Neonatal innate immunity response in invasive candidiasis.

Infections caused by Candida spp. are frequent in critically hospitalized patients, especially among premature neonates, representing one of the most common healthcare-related infections. Although there is considerable production of current knowledge about the mechanisms of immune response, aspects involved in the newborn's innate defense are not fully understood. The aim of this study was to describe the innate immune mechanisms involved in the defense of neonates against invasive candidiasis. This is an integrative literature review from the Scopus, Scifinder, Medline, Web of Science databases and the electronic libraries ScienceDirect and Scielo, in the period between 2002 and 2020, with rescue based on primary descriptor Immunity Innate plus secondary descriptors Candidiasis Invasive AND Infant Newborn. We have observed the involvement of various mechanisms in the neonatal response against invasive candidiasis, including the recognition, signaling, recruitment, and initiation of an effective immune response. These mechanisms encompass the presence of antimicrobial peptides, phagocytosis, synthesis of reactive oxygen species, inflammatory mediators, and complex cell signaling systems mediated by Pattern Recognition Receptors (PRRs). With this study, it is expected to contribute to the expansion of knowledge about the immunological mechanisms involved in the innate immune response of the newborn against disseminated infections caused by Candida species, and in the same sense, highlight the importance of this knowledge as a reflex in the decrease in mortality in the neonatal period.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Case Report: Cutaneous Leishmaniasis due to Leishmania (Viannia) panamensis in Two Travelers Successfully Treated with Miltefosine.

We present two cases of Leishmania (V) panamensis in returning travelers from Central America successfully treated with miltefosine. The couple presented with ulcerative skin lesions nonresponsive to antibiotics. Skin biopsy with polymerase chain reaction (PCR) revealed L. (V) panamensis. To prevent the development of mucosal disease and avoid the inconvenience of parental therapy, we treated both patients with oral miltefosine. We suggest that miltefosine represents an important therapeutic alternative in the treatment of cutaneous lesions caused by L. panamensis and in preventing mucosal involvement.

Descriptions of two new cases of Rocky Mountain spotted fever in Panama, and coincident infection with Rickettsia rickettsii in Rhipicephalus sanguineus s.l. in an urban locality of Panama City, Panama.

The clinical and pathologic characterisation of two fatal cases of tick-borne rickettsiosis in rural (El Valle) and urban (City of Panama) Panama are described. Clinical and autopsy findings were non-specific, but the molecular analysis was used to identify Rickettsia rickettsii in both cases. No ticks were collected in El Valle, while in the urban case, R. rickettsii was detected in Rhipicephalus sanguineus s.l., representing the first molecular finding in this tick in Panama and Central America.

[Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients]. / Prescripción potencialmente inadecuada en pacientes mayores grandes polimedicados según criterios "STOPP".

INTRODUCTION: Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions. PATIENTS AND METHODS: A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression. RESULTS: A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI:5.76-7.08), a mean age of 79.2 years (SD:3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD:1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean: 1.32 (SD:1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were: therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR=1.22 [95% CI:1.04-1.43]) and inversely to the Charlson index (OR=0.76 [95% CI:0.65-0.89]). CONCLUSIONS: PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP.

Mechanical ventilation in critically-ill pregnant women: a case series.

BACKGROUND: Approximately 0.1-0.2% of pregnancies are complicated by respiratory failure requiring mechanical ventilatory support, but few data exist to inform clinical management. This study aimed to characterize current practice and the effect of delivery on respiratory function. METHODS: A retrospective review was performed of pregnant women who received mechanical ventilation for more than 24h, from four intensive care units in institutions with large-volume obstetric units. RESULTS: Data were collected from 29 patients with a mean gestation at intensive care unit admission of 25.3 ± 6 weeks. Tidal volumes were 7.7 ± 1.7 mL/kg predicted body weight. Estimated respiratory system compliance was reduced, but was higher in four patients ventilated for neurological conditions without lung disease. Three maternal and three neonatal deaths occurred. Ten patients delivered while on ventilatory support: one spontaneous delivery, four for obstetric indications and five for worsening maternal condition. Following delivery of these 10 patients, three demonstrated a greater than 50% decrease in oxygenation index and five a greater than 50% increase in compliance. No characteristics identified which patients may benefit from delivery. CONCLUSIONS: Review of current practice in four centers suggests that mechanical ventilation in pregnant patients follows usual guidelines applicable to non-pregnant patients. Delivery was associated with modest improvement in maternal respiratory function in some patients. Any potential benefit of delivery in improving maternal physiology must be weighed against the stress of delivery. The risks of premature birth for the fetus must be weighed against continued exposure to maternal hypoxemia and hypotension.

Multilayer perceptron neural network for flow prediction.

Artificial neural networks (ANNs) have proven to be a tool for characterizing, modeling and predicting many of the non-linear hydrological processes such as rainfall-runoff, groundwater evaluation or simulation of water quality. After proper training they are able to generate satisfactory predictive results for many of these processes. In this paper they have been used to predict 1 or 2 days ahead the average and maximum daily flow of a river in a small forest headwaters in northwestern Spain. The inputs used were the flow and climate data (precipitation, temperature, relative humidity, solar radiation and wind speed) as recorded in the basin between 2003 and 2008. Climatic data have been utilized in a disaggregated form by considering each one as an input variable in ANN(1), or in an aggregated form by its use in the calculation of evapotranspiration and using this as input variable in ANN(2). Both ANN(1) and ANN(2), after being trained with the data for the period 2003-2007, have provided a good fit between estimated and observed data, with R(2) values exceeding 0.95. Subsequently, its operation has been verified making use of the data for the year 2008. The correlation coefficients obtained between the data estimated by ANNs and those observed were in all cases superior to 0.85, confirming the capacity of ANNs as a model for predicting average and maximum daily flow 1 or 2 days in advance.

Effects of pH, temperature and SO2 on the formation of pyranoanthocyanins during red wine fermentation with two species of Saccharomyces.

The formation of vitisins A and B, p-coumaroyl and acetyl derivatives during the fermentation of red wine with two species of Saccharomyces was examined. One species, Saccharomyces cerevisiae strain 7VA was selected for its high production of acetaldehyde and pyruvic acid (7VA). The other (control) species, Saccharomyces uvarum strain S6U is used commercially for wine production. The final vitisins A and B concentrations produced with S. cerevisiae were, respectively, twice and three times that produced with S. uvarum. Models for the formation and accumulation of these vitisins are proposed. This is the first report that the formation of a vinylphenolic derivative of anthocyanin, malvidin-3-O-glucoside-4-vinylguaiacol, can be favored by fermentation with certain yeasts, possibly those with cinnamoyl decarboxylase activity. The effect of SO2, pH and temperature on the formation of pyranoanthocyanins during fermentation with S. cerevisiae and S. uvarum was also analyzed using High Pressure Liquid Chromatography (HPLC)/Photodiode Array Detection. The identification of these compounds was confirmed using HPLC/Electrospray Ionization-Mass Spectrometry.

Pyruvic acid and acetaldehyde production by different strains of Saccharomyces cerevisiae: relationship with Vitisin A and B formation in red wines.

The production of pyruvate and acetaldehyde by 10 strains of Saccharomyces cerevisiae was monitored during the fermentation of Vitis vinifera L. variety Tempranillo grape must to determine how these compounds might influence the formation of the pyroanthocyanins vitisin A and B (malvidin-3-O-glucoside-pyruvate acid and malvidin-3-O-glucoside-4 vinyl, respectively). Pyruvate and acetaldehyde production patterns were determined for each strain. Pyruvate production reached a maximum on day four of fermentation, while acetaldehyde production was at its peak in the final stages. The correlation between pyruvate production and vitisin A formation was especially strong (R (2) = 0.80) on day 4, when the greatest quantity of pyruvate was found in the medium. The correlation between acetaldehyde production and the formation of vitisin B was strongest (R (2) = 0.81) at the end of fermentation when the acetaldehyde content of the medium was at its highest. Identification and quantification experiments were performed by HPLC-DAD. The identification of the vitisins was confirmed by LC/ESI-MS.

Adsorption of anthocyanins by yeast cell walls during the fermentation of red wines.

This paper reports the anthocyanin adsorption profiles of the cell walls of different Saccharomyces strains isolated from grapes collected in the Spanish appellation controlée regions of La Rioja, Navarra, and Ribera del Duero. These strains are habitually used in red wine-making. The acyl derivatives of anthocyanins (acetyl and p-coumaryl compounds) were more strongly adsorbed than nonacyl derivatives. Peonidin-3G was also strongly adsorbed, as were its acyl derivatives. The greater presence of acetyl derivatives in the cell wall adsorbate leads to an increase in yellow color and a reduction in blue color with respect to the corresponding wine.

Myopathic camptocormia in a patient with levodopa unresponsive parkinsonism.

Camptocormia may be seen in Parkinson's disease. As no changes in paraspinal musculature are found, it is attributed to dystonia or extreme rigidity. However, several cases of parkinsonism and dropped head due to neck extensor myopathy have been reported. We report the first patient with levodopa unresponsive parkinsonism and camptocormia of muscular origin.

Camptocormia de origen miopático en un paciente con parkinsonismo resistente a levodopa / Myopathic camptocormia in a patient with levodopa unresponsive parkinsonism

Las anomalías de la postura son frecuentes en la enfermedad de Parkinson (EP). La camptocormia es un trastorno postural extremo que puede verse en pacientes con EP. Contrariamente a lo que sucede en personas con camptocormia aislada, en los pocos casos publicados de camptocormia asociada a EP no se ha encontrado ninguna anomalía en la musculatura paraespinal. Por esta razón, la camptocormia de la EP ha sido relacionada con la rigidez o con distonía. Sin embargo, recientemente se han descrito 7 casos de probable atrofia multisistema con antecolis debido a miopatía de los extensores del cuello. Presentamos un paciente con parkinsonismo resistente a levodopa y con camptocormia de origen miopático. (AU)

Radiochemical analysis of 93Zr.

The zirconium isotope 93Zr is a long-lived pure beta-particle-emitting radionuclide, which is produced by nuclear fission and neutron activation of the stable isotope 92Zr. This element is a constituent of the structural components of nuclear reactor vessels. A selective liquid-liquid extraction method for radiochemical separation of Zr, based on liquid-liquid extraction with 1-(2'-thenoyl)-3,3,3-trifluoroacetone in xylene and a subsequent stripping of 93Zr by an aqueous acid solution, has been developed. The method was utilised to separate Zr from other pure beta-particle and beta-gamma emitters in different kinds of samples. Decontamination factors higher than 99% for the pure beta-particle and beta-gamma emitters and an overall chemical yield of 80% were obtained. The sensitivity of the method allows the determination of the isolated 93Zr by liquid scintillation counting and the minimum detectable activity value obtained was 0.067 Bq over a counting period of 60 min.

An assessment of the ability of routine restaurant inspections to predict food-borne outbreaks in Miami-Dade County, Florida.

OBJECTIVES: This study sought to determine the usefulness of restaurant inspections in predicting food-borne outbreaks in Miami-Dade County, Fla. METHODS: Inspection reports of restaurants with outbreaks in 1995 (cases; n = 51) were compared with those of randomly selected restaurants that had no reported outbreaks (controls; n = 76). RESULTS: Cases and controls did not differ by overall inspection outcome or mean number of critical violations. Only 1 critical violation--evidence of vermin--was associated with outbreaks (odds ratio = 3.3; 95% confidence interval = 1.1, 13.1). CONCLUSIONS: Results of restaurant inspections in Miami-Dade County did not predict outbreaks. If these findings are representative of the situation in other jurisdictions, inspection practices may need to be updated.

Ovarian ependymoma. A case report.

We present the case of a 30-year-old woman who was referred to our institution with an erroneous diagnosis of poorly differentiated carcinoma of the ovary. The patient presented pelvic pain for one year prior to surgery. A second laparotomy revealed a bilateral pure ovarian ependymoma that infiltrated the uterus and presented implants on the omentum. Differential diagnosis included mainly endometrioid and small cell carcinoma of the ovary. Presence of typical ependymal rosettes and positivity to GFAP confirmed the diagnosis of ependymoma. Other teratomatous elements were not observed. Ovarian ependymomas are rare tumors; only eight cases, to our knowledge, have been reported in the literature. They have a favorable prognosis; patients with advanced stage disease are reported alive and well after treatment with surgery and chemotherapy.

Enteric virus infections and diarrhea in healthy and human immunodeficiency virus-infected children.

Forty-three stool samples from 27 human immunodeficiency virus (HIV)-seropositive children and 38 samples from 38 HIV-negative children, collected during a 15-month period, were examined for enteric viruses. Diagnostic assays included enzyme immunoassays for rotavirus, adenovirus, and Norwalk virus; polyacrylamide gel electrophoresis for picobirnavirus and atypical rotavirus; and PCR for astrovirus and enterovirus. Specimens from HIV-positive children were more likely than those of HIV-negative children to have enterovirus (56 versus 21%; P < 0.0002) and astrovirus (12 versus 0%; P < 0.02), but not rotavirus (5 versus 8%; P > 0.5). No adenoviruses, picobirnaviruses, or Norwalk viruses were found. The rates of virus-associated diarrhea were similar among HIV-positive and HIV-negative children. Enteroviruses were excreted for up to 6 months in HIV-positive children; however, no evidence for prolonged excretion of poliovirus vaccine was observed. These results suggest that although infection with enterovirus and astrovirus may be frequent in HIV-infected children, enteric viruses are not associated with the diarrhea frequently suffered by these children.