.72, 95% CI, 1.07-2.77). These findings can help hospitals prioritize patient care and service planning for future SARS-CoV-2 variants.

Climate change and adventure guiding: The role of nature connection in guide wellbeing.

Ecological challenges are quickly shaping the future of the tourism industry with an increasing focus on how to develop more sustainable adventure tourism practises. Adventure guides play an important role in this transition and in shaping client experiences, however there is a need to better understand how climate change may have important impacts on guides' wellbeing. This study explored adventure guides' experiences of nature connectedness and potential links between climate change, nature connexion, and wellbeing for adventure guides. Semi-structured qualitative interviews (x = 11) with adventure guides were analysed using reflexive thematic analysis to explore these relationships. Adventure guides reported experiencing meaningful connexions and relationships with the natural environments in which they worked, while also highlighting why not all types of nature nor time spent outdoors facilitated this connexion. Guides that reported being more connected to nature also reported a higher sense of environmental responsibility, and guides described how this often created "ethical dilemmas" in seeking to resolve tensions between their deep connexion to nature and unsustainable practises that their guiding work often entailed. Analysis also highlighted the value and wellbeing guides derived from sharing their love of nature with clients. These findings expand emerging theoretical models of adventure guide wellbeing, and suggest a range of practises that can support a more ecologically sustainable adventure tourism industry.

Fungal Septic Knee Arthritis Caused by Aspergillus fumigatus following Anterior Cruciate Ligament Reconstruction.

Postoperative infections after arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) represent a rare but severe complication. An extremely rare case of Aspergillus septic arthritis in a 27-year-old patient following arthroscopic ACLR is reported. The patient presented with signs of knee infection 14 days after ACLR. Two consecutive arthroscopic debridements were performed, while eventually histopathology, cultures and multiplex PCR test revealed Aspergillus identified as A. fumigatus by mass spectrometry. The patient commenced long-term treatment with voriconazole. Fungal arthritis or osteomyelitis following ACLR has a mild local and general inflammatory reaction when compared to the bacterial ones. Nevertheless, such infections may lead to aggressive osseous destruction and necrosis. A high index of suspicion is of utmost importance for early detection, while microscopic, histological examination and multiplex PCR may be more helpful for the diagnosis than cultures since cultures are more time-consuming and may vary depending on different factors.

Urban wastewater treatment by using Ag/ZnO and Pt/TiO2 photocatalysts.

In this study, the treatment of wastewater coming from a river highly polluted with domestic and industrial effluents was evaluated. For this purpose, series of photocatalysts obtained by ZnO and TiO2 modification were evaluated. The effect of metal addition and Ti precursor (in the case of the titania series) over the physicochemical and photocatalytic properties of the materials obtained was also analyzed. The evaluation of the photocatalytic activity showed that semiconductor modification and precursor used in the materials synthesis are important factors influencing the physicochemical and therefore the photocatalytic properties of the materials obtained. The water samples analyzed in the present work were taken from a highly polluted river, and it was found that the effectiveness of the photocatalytic treatment increases when the reaction time increases and for both, wastewater samples and isolated Escherichia coli strain follow the next order Pt/TiO2 << ZnO. It was also observed that biochemical and chemical demand oxygen and turbidity significantly decrease after treatment, thus indicating that photocatalysis is a non-selective technology, which can lead to recover wastewater containing different pollutants.

Powder and Nanotubes Titania Modified by Dye Sensitization as Photocatalysts for the Organic Pollutants Elimination.

In this study, titanium dioxide powder obtained by the sol-gel method and TiO2 nanotubes, were prepared. In order to increase the TiO2 photoactivity, the powders and nanotubes obtained were modified by dye sensitization treatment during the oxide synthesis. The sensitizers applied were Quinizarin (Q) and Zinc protoporphyrin (P). The materials synthesized were extensively characterized and it was found that the dye sensitization treatment leads to modify the optical and surface properties of Titania. It was also found that the effectiveness of the dye-sensitized catalysts in the phenol and methyl orange (MO) photodegradation strongly depends on the dye sensitizer employed. Thus, the highest degradation rate for MO was obtained over the conventional Q-TiO2 photocatalyst. In the case of the nanotubes series, the most effective photocatalyst in the MO degradation was based on TiO2-nanotubes sensitized with the dye protoporfirin (ZnP). Selected catalysts were also tested in the phenol and MO photodegradation under visible light and it was observed that these samples are also active under this radiation.

Comparing the Performance of Bread and Breakfast Cereals, Dairy, and Meat in Nutritionally Balanced and Sustainable Diets.

Objective: To quantify the performance of food products in a sustainable diet based on the balance of their contribution to nutrient intake and environmental impact, within the context of the Dutch diet. Design: While fixing the quantity of a specific food group at different levels, optimized diets that met nutrient requirements and stayed as close as possible to the current Dutch diet were calculated, in order to understand its potential environmental impact and its nutritional quality. Bread & breakfast cereals, dairy, and meat were compared between 0 and 250% of current intake. Their performance is expressed in the relationship between the quantity of these food products and (1) the environmental impact of diets and (2) the nutrient balance of the diets. Setting: The Netherlands. Subjects: Women aged 31-50. Results: The amount of bread & breakfast cereals in the optimized diets were inversely correlated with their environmental impact. The nutrient balance of the optimized diets was maintained despite varying cereal content, with the expected improvement over the current diet. Increasing amounts of dairy in the optimized diet were associated with an increase in environmental impact and meat with a steep increase. The nutrient balance of optimized diets with varying dairy and meat contents was also maintained at high levels, even at 0% content. Conclusions: Bread and breakfast cereals are sources of nutrients with a better environmental performance compared to dairy or meat within the context of the Dutch diet. It is possible to optimize diets for environmental impact whilst maintaining a high nutrient balance.

[Reproductive risk factors of breast cancer in patients attended at a second level urban hospital]. / Factores de riesgo reproductivo para cáncer de mama en pacientes atendidas en un hospital urbano de segundo nivel.

OBJECTIVE: To evaluate the implication of reproductive risk factors for breast cancer of patients at a breast clinic of a second level urban hospital. PATIENTS AND METHOD: Women with breast cancer and randomly selected age-matched control subjects were evaluated. Age, age of menarche and menopause, age of first full term pregnancy, number of pregnancies, lactation, family history of breast cancer and family history of other cancers were analyzed. RESULTS: Sixty-six cases with breast cancer and 132 controls were study. Cases were older at first full term pregnancy (25.8 +/- 6.4 vs 23.3 +/- 5 years old, p = 0.01) and presented frequently first full term pregnancies after 30 years old (19.6 vs. 6%, p = 0.01); these differences also were significative for cases of 50 years or older. Cases younger than 50 years old had short lifetime lactation (11.5 +/- 8.2 vs. 27 +/- 30 months, p < 0.001), and few presented lactation longer than 12 months (27.8 vs 55.8%, p = 0.02). CONCLUSIONS: In this research the most important breast cancer risk factor for women older than 50 years old was the age of first full term pregnancy. For women younger than 50 years old periods of lifetime lactation shorter than 12 months seems a risk factor.

Extracción de catarata mediante la técnica de facoemulsificación con implante de lente intraocular / Cataract´s extraction by phacoemulsification´s technique with intraocular lens

Fundamento: La facoemulsificación es la técnica quirúrgica más aceptada en la actualidad para la cirugía de catarata Objetivo: Describir los resultados de la cirugía de catarata mediante la técnica de facoemulsificación. Metodología: Se realizó un estudio descriptivo, longitudinal y prospectivo en 115 ojos de pacientes con diagnóstico de catarata operados en el Hospital General Provincial Camilo Cienfuegos, entre julio 2009 y agosto 2015. Se analizaron las variables: edad, sexo, tipo de catarata, agudeza visual sin corrección y mejor corregida, tipo de lente intraocular empleado y posición del mismo, complicaciones transoperatorias y posoperatorias. Resultados: El grupo etario que prevaleció fue el de 60 años y más con 47 %, hubo un predominio de féminas sobre masculinos para un 55,7 %; se halló un 53 % de catarata relacionada con la edad, se encontró un 45,2 % de pacientes con agudeza visual preoperatoria de 0.1 a 0.3 de visión; en cuanto a la agudeza visual posoperatoria, a los siete días ya un 13 % alcanzó la unidad de visión, situación que cambió al mes con un 27 %; ya con la agudeza visual mejor corregida se observó un 86,1 % de pacientes con una visión de 1.0 y con visión de 0.8 a 0.9 para un 6,8 %, lo que evidenció la mejoría en la misma. La complicación transoperatoria más frecuente fue el surge y la posquirúrgica, la opacidad de cápsula posterior, aunque en ambos casos el mayor por ciento de pacientes no las presentó. Conclusiones: Se constató una mejoría importante de la agudeza visual sin corregir y con corrección después de la cirugía con un menor número de complicaciones

PROMOCIÓN DEL CRECIMIENTO DE Baccharis macrantha (ASTERACEAE) CON BACTERIAS SOLUBILIZADORAS DE FOSFATOS ASOCIADAS A SU RIZOSFERA / Growth Promotion of Baccharis macrantha (Asteraceae) by Phosphate Solubilizing Rhizosphere Bacteria

El objetivo de esta investigación fue aislar y caracterizar bacterias solubilizadoras de fosfatos (BSF) asociadas a la rizosfera de Baccharis macrantha y Viburnum triphyllum, y evaluar su capacidad para solubilizar fosfatos en condiciones in vitro. Además se determinó el efecto de la inoculación de las cepas de BSF más eficientes sobre el crecimiento de B. macrantha. Las muestras de suelo rizosférico de B. macrantha y V. triphyllum fueron colectadas en los meses de mayo-período de lluvia y septiembre-período seco del 2012. Para la cuantificación de bacterias heterótrofas cultivables y BSF se empleó el método de recuento en placa en los medios Agar Tripticasa de Soya y Pikovskaya (PVK) respectivamente. La capacidad de solubilización de fosfatos de las cepas aisladas se estimó a partir del diámetro de los halos formados alrededor de las colonias en el medio de cultivo PVK después de 7 días de incubación a 28 °C. Los ensayos de inoculación en B. macrantha se realizaron con las BSF más eficientes. La inoculación de las BSF B. firmusy P. fluorescens de forma individual y como inoculante combinado mostro un efecto benéfico, incrementando significativamente el porcentaje de germinación de semillas, la altura de la plántula, la longitud de la raíz y el peso seco de B. macrantha. La inoculación de BSF podría ser considerada una estrategia para mejorar el crecimiento y establecimiento de B. macrantha en pastizales abandonados.

The objectives of this research was to isolate and characterize phosphate solubilizing bacteria (BSF) associated to the rhizosphere of Baccharis macrantha and Viburnum triphyllum, and to assess their ability to solubilize phosphate under conditions in vitro. Furthermore to determine the effect of inoculation of the strains BSF more efficient on the growth of B. macrantha. Rhizosphere soil samples of B. macrantha and V. triphyllum were collected in the months of May-rainy season and September-period dry the 2012. Trypticase Soya Agar and Pikovskaya (PVK) were used for quantification of culturable heterotrophic bacteria and BSF, respectively. The phosphate solubilizing capacity of the isolated strains was estimated from the diameter of the halo around the colonies formed in the culture medium PVK after 7 days incubation at 28 °C. Inoculation assays were performed with more efficient BSF in B. macrantha. Inoculation of BSF Bacillus firmus and Pseudomona fluorescens individually and as inoculant combined showed a beneficial effect, significantly increasing the percentage of seed germination, seedling height, root length and dry weight of B . macrantha. Inoculation the BSF could be considered a strategy to improve the growth and development of B. macrantha in abandoned pastures.

Adenocarcinoma mucinoso de tipo endocervical e intestinal a partir de un teratoma quístico maduro del ovario / Endocervical and intestinal-type mucinous adenocarcinoma from a Mature Cystic Teratoma

Los tumores derivados de células germinales representan el 20-25% de tumores ováricos, siendo sólo 3% malignos. La degeneración maligna se presenta únicamente en 1-2% de los casos. La edad de presentación promedio de la transformación maligna es a los 50 años, siendo los más frecuentes el carcinoma de células escamosas y el adenocarcinoma (1). Dado que la supervivencia a largo plazo se encuentra en relación con la detección temprana y la completa resección quirúrgica, se hace necesario determinar las características clínico-patológicas que sugieran una posible transformación maligna de estos tumores. A continuación, se presenta el caso de una paciente perimenopáusica, con hallazgos histopatológicos indicativos de transformación maligna de un teratoma quístico maduro a cistoadenocarcinoma mucinoso bien diferenciado de tipo endocervical e intestinal.

The germ cell-derived tumors account for 20-25% of ovarian tumors, with 3% being malignant. The degeneration occurs in 1-2% of cases. The age of presentation is menopause, around the age 50, and the most common malignant histological types in this context are squamous cell carcinoma and adenocarcinoma. It is important to determine the clinical-pathological characteristics of malignant transformation (although currently not well established), as because early detection and complete surgical resection are important for long-term survival. A case is presented on a peri-menopausal woman with histopathological findings of malignant transformation of a mature cystic teratoma to well-differentiated mucinous cystadenocarcinoma endocervical and intestinal type.

Serine phosphorylation of ephrinB2 regulates trafficking of synaptic AMPA receptors.

Plasticity in the brain is essential for maintaining memory and learning and is associated with the dynamic membrane trafficking of AMPA receptors. EphrinB proteins, ligands for EphB receptor tyrosine kinases, are transmembrane molecules with signaling capabilities that are required for spine morphogenesis, synapse formation and synaptic plasticity. Here, we describe a molecular mechanism for ephrinB2 function in controlling synaptic transmission. EphrinB2 signaling is critical for the stabilization of AMPA receptors at the cellular membrane. Mouse hippocampal neurons from conditional ephrinB2 knockouts showed enhanced constitutive internalization of AMPA receptors and reduced synaptic transmission. Mechanistically, glutamate receptor interacting proteins bridge ephrinB ligands and AMPA receptors. Moreover, this function involved a regulatory aspect of ephrinB reverse signaling that involves the phosphorylation of a single serine residue in their cytoplasmic tails. In summary, our findings uncover a model of cooperative AMPA receptor and ephrinB reverse signaling at the synapse.

Synthesis of DL-fluorobenzenamides as anticonvulsants.

DL-2-Hydroxy-2-phenyl butyramide (1, CAS 52839-87-9), DL-3-hydroxy-3-phenyl pentanamide (2, CAS 131802-69-2) and DL-4-hydroxy-4-phenyl hexanamide (3, CAS 67880-30-2) are anticonvulsants. Searching for more active compounds, some DL-fluorobenzenamides were prepared and tested: DL-2-hydroxy-2-(3'-trifluoromethylphenyl)butyramide (4), DL-2-Hydroxy-2-4'-trifluoromethylphenyl) butyramide (5, CAS 620950-10-9), DL-2-hydroxy-2-[3',5'-bis(trifluoromethyl)phenyl]butyramide (6, CAS 620950-09-6), DL-3-hydroxy-3-(3'-trifluoromethylphenyl) pentanamide (7), DL-3-hydroxy-3-(4'-trifluoromethylphenyl)pentanamide (8), and DL-3-hydroxy-3-[3',5'-bis(trifluoromethyl)phenyl]pentanamide (9, CAS 863976-07-2). Compounds 4-9 exhibited anticonvulsant activity in seizures induced by pentylenetetrazol in mice. Incorporation of trifluoromethyl groups in the phenyl ring of 1, 2 and 3 increased their potency. Compounds 4, 6 and 9 exhibited a similar anticonvulsant activity as the reference drug phenobarbital (CAS 50-06-6).

Origen anómalo de la arteria subclavia izquierda a partir de un conducto arterioso persistente en un paciente con arco aórtico a la izquierda / Anomalous origin of left subclavian artery from a patent ductus arteriosus in a patient with left aortic arch

Se trata de paciente masculino de 7 años de edad, con diagnóstico de persistencia de conducto arterioso, en quien se encontró que la arteria subclavia izquierda se originaba del conducto arterioso. El paciente fue intervenido con éxito