Carriage of multidrug-resistant Gram-negative bacilli: duration and risk factors.

Identification of risk factors influencing the duration of carriage of multidrug-resistant Gram-negative bacilli (MDR-GNB) may be useful for infection control. The aim of this study is to estimate the impact of several factors collected for routine hospital surveillance on the duration of carriage of selected MDR-GNB. From January 2015 to July 2021, patients with at least two clinical/surveillance samples positive for MDR-GNB different from ESBL-producing E. coli or AmpC - exclusively producing Enterobacterales were assessed. Microorganisms, age, number of admissions, clinical or rectal sample, sex, and admission service were evaluated as risk factors. Multivariate analysis was performed by a Cox proportional hazard model. A total of 1981 episodes of colonization were included. Involved microorganisms were ESBL-Klebsiella pneumoniae (KP) in 1057 cases (53.4%), other ESBL-non-E. coli Enterobacterales in 91 (4.6%), OXA-48-KP in 263 (13.3%), KPC-KP in 90 (4.5%), VIM-KP in 29 (1.5%), carbapenemase-producing non-KP Enterobacterales (CP-non-KP) in 124 (6.3%), and MDR Pseudomonas aeruginosa (MDR-PAER) in 327 (16.5%). No differences in duration of colonization were observed among ESBL-KP (median colonization time 320 days), ESBL-non-E. coli Enterobacterales (226 days), OXA48-KP (305 days), and MDR-PAER (321 days). For each group, duration of colonization was significantly longer than that of KPC-KP (median colonization time 60 days), VIM-KP (138 days), and CP-non-KP (71 days). Male sex (HR = 0.88; 95% CI 0.78-0.99), detection in Hepatology-Gastroenterology (HR = 0.71; 95% CI 0.54-0.93), clinical sample (HR = 0.61; 95% CI 0.53-0.69), and > 2 admissions after first detection (HR = 0.47; 95% CI 0.42-0.52) were independent predictors of longer carriage, whereas VIM-KP (HR = 1.61; 95% CI 1.04-2.48), KPC-KP (HR = 1.85; 95% CI 1.49-2.3), and CP-non-KP (HR = 1.92; 95% CI 1.49-2.47) were associated with shorter colonization time. Duration of colonization was significantly longer for ESBL-KP, other ESBL-non-E. coli Enterobacterales, OXA-48-KP, and MDR-PAER. For these microorganisms, prolonging surveillance up to 2.5-3 years should be considered. Male sex, clinical sample, multiple readmissions, admission service, and type of microorganism are independent predictors of the duration of carriage.

The impact of COVID-19 lockdown on food priorities. Results from a preliminary study using social media and an online survey with Spanish consumers.

This preliminary study describes the impact of the COVID-19 health crisis on people's interests, opinions, and behaviour towards food. Here, the evolution of people's internet searches, the characteristics of the most watched YouTube videos, and Tweeted messages in relation to COVID-19 and food was studied. Additionally, an online questionnaire (Spanish population, n = 362) studied changes in food shopping habits during the lockdown, motivations behind the changes, and perceived reliability of the information received from media. Results showed initial trending searches and most watched YouTube videos were about understanding what COVID-19 is and how the illness can progress and spread. When the official statement of a pandemic was released, trending searches in relation to food and shopping increased. Data retrieved from Twitter also showed an evolution from shopping concerns to the feeling of uncertainty for the oncoming crisis. The answers to the online questionnaire showed reduction of shopping frequency but no changes in shopping location. Products purchased with higher frequency were pasta and vegetables (health motivations), others were purchased to improve their mood (nuts, cheese, and chocolates). Reduced purchasing was attributed to products with a short shelf-life (fish, seafood) or because they were unhealthy and contributed to gained body weight (sugary bakery goods) or mood (desserts). Statements made by experts or scientists were considered by consumers to be the most reliable.

Oral processing and dynamics of texture perception in commercial gluten-free breads.

There is an increasing demand for gluten-free products, with the texture being a critical aspect. The aim of this work was to study the food bolus properties of gluten-free breads in relation to the dynamics of sensations perceived during its consumption. In this study, five-commercial gluten-free breads and two regular breads were analysed for their texture, crumb structure, and moisture content. Bread bolus particle size after three chews, bolus characteristics at the swallowing point, and oral activity were determined. The dynamics of textural sensations during bread consumption was evaluated using the temporal dominance of sensations (TDS) technique. Texture and structure properties vary among gluten-free breads being some of them close to regular breads (crumb with more and smaller cells that shows low hardness and high springiness) that lead to different in-mouth breakdown and TDS patterns. At the beginning, harder breads with low springiness values resulted in hard dominant sensations, in contrast, breads with low hardness and high springiness values were perceived soft and spongy. Breads that fragmented into a greater number of small size particles created crumbly and sandy sensations, characteristic of gluten-free breads with large air cell sizes. Compact sensation appeared in breads with low saliva uptake during bolus formation, while pasty and sticky sensations were related to a cohesive and adhesive bolus, respectively. Not only structure and mechanical properties, but also its oral behaviour in terms of fragmentation and bolus formation can fully explain the dynamics of texture perception of gluten-free breads.

[Regional diastolic function is more preserved in viable than non-viable myocardium. Demonstration by pulsed-wave Doppler tissue imaging in basal conditions]. / La función diastólica regional está más conservada en el miocardio viable que en el no viable. Demostración mediante Doppler pulsado tisular realizado en condiciones basales.

INTRODUCTION AND OBJECTIVES: The aim of this study was to analyze the differences in regional diastolic function between viable and non-viable myocardium when assessed by pulsed-wave Doppler tissue imaging performed in basal conditions. PATIENTS AND METHODS: The study population included 21 patients with three-vessel disease and regional systolic dysfunction. These patients underwent transthoracic echocardiographic study and pulsed-wave Doppler tissue imaging in basal conditions and, in addition, stress echocardiography with dobutamine performed by a different investigator. RESULTS: Three-hundred and twenty-two segments were studied, 140 of which (43%) had systolic dysfunction. Of the 140 segments with systolic dysfunction, 52 (37%) were considered hypokinetic by transthoracic echocardiography, 80 (57%) akinetic and 8 (6%) dyskinetic. As assessed by dobutamine echocardiography, 67 segments (48%) were considered viable and 73 (52%) non-viable. Viable segments had a higher peak velocity of the early diastolic wave e (5.5 +/- 1.9 vs. 4.7 +/- 2.0 cm/s; p = 0.03). An e/a ratio < 1 was more frequent in non-viable versus non-viable segments (52 vs. 70%; p < 0.05). There were no differences in relation to regional isovolumetric relaxation time and peak velocity of a wave. Although peak velocity of s wave was lower in non-viable segments, differences were not statistically significant. CONCLUSION: Compared with non-viable segments, viable myocardial segments have less impaired regional diastolic function as assessed by pulsed-wave Doppler tissue imaging.

Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging.

AIMS: The aim of this study was to determine the utility of pulsed wave Doppler tissue imaging in the evaluation of regional left ventricular diastolic function in patients with ischaemic heart disease. METHODS AND RESULTS: In 30 normal subjects and 43 patients with ischaemic heart disease, Doppler tissue imaging was performed in each of the 16 segments of the myocardium. The following diastolic pulsed wave Doppler tissue imaging parameters were obtained for each segment: (1) regional early diastolic peak velocity (regional e wave cm.s-1); (2) regional late diastolic peak velocity (regional a wave cm.s-1); (3) regional diastolic e/a velocity ratio; and (4) the regional isovolumic relaxation time, defined as the time interval from the second heart sound to the onset of the diastolic E wave. In patients with ischaemic heart disease, each of these parameters was evaluated and compared in ischaemic and normally perfused segments, based on the presence or absence of obstructive lesions of the supplying coronary artery. In patients with coronary artery disease, several differences were observed between diseased and normal wall segments: the mean segmental peak early diastolic velocity (e wave) was reduced (mean +/- SD: 6.4 +/- 2.1 cm.s-1 vs 8.5 +/- 2.8 cm.s-1; P < 0.01); the e/a diastolic velocity ratio was decreased (0.95 +/- 0.3 vs 1.5 +/- 0.6, respectively; P < 0.01) and the regional isovolumic relaxation time was prolonged (104 +/- 36.7 ms vs 69.6 +/- 30 ms; P < 0.01. No differences were observed in any of these parameters between the normally perfused segments of ischaemic patients and normal subjects. Patients with a normal transmitral diastolic Doppler inflow pattern had a mean of 3.7 +/- 2.7 myocardial segments with a local e/a pulsed wave Doppler tissue imaging velocity ratio < 1, fewer than those with an inverted diastolic transmitral Doppler inflow pattern (10.3 +/- 3 segments; P < 0.001). Overall sensitivity and specificity for an inverted local e/a ratio and a local isovolumetric relaxation time > or = 85 ms were of 62% and 72% and 69% and 80%, respectively. CONCLUSION: Regional diastolic wall motion is impaired at baseline in ischaemic myocardial segments, even when systolic contraction is preserved. Pulsed wave Doppler tissue imaging is a useful non-invasive technique which allows the assessment of regional diastolic performance and dynamics of the left ventricular myocardium. Further studies are required to define this role in the evaluation of coronary heart disease.