Corrigendum to "review on recycling energy resources and sustainability".

[This corrects the article DOI: 10.1016/j.heliyon.2023.e15107.].

Review on recycling energy resources and sustainability.

Shifting the production and disposal of renewable energy as well as energy storage systems toward recycling is vital for the future of society and the environment. The materials that make up the systems have an adverse effect on the environment. If no changes are made, the CO2 emissions will continue to increase while also impacting vital resources such as contaminating water sources and wildlife, manifesting in rising sea levels, and air pollution. The development of renewable energy storage systems (RESS) based on recycling utility and energy storage have been an important step in making renewable energy more readily available and more reliable. The emergence of RESS has revolutionized the way energy is obtained and stored for future uses. RESS such as those based on recycling utility and energy storage, provide a reliable and efficient means to harvest, store and provide energy from renewable sources on a large scale. The potential to reduce our dependence on fossil fuels, increase energy security, and help protect the environment makes RESS an important tool in the fight against climate change. As the technology evolves, such systems will continue to play a vital role in the green energy revolution, providing access to a reliable, efficient, and cost-effective power source. This paper provides an overview of the current research on recycling utility based renewable energy storage systems, including their components, power sources, benefits, and challenges. Finally, it assesses potential methods to overcome the challenges and improve the efficiency and reliability of the recycling utility based renewable energy storage systems.

Variation in renal parameter values after a change in antiretroviral therapy from elvitegravir/cobicistat/emtricitabine/tenofovir-alafenamide to bictegravir/emtricitabine/tenofovir-alafenamide / Variación de los valores de los parámetros renales tras un cambio en la terapia antirretroviral de elvitegravir/cobicistat/emtricitabina/tenofoviralafenamida a bictegravir/emtricitabina/ tenofovir-alafenamida

El cambio de EVG/COBI/FTC/TAF a BIC/FTC/TAF es una estrategia para optimizar la terapia antirretroviral. Nuestro objetivo fue analizar cómo variaban los parámetros analíticos renales tras cambiar tratamiento. Los objetivos secundarios fueron determinar si edad y sexo de los pacientes y el tiempo que habían tomado cobicistat previamente condicionaba la posible variación de los parámetros renales. Se realizó un estudio piloto observacional, descriptivo y ambispectivo. Los parámetros renales se obtuvieron de las analíticas previas más cercanas al cambio (considerándose este valor el basal) y después de 12, 24 semanas y 12 meses tras cambiar tratamiento. Se incluyeron 60 pacientes. En los niveles de creatinina sérica, se observó cambio a las 24 semanas (aumento medio de 0,06 mg/dL, p=0,025) y a los 12 meses (aumento medio de 0,03 mg/dL, p=0,05). Considerando la tasa de filtración glomerular (CKD-EPI), hubo bajada en los 3 períodos analizados, pero sin significación estadística. No hubo influencia del sexo, edad ni tiempo que los pacientes habían tomado cobicistat previamente. (AU)

Switching of EVG/COBI/FTC/TAF to BIC/FTC/TAF is a valid strategy for antiretroviral therapy optimization. Our aim was to analize how the variation of analytical parameters for renal function estimation after the change of their treatment. Secondary objectives were to determine if age and sex of the patients and the time they have previously taken cobicistat conditions the possible variation in renal parameters. An observational, descriptive and ambispective pilot study was performed. The renal laboratory parameters were obtained from the previous laboratory tests closest in time to the change (this value being considered the baseline) and after 12, 24 weeks and 12 months after a change in treatment with BIC/FTC/TAF. 60 patients were included. Regarding serum creatinine levels, a change in serum creatine levels was observed at 24 weeks (mean increase of 0.06 mg/dL, p=0.025) and at 12 months (mean increase of 0.03 mg/dL, p=0.05). Considering glomerular filtration (CKD-EPI), there was downward trend in the 3 periods analyzed, but statistical significance was not reached. There was no influence of sex, age and the length of time that the patients had taken cobicistat before the change. (AU)

Effect of Drosophila suzukii on Blueberry VOCs: Chemical Cues for a Pupal Parasitoid, Trichopria anastrephae.

Biocontrol agents such as parasitic wasps use long-range volatiles and host-associated cues from lower trophic levels to find their hosts. However, this chemical landscape may be altered by the invasion of exotic insect species. The spotted-wing drosophila (SWD), Drosophila suzukii (Diptera: Drosophilidae), is a highly polyphagous fruit pest native to eastern Asia and recently arrived in South America. Our study aimed to characterize the effect of SWD attack on the volatile organic compounds (VOCs) of blueberries, a common host fruit, and to correlate these odor changes with the olfactory-mediated behavioral response of resident populations of Trichopria anastrephae parasitoids, here reported for the first time in Uruguay. Using fruit VOC chemical characterization followed by multivariate analyses of the odor blends of blueberries attacked by SWD, we showed that the development of SWD immature stages inside the fruit generates a different odor profile to that from control fruits (physically damaged and free of damage). These differences can be explained by the diversity, frequency, and amounts of fruit VOCs. The behavioral response of T. anastrephae in Y-tube bioassays showed that female wasps were significantly attracted to volatiles from SWD-attacked blueberries when tested against both clean air and undamaged blueberries. Therefore, T. anastrephae females can use chemical cues from SWD-infested fruits, which may lead to a successful location of their insect host. Since resident parasitoids are able to locate this novel potential host, biological control programs using local populations may be plausible as a strategy for control of SWD.

Oligodendroglioma anaplásico quístico: reporte de caso / Anaplastic cystic oligodendroglioma: case report

Resumen: Los oligodendrogliomas anaplásicos son gliomas infiltrantes grado III de la organización mundial de la salud (OMS). Son tumores poco frecuentes y representan el 5-10% de todas las neoplasias intracraneales primarias. Su incidencia es de 0.3 por 100.000 habitantes por año en Estados Unidos. Con frecuencia se presentan en adultos entre los 40-60 años de edad. Los síntomas principales pueden ser déficit motor, déficit cognitivos y síntomas de aumento de la presión intracraneal. Su comportamiento en resonancia magnética muestra un aspecto heterogéneo con necrosis, degeneración quística y hemorragia intratumoral. Las presentaciones quísticas extensas son poco frecuentes. Reportamos el caso de un oligodendroglioma anaplásico de aspecto predominantemente quístico en una mujer joven.

Abstract: Anaplastic oligodendrogliomas are grade III infiltrating gliomas of the World Health Organization (WHO). They are rare tumors and represent 5-10% of all primary intracranial neoplasms. Its incidence is 0.3 per 100.000 inhabitants per year in the United States. They often occur in adults between 40-60 years of age. The main symptoms may be motor deficit, cognitive deficits and symptoms of increased intracranial pressure. Its behavior in MRI shows a heterogeneous appearance with necrosis, cystic degeneration and intratumoral hemorrhagic. Extensive cystic presentations are rare. We report the case of an anaplastic oligodendroglioma of predominantly cystic appearance in a young woman.

Impact of pre-radiation therapy quality of life in lung cancer survival: a prospective, intention-to-treat, multicenter study.

PURPOSE: Lung cancer (LC) has a significant impact on patients' health-related quality of life (HRQoL). We investigate the correlations between pre-radiation therapy HRQoL and survival. MATERIALS AND METHODS: A prospective, intention-to-treat, multicentre study of 437 patients with LC recruited at the radiation oncology departments of three different institutions was conducted between 2012 and 2016. QoL was assessed using the EORTC-QLQ-C30 (v3.0) and EORTC-QLQ-LC13 questionnaires. Global health status (GHS), physical (PF), role functioning (RF), emotional (EF), cognitive (CF), and social functioning (SF) as well as symptoms scores were evaluated in univariate and multivariate analyses. RESULTS: The cohort consisted of 376 men (86%) and 61 women, with a median age of 66 years (range 31-88). Histology was: 72% (n = 315) non-small cell lung cancer and 28% small cell lung cancer. The most common stage was III (80%) and the median follow-up for alive patients was 30 months (range 7-76). Multivariate analysis showed that RF was associated with a lower risk of mortality (HR: 0.693; p = 0.008) and recurrence (HR: 0.737; p = 0.040). Additionally, lower scores on EF and PF were associated with higher mortality (HR: 0.696; p = 0.003 and HR: 0.765; p = 0.044, respectively). Appetite loss, constipation, and dysphagia were associated with a higher risk of mortality (HR: 1.985; p < 0.001, HR: 1.373; p = 0.036, and HR: 1.659; p = 0.002, respectively), while appetite loss was the only symptom associated with a higher risk of recurrence (HR: 1.525; p = 0.014). CONCLUSIONS: Pre-radiation therapy scores on RF, EF, and PF and symptoms like appetite loss, dysphagia, and constipation were associated with the risk of mortality. This information could be added to other prognostic factors to guide our treatment decisions.

Resultados en calidad de vida comunicados por pacientes en tratamiento antirretroviral / Health-related quality of life among people livingwith human immunodeficiency virus infection

OBJETIVO: Conocer las impresiones de los pacientes con terapia antirretroviral acerca de su calidad de vida relacionada con la salud (CVRS), salud y bienestar general respecto a la infección por VIH. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, prospectivo y transversal. Se incluyeron pacientes mayores de edad VIH positivos que recogiesen tratamiento en el Servicio de Farmacia durante 3 meses. Como medida de la CVRS, se utilizó el World Health Organization Quality of Life in HIV-infected Persons instrument (WHOQOL-HIV-BREF) versión castellano. Se midieron seis dominios: capacidad física, factores psicológicos, nivel de independencia, relaciones sociales, entorno y creencias personales/religiosas/espirituales más 5 preguntas específicas de infección por VIH/SIDA. El cuestionario fue anónimo y auto-administrado. Se recogieron edad, sexo, estado civil y nivel de educación máximo alcanzado. Se calcularon medianas y rangos intercuartílicos (IQR) para cada dominio, así como los posibles factores influyentes. RESULTADOS: Se incluyeron 69 pacientes. 72,5% varones. Edad (mediana [IQR]) = 50,4 [55,1-43] años. Nivel de educación: ninguno 5,8%; educación primaria 37,7%; secundaria 47,8%; terciaria 8,7%. Estado civil: casado/a 21,9%; en pareja 15,9%; divorciado/a 7,2%; soltero/a 47,8%; viudo/a 7,2%. Resultados para cada dominio: capacidad física (mediana [IQR]) = 75 [65-80]; factores psicológicos = 68 [57-76]; nivel de independencia = 70 [59-80]; relaciones sociales = 65 [58-80]; entorno = 70 [64-80] y creencias personales/religiosas/espirituales = 63 [55-75]. Resultado global = 67 [71-78]. La edad (≤ 50 años) se relacionó con la CVRS (diferencia de medias IC95%; p) en el dominio de capacidad física (11,41 IC95% 4,12-18,69; p = 0,03), nivel de independencia (10,47 IC95% 1,85-19,08; p = 0,018) y en el resultado global (8,33 IC95% 1,99-14,67; p = 0,011). CONCLUSIONES: La CVRS fue inferior en el dominio de creencias personales, seguida por las relaciones sociales. La edad superior a 50 años se relacionó con una peor CVRS

PURPOSE: To know about quality of life, health and general well-being among people living with HIV who take antiretroviral therapy. MATERIAL AND METHODS: Cross-sectional descriptive prospective observational study. Adults with HIV's infection and antiretroviral therapy dispensed by our Pharmacy Service during 3 months were included. World Health Organization Quality of Life in HIV-infected Persons instrument (WHOQOL-HIV-BREF) was used to explore the quality of life (QoL). The scores denote an individual's perception of QoL in six domains: physical, psychological, level of independence, social relationships, environment and spirituality. Items are rated on a 5-point Likert scale with a transformed maximum score of 100 points per item. Five questions are specific to HIV/AIDS (Q:4,8-10,17). The questionnaire was self-administered. Age (≤ 50 years), gender, civil status and level of studies was also collected. The questionnaire, anonymous and voluntary, was returned in the next visit to our centre. Median and interquartile range was calculated for each domain. Relationship among scores and demographic variables was explored. RESULTS: 69 patients were included (response rate 45.1%), 72.5% male. Age (median [IQR]) = 50.4 [55.1-43] years. Education received: none 5.8%; primary school 37.7%; secondary 47.8%; tertiary 8.7%. Civil status: married 21.9%; living as married 15.9%; divorced 7.2%; single 47.8%; widowed 7.2%. Results of domains transformed score: physical (median [IQR]) = 75 [65-80], psychological = 68 [57-76]; level of independence = 70 [59-80]; social relationships = 65 [58-80], environment = 70 [64-80]; and spirituality = 63 [55-75]. Global score = 67 [71-78]. Age (≤ 50 years) was the only variable related with test score (mean difference (IC95%; p); physical domain (11.41 (4.12-18.69); 0.03), level of independence (10.47 (1.85-19.08); 0.018) and global score (8.33 (1.99-14.67); 0.011). CONCLUSIONS: QoL score was lower regarding spirituality domain followed by social relationships. Age over 50 was statistically associated with a worse self-reported QoL

Protists and other organisms on a minute snail periostracum / Protistas e outros organismos em um pequeno periostracum de caracol

Abstract Since the foundation of the Malacological Center in 1980, Universidad Centro Americana (UCA), Managua-Nicaragua, has been monitoring and collecting the marine, terrestrial, fluvial and lake mollusk population of the country. Many specimens have been photographed by Scanning Electronic Microscope (SEM), and in one of these, observation of the hairy periostracum reveals a seemingly thriving population of minute protists in possible symbiosis with their host. Adequate magnification and comparison with previous studies allowed the determination of these hosts as diatoms, testaceous amoebae, yeast, phacus, spores and other undetermined organisms which occur in tropical forests on rocks, trees and leaves. Here illustrated are diatoms and other organisms detected for the first time on the periostracum of a tropical rainforest mollusk.

Resumo Desde a fundação do Centro Malacológico em 1980, a Universidad Central Americana (UCA), Manágua-Nicarágua, vem acompanhando e coletando a população de moluscos marinhos, terrestres, fluviais e lagoas do país. Muitos espécimes foram fotografados pelo microscópio eletrônico de varredura (SEM) e, em um deles, a observação do periostracum peludo revela uma população aparentemente próspera de protistas de minuto em possível simbiose com o hospedeiro. A ampliação adequada e a comparação com estudos anteriores permitem a determinação dessas diatomáceas, amebas testaceas, leveduras, phacus, esporos e outros organismos indeterminados que ocorrem em florestas tropicais em rochas, árvores e folhas. Aqui estão as diatomeas e outros organismos pela primeira vez detectados no periostracum de um molusco tropical.

Ag Nanoparticles/α-Ag2WO4 Composite Formed by Electron Beam and Femtosecond Irradiation as Potent Antifungal and Antitumor Agents.

The ability to manipulate the structure and function of promising systems via external stimuli is emerging with the development of reconfigurable and programmable multifunctional materials. Increasing antifungal and antitumor activity requires novel, effective treatments to be diligently sought. In this work, the synthesis, characterization, and in vitro biological screening of pure α-Ag2WO4, irradiated with electrons and with non-focused and focused femtosecond laser beams are reported. We demonstrate, for the first time, that Ag nanoparticles/α-Ag2WO4 composite displays potent antifungal and antitumor activity. This composite had an extreme low inhibition concentration against Candida albicans, cause the modulation of α-Ag2WO4 perform the fungicidal activity more efficient. For tumor activity, it was found that the composite showed a high selectivity against the cancer cells (MB49), thus depleting the populations of cancer cells by necrosis and apoptosis, without the healthy cells (BALB/3T3) being affected.

[Is it possible to extract intracranial pressure information based on the EEG activity?] / Es posible obtener informacion de la presion intracraneal a partir de la actividad electroencefalografica?

INTRODUCTION: The capability of the electroencephalography (EEG) of recording the bioelectrical activity of the brain has made of it a fundamental tool for the evaluation of the patient's neurological condition. In recent years, moreover, it has also begun to be used in obtaining information for other kind of variables, as the ones related with the cerebral hemodynamics. AIM: To study the potential relationship between the EEG activity and the intracranial pressure (ICP) in patients suffering from traumatic brain injury and subarachnoid hemorrhage, during their stay at the intensive care unit. PATIENTS AND METHODS: Twenty-one adult patients (10 women) were included in the present observational prospective cohort study. They suffered from either traumatic brain injury or subarachnoid hemorrhage, requiring continuous EEG and ICP monitoring. In every patient, Granger causality between spectral functions of the EEG and the ICP was evaluated. Temporal windows of 10 minute were used to evaluate whether a causal relationship between those variables exist or not. In all of the cases, several days of continuous recording and assessment were performed. RESULTS: In most patients and during most of the time, Granger causality turns out to be significant in the direction from the EEG to the ICP, meaning that the EEG dynamics actually leads the ICP dynamics. CONCLUSIONS: The present work provides useful information and shed light in discovering a hidden relationship between the ICP and EEG dynamics. The potential use of this relationship could lead to develop a medical device to measure ICP in a non-invasive fashion.

TITLE: Es posible obtener informacion de la presion intracraneal a partir de la actividad electroencefalografica?Introduccion. El electroencefalograma (EEG) permite obtener informacion directa de la actividad bioelectrica del cerebro y es una herramienta fundamental para la evaluacion de la condicion neurologica del paciente. En los ultimos años ha comenzado a emplearse tambien para obtener indirectamente informacion sobre la hemodinamica cerebral y las variables que intervienen en la autorregulacion del flujo sanguineo cerebral. Objetivo. Estudiar la posible relacion entre la actividad electroencefalografica y la presion intracraneal (PIC) en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea ingresados en cuidados intensivos. Pacientes y metodos. Se incluyo a 21 pacientes (10 mujeres) mayores de 18 años con traumatismo craneoencefalico o hemorragia subaracnoidea que requerian monitorizacion de la PIC y a los que se les registro el EEG de forma continua. Se determino la causalidad de Granger entre la PIC con respecto a las variables espectrales del EEG para ventanas temporales de 10 minutos durante la estancia en cuidados intensivos. Resultados. La causalidad de Granger mostro una alta correlacion entre la PIC con las bandas del EEG. En la mayoria de los pacientes existe una causalidad de Granger significativa en la direccion del EEG hacia la PIC en gran parte del tiempo de monitorizacion, de forma que las variables del EEG precedian a la PIC. Conclusiones. El presente trabajo expone la relacion temporal subyacente entre la dinamica de la PIC y la actividad bioelectrica cerebral registrada mediante EEG en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea. El potencial uso de esta relacion podria permitir estimar la PIC de manera no invasiva.

Protists and other organisms on a minute snail periostracum.

Since the foundation of the Malacological Center in 1980, Universidad Centro Americana (UCA), Managua-Nicaragua, has been monitoring and collecting the marine, terrestrial, fluvial and lake mollusk population of the country. Many specimens have been photographed by Scanning Electronic Microscope (SEM), and in one of these, observation of the hairy periostracum reveals a seemingly thriving population of minute protists in possible symbiosis with their host. Adequate magnification and comparison with previous studies allowed the determination of these hosts as diatoms, testaceous amoebae, yeast, phacus, spores and other undetermined organisms which occur in tropical forests on rocks, trees and leaves. Here illustrated are diatoms and other organisms detected for the first time on the periostracum of a tropical rainforest mollusk.

Molecular mechanisms involved in the protective actions of Selective Estrogen Receptor Modulators in brain cells.

Synthetic selective modulators of the estrogen receptors (SERMs) have shown to protect neurons and glial cells against toxic insults. Among the most relevant beneficial effects attributed to these compounds are the regulation of inflammation, attenuation of astrogliosis and microglial activation, prevention of excitotoxicity and as a consequence the reduction of neuronal cell death. Under pathological conditions, the mechanism of action of the SERMs involves the activation of estrogen receptors (ERs) and G protein-coupled receptor for estrogens (GRP30). These receptors trigger neuroprotective responses such as increasing the expression of antioxidants and the activation of kinase-mediated survival signaling pathways. Despite the advances in the knowledge of the pathways activated by the SERMs, their mechanism of action is still not entirely clear, and there are several controversies. In this review, we focused on the molecular pathways activated by SERMs in brain cells, mainly astrocytes, as a response to treatment with raloxifene and tamoxifen.

Estudio comparativo sobre fijación de catéter venoso central mediante sutura versus dispositivo adhesivo / Comparative study on fixation of central venous catheter by suture versus adhesive device

Objetivos: El objetivo principal fue valorar la eficacia de un dispositivo de fijación adhesiva de catéter venoso central (CVC) para prevenir complicaciones asociadas. Los objetivos secundarios fueron: determinar la frecuencia de cambios de apósito, días de cateterización y motivos de retirada de los catéteres en ambos grupos del estudio, y evaluar el grado de satisfacción del personal en base al uso del sistema adhesivo. Método: Estudio piloto, aleatorizado, prospectivo y abierto, de grupos paralelos realizándose una evaluación comparativa entre fijación de CVC con sutura y un sistema de seguridad adhesivo. El estudio se realizó en la Unidad Coronaria del Hospital Universitari de Bellvitge, entre abril y noviembre de 2016. La población estudiada fueron aquellos pacientes portadores de CVC. Los resultados se analizaron mediante SPSS 18.0. El estudio fue aprobado por el Comité Ético de Investigación Clínica. Resultados: Fueron analizados 100 pacientes (47 con sistema adhesivo y 53 con sutura). Ambos grupos fueron homogéneos en cuanto a variables demográficas, anticoagulación y días de cateterización. La frecuencia de aparición de complicaciones en el sistema adhesivo fue del 21,3%, mientras que con la sutura fue del 47,2% (p = 0,01). El grupo sutura presentó mayor frecuencia de signos locales de infección (p = 0,006), desplazamiento del catéter (p = 0,005) y bacteriemias asociadas a catéter (p = 0,05). El uso de la fijación adhesiva se asoció a menor requerimiento de cambios de apósito por sangrado (p = 0,006). El 96,7% del personal recomendó la utilización del sistema de seguridad adhesivo. Conclusiones: Los catéteres fijados con sistema adhesivo presentaron menos complicaciones infecciosas y grado de desplazamiento

Objectives: To assess the efficacy of a central venous catheter adhesive fixation device (CVC) to prevent associated complications. To establish the need for dressing changes, number of days' catheterization and reasons for catheter removal in both study groups. To assess the degree of satisfaction of personnel with the adhesive system. Method: A, randomized, prospective and open pilot study, of parallel groups, with comparative evaluation between CVC fixation with suture and with an adhesive safety system. The study was performed in the Coronary Unit of the Universitari de Bellvitge Hospital, between April and November 2016. The population studied were patients with a CVC. The results were analyzed using SPSS Statistics software. The study was approved by the Clinical Research Ethics Committee. Results: 100 patients (47 adhesive system and 53 suture) were analyzed. Both groups were homogeneous in terms of demographic variables, anticoagulation and days of catheterization. The frequency of complications in the adhesive system group was 21.3%, while in the suture group it was 47.2% (P = .01). The suture group had a higher frequency of local signs of infection (p = .006), catheter displacement (p = .005), and catheter-associated bacteraemia (P = .05). The use of adhesive fixation was associated with a lower requirement for dressing changes due to bleeding (P = .006). Ninety-six point seven percent of the staff recommended using the adhesive safety system. Conclusions: The catheters fixed with adhesive systems had fewer infectious complications and less displacement

[Minor stroke in a patient with thrombocytopenia]. / Ictus menor en una paciente con trombocitopenia.

TITLE: Ictus menor en una paciente con trombocitopenia.

Comparative study on fixation of central venous catheter by suture versus adhesive device. / Estudio comparativo sobre fijación de catéter venoso central mediante sutura versus dispositivo adhesivo.

OBJECTIVES: To assess the efficacy of a central venous catheter adhesive fixation device (CVC) to prevent associated complications. To establish the need for dressing changes, number of days' catheterization and reasons for catheter removal in both study groups. To assess the degree of satisfaction of personnel with the adhesive system. METHOD: A, randomized, prospective and open pilot study, of parallel groups, with comparative evaluation between CVC fixation with suture and with an adhesive safety system. The study was performed in the Coronary Unit of the Universitari de Bellvitge Hospital, between April and November 2016. The population studied were patients with a CVC. The results were analyzed using SPSS Statistics software. The study was approved by the Clinical Research Ethics Committee. RESULTS: 100 patients (47 adhesive system and 53 suture) were analyzed. Both groups were homogeneous in terms of demographic variables, anticoagulation and days of catheterization. The frequency of complications in the adhesive system group was 21.3%, while in the suture group it was 47.2% (P=.01). The suture group had a higher frequency of local signs of infection (p=.006), catheter displacement (p=.005), and catheter-associated bacteraemia (P=.05). The use of adhesive fixation was associated with a lower requirement for dressing changes due to bleeding (P=.006). Ninety-six point seven percent of the staff recommended using the adhesive safety system. CONCLUSIONS: The catheters fixed with adhesive systems had fewer infectious complications and less displacement.

Limitación del esfuerzo terapéutico en pacientes hospitalizados en servicios de medicina interna / Limitation of therapeutic effort in patients hospitalised in departments of internal medicine

Introducción. Existe escasa información sobre la limitación del esfuerzo terapéutico (LET) en pacientes ingresados en unidades de hospitalización de medicina interna. Objetivos. Describir las pautas de LET indicadas en los servicios de medicina interna y las características de los pacientes que las reciben. Pacientes y métodos. Estudio observacional descriptivo y retrospectivo de 4 hospitales de la Comunidad de Madrid. Se recogieron datos demográficos, de comorbilidad y las órdenes de LET pautadas en todos los pacientes fallecidos en un periodo de 6 meses. Resultados. Se incluyeron 382 pacientes cuya edad media fue de 85±10 años; 204 eran mujeres (53,4%) y 222 (58,1%) procedían de su domicilio. El 51,1% eran enfermos terminales, el 43,2% tenían demencia moderada/grave y el 95,5% presentaban comorbilidad al menos moderada. En 318 pacientes (83,7%) se realizó algún tipo de LET, siendo las más frecuentes las órdenes de «no reanimación cardiopulmonar» (292 enfermos, 76,4%; IC 95%: 72,1-80,8), «no usar medidas agresivas» (113 pacientes, 16,4%; IC 95%: 13,7-19,4) y «no ingresar en unidad de cuidados intensivos» (102 casos, 14,8%; IC 95%: 12,3-17,7). Conclusiones. La LET es muy frecuente en los pacientes que fallecen en medicina interna. Las pautas más utilizadas son «no reanimación cardiopulmonar» y la expresión poco concreta de «no usar medidas agresivas». Los pacientes son de edad avanzada, con importante comorbilidad, enfermedad terminal y demencia avanzada (AU)

Introduction. There is little information on the limitation of therapeutic effort (LTE) in patients admitted to hospital internal medicine units. Objectives. To describe the indicated LTE regimens in the departments of internal medicine and the characteristics of the patients who undergo them. Patients and methods. An observational, descriptive retrospective study was conducted on 4 hospitals of the Community of Madrid. The study collected demographic and comorbidity data and the LTE orders prescribed for all patients who died during a period of 6 months. Results. The study included 382 patients with a mean age of 85±10 years; 204 were women (53.4%) and 222 (58.1%) came from their homes. Some 51.1% of the patients were terminal, 43.2% had moderate to severe dementia, and 95.5% presented at least moderate comorbidity. Some type of LTE was performed in 318 patients (83.7%); the most common orders were «No cardiopulmonary resuscitation» (292 patients, 76.4%; 95% CI 72.1-80.8), «Do not use aggressive measures» (113 patients, 16.4%; 95% CI 13.7-19.4) and «Do not transfer to an intensive care unit» (102 cases, 14.8%, 95% CI 12.3-17.7). Some type of LTE was performed in 318 patients (83.7%); the most common orders were «No cardiopulmonary resuscitation» (292 patients, 76.4%; 95% CI 72.1-80.8), «Do not use aggressive measures» (113 patients, 16.4%; 95% CI 13.7-19.4) and «Do not transfer to an intensive care unit» (102 cases, 14.8%, 95% CI 12.3-17.7). Conclusions. LTE is common among patients who die in Internal Medicine. The most widely used regimens were «No CPR» and the unspecific statement «Do not use aggressive measures». The patients were elderly and had significant comorbidity, terminal illness and advanced dementia (AU)

Differential serum cytokine profile in patients with systemic lupus erythematosus and posterior reversible encephalopathy syndrome.

Systemic lupus erythematosus (SLE) patients are susceptible to the development of posterior reversible encephalopathy syndrome (PRES). The main theory concerning the physiopathology of PRES suggests that there is brain-blood barrier damage, which is associated with endothelial dysfunction, and characterized by vasogenic oedema. However, current evidence regarding its physiopathogenic mechanisms is quite scant. The aim of this study was to analyse the expression of different serum cytokines, as well as vascular endothelial growth factor (VEGF) and soluble CD40 ligand (sCD40L), in patients with PRES/systemic lupus erythematosus (SLE) and to compare them with levels in SLE patients without PRES and in healthy controls. We performed a transversal study in a tertiary care centre in México City. We included 32 subjects (healthy controls, n = 6; remission SLE, n = 6; active SLE, n = 6 and PRES/SLE patients, n = 14). PRES was defined as reversible neurological manifestations (seizures, visual abnormalities, acute confusional state), associated with compatible changes by magnetic resonance imaging (MRI). Serum samples were obtained during the first 36 h after the PRES episode and were analysed by cytometric bead array, Luminex multiplex assay or enzyme-linked immunosorbent assay (ELISA). Interleukin (IL)-6 and IL-10 levels were significantly higher in PRES/SLE patients (P = 0·013 and 0·025, respectively) when compared to the other groups. Furthermore, IL-6 and IL-10 levels displayed a positive correlation (r = 0·686, P = 0·007). There were no differences among groups regarding other cytokines, sCD40L or VEGF levels. A differential serum cytokine profile was found in PRES/SLE patients, with increased IL-6 and IL-10 levels. Our findings, which are similar to those described in other neurological manifestations of SLE, support the fact that PRES should be considered among the SLE-associated neuropsychiatric syndromes.

Ecological and physiological thermal niches to understand distribution of Chagas disease vectors in Latin America.

In order to assess how triatomines (Hemiptera, Reduviidae), Chagas disease vectors, are distributed through Latin America, we analysed the relationship between the ecological niche and the limits of the physiological thermal niche in seven species of triatomines. We combined two methodological approaches: species distribution models, and physiological tolerances. First, we modelled the ecological niche and identified the most important abiotic factor for their distribution. Then, thermal tolerance limits were analysed by measuring maximum and minimum critical temperatures, upper lethal temperature, and 'chill-coma recovery time'. Finally, we used phylogenetic independent contrasts to analyse the link between limiting factors and the thermal tolerance range for the assessment of ecological hypotheses that provide a different outlook for the geo-epidemiology of Chagas disease. In triatomines, thermo-tolerance range increases with increasing latitude mainly due to better cold tolerances, suggesting an effect of thermal selection. In turn, physiological analyses show that species reaching southernmost areas have a higher thermo-tolerance than those with tropical distributions, denoting that thermo-tolerance is limiting the southern distribution. Understanding the latitudinal range along its physiological limits of disease vectors may prove useful to test ecological hypotheses and improve strategies and efficiency of vector control at the local and regional levels.