Biologically synthesized silver nanoparticles as potent antibacterial effective against multidrug-resistant Pseudomonas aeruginosa.

Pseudomonas aeruginosa is one of the most worrisome infectious bacteria due to its intrinsic and acquired resistance against several antibiotics and the recalcitrance of its infections; hence, the development of novel antimicrobials effective against multidrug-resistant P. aeruginosa is mandatory. In this work, silver nanoparticles obtained by green synthesis using a leaf extract and fungi were tested against a battery of clinical strains from cystic fibrosis, pneumonia and burnt patients, some of them with multidrug resistance. Both nanoparticles showed a potent antibacterial effect, causing severe damage to the cell wall, membrane and DNA, and inducing the production of reactive oxygen species. Moreover, the nanoparticles derived from fungi showed synergistic antibacterial effects with the antibiotics meropenem and levofloxacin for some clinical strains and both kinds of nanoparticles were nontoxic for larvae of the moth Galleria mellonella, encouraging further research for their implementation in the treatment of P. aeruginosa infections.

Influence of vitamin D supplementation on the quality of life of asthma patients: Findings from ACVID randomised clinical trial.

Published data on vitamin D and the quality of life of asthma patients are scarce and disparate. The ACVID clinical trial, published in 2020, showed the efficacy of calcifediol in improving asthma control in asthma patients with vitamin D deficiency. Data on vitamin D and quality of life measured by the Mini-AQLQ questionnaire were analysed: supplemented patients showed improved quality of life compared with a placebo group, and the initial mini-AQLQ scores were improved for both groups.

OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis

To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data. We sought evidence for 60 unique interventions. A systematic search of all relevant databases was conducted from inception through July 2018. After abstract and full-text screening by two independent reviewers, eligible studies were matched to PICO questions. Data were extracted and meta-analyses were conducted using RevMan software. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence Profiles were compiled using the GRADEpro web application. Voting for Core Treatments took place first. Four subsequent voting sessions took place via anonymous online survey, during which Panel members were tasked with voting to produce recommendations for all joint locations and comorbidity classes. We designated non-Core treatments to Level 1A, 1B, 2, 3, 4A, 4B, or 5, based on the percentage of votes in favor, in addition to the strength of the recommendation. Core Treatments for Knee OA included arthritis education and structured land-based exercise programs with or without dietary weight management. Core Treatments for Hip and Polyarticular OA included arthritis education and structured land-based exercise programs. Topical non-steroidal anti-inflammatory drugs (NSAIDs) were strongly recommended for individuals with Knee OA (Level 1A). For individuals with gastrointestinal comorbidities, COX-2 inhibitors were Level 1B and NSAIDs with proton pump inhibitors Level 2. For individuals with cardiovascular comorbidities or frailty, use of any oral NSAID was not recommended. Intra-articular (IA) corticosteroids, IA hyaluronic acid, and aquatic exercise were Level 1B/Level 2 treatments for Knee OA, dependent upon comorbidity status, but were not recommended for individuals with Hip or Polyarticular OA. The use of Acetaminophen/Paracetamol (APAP) was conditionally not recommended (Level 4A and 4B), and the use of oral and transdermal opioids was strongly not recommended (Level 5). A treatment algorithm was constructed in order to guide clinical decision-making for a variety of patient profiles, using recommended treatments as input for each decision node. These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA.

La intervención enfermera y la consulta de enfermería en la mejora de la calidad asistencial (calidad percibida y calidad científico-técnica) en pacientes sometidos a colecistectomía laparoscópica ambulatoria / Nursing intervention and specialized nursing ambulatory surgery clinic improvement of total quality management (perceived and scientific and technical quality) in patients undergoing ambulatory laparoscopic cholecystectomy

Objetivo: Determinar el valor de la transformación de la actividad enfermera en el proceso de colecistectomía ambulatoria en el incremento de la aceptación y la seguridad del proceso por los pacientes, así como el aumento de la calidad asistencial en sus dos áreas: la científico-técnica y la percibida. Material y métodos: Pacientes de compañías aseguradoras privadas sometidos a CLA en el ámbito del Instituto de Cirugía y Aparato Digestivo (ICAD) en el Hospital Quirón de Valencia. La evaluación de calidad se realizó mediante la aplicación del cuestionario ICAD15, basado en el SUCMA 14 y modificado para el proceso de CLA, aplicado de forma prospectiva. El grupo control lo constituyeron dos grupos de pacientes: 404 casos evaluados previamente a la instauración del ICAD15 y 75 casos correspondientes al ensayo piloto del cuestionario de satisfacción. Principales medidas de resultados: se evaluaron como puntos finales de resultado la satisfacción global con el procedimiento y la proporción de pacientes con seguridad y consideración de estancia hospitalaria adecuada (medidas de aceptación del proceso ambulatorio). El análisis estadístico se realizó mediante el SPPS vs. 11 y se utilizó la comparación de porcentajes de la Chi cuadrado, aceptándose como significativo una p < 0.05. Resultados: El porcentaje de pacientes muy satisfechos o satisfechos alcanzado en el grupo del protocolo de investigación fue del 98,5%, similar al expresado por el grupo control, y el del grupo piloto que fue del 94%, no mostrando diferencias significativas. Por el contrario, el porcentaje de pacientes que consideraron adecuado el proceso ambulatorio fue del 81,1 % en el grupo del protocolo de investigación en comparación con un 69.6 % del grupo control (p < 0.05). De igual modo, también alcanzó significación el porcentaje de pacientes que consideraron adecuado el tiempo de estancia en el hospital (75,0%) del grupo de protocolo de investigación en comparación con el grupo control (55,4%).Además la intervención enfermera del grupo del protocolo de investigación disminuyó significativamente los requerimientos de consulta médica urgente y de consulta anticipada. Conclusiones: La modificación de la intervención enfermera en el proceso de CLA mejora la aceptación del procedimiento aumentando la seguridad percibida del mismo por los pacientes, alcanza un alto nivel de satisfacción y disminuye los requerimientos asistenciales no planificados derivados de la discontinuidad asistencial generada por el proceso ambulatorio. La intervención enfermera de CMA global, como se ha desarrollado en este protocolo de investigación, debería implementarse en las unidades de CMA (AU)

Objective: To determine the added value of nursing intervention in ambulatory laparoscopic cholecystectomy in acceptance and security rates by patients and the associated increase in quality perception in terms of scientific and technical quality and perceived quality. Patients and methods: Patients belonged to private insurance companies undergoing elective ALC at the Institutor de Cirugía y Aparato Digestivo (ICAD) in Quiron Hospital at Valencia City. Quality assessment was performed trough the ICAD 15 questionnaire which is based on SUCMA14 modified for ALC patients. For comparison analysis we used a control group previously evaluated with the original ICAD questionnaire and the pilot study group of the ICAD questionnaire. Main measurements and outcomes: end point analysis included global satisfaction with ALC and the percentage of patients with security feeling at discharge and adequate consideration of postoperative hospital stay (measurement of ambulatory acceptance). Statistical analysis was performed with the SPSS (11 vs) using the Chi square test for percentages comparison. Statistical significances was accepted with a p value less than 0.05. Results: The rate of patients feeling satisfied or very satisfied in the Project investigation group reached 98.5 % which was similar to that in control group and the pilot study group, 94% without reaching statistical significance. In contrast the percentage of patients considering appropriate the ambulatory process was 81.1 % in the investigative protocol group in comparison with 69,6% in the control group, p < 0.05. Similarly the percentage of patients considering as adequate the postoperative stay at the hospital reached 75% of patients in the investigative protocol group in comparison with 55.4 % in the control group. Moreover the nursing intervention decreased emergency medical consultations and anticipated office appointments reaching statistical significance. Conclusions: Increasing Nursing intervention all along through the clinical process of ALC increases acceptance, security and global satisfaction by patients, decreasing unplanned medical requirements due to care discontinuity associated to ambulatory procedures. A nursing intervention as a holistic ambulatory surgery nurse should be developed in all ambulatory units (AU)

Malformaciones vasculares: manejo mediante técnicas de radiología intervencional y satisfacción de los pacientes / Vascular malformations: interventional radiology management and assesment of patient satisfaction

Background: Vascular anomalies are prevalent in the general population and may produce significant impairment in quality of life. In recent years, minimally invasive interventional radiology techniques have become an efficient alternative for the treatment of these patients. The aim of this study was to present our experience in the management of vascular malformations with such techniques at Clínica Alemana in Santiago, Chile, and assess the satisfaction of patients with this management. Material and Methods: Evaluation of the follow-up of patients with vascular malformations treated in the Interventional Radiology Unit at our center since June - 2006 to June - 2009. Patients were classified according to the hemodynamics of the lesions (high vs low-flow). Complications and patient satisfaction with the treatment were assessed. Results: Eighty-seven patients (253 procedures) were included in the study, 36 men and 51 women, all with complete follow-up during the period of the study. Their average age was 20.6 years. In over 50 percent of the patients the vascular anomaly was located on the face or the lower extremities. Twenty-eight percent (25 patients) had a high-flow malformation (pure or mixed) and 62 (72 percent) had a low-flow lesion (vascular malformation, lymphangioma or mixed). On average, each patient underwent 2.9 procedures (1-10). There were 4 major complications (1.65 percent), one of which was predominantly cosmetic with necrosis in the area of the lesion. The average satisfaction rate was 7.95 (on a rating scale of 1 to 10). Satisfaction was significantly higher in patients with low-flow malformations (8.27) than in those with high-flow lesions (7.16). (p < 0.05) Discussion: Treatment of vascular malformations using interventional radiology techniques is an effective alternative, with good prospects of clinical improvement, patient satisfaction and low complication rates.

Introducción: Las anomalías vasculares son una patología frecuente en la población general, y son causa de deterioro de la calidad de vida de los pacientes que las padecen. En los últimos años, las técnicas mínimamente invasivas de radiología intervencional se han convertido en una alternativa eficaz para el tratamiento de estos pacientes. El objetivo del presente estudio es mostrar nuestra experiencia en el manejo de malformaciones vasculares con estas técnicas en la Clínica Alemana de Santiago y evaluar la satisfacción de los pacientes con este manejo. Material y Métodos: Evaluación del seguimiento de todos los pacientes con malformaciones vasculares tratados en la Unidad de Radiología Intervencional desde el año 2006 hasta junio del año 2009. Los pacientes fueron clasificados en base a la hemodinamia de la malformación vascular (alto flujo vs. bajo flujo). Se evaluaron las complicaciones, y se realizó una encuesta sobre la satisfacción de los pacientes con el tratamiento. Resultados: Ochenta y siete pacientes (253 procedimientos) fueron incluidos en el estudio, 36 hombres y 51 mujeres, todos con seguimiento completo en este periodo. La edad promedio de ellos fue de 20,6 años. En más del 50 por ciento de los pacientes la anomalía vascular se ubicó en la cara o extremidades inferiores. Un 28 por ciento (25 pacientes) presentó malformación de alto flujo (pura o mixta) y 72 por ciento (62 pacientes) de bajo flujo (malformaciones vasculares, linfangiomas o mixtas). En promedio, cada paciente se realizó 2,9 procedimientos (1-10). Del total de procedimientos realizados, hubo 4 complicaciones mayores (1,65 por ciento), una de ellas con secuelas estéticas producto de necrosis de la zona. El promedio de satisfacción fue de un 7,95 en una escala de 1 a 10, siendo significativamente mayor en pacientes con malformaciones de bajo flujo (8,27) que en los de alto flujo (7,16) (p < 0.05)...

A propósito de un caso de intestino corto en un paciente de edad avanzada / A propos of a case of short bowel in an elderly patient

La resección de grandes segmentos de intestino delgado puede causar grados variables de mala bsorción. Por lo tanto, las consecuencias de la resección dependerán de la longitud y la localización del segmento resecado, pero también de la edad y de la enfermedad que originó la resección. La instauración del Soporte Nutricional tras la resección intestinal es el principal factor estimulador de la adaptación del intestino remanente e importante para evitar la desnutrición. La relevancia de este caso se debe a que nuestro paciente con 87 años de edad y después de 10 años de cirugía, tiene un buen estado nutricional y una buena calidad de vida, adaptándose su intestino remanente a las funciones fisiológicas (AU)

Resection of long segments of the small bowel may cause variable degrees of malabsorption. Therefore, the results of the resection will depend on the length and location of the resected segment, and on the age of the patient and the underlying disease that motivated the resection. The implementation of Nutritional Support after intestinal resection is the main stimulating factor for adaptation of the remnant bowel and is important to prevent hyponutrition. The relevance of this case is due to the fact that our 87 years old patient has a good nutritional status and good quality of life 10 years after resection was performed, his remnant bowel having adapted to physiological functions (AU)

Iron type catalysts for the ozonation of oxalic acid in water.

Two iron catalysts (Fe(III) and Fe2O3/Al2O3) have been used in the ozonation of oxalic acid in water at pH 2.5. Percentage removals of oxalic acid were 1.8%, 7% and 30% corresponding to the non-catalytic, homogeneous (Fe(III)) and heterogeneous (Fe2O3/Al2O3) catalytic ozonations, respectively. Catalytic oxalic acid ozonation leads in all cases to total mineralization. The mechanism of ozonation likely develops through formation of iron-oxalate complexes that further react with ozone without the participation of hydroxyl radicals. Because of the stringent acidic conditions, some metal leaching has been observed and quantified in the heterogeneous process. In the homogeneous catalysis, the kinetics was found to be first order with respect to ozone and oxalic acid while for the heterogeneous catalysis, the kinetic order depends on the concentration of ozone in the gas fed. Thus, at ozone concentrations lower than 30 mg L(-1), the heterogeneous ozonation is between first and zero order with respect to both ozone and oxalic acid while at higher ozone gas concentrations, the kinetics was found to be first and zero order with respect to oxalic acid and ozone, respectively. This kinetics is supported through an Eley-Rideal mechanism that involves a surface reaction between non-adsorbed ozone and adsorbed oxalic acid. Apparent activation energies of the homogeneous and heterogeneous catalytic ozonations were found to be 18.2 and 13.6 kcal mol(-1), respectively.

[Clinical importance of cross-reactivity between allergens]. / Implicación clínica de la reactividad cruzada entre alergenos.

Cross reactivity describes the development of symptoms as a consequence of the presence of specific IgE to a protein without the subject having had previous contact with that protein. Cross-reactivity depends on factors such as the individual's immune response, the type and intensity of exposure and, above all, the type of allergen. The identification of pan-allergens, which are present in various animal and vegetable sources and which show great structural and sequential similarity, even among species with little taxonomic relation, explains the existence of distinct, well-defined cross-reactivity syndromes. Knowledge of these phenomena could have important diagnostic and therapeutic consequences.

Implicación clínica de la reactividad cruzada entre alergenos / Clinical importance of cross-reactivity between allergens

La Reactividad Cruzada (RC) expresa el desarrollo de síntomas como consecuencia de la presencia de IgE específica frente a una fuente proteica sin que haya existido contacto previo con la misma. La RC depende de factores como la respuesta inmune del individuo, del tipo e intensidad de la exposición y, sobre todo, de la naturaleza del alergeno. En este sentido, la identificación de Pan-alergenos, presentes en diferentes fuentes de origen animal y vegetal, compartiendo una gran similitud estructural y secuencial, incluso entre especies taxonómicamente muy poco relacionadas, explica la existencia de diferentes síndromes de RC bien definidos. El conocimiento de estos hechos puede tener importantes consecuencias de tipo diagnóstico y terapéutico (AU)

Cross reactivity describes the development of symptoms as a consequence of the presence of specific IgE to a protein without the subject having had previous contact with that protein. Cross-reactivity depends on factors such as the individual's immune response, the type and intensity of exposure and, above all, the type of allergen. The identification of pan-allergens, which are present in various animal and vegetable sources and which show great structural and sequential similarity, even among species with little taxonomic relation, explains the existence of distinct, well-defined cross-reactivity syndromes. Knowledge of these phenomena could have important diagnostic and therapeutic consequences (AU)

Situacion al año de los adictos a opiaceos que siguieron tratamiento ambulatorio tras desintoxicación hospitalaria / One year follow-up of opiate addicts in an outpatient programme after in-hospital detoxification

Se analiza la evolución al año de los dependientes de opiáceos en un programa ambulatorio que previamente han realizado desintoxicación hospitalaria. Se estudia a 32 pacientes, que constituyen la totalidad de los pacientes de un centro de atención ambulatoria (CAD 7 de Madrid) que durante el año 1998 son remitidos a desintoxicación a una Unidad de Desintoxicación Hospitalaria.El perfil del paciente corresponde a un varón (84 por ciento), soltero (41 por ciento), usuario de drogas por vía inhalatoria (68 por ciento), con una historia de dependencia a opiáceos de más de 9 años de evolución (68 por ciento), con consumo concomitante de otras drogas (81 por ciento). Al año la mayoría de los pacientes (72 por ciento) continúan en contacto con el Centro aunque el 37.5 por ciento del grupo inicial reciben tratamiento con metadona. No se encuentran diferencias entre los que abandonan la desintoxicación y los que son dados de alta del programa hospitalario en relación con su inclusión o abandono de diversos programas, lo que se atribuye a lo reducido de la muestra del estudio La evolución de estos pacientes hace necesario definir mejor el perfil de los pacientes que van a beneficiarse de la desintoxicación y los Programas libres de drogas (AU)

Analysis of the t(6;11)(q27;q23) in leukemia shows a consistent breakpoint in AF6 in three patients and in the ML-2 cell line.

The t(6;11)(q27;23) is one of the most common translocations observed in patients with acute myeloid leukemia (AML). The translocation breakpoint involves the MLL gene, which is the human homolog of the Drosophila trithorax gene, at 11q23 and the AF6 gene at 6q27. Reverse transcriptase-polymerase chain reaction (RT-PCR) using an MLL sense primer and an AF6 antisense primer detected the MLL/AF6 fusion cDNA from three leukemia patients with the t(6;11) [two AML and one T-acute lymphoblastic leukemia (ALL)] and one cell line. The fusion point in the AF6 cDNA from these cases is identical, regardless of the leukemia phenotype. The ML-2 cell line, which was established from a patient with AML that developed after complete remission of T-cell lymphoma, has retained an 11q23-24 deletion from the lymphoma stage and has acquired the t(6;11) with development of AML. The ML-2 cells have no normal MLL gene on Southern blot analysis, which indicates that an intact MLL gene is not necessary for survival of leukemic cells.

Isolation of a cDNA clone encoding a KATP channel-like protein expressed in insulin-secreting cells, localization of the human gene to chromosome band 21q22.1, and linkage studies with NIDDM.

The metabolism of glucose in insulin-secreting cells leads to closure of ATP-sensitive K+ channels (KATP), an event that initiates the insulin secretory process. Defects in insulin secretion are a common feature of non-insulin-dependent diabetes mellitus (NIDDM), and the beta-cell KATP that couples metabolism and membrane potential is a candidate for contributing to the development of this clinically and genetically heterogeneous disorder. We screened a hamster insulinoma cDNA library by low-stringency hybridization with a probe coding for the G-protein-coupled inwardly rectifying K+ channel GIRK1/KGA and isolated clones encoding a protein, KATP-2, whose sequence is 90% similar to that of the recently described KATP-1, an ATP-sensitive K+ channel expressed in heart and other tissues. RNA blotting showed that KATP mRNA was present in insulin-secreting cells and brain but not in heart. To assess the contribution of KATP-2 to the development of NIDDM, the human KATP-2 gene (symbol KCNJ7) was isolated and mapped to chromosome band 21q22.1 by fluorescence in situ hybridization. A simple tandem repeat DNA polymorphism, D21S1255, was identified in the region of the KATP-2 gene, and linkage studies between this marker and NIDDM were carried out in a group of Mexican-American sib pairs with NIDDM. There was no evidence for linkage between D21S1255 and NIDDM, indicating that KATP-2 is not a major susceptibility gene in this population.

Circular dichroism of stem bromelain: a third spectral class within the family of cysteine proteinases.

Two forms of stem bromelain (EC 3.4.22.4) were isolated from commercial, crude and chromatographically purified preparations of the enzyme by means of gel-filtration and cation-exchange liquid chromatography. These forms possess nearly identical secondary and tertiary structures, as judged from their circular dichroism (c.d.) spectra. The spectral characteristics of stem bromelain suggest that this enzyme belongs to the alpha + beta protein class, as other cysteine proteinases do. In agreement with these results, quantitative estimation of secondary structures yielded amounts similar to those for papain and proteinase omega. However, the bromelain c.d. curve is clearly distinguishable from those reported for papain and proteinase omega, on one hand, and that of chymopapain, on the other. Thus, it is apparent that there are at least three types of c.d. spectra associated with the family of cysteine proteinases.

Isolation of the human peroxisomal acyl-CoA oxidase gene: organization, promoter analysis, and chromosomal localization.

Peroxisomal acyl-CoA oxidase (ACOX; EC 1.3.3.6) is the first enzyme of the fatty acid beta-oxidation pathway, which catalyzes the desaturation of acyl-CoAs to 2-trans-enoyl-CoAs, and it donates electrons directly to molecular oxygen, thereby producing H2O2. The discovery of carcinogenic peroxisome proliferators, which markedly increase the levels of this H2O2-producing ACOX in rat and mouse liver, generated interest in peroxisomal beta-oxidation system genes. The present study deals with the structural organization of human ACOX gene. This gene spans approximately 33 kb and consists of 14 exons and 13 introns. Primer-extension analysis revealed three principal cap sites, which were mapped at 50, 52, and 53 nt upstream of the initiator methionine codon. The 5' flanking region of the ACOX gene was sequenced up to 500 bp upstream of the cap sites. This promoter region is G + C-rich and contains three copies of the "GC box" hexanucleotides. Multiple GC boxes are a characteristic feature of the rat ACOX and bifunctional protein genes of the beta-oxidation system. A + T-rich TATA-boxlike sequences, TTTATTT and TTATT, have also been identified in this human ACOX gene, but typical CCAAT motifs are absent. This ACOX gene has been mapped to chromosome 17q25 by in situ hybridization, using a biotinlabeled probe.