[Clinical and pharmacological data in COVID-19 hospitalized nonagenarian patients]. / Variables clínicas y farmacológicas de pacientes nonagenarios hospitalizados por COVID-19.

OBJECTIVE: Despite the impact of SARS-CoV-2 infection in geriatrics, data on nonagenarian patients is scarce. The aim of this study is to describe the clinical features of COVID19-diagnosed nonagenarians, as well as its clinical evolution and therapeutic response. METHODS: Retrospective observational study of nonagenarians, admitted for COVID-19. Sociodemographic and clinical variables were registered, including previous polypharmacy. Blood analysis data and COVID-19-specific treatment were registered. RESULTS: A total of 79 patients were included, with 50.6% (40 patients) of mortality. None of the comorbidities registered correlated with mortality, which was significantly higher among patients with moderate/complete functional dependence, compared to those mild-dependents/independents (59.5% vs 40.5%; p=0.015). Most prescribed drugs were hydroxychloroquine/chloroquine and azithromycin. Non-survivors presented higher counts of leukocytes and neutrophils, and higher lymphopenia. CONCLUSIONS: Nonagenarians with functional dependence presented higher mortality, irrespective of comorbidities or treatment received. Implementing an integral geriatric evaluation would enhance the implementation of personalized therapeutic strategies for nonagenarians.

Seasonal shifts in the presence of pathogenic leptospires, Escherichia coli, and physicochemical properties in coastal rivers and streams of Puerto Rico.

Leptospirosis is an emerging zoonotic disease in the Caribbean region and the island of Puerto Rico. Information on the presence of pathogenic Leptospira in rivers and streams of Puerto Rico is currently lacking. This study aimed to evaluate seasonal shifts in the presence of pathogenic leptospires and the level of Escherichia coli from 32 coastal locations in Puerto Rico's dry and wet seasons. Physicochemical parameters (temperature, salinity, pH, and dissolved oxygen) were determined at each site. The temperature (25.8 °C) and pH (average 7.6) values were all within acceptable USEPA regulatory standards. Thirty-eight percent of the sites of the dry season and 28% of the wet season sites contained dissolved oxygen levels ≤4 mg L-1 , which is relatively low. In the dry season, 19 sites (59%) and 18 (56%) of the wet season sites had E. coli counts >410 most probable number (MPN) 100 ml-1 and would be considered unsafe for recreational use. The lipl32 gene quantitative polymerase chain reaction assay was used for the detection of pathogenic leptospires in the samples. Low concentrations of pathogenic leptospires (<60 genome copies 100 ml-1 ) at Camuy, Espíritu Santo, Río Guayanilla, Quebrada Majagual, and Río Fajardo were detected during the wet season. Pathogenic leptospires were detected (∼40 genome copies 100 ml-1 ) at only one site, Loíza, during the dry season. There was no predictable relationship between the physicochemical parameters, concentrations of E. coli, and the presence of pathogenic leptospires in water samples.

Ultralow-temperature device dedicated to soft X-ray magnetic circular dichroism experiments.

A new ultralow-temperature setup dedicated to soft X-ray absorption spectroscopy and X-ray magnetic circular dichroism (XMCD) experiments is described. Two experiments, performed on the DEIMOS beamline (SOLEIL synchrotron), demonstrate the outstanding performance of this new platform in terms of the lowest achievable temperature under X-ray irradiation (T = 220 mK), the precision in controlling the temperature during measurements as well as the speed of the cooling-down and warming-up procedures. Moreover, owing to the new design of the setup, the eddy-current power is strongly reduced, allowing fast scanning of the magnetic field in XMCD experiments; these performances lead to a powerful device for X-ray spectroscopies on synchrotron-radiation beamlines facilities.

Versatile variable temperature insert at the DEIMOS beamline for in situ electrical transport measurements.

The design and the first experiments are described of a versatile cryogenic insert used for its electrical transport capabilities. The insert is designed for the cryomagnet installed on the DEIMOS beamline at the SOLEIL synchrotron dedicated to magnetic characterizations through X-ray absorption spectroscopy (XAS) measurements. This development was spurred by the multifunctional properties of novel materials such as multiferroics, in which, for example, the magnetic and electrical orders are intertwined and may be probed using XAS. The insert thus enables XAS to in situ probe this interplay. The implementation of redundant wiring and careful shielding also enables studies on operating electronic devices. Measurements on magnetic tunnel junctions illustrate the potential of the equipment toward XAS studies of in operando electronic devices.

Fast continuous energy scan with dynamic coupling of the monochromator and undulator at the DEIMOS beamline.

In order to improve the efficiency of X-ray absorption data recording, a fast scan method, the Turboscan, has been developed on the DEIMOS beamline at Synchrotron SOLEIL, consisting of a software-synchronized continuous motion of the monochromator and undulator motors. This process suppresses the time loss when waiting for the motors to reach their target positions, as well as software dead-time, while preserving excellent beam characteristics.

Infecciones relacionadas con catéteres vasculares de corta permanencia en cuidados críticos / Short term catheter related infections in critical care

Las infecciones por catéter son la tercera causa de infección nosocomial en UCI. El riesgo de infección depende del tipo de dispositivo, el sitio de inserción y las adecuadas medidas de prevención. Su manejo implica la decisión de retirar el catéter y la terapia antimicrobiana sistémica. Esta revisión se centra en la epidemiología, patogénesis, diagnóstico y manejo de las infecciones relacionadas con catéter, centrándose en el manejo de acorde con el patógeno (AU)

Catheter related infections are third cause of nosocomial infections in the ICU. The risk of infection depends on the tapy of device, the site of insertion and the appropriate prevention measures. Management involves deciding on catheter removal and systemic antimicrobial therapy. This review outlines the epidemiology, pathogenesis, diagnosis and management of catheter related infections, mainly focusing on the management according to the patogen (AU)

DEIMOS: a beamline dedicated to dichroism measurements in the 350-2500 eV energy range.

The DEIMOS (Dichroism Experimental Installation for Magneto-Optical Spectroscopy) beamline was part of the second phase of the beamline development at French Synchrotron SOLEIL (Source Optimisée de Lumière à Energie Intermédiaire du LURE) and opened to users in March 2011. It delivers polarized soft x-rays to perform x-ray absorption spectroscopy, x-ray magnetic circular dichroism, and x-ray linear dichroism in the energy range 350-2500 eV. The beamline has been optimized for stability and reproducibility in terms of photon flux and photon energy. The main end-station consists in a cryo-magnet with 2 split coils providing a 7 T magnetic field along the beam or 2 T perpendicular to the beam with a controllable temperature on the sample from 370 K down to 1.5 K.

Ultrasensitive, simple and solvent-free micro-assay for determining sulphite preservatives (E220-228) in foods by HS-SDME and UV-vis micro-spectrophotometry.

A new method based on headspace single-drop microextraction in combination with UV-vis micro-spectrophotometry has been developed for the ultrasensitive determination of banned sulphite preservatives (E220-228) in fruits and vegetables. Sample acidification was used for SO2 generation, which is collected onto a 5,5'-dithiobis-(2-nitrobenzoic acid) microdrop for spectrophotometric measurement. A careful study of this reaction was necessary, including conditions for SO2 generation from different sulphating salts, drop pH, 5,5'-dithiobis-(2-nitrobenzoic acid) concentration and potential interference effects. Variables influencing mass transfer (stirring, sample volume and addition of salt) and microextraction time were also studied. A simple sulphite extraction was carried out, and problems caused by oxidation during the extraction process were addressed. A high enrichment factor (380) allows the determination of low levels of free SO2 in fruits and vegetables (limit of detection 0.06 µg g(-1), limit of quantification 0.2 µg g(-1)) with an adequate precision (repeatability, relative standard deviation 5 %). In addition, the sulphiting process was studied through the monitoring of residual SO2 in a vegetal sample, thus showing the importance of a sensitive tool for SO2 detection at low levels.

Magnetism of TbPc2 SMMs on ferromagnetic electrodes used in organic spintronics.

Structural features and magnetic behaviour of TbPc2 thin films sublimated on LSMO and on cobalt surfaces have been investigated by synchrotron-based XNLD and XMCD techniques. Different orientation of the molecules is observed for the two substrates. No significant magnetic interaction with the ferromagnetic substrates is detected.

First glimpse of the soft x-ray induced excited spin-state trapping effect dynamics on spin cross-over molecules.

The dynamics of the soft x-ray induced excited spin state trapping (SOXIESST) effect of Fe(phen)2(NCS)2 (Fe-phen) powder have been investigated by x-ray absorption spectroscopy (XAS) using the total electron yield method, in a wide temperature range. The low-spin (LS) state is excited into the metastable high-spin (HS) state at a rate that depends on the intensity of the x-ray illumination it receives, and both the temperature and the intensity of the x-ray illumination will affect the maximum HS proportion that is reached. We find that the SOXIESST HS spin state transforms back to the LS state at a rate that is similar to that found for the light induced excited spin state trapping (LIESST) effect. We show that it is possible to use the SOXIESST effect in combination with the LIESST effect to investigate the influence of cooperative behavior on the dynamics of both effects. To investigate the impact of molecular cooperativity, we compare our results on Fe-phen with those obtained for Fe{[Me2Pyrz]3BH}2 (Fe-pyrz) powder, which exhibits a similar thermal transition temperature but with a hysteresis. We find that, while the time constant of the dynamic is identical for both molecules, the SOXIESST effect is less efficient at exciting the HS state in Fe-pyrz than in Fe-phen.

Tuberculous hepatic abscess appearing after liver transplantation in a patient with human immunodeficiency virus and hepatitis B and C virus co-infection.

Tuberculosis infection occurs relatively frequently in solid organ transplant recipients, although the occurrence of tuberculous hepatic abscesses is uncommon. Anti-tuberculous therapy has several concerns in transplant recipients, including an increased risk of cellular rejection and potential hepatotoxicity. We present the case of a human immunodeficiency virus-infected liver transplant patient who developed multiple tuberculous liver abscesses. Treatment with isoniazid, ethambutol, pyrazinamide, and moxifloxacin was efficacious, well tolerated, and safe.

Anafilaxia perioperatoria / No disponible

La anafilaxia perioperatoria puede ser una un cuadro clínico que amenaza la vida del paciente, producido por los fármacos o sustancias usadas en la anestesia. Después de una anafilaxia, debe realizarse un estudio alergológico para identificar el agente responsable y prevenir recurrencias. La incidencia global es de 1 entre 10.000-20.000 anestesias. Los agentes más frecuentemente implicados son los bloqueantes neuromusculares, látex y antibióticos. El diagnóstico inicial es mediante la clínica. En el tratamiento es esencial la adrenalina(AU)

Perioperative anaphylaxis may be a life threatening clinical condition and is typically a results of drugs used for anesthesia. After anaphylaxis, allergologic assessment is essential to identify the offending agent and prevent recurrences. The overall incidence is estimated at 1 in 10,000-20,000 anesthetic procedures. The most commonly involved agents are neuromuscular blocking agents, latex and antibiotics. The initial diagnosis is presumptive, including clinical signs. Adrenalin is the treatment of choice(AU)

Quantum tunnelling of the magnetization in a monolayer of oriented single-molecule magnets.

A fundamental step towards atomic- or molecular-scale spintronic devices has recently been made by demonstrating that the spin of an individual atom deposited on a surface, or of a small paramagnetic molecule embedded in a nanojunction, can be externally controlled. An appealing next step is the extension of such a capability to the field of information storage, by taking advantage of the magnetic bistability and rich quantum behaviour of single-molecule magnets (SMMs). Recently, a proof of concept that the magnetic memory effect is retained when SMMs are chemically anchored to a metallic surface was provided. However, control of the nanoscale organization of these complex systems is required for SMMs to be integrated into molecular spintronic devices. Here we show that a preferential orientation of Fe(4) complexes on a gold surface can be achieved by chemical tailoring. As a result, the most striking quantum feature of SMMs-their stepped hysteresis loop, which results from resonant quantum tunnelling of the magnetization-can be clearly detected using synchrotron-based spectroscopic techniques. With the aid of multiple theoretical approaches, we relate the angular dependence of the quantum tunnelling resonances to the adsorption geometry, and demonstrate that molecules predominantly lie with their easy axes close to the surface normal. Our findings prove that the quantum spin dynamics can be observed in SMMs chemically grafted to surfaces, and offer a tool to reveal the organization of matter at the nanoscale.

Preeclampsia. Revisión de la literatura y protocolo de tratamiento / No disponible

La preeclampsia s una causa importante de mortalidad (15-20% en países desarrollados) y morbilidad materna, así como de muerte perinatal, prematuridad y crecimiento intrauterino retardado. Es un síndrome caracterizado por el desarrollo de hipertensión y proteinuria después de la semana 20 de gestación en una mujer previamente normotensa. Se clasifica en leve y grave. La forma leve se asocia a una mínima morbilidad materna y neonatal. La forma grave se asocia con complicaciones maternas y neonatales significativas. Las mujeres diagnosticadas de preeclampsia necesitan una evaluación materna y fetal estricta durante todo el embarazo y aquellas que tengan la forma grave deberían ingresar en un hospital para su manejo. La decisión de finalizar la gestación o seguir un manejo expectante depende de la edad gestacional, el estado del feto y las condiciones maternas en el momento de la evaluación. Los esteroides son efectivos en reducir la mortalidad y morbilidad fetal y deben administrarse en los casos graves entre las semanas 24 y 34 de gestación. El sulfato de magnesio debe emplearse durante el trabajo de parto y al menos 24 horas postparto en todas las mujeres con la forma grave para prevenir las convulsiones. En este artículo realizamos una revisión de la literatura y damos una serie de recomendaciones para el diagnóstico y tratamiento de estas pacientes (AU)

Preeclampsia is a major cause of maternal mortality (15-20%in developed countries) and morbidities, perinatal deaths, preterm birth and intrauterine grow restriction. Refers to a syndrome characterized by the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. It is classified as mild or severe. Women with diagnosed preeclampsia require close evaluation of maternal and fetal conditions for the duration of pregnancy, and those with severe disease should be managed in hospital. The decision between delivery and expectant management depends on fetal gestational age, fetal status and severity of maternal condition at time of evaluation. Steroids are effective in reducing neonatal mortality and morbidity when administered to those with severe disease between 24 and 34 weeks gestation. Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all women with severe disease. The aim of this article was to review literature and to make recommendations for diagnosis and treatment (AU)

Improvement of renal function after conversion to mycophenolate mofetil combined with low-level calcineurin inhibitor in liver transplant recipients with chronic renal dysfunction.

INTRODUCTION: Calcineurin inhibitors (CNI) are the main pathogenic factors for renal dysfunction in solid organ transplant recipients. Introduction of non-nephrotoxic immunosuppressive drugs, such as mycophenolate mofetil (MMF), may allow discontinuation or reduction of CNI treatment, thereby improving renal function. The aim of this study was to assess the feasibility, efficacy and safety of MMF introduction and CNI dosage reduction in the maintenance immunosuppressive protocol to improve renal function in liver transplant recipients with chronic renal dysfunction. PATIENTS AND METHODS: We prospectively included 88 liver transplant recipients including 74 men and an overall mean age of 58.8 +/- 10.3 years who all displayed chronic renal dysfunction (creatinine >1.4 mg/dL) and proteinuria <1 g/d. They were subdivided into 3 groups according to the basal creatinine value 1.4-1.7 mg/dL (group I; n = 41); 1.8-2.0 mg/dL (group II; n = 28); and >2 mg/dL (group III; n = 19). MMF was initiated at 1.5-2.0 g/d. Reduction of tacrolimus or cyclosporine dosage was performed to achieve respective target trough levels of <5 ng/mL or <50 ng/mL. We performed periodic determinations of arterial pressure, liver function tests, serum creatinine, blood cells count, CNI levels, and proteinuria. RESULTS: Creatinine values after conversion were 1.4 +/- 0.5 mg/dL in the overall group. Improvement of renal function was more frequent among groups I (80.4%) and II (92.8%) versus III (73.6%). Normalization of creatinine values was more frequent in group I (68.2%) with respect to cohorts II (21.4%) and III (10.5%). Rejection was not detected. CONCLUSION: Application of an immunosuppressive protocol with MMF and low-level CNI in liver transplant recipients with chronic renal dysfunction was associated with improvement or normalization of creatinine, without an increased risk of rejection. Early conversion is needed to achieve the best results.

Alergia al látex (II): medidas de prevención / No disponible

La alergia al látex ha aumentado en los últimos años hasta convertirse en importante causa de morbilidad y, hoy en día, está reconocida como problema internacional de salud. Su prevalencia en la población general está en torno al 1%, pudiendo aumentar hasta un 20% entre el personal sanitario. En pacientes alérgicos al látex, al no existir un tratamiento específico definitivo ni una premedicación efectiva, la única alternativa es evitar la exposición. Por ello, es importante la identificación de pacientes con factores de riesgo de sensibilización. La prevención tiene un papel fundamental, pero la ubicuidad del látex convierte esa prevención en una labor compleja, que obliga a considerar cambios en la asistencia sanitaria. En esta revisión analizaremos la prevención, haciendo énfasis en la importancia de diagnóstico precoz y educación de pacientes para que eviten la exposición al látex, así como en la necesidad de creación de comités multidisciplinarios y multiprofesionales, que puedan coordinar la atención médica que debe recibir el paciente alérgico al látex desde su ingreso hasta su alta y desarrollar reglas de actuación para proteger a los trabajadores de un hospital. Insistiremos en la trascendencia de la disminución de las concentraciones de látex en el ambiente (AU)

Latex allergy has increased in the last years up to turning into an important reason of morbidity and, nowadays, it is recognized as an international problem of health. It prevalence in the general population is concerning 1%, being able to increase up to 20% among the sanitary personnel. In the patients with latex allergy, when exist neither a specific definitive treatment nor an effective premedication, the only alternative is to avoid the exhibition. For it, the patients' identification is fundamental in addition with factors of risk of sensitization to the latex. The prevention has a fundamental role, but the ubiquity of the latex turns this prevention into a complex labour, which forces to consider changes in the sanitary assistance. In this review we will analyze the prevention of the allergy to the latex, doing emphasis in the importance of precocious diagnosis and education of the patients in order that they avoid the exhibition to the latex, as well as in the need of creation of multidisciplinary and multiprofessional committees, which they could coordinate the medical attention that the patient allergic to the latex must receive from his revenue up to his discharge and develop rules of action to protect the workers of a hospital. We will insist on the significance of the decrease of the concentrations of latex on the environment (AU)

Descending deep neck infection in a liver transplant patient.

Descending deep neck space infections are serious conditions that appear as a complication of cervical and odontogenic infections. Infecting bacteria descend into the mediastinum causing systemic toxicity and septic shock. Liver transplant patients are at increased risk of developing life-threatening infections, but reports about descending deep neck space infections in these patients are scarce. Here, we report a case of deep neck infection resulting in mediastinitis in a liver transplant patient. Streptococcus anginosus was isolated in blood cultures.

Alergia al látex (I): implicaciones para el anestesiólogo / No disponible

La alergia al látex es una patología importante en el ámbito sanitario. Son grupos de riesgo para desarrollar alergia al látex los pacientes multioperados y los profesionales sanitarios. La prevalencia en la población general es calcula en un 1%, mientras que en los trabajadores sanitarios es del 2,6 al 19,6%, siendo mayor en los trabajadores de las áreas quirúrgicas. La clínica varía desde rinitis hasta shock anafiláctico, pudiendo ser causa de muerte. El diagnóstico se basa en una buena historia clínica, test cutáneos y, si es necesario, pruebas de provocación controlada. Existen protocolos para prevenir el desarrollo de síntomas en los pacientes alérgicos, cuando van a ser intervenidos quirúrgicamente. El tratamiento etiológico se basa en la inmunoterapia yen nuevas técnicas de ADN recombinante. En este artículo, se describe la clínica, protocolos diagnósticos, así como protocolos de prevención y tratamientos etiológicos de la alergia al látex (AU)

Hypersensitivity to natural rubber latex has been recognized as an important health problem. Risks groups for natural rubber latex allergy included health workers and patients who have under gone multiple surgical procedures. The prevalence of latex allergy among general population is probably 1%, in heath workers the estimated prevalence is between 2.6 to 19.6% and tends to be higher in surgical settings. Symptoms vary between rhinitis to anaphylaxis, even death. Diagnosis of latex allergy is based in clinical history, skin test and provocation test. Several protocol shave been described to avoid symptoms in allergy patients when they undergo surgical procedures. Etiological treatment is based on specific immunotherapy and recombinant allergens techniques. The aim of this article was to review etiology, diagnosis, prevention and treatment of latex allergy (AU)