Introducción: La esclerosis lateral amiotrófica (ELA) es una enfermedad neurodegenerativa, progresiva y de etiología desconocida caracterizada por la degeneración de motoneuronas superiores e inferiores. Aproximadamente el 90% de los casos de ELA son esporádicos, mientras que el 10% restante se consideran familiares. Independientemente de si son familiares o esporádicas, los pacientes desarrollan una debilidad progresiva, atrofia muscular con espasticidad y contracturas. Por lo general, la esperanza de vida en los pacientes de ELA es de 2 a 5 años. Desarrollo: Los modelos in vivo han ayudado a explicar la etiología y la patogénesis, así como los mecanismos de la ELA. Sin embargo, estos mecanismos no están del todo esclarecidos aún, por lo que los modelos experimentales son fundamentales para continuar con el estudio de los mismos, así como para la búsqueda de posibles dianas terapéuticas. A pesar de que el 90% de los casos son esporádicos, la mayoría de los modelos utilizados hasta la actualidad para estudiar la patogénesis están basados en las mutaciones genéticas asociadas a la enfermedad familiar, lo que provoca que la patogénesis de la ELA esporádica no sea aún conocida. Por tanto, sería fundamental el estudio de la enfermedad en modelos basados en la enfermedad esporádica. Conclusión: En el presente artículo se han revisado los principales modelos experimentales, tanto genéticos como esporádicos, utilizados en el estudio de esta enfermedad, enfocándonos en los que se han desarrollado utilizando el roedor como plataforma experimental.(AU)
Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease whose aetiology is unknown. It is characterised by upper and lower motor neuron degeneration. Approximately 90% of cases of ALS are sporadic, whereas the other 10% are familial. Regardless of whether the case is familial or sporadic, patients will develop progressive weakness, muscle atrophy with spasticity, and muscle contractures. Life expectancy of these patients is generally 25 years after diagnosis. Development: In vivo models have helped to clarify the aetiology and pathogenesis of ALS, as well as the mechanisms of the disease. However, as these mechanisms are not yet fully understood, experimental models are essential to the continued study of the pathogenesis of ALS, as well as in the search for possible therapeutic targets. Although 90% of cases are sporadic, most of the models used to study ALS pathogenesis are based on genetic mutations associated with the familial form of the disease; the pathogenesis of sporadic ALS remains unknown. Therefore, it would be critical to establish models based on the sporadic form. Conclusion: This article reviews the main genetic and sporadic experimental models used in the study of this disease, focusing on those that have been developed using rodents.(AU)
Humans , Animals , Male , Female , Mice , Amyotrophic Lateral Sclerosis/diagnosis , Amyotrophic Lateral Sclerosis/drug therapy , Neurodegenerative Diseases , Cerebrospinal Fluid , Neurology , Nervous System Diseases
INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease whose aetiology is unknown. It is characterised by upper and lower motor neuron degeneration. Approximately 90% of cases of ALS are sporadic, whereas the other 10% are familial. Regardless of whether the case is familial o sporadic, patients will develop progressive weakness, muscle atrophy with spasticity, and muscle contractures. Life expectancy of these patients is generally 2 to 5 years after diagnosis. DEVELOPMENT: In vivo models have helped to clarify the aetiology and pathogenesis of ALS, as well as the mechanisms of the disease. However, as these mechanisms are not yet fully understood, experimental models are essential to the continued study of the pathogenesis of ALS, as well as in the search for possible therapeutic targets. Although 90% of cases are sporadic, most of the models used to study ALS pathogenesis are based on genetic mutations associated with the familial form of the disease; the pathogenesis of sporadic ALS remains unknown. Therefore, it would be critical to establish models based on the sporadic form. CONCLUSIONS: This article reviews the main genetic and sporadic experimental models used in the study of this disease, focusing on those that have been developed using rodents.
Amyotrophic Lateral Sclerosis , Neurodegenerative Diseases , Humans , Animals , Mice , Amyotrophic Lateral Sclerosis/pathology , DNA-Binding Proteins/genetics , Mutation
INTRODUCTION: Aeromedical evacuation missions to transport highly infectious critical COVID-19 patients involve multiple factors, therefore planning is essential in their preparation. The management of specialist nurses is cross-cutting, as they participate in the planning, organisation and implementation of aero-evacuation protocols, delivery of care and operational safety procedures throughout the operation, with an integrated aeromedical crew working as a team alongside the air crew. OBJECTIVE: To study the management of nurses specialised in the aero-evacuation of highly infectious critical patients during the COVID-19 pandemic. DESIGN: Through a systematic search of the biomedical literature, this study was conducted according to the standards of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. The literature search included articles published from 2019 to August 2020 and meta-search engines, yielding a total of 142 articles, and a triangulation of information was performed. A total of 11 articles were eventually included in the review, and the validity of each article was determined according to the guidelines of the Joanna Briggs Institute level of evidence. RESULTS AND DISCUSSION: The systematic review identified 11 studies that use different methodological considerations for conducting an aeromedical evacuation and covering key aspects for a successful operation. CONCLUSION: The management of specialist nurses has a direct impact on the aeromedical evacuation of the critical patient. It covers planning, organisation, and operational safety, applied in the instruction, training, execution and strict monitoring of the work of the aeromedical crew as a solid team. This contributes to the success of the aero-evacuation mission and the infectious patient's high likelihood of survival during the COVID-19 pandemic.
Air Ambulances , COVID-19 , Communicable Diseases , Nurses , Humans , Pandemics
Introducción: Las misiones de Evacuación Aeromédica de Paciente Crítico Altamente Infeccioso de paciente COVID-19, consideran múltiples factores, es por eso que la planificación, es la estructura fundamental de la preparación de la misión. La gestión de enfermeras/os especializados es transversal, ya que participa en gran parte en la planificación, organización y la aplicación de protocolos de aeroevacuación, ejecución de procedimientos asistenciales y de seguridad operacional durante toda la operación, con una Tripulación Aerosanitaria integrada trabajando en equipo junto a la tripulación aérea. Objetivo: Analizar la gestión de enfermeras/os especializados en la aeroevacuación de pacientes críticos altamente infecciosos, durante la pandemia por COVID-19. Diseño: Mediante una búsqueda sistemática de la literatura biomédica, este estudio se realiza según normas del manual Cochrane para las revisiones sistemáticas de las intervenciones y PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). La búsqueda bibliográfica incluye artículos publicados desde el 2019 hasta agosto del 2020 y se utiliza metabuscadores, de lo cual se obtiene un total de 142 artículos, se realiza una triangulación de la información. Finalmente 11 artículos se incluyen en la revisión, y la validez de cada uno de ellos fue determinada de acuerdo con las directrices publicadas por el nivel de evidencia de Joanna Briggs. Resultados y discusión: La revisión sistemática evidencia 11 estudios que utilizan diferentes consideraciones metodológicas para la realización de una evacuación aeromédica considerando aspectos claves para una operación exitosa. Conclusión: La gestión de enfermeras/os especializados tiene un impacto directo en el proceso de Evacuación Aeromédica de Paciente Crítico Altamente Infeccioso, en diversos aspectos, como lo es la planificación, organización y seguridad operacional, aplicada en la instrucción...(AU)
Introduction: Aeromedical evacuation missions to transport highly infectious critical COVID-19 patients involve multiple factors, therefore planning is essential in their preparation. The management of specialist nurses is cross-cutting, as they participate in the planning, organisation and implementation of aero-evacuation protocols, delivery of care and operational safety procedures throughout the operation, with an integrated aeromedical crew working as a team alongside the air crew. Objective: To study the management of nurses specialised in the aero-evacuation of highly infectious critical patients during the COVID-19 pandemic. Design: Through a systematic search of the biomedical literature, this study was conducted according to the standards of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. The literature search included articles published from 2019 to August 2020 and meta-search engines, yielding a total of 142 articles, and a triangulation of information was performed. A total of 11 articles were eventually included in the review, and the validity of each article was determined according to the guidelines of the Joanna Briggs Institute level of evidence. Results and discussion: The systematic review identified 11 studies that use different methodological considerations for conducting an aeromedical evacuation and covering key aspects for a successful operation. Conclusion: The management of specialist nurses has a direct impact on the aeromedical evacuation of the critical patient. It covers planning, organisation, and operational safety, applied in the instruction, training, execution and strict monitoring of the work of the aeromedical crew as a solid team. This contributes to the success of the aero-evacuation mission and the infectious patient's high likelihood of survival during the COVID-19 pandemic.(AU)
Humans , Male , Female , Nurse Specialists , Pandemics , Coronavirus Infections , Military Nursing , Nursing , Critical Care
Introduction: Aeromedical evacuation missions to transport highly infectious critical COVID-19 patients involve multiple factors, therefore planning is essential in their preparation. The management of specialist nurses is cross-cutting, as they participate in the planning, organisation and implementation of aero-evacuation protocols, delivery of care and operational safety procedures throughout the operation, with an integrated aeromedical crew working as a team alongside the air crew. Objective: To study the management of nurses specialised in the aero-evacuation of highly infectious critical patients during the COVID-19 pandemic. Design: Through a systematic search of the biomedical literature, this study was conducted according to the standards of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. The literature search included articles published from 2019 to August 2020 and meta-search engines, yielding a total of 142 articles, and a triangulation of information was performed. A total of 11 articles were eventually included in the review, and the validity of each article was determined according to the guidelines of the Joanna Briggs Institute level of evidence. Results and discussion: The systematic review identified 11 studies that use different methodological considerations for conducting an aeromedical evacuation and covering key aspects for a successful operation. Conclusion: The management of specialist nurses has a direct impact on the aeromedical evacuation of the critical patient. It covers planning, organisation, and operational safety, applied in the instruction, training, execution and strict monitoring of the work of the aeromedical crew as a solid team. This contributes to the success of the aero-evacuation mission and the infectious patient's high likelihood of survival during the COVID-19 pandemic.
BACKGROUND: Psoriasis is a pro-inflammatory disease with unknown etiology, that is characterized by skin inflammation and keratinocytes hyperproliferation. Specific inhibition of inflammation has shown positive effects avoiding the progression of the psoriatic lesions in different animal models of the disease, turning this strategy as a remarkable therapeutic alternative. OBJECTIVE: To screen the effectiveness of a novel IFN-α/ß signalling inhibitor in the development reduction of skin lesions in IMQ and TPA mice models of psoriasis. METHODS: We used a Phage-peptide library for the screening of a peptide with inhibitory effects on the development of psoriasis-like lesions in mice. To evaluate the in vivo effect of the phage-peptides (Phpep3D) and the derived peptide (Pep3D), we administered Phpep3D or Pep3D intradermally in mice with imiquimod (IMQ)-induced psoriasis and 12-O-tetradecanoyl phorbol-13-acetate (TPA)-induced psoriasis. We scored the lesions, and we determined the number of neutrophils and the production of some pro-inflammatory cytokines in the lesions. RESULTS: In this work, we describe how the Ph3pepD and Pep3D reduced skin thickness, redness, and acanthosis despite the presence of the psoriasis inducers, IMQ or TPA. We also found that Pep3D reduced the number of GR1+ infiltrated cells and decreased the production of IL-17A and TNFα in the psoriatic skin of mice. In-silico, docking analysis showed that Pep3D may interact with the interferon-alpha receptor, but further analyses should be performed to uncover the mechanism of action of this peptide. CONCLUSION: Our results suggest that Pep3D could be used as a new treatment for psoriasis.
Over the last years, an increasing concern has emerged regarding the eco-friendly management of wastewater. Apart from the role of wastewater treatment plants (WWTPs) for wastewater and sewage sludge treatment, the increasing need of the recovery of the resources contained in wastewater, such as nutrients and water, should be highlighted. This would allow for transforming a wastewater treatment plant (WWTP) into a sustainable technological system. The objective of this review is to propose a moving bed biofilm reactor (MBBR) as a novel technology that contributes to the circularity of the wastewater treatment sector according to the principles of circular economy. In this regard, this paper aims to consider the MBBR process as the initial step for water reuse, and nutrient removal and recovery, within the circular economy model.
Biofilms , Wastewater , Bioreactors , Nutrients , Sewage , Waste Disposal, Fluid
In the original version of this article, affiliation 3 was given as: "Division of Life Sciences, State Key Laboratory of Molecular Neuroscience, Hong Kong, University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China". This has now been corrected to: "Division of Life Sciences, State Key Laboratory of Molecular Neuroscience, Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China".Additionally in the 'Data availability' section an incorrect accession code was given. The accession code has now been changed from 'PDB A9X (AnkG:GABARAPL)' to 'PDB 6A9X (AnkG:GABARAP)'.These errors have been corrected in both the PDF and HTML versions of the Article.
GABAergic circuits are critical for the synchronization and higher order function of brain networks. Defects in this circuitry are linked to neuropsychiatric diseases, including bipolar disorder, schizophrenia, and autism. Work in cultured neurons has shown that ankyrin-G plays a key role in the regulation of GABAergic synapses on the axon initial segment and somatodendritic domain of pyramidal neurons, where it interacts directly with the GABAA receptor-associated protein (GABARAP) to stabilize cell surface GABAA receptors. Here, we generated a knock-in mouse model expressing a mutation that abolishes the ankyrin-G/GABARAP interaction (Ank3 W1989R) to understand how ankyrin-G and GABARAP regulate GABAergic circuitry in vivo. We found that Ank3 W1989R mice exhibit a striking reduction in forebrain GABAergic synapses resulting in pyramidal cell hyperexcitability and disruptions in network synchronization. In addition, we identified changes in pyramidal cell dendritic spines and axon initial segments consistent with compensation for hyperexcitability. Finally, we identified the ANK3 W1989R variant in a family with bipolar disorder, suggesting a potential role of this variant in disease. Our results highlight the importance of ankyrin-G in regulating forebrain circuitry and provide novel insights into how ANK3 loss-of-function variants may contribute to human disease.
Ankyrins/metabolism , Apoptosis Regulatory Proteins/metabolism , Microtubule-Associated Proteins/metabolism , Neural Pathways , Prosencephalon/cytology , Prosencephalon/metabolism , Adult , Aged , Animals , Ankyrins/genetics , Bipolar Disorder/genetics , Bipolar Disorder/metabolism , Cells, Cultured , Female , GABAergic Neurons/metabolism , Humans , Male , Mice , Middle Aged , Synapses/metabolism , Young Adult
Ovalbumin is considered a protein of high nutritional value because it contains essential amino acids and is highly digestible. Therefore, it has a high biological value. Currently, the high food demand requires worldwide attention because food production is insufficient. Therefore, other alternatives are necessary to satisfy food demands, such as protein engineering. In this work, a protein with a high essential amino acid content similar to ovalbumin was synthesized by protein engineering, expressed, and digested in vitro. The assembly and sequential overlap extension PCR strategy was used to synthesize a 345-bp gene that encodes a high essential amino acid content protein (HEAAP). The 345-bp product was cloned into the vector pBAD TOPO®, and expressed in Escherichia coli BL21. PCR reactions and sequencing demonstrated the presence, orientation, and correct sequence of the insert. HEAAP expression was induced by L-arabinose and then purified using Ni-NTA affinity chromatography. The expression in E. coli was low and barely detected by Western blot assay. The in vitro multienzyme digestibility of HEAAP was around 79%, which suggests that the protein is potentially nutritious. Virtual analysis classifies the protein as unstable and hydrophilic, with a half-life in E. coli of 10 h. The recombinant HEAAP was successfully synthesized, but it is necessary to improve the digestibility and to optimize expression including selecting other expression models.
Protein Engineering/methods , Recombinant Proteins/chemical synthesis , Recombinant Proteins/isolation & purification , Amino Acids, Essential/chemical synthesis , Amino Acids, Essential/physiology , Chromatography, Affinity , Cloning, Molecular/methods , Dietary Supplements , Escherichia coli/genetics , Polymerase Chain Reaction/methods , Proteins/chemical synthesis , Proteins/isolation & purification , Recombinant Fusion Proteins/genetics , Recombinant Proteins/genetics
This work analyzes the effect of nalidixic acid (NAL) on the kinetics of the heterotrophic and autotrophic biomass growth within a "NIPHO" activated sludge reactor treating municipal wastewater. Thus, the effect of this chemical in the degradation rates of carbon and nitrogen sources and net biomass growth rate is evaluated. Activated sludge samples were taken at three different operation conditions, changing the values of hydraulic retention time (2.8-3.8â¯h), biomass concentration (1400-1700 mgVSS L-1), temperature (12.6-14.8⯰C), and sludge retention time (11.0-12.6 day). A respirometric method was applied to model the kinetic performance of heterotrophic and autotrophic biomass in absence and presence of NAL, and a multivariable statistical analysis was carried out to characterize the influence of the operation variables on the kinetic response of the system, which was finally optimized. The results showed that there was no inhibitory effect of NAL on heterotrophic biomass, with an increase of net heterotrophic biomass growth rate from 1.70 to 6.73 mgVSS L-1 h-1 at the most favorable period. By contrast, the autotrophic biomass was negatively affected by NAL, reducing the value of net autotrophic biomass growth rate from 25.37 to 10.29 mgVSS L-1 h-1 at the best operation conditions. In general, biomass concentration and temperature had the highest influence on the degradation rate of carbon and nitrogen sources, whereas hydraulic retention time and sludge retention time were the most influential on net heterotrophic and autotrophic biomass growth rates.
Biomass , Bioreactors/microbiology , Nalidixic Acid/pharmacology , Sewage/chemistry , Anti-Bacterial Agents/pharmacology , Autotrophic Processes , Carbon , Heterotrophic Processes , Kinetics , Nitrogen , Sewage/microbiology , Wastewater/chemistry
BACKGROUND AND OBJECTIVES: Practice guidelines for preoperative fasting have not clearly established the fasting time needed after oral administration of water-soluble contrast media. The aim of this study was to determine the time required for the gastric emptying during the water-soluble contrast media in patients with acute abdominal pain. METHODS: This prospective longitudinal study included sixty-eight patients older than 18 years of age with acute abdominal pain, who required a water-soluble contrast media enhanced abdominal computed tomography study. Plain radiographs were obtained hourly until complete the gastric emptying. Patients with probable bowel obstruction were not included in the study. RESULTS: A total of 31 (45,6%), 54 (79,4%), and 64 (94,1%) patients achieved a complete gastric clearance of barium in 1, 2 and 3 hours, respectively. All patients achieved complete emptying of water-soluble contrast media within 6 hours. Gastric emptying time was not associated with gender (P=0,44), body mass index (P=.35), fasting time prior to water-soluble contrast media intake (P=0,12), administration of opioids in the emergency room (P=0,7), and the presence of comorbidities (P=0,36). CONCLUSION: Ninety-four percent of the patients with acute abdominal pain achieved complete gastric emptying within 3hours after the administration of water-soluble contrast media. All of them achieved complete gastric emptying within 6hours. The results suggested 6hours after oral intake of the contrast media is enough to complete transit of water-soluble contrast media through the stomach and avoid unnecessary risks.
Abdomen, Acute/diagnostic imaging , Barium Sulfate/pharmacokinetics , Contrast Media/pharmacokinetics , Fasting , Gastric Emptying , Tomography, X-Ray Computed/methods , Abdomen, Acute/physiopathology , Adult , Barium Sulfate/administration & dosage , Diatrizoate/administration & dosage , Diatrizoate Meglumine/administration & dosage , Female , Humans , Longitudinal Studies , Male , Practice Guidelines as Topic , Prospective Studies , Sex Factors , Solubility , Time Factors
A membrane bioreactor (MBR) and a hybrid moving bed biofilm reactor-membrane bioreactor (hybrid MBBR-MBR) for municipal wastewater treatment were studied to determine the effect of salinity on nitrogen removal and autotrophic kinetics. The biological systems were analyzed during the start-up phase with a hydraulic retention time (HRT) of 6 h, total biomass concentration of 2,500 mg L-1 in the steady state, and electric conductivities of 1.05 mS cm-1 for MBR and hybrid MBBR-MBR working under regular salinity and conductivity variations of 1.2-6.5 mS cm-1 for MBR and hybrid MBBR-MBR operating at variable salinity. The variable salinity affected the autotrophic biomass, which caused a reduction of the nitrogen degradation rate, an increase of time to remove ammonium from municipal wastewater and longer duration of the start-up phase for the MBR and hybrid MBBR-MBR.
Bioreactors , Salinity , Waste Disposal, Fluid/methods , Water Pollutants, Chemical/metabolism , Ammonium Compounds/metabolism , Biofilms , Biomass , Electric Conductivity , Kinetics , Membranes, Artificial , Nitrogen/metabolism , Wastewater
The start-up phase of a membrane bioreactor (MBR) for municipal wastewater treatment was studied to determine the effect of temperature on the organic matter removal and heterotrophic kinetics. The MBR system was analyzed during four start-up phases with values of hydraulic retention time (HRT) of 6 h and 10 h, mixed liquor suspended solids (MLSS) concentrations of 4,000 mg L-1 and 7,000 mg L-1 in the steady state, and temperature values of 11.5, 14.2, 22.9 and 30.1 °C. The influence of temperature on the biological process of organic matter removal was determined through the Arrhenius equation and Monod model. At the most favorable operation conditions of HRT (10 h) and MLSS (7,000 mg L-1) corresponding to phase 4, the effect of these variables dominated over the temperature. Heterotrophic biomass from phase 2 (HRT = 10 h, MLSS = 4,000 mg L-1 and T = 30.1 °C) had the highest values of chemical oxygen demand (COD) degradation rate (rsu,H), implying less time to remove organic matter and shorter duration of the start-up phase.
Bioreactors/microbiology , Membranes, Artificial , Models, Theoretical , Temperature , Water Purification/methods , Biological Oxygen Demand Analysis , Biomass , Kinetics , Sewage/chemistry , Wastewater/chemistry
PURPOSE: Studies have found that pomegranate juice (PJ) consumption increases the binding of high-density lipoproteins (HDL) to paraoxonase 1 (PON1), thus increasing the catalytic activity of this enzyme. PON1 is an antioxidant arylesterase synthesized in the liver and transported in plasma in association with HDL. Decreased levels of PON1 are associated with higher levels of cholesterol. We determined the effects of PJ on body weight, cholesterol, and triacylglycerols through 5 months of supplementation. In addition, the effect of PJ on pon1 gene expression in the liver was also measured by RT-qPCR as well as the activity in serum by a semiautomated method using paraoxon as a substrate. METHODS: CD-1 mice were either fed a control diet or were fed a high-fat diet 1.25% (wt/wt) cholesterol, 0.5% (wt/wt) sodium cholate, and 15% (wt/wt) saturated fat. 300 µL of PJ containing 0.35 mmol total polyphenols was administered by oral gavage to half of the high fat mice daily. The rest of the high fat mice and the control mice were administered with 300 µL of water. RESULTS: PJ-supplemented animals had significantly higher levels of expression of pon1 compared to the unsupplemented group. PJ-supplemented animals had twice the PON1 activity of the unsupplemented group. In addition, PJ-supplemented animals had the lowest body weight and significantly reduced cholesterol and triacylglycerol levels, although the tricylglycerol levels were not consistently decreased. CONCLUSIONS: These results suggest that PJ protects against the effects of a high-fat diet in body weight, and cholesterol levels.
Aryldialkylphosphatase/blood , Aryldialkylphosphatase/genetics , Diet, High-Fat/adverse effects , Fruit and Vegetable Juices , Fruit , Lythraceae , Animals , Body Weight , Cholesterol/blood , Dietary Supplements , Gene Expression , Liver/chemistry , Mice , RNA, Messenger/analysis , Triglycerides/blood
OBJECTIVE: Seasonal influenza is responsible for high annual morbidity and mortality worldwide, especially in elderly patients. The aim of the study was to analyse the epidemiological, clinical and prognostic features of influenza in octogenarians and nonagenarians admitted to a general hospital, as well as risk factors associated with mortality. METHODS: Retrospective, cross-sectional, descriptive study in patients admitted and diagnosed with influenza by molecular biology in the General University Hospital of Alicante from 1 January to 31 April 2015. RESULTS: A total of 219 patients were diagnosed with influenza in the study period: 55 (25.1%) were ≤64 years-old; 77 (35.2%) were aged 65-79; 67 (30.6%) were aged 80-89 years; and 20 (9.1%) were aged ≥90 years. Most flu episodes were caused by influenza A (n=181, 82.6%). Patients aged 80 years or older had lower glomerular filtration rate (mean: 49.7 mL/min vs. 62.2 mL/min; p=0.006), a greater need for non-invasive mechanical ventilation (22% vs 9.3%; p=0.02), greater co-morbidity due to cardiac insufficiency (40.5% vs. 16.4%; p<0.001) and chronic renal disease (32.9 vs. 20%, p=0.03), and greater mortality (19% vs. 2.9%; p<0.001). In a multivariate analysis, mortality was higher in those aged 80 or over (adjusted odds ratio [ORa] 9.2, 95% confidence interval [CI] 1.65-51.1), those who had acquired the flu in a long-term care facility (ORa 11.9, 95% CI 1.06-134), and those with hyperlactataemia (ORa 1.89, 95% CI 1.20-3.00). CONCLUSIONS: Seasonal influenza is a serious problem leading to elevated mortality in octogenarian and nonagenarian patients admitted to a general hospital.
Hospitalization/statistics & numerical data , Influenza, Human/epidemiology , Age Factors , Aged , Aged, 80 and over , Comorbidity , Cross-Sectional Studies , Female , Hospitals, General , Humans , Influenza, Human/mortality , Influenza, Human/therapy , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Spain/epidemiology
The objective of this study was to assess the effectiveness of a catheter-related bloodstream infection (CR BSI) reduction programme and healthcare workers' compliance with recommendations. A 3-year surveillance programme of CR BSIs in all hospital settings was implemented. As part of the programme, there was a direct observation of insertion and maintenance of central venous catheters (CVCs) to determine performance. A total of 38 education courses were held over the study period and feedback reports with the results of surveillance and recommendations were delivered to healthcare workers every 6 months. A total of 6722 short-term CVCs were inserted in 4982 patients for 58 763 catheter-days. Improvements of compliance with hand hygiene was verified at the insertion (87·1-100%, P < 0·001) and maintenance (51·1-72·1%, P = 0·029) of CVCs; and the use of chlorhexidine for skin disinfection was implemented at insertion (35·7-65·4%, P < 0·001) and maintenance (33·3-45·9%, P < 0·197) of CVCs. There were 266 CR BSI incidents recorded with an annual incidence density of 5·75/1000 catheter-days in the first year, 4·38 in the second year [rate ratio (RR) 0·76, 95% confidence interval (CI) 0·57-1·01] and 3·46 in the third year (RR 0·60, 95% CI 0·44-0·81). The education programme clearly improved compliance with recommendations for CVC handling, and was effective in reducing the burden of CR BSIs.
Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Health Services Research , Infection Control/methods , Sepsis/epidemiology , Sepsis/prevention & control , Adult , Aged , Attitude of Health Personnel , Catheterization/adverse effects , Central Venous Catheters/adverse effects , Disinfection/methods , Disinfection/statistics & numerical data , Education, Medical , Female , Guideline Adherence , Humans , Incidence , Male , Middle Aged , Tertiary Care Centers
El mantenimiento correctivo está orientado a corregir los defectos observados en los equipamientos o instalaciones, localizando las averías y reparándolas. Los costos de reparación de un equipo suelen ser mucho mayores en la etapa correctiva que en la etapa preventiva, y la literatura existente está orientada más hacia la prevención que hacia la corrección. Sin embargo, es inevitable que en una institución hospitalaria, como en cualquier otra, se presenten frecuentemente problemas en los equipos que no pudieron ser previstos o evitados mediante el mantenimiento preventivo o correctivo. Por esta razón, se hace necesario contar con protocolos para el mantenimiento correctivo que contengan criterios y procesos claramente definidos para mejorar la eficiencia y la eficacia en la solución de los problemas y que permitan la máxima disponibilidad en la prestación de los servicios. En este trabajo se presenta, como caso de estudio, el desarrollo e implementación de un Manual para la Gestión del Mantenimiento Correctivo en una de las clínicas de más alto nivel en la ciudad de Cali: La Fundación Valle del Lili.
The corrective maintenance is aimed at correcting the shortcomings in the equipment or facilities, locating faults and repairing them. Repair costs of equipment are usually much higher in the corrective stage than in the preventive stage, and the existing literature is oriented more towards prevention than correction. However, it is inevitable that in a hospital, as elsewhere, problems are often present on computers that could not be foreseen or avoided through preventive or corrective maintenance. For this reason corrective maintenance protocols containing clearly defined criteria and processes to improve efficiency and effectiveness in solving problems and ensuring maximum availability in the provision of services, are needed. This paper presents a case study, development and implementation of a Management Manual for corrective maintenance of the highest level clinics in the city of Cali: The Fundación Valle del Lili.
A Manutenção corretiva visa corrigir as deficiências do equipamento ou instalações, localizando falhas e reparálas. Os Custos de reparação de equipamento são geralmente muito maior na fase corretiva que na fase preventiva, e a literatura existente é mais orientada para a prevenção que para a correção. No entanto, é inevitável que em um hospital, como em outros lugares, muitas vezes se apresentam problemas nos equipamentos que não podiam ser previstos ou evitados através da manutenção preventiva ou corretiva. Por esta razão, é necessário ter protocolos de manutenção corretiva que contenham critérios e processos claramente definidos para melhorar a eficiência e eficácia na resolução de problemas e para assegurar a máxima disponibilidade na prestação de serviços. Este trabalho se apresenta como um caso de estudo, o desenvolvimento e a implementação de um Manual de Gestão para manutenção corretiva das clínicas de maior nível na cidade de Cali: a Fundação Valle del Lili.
A hybrid moving bed biofilm reactor-membrane bioreactor (hybrid MBBR-MBR) system was studied as an alternative solution to conventional activated sludge processes and membrane bioreactors. This paper shows the results obtained from three laboratory-scale wastewater treatment plants working in parallel in the start-up and steady states. The first wastewater treatment plant was a MBR, the second one was a hybrid MBBR-MBR system containing carriers both in anoxic and aerobic zones of the bioreactor (hybrid MBBR-MBRa), and the last one was a hybrid MBBR-MBR system which contained carriers only in the aerobic zone (hybrid MBBR-MBRb). The reactors operated with a hydraulic retention time of 30.40 h. A kinetic study for characterizing heterotrophic biomass was carried out and organic matter and nutrients removals were evaluated. The heterotrophic biomass of the hybrid MBBR-MBRb showed the best kinetic performance in the steady state, with yield coefficient for heterotrophic biomass=0.30246 mg volatile suspended solids per mg chemical oxygen demand, maximum specific growth rate for heterotrophic biomass=0.00308 h(-1) and half-saturation coefficient for organic matter=3.54908 mg O2 L(-1). The removal of organic matter was supported by the kinetic study of heterotrophic biomass.
Bacteria/metabolism , Biofilms , Waste Disposal, Fluid/methods , Wastewater/microbiology , Bacteria/chemistry , Biodegradation, Environmental , Biomass , Bioreactors/microbiology , Kinetics , Sewage/chemistry , Sewage/microbiology , Wastewater/chemistry
The moving bed biofilm reactor-membrane bioreactor (MBBR-MBR) is a novel solution to conventional activated sludge processes and membrane bioreactors. In this study, a pure MBBR-MBR was studied. The pure MBBR-MBR mainly had attached biomass. The bioreactor operated with a hydraulic retention time (HRT) of 9.5 h. The kinetic parameters for heterotrophic and autotrophic biomasses, mainly nitrite-oxidizing bacteria (NOB), were evaluated. The analysis of the bacterial community structure of the ammonium-oxidizing bacteria (AOB), NOB, and denitrifying bacteria (DeNB) from the pure MBBR-MBR was carried out by means of pyrosequencing to detect and quantify the contribution of the nitrifying and denitrifying bacteria in the total bacterial community. The relative abundance of AOB, NOB, and DeNB were 5, 1, and 3%, respectively, in the mixed liquor suspended solids (MLSS), and these percentages were 18, 5, and 2%, respectively, in the biofilm density (BD) attached to carriers. The pure MBBR-MBR had a high efficiency of total nitrogen (TN) removal of 71.81±16.04%, which could reside in the different bacterial assemblages in the fixed biofilm on the carriers. In this regard, the kinetic parameters for autotrophic biomass had values of YA=2.3465 mg O2 mg N(-1), µm, A=0.7169 h(-1), and KNH=2.0748 mg NL(-1).
Bacteria/metabolism , Biofilms/growth & development , Bioreactors/microbiology , Biota , Membranes/microbiology , Nitrification , Wastewater/microbiology , Ammonium Compounds/metabolism , Bacteria/classification , Metagenomics , Nitrites/metabolism , Oxidation-Reduction , Water Purification
