Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort

The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.

Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort.

The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.

Self-assembly of perovskite nanoplates in colloidal suspensions.

In recent years, perovskite nanocrystal superlattices have been reported with collective optical phenomena, offering a promising platform for both fundamental science studies and device engineering. In this same avenue, superlattices of perovskite nanoplates can be easily prepared on different substrates, and they too present an ensemble optical response. However, the self-assembly and optical properties of these aggregates in solvents have not been reported to date. Here, we report on the conditions for this self-assembly to occur and show a simple strategy to induce the formation of these nanoplate stacks in suspension in different organic solvents. We combined wide- and small-angle X-ray scattering and scanning transmission electron microscopy to evaluate CsPbBr3 and CsPbI3 perovskite nanoplates with different thickness distributions. We observed the formation of these stacks by changing the concentration of nanoplates and the viscosity of the colloidal suspensions, without the need for antisolvent addition. We found that, in hexane, the concentration for the formation of the stacks is rather high and approximately 80 mg mL-1. In contrast, in decane, dodecane, and hexadecane, we observe a much easier self-assembly of the nanoplates, presenting a clear correlation between the degree of aggregation and viscosity. We, then, discuss the impact of the self-assembly of perovskite nanoplates on Förster resonant energy transfer. Our predictions suggest an energy transfer efficiency higher than 50% for all the donor-acceptor systems evaluated. In particular, we demonstrate how the aggregation of these particles in hexadecane induces FRET for CsPbBr3 nanowires. For the n = 2 nanowires (donor) to the n = 3 nanowires (acceptor), the FRET rate was found to be 4.1 ns-1, with an efficiency of 56%, in agreement with our own predictions.

Fear of relapse and quality of life in multiple sclerosis: The mediating role of psychological resilience.

The goal of this study was to examine the mediating role of psychological resilience in the relationship between fear of relapse and quality of life in a sample of patients with multiple sclerosis (PwMS). This cross-sectional study was developed online. A total of 240 PwMS were surveyed using the Multiple Sclerosis Quality of Life inventory, the Fear of Relapse Scale and the Connor-Davidson Resilience Scale. To perform the mediation analysis PROCESS macro was used. In our study, fear of relapse was a predictor of psychological resilience and quality of life, and psychological resilience was a predictor of quality of life. Finally, psychological resilience showed a mediating role in the relationship between fear of relapse and quality of life. Considering that resilience is a modifiable variable, the implementation of interventions aimed at enhancing resilience can have a favorable impact on the psychological well-being and quality of life of patients with multiple sclerosis.

Predictors of mortality in critically ill patients with COVID-19 and diabetes.

The COVID-19 pandemic has challenged the entire world, and patients with diabetes mellitus (DM) have been particularly affected. We aimed to evaluate predictors of mortality during the first 30 days of hospitalization in critically ill patients with COVID-19 and comorbid DM. This prospective study included 110 critically ill patients admitted with COVID-19 infection. Thirty-two (29%) patients had a previous diagnosis of DM. Clinical variables, laboratory tests, and vascular biomarkers, such as VCAM-1, syndecan-1, ICAM-1, angiopoietin-1, and angiopoeitin-2, were evaluated after intensive care unit (ICU) admission. A comparison was made between patients with and without DM. No difference in mortality was observed between the groups (48.7 vs 46.9%, P=0.861). In the multivariate Cox regression analysis, VCAM-1 levels at ICU admission (HR: 1 [1-1.001], P<0.006) were associated with death in patients with DM. Among patients with DM, advanced age (HR 1.063 [1.031-1.096], P<0.001), increased Ang-2/Ang-1 ratio (HR: 4.515 [1.803-11.308] P=0.001), and need for dialysis (HR: 3.489 [1.409-8.642], P=0.007) were independent predictors of death. Higher levels of VCAM-1 in patients with DM was better at predicting death of patients with severe COVID-19 and comorbid DM, and their cut-off values were useful for stratifying patients with a worse prognosis. Vascular biomarkers VCAM-1 and Ang-2/Ang-1 ratio were predictors of death in patients with severe COVID-19 and comorbid DM and those without DM. Additionally, kidney injury was associated with an increased risk of death.

Two-photon absorption in colloidal semiconductor nanocrystals: a review.

Large two-photon absorption (2PA) cross-section combined with high emission quantum efficiency and size-tunable bandgap energy has put colloidal semiconductor nanocrystals (NCs) on the vanguard of nonlinear optical materials. After nearly two decades of intense studies on the nonlinear optical response in quantum-confined semiconductors, this is still a vibrant field, as novel nanomaterials are being developed and new applications are being proposed. In this review, we examine the progress of 2PA research in NCs, highlighting the impact of quantum confinement on the magnitude and spectral characteristics of this nonlinear response in semiconductor materials. We show that for NCs with three-dimensional quantum confinement, the so-called quantum dots, 2PA cross-section grows linearly with the nanoparticle volume, following a universal volume scaling. We overview strategies used to gain further control over the nonlinear optical response in these structures by shape and heterostructure engineering and some applications that might take advantage of the series of unique properties of these nanostructures.

Binary fluoride and As(V) adsorption in water using pleco fish bone chars.

The present work studied individual and binary adsorption of fluorides and As(V) in water on pleco fish bone chars (BC), as well as the effect of BC mass variation on the adsorption capacity of fluoride and As(V) in water for human consumption. The results of individual adsorption indicated that the adsorption of fluoride and As(V) on BC depends on solution pH. The adsorption capacity of fluorides at an initial concentration of 30 mg L-1 increases approximately 3 times, from 5.9 to 15.3 mg g-1, when decreasing the pH of the solution from 9 to 5, however, for the case of As(V) an antagonistic effect is observed, the adsorption capacity increases 7 times when raising the pH from 5 to 9, from 18.4 to 132.1 µg g-1 at an initial As(V) concentration of 300 µg L-1. Besides, in the binary adsorption, BC showed a higher affinity to adsorb fluoride since its adsorption capacity decreased from 16.55 to 12.50 mg g-1 as the As(V) concentration increased from 0 to 800 µg L-1 in solution. In contrast, As(V) adsorption was severely affected, decreasing from 140.2 to 32.7 µg g-1 when the fluoride concentration in the solution increased from 0 to 100 mg L-1. On the other hand, in the adsorption of groundwater contaminated with fluoride and As(V), it was determined that increasing the mass of BC from 0.5 to 20 g increases the removal percentage, reaching 99.3 and 75.7% removal for fluoride and As(V), respectively, due to the fact that increasing the mass of the adsorbent leads to a larger area and a greater number of sites that allow the adsorption of these contaminants. The thermodynamic study revealed the spontaneity of fluoride and As(V) adsorption, better affinity for fluoride but higher adsorption rate of As(V) on BC. Characterization techniques such as XRD and EDS allowed identifying hydroxyapatite as the mineral phase of BC, which is responsible for the adsorption of BC. By studying the effect of solution pH on the adsorption capacities and the characterization of BC such as XRD, EDS and TGA, it was determined that the mechanisms of fluoride adsorption are by electrostatic attractions and ion exchange, and for As(V) it is by coprecipitation and ion exchange. It was concluded that BC from pleco fish could be an alternative for treating water contaminated by fluorides and As(V).

Beyond Universal Volume Scaling: Tailoring Two-Photon Absorption in Nanomaterials by Heterostructure Design.

Colloidal semiconductor nanomaterials present broadband, with large cross-section, two-photon absorption (2PA) spectra, which turn them into an important platform for applications that benefit from a high nonlinear optical response. Despite that, to date, the only means to control the magnitude of the 2PA cross-section is by changing the nanoparticle volume, as it follows a universal volume scale, independent of the material composition. As the emission spectrum is connected utterly to the nanomaterial dimensions, for a given material, the magnitude of the nonlinear optical response is also coupled to the emission spectra. Here, we demonstrate a means to decouple both effects by exploring the 2PA response of different types of heterostructures, tailoring the volume dependence of the 2PA cross-section due to the different dependence of the density of final states on the nanoparticle volume. By heterostructure engineering, one can obtain 1 order of magnitude enhancement of the 2PA cross-section with minimum emission spectra shift.

Postcardiac Surgery Euglycemic Diabetic Ketoacidosis in Patients on Sodium-Glucose Cotransporter 2 Inhibitors.

OBJECTIVES: To evaluate sodium-glucose cotransporter 2 inhibitors (SGLT2i) use and complications (euglycemic diabetic ketoacidosis [eDKA] rate, mortality, infection, hospital, and cardiovascular intensive care unit [CVICU] length of stay [LOS]) in patients undergoing cardiac surgery. DESIGN: A retrospective study. SETTING: At an academic university hospital. PARTICIPANTS: Adult patients undergoing cardiac surgery. INTERVENTIONS: SGLT2i use versus no SGLT2i use. MEASUREMENTS AND MAIN RESULTS: The authors evaluated patients undergoing cardiac surgery within 24 hours of hospital admission (between February 2, 2019 to May 26, 2022) for SGLT2i prevalence and eDKA frequency. The outcomes were compared using Wilcoxon rank sum and chi-square testing as appropriate. The cohort included 1,654 patients undergoing cardiac surgery, of whom 53 (3.2%) were prescribed an SGLT2i before surgery; 8 (15.1%) of 53 had eDKA. The authors found no differences between patients with and without SGLT2i use in hospital LOS (median [IQR]: 4.5 [3.5-6.3] v 4.4 [3.4-5.6] days, p = 0.46) or CVICU LOS (median [IQR]: 1.2 [1.0-2.2] v 1.1 [1.0-1.9] days, p = 0.22), 30-day mortality (1.9% v 0.7%, p = 0.31), or sternal infections (0.0% v 0.3%, p = 0.69). Among patients prescribed an SGLT2i, those with and without eDKA had similar hospital LOS (5.1 [4.0-5.8] v 4.4 [3.4-6.3], p = 0.76); however, CVICU LOS was longer in patients with eDKA (2.2 [1.5-2.9] v 1.2 [0.9-2.0], p = 0.042). Mortality (0.0% v 2.2%, p = 0.67) and wound infections (0.0% v 0.0%, p > 0.99) were similarly rare. CONCLUSIONS: Postoperative eDKA occurred in 15% of patients on an SGLT2i prior to cardiac surgery, and was associated with longer CVICU LOS. Future studies into SGLT2i management perioperatively are important.

Predictors of mortality in critically ill patients with COVID-19 and diabetes

The COVID-19 pandemic has challenged the entire world, and patients with diabetes mellitus (DM) have been particularly affected. We aimed to evaluate predictors of mortality during the first 30 days of hospitalization in critically ill patients with COVID-19 and comorbid DM. This prospective study included 110 critically ill patients admitted with COVID-19 infection. Thirty-two (29%) patients had a previous diagnosis of DM. Clinical variables, laboratory tests, and vascular biomarkers, such as VCAM-1, syndecan-1, ICAM-1, angiopoietin-1, and angiopoeitin-2, were evaluated after intensive care unit (ICU) admission. A comparison was made between patients with and without DM. No difference in mortality was observed between the groups (48.7 vs 46.9%, P=0.861). In the multivariate Cox regression analysis, VCAM-1 levels at ICU admission (HR: 1 [1-1.001], P<0.006) were associated with death in patients with DM. Among patients with DM, advanced age (HR 1.063 [1.031-1.096], P<0.001), increased Ang-2/Ang-1 ratio (HR: 4.515 [1.803-11.308] P=0.001), and need for dialysis (HR: 3.489 [1.409-8.642], P=0.007) were independent predictors of death. Higher levels of VCAM-1 in patients with DM was better at predicting death of patients with severe COVID-19 and comorbid DM, and their cut-off values were useful for stratifying patients with a worse prognosis. Vascular biomarkers VCAM-1 and Ang-2/Ang-1 ratio were predictors of death in patients with severe COVID-19 and comorbid DM and those without DM. Additionally, kidney injury was associated with an increased risk of death.

On the prebiotic selection of nucleotide anomers: A computational study.

Present-day known predominance of the ß- over the α-anomers in nucleosides and nucleotides emerges from a thermodynamic analysis of their assembly from their components, i.e. bases, sugars, and a phosphate group. Furthermore, the incorporation of uracil into RNA and thymine into DNA rather than the other way around is also predicted from the calculations. An interplay of kinetics and thermodynamics must have driven evolutionary selection of life's building blocks. In this work, based on quantum chemical calculations, we focus on the latter control as a tool for "natural selection".

Triglyceride-glucose index impact on in-hospital mortality in acute myocardial infarction. Results from the RECUIMA multicenter registry.

INTRODUCTION: The triglyceride-glucose (TyG) index is considered a new marker of insulin resistance, and is associated with the development of cardiovascular diseases. OBJECTIVE: To evaluate the capability of TyG index to predict in-hospital -mortality in patients with acute ST-elevation myocardial infarction. METHODS: Multicenter cohort study that enrolled 1123 patients included in the Cuban Registry of Acute Myocardial Infarction between January 2018 and June 2021. RESULTS: TyG index optimal cutoff point to predict mortality was 8.96 (sensitivity, 65.2%; specificity, 62.0%; area under the curve; 0.636; p < 0.001). In-hospital mortality was significantly higher in the group with TyG index ≥ 8.96. The logistic regression analysis revealed that the TyG index was an independent mortality predictor (OR = 2.959; 95% CI = 1.457-6.010; p = 0.003). When the TyG index was included in the multivariate model, it increased its predictive capacity (area under the curve, 0.917, p < 0.001). Kaplan-Meier curves showed significant differences between patient groups (p < 0.001). CONCLUSIONS: The TyG index constitutes an independent risk factor of in-hospital mortality in patients with acute ST-elevation myocardial infarction.

INTRODUCCIÓN: El índice triglicéridos-glucemia (ITG/G) es considerado un nuevo marcador de resistencia a la insulina y está relacionado con el desarrollo de enfermedades cardiovasculares. OBJETIVO: Evaluar la capacidad del ITG/G para predecir mortalidad intrahospitalaria en los pacientes con infarto agudo del miocardio con elevación del segmento ST. MÉTODOS: Estudio multicéntrico de cohorte que incluyó a 1123 pacientes del Registro Cubano de Infarto del Miocardio Agudo entre enero de 2018 y junio de 2021. RESULTADOS: El punto de corte óptimo del ITG/G para predecir mortalidad fue 8.96 (sensibilidad de 65.2 %, especificidad de 62.0 % y área bajo la curva de 0.636; p < 0.001). La mortalidad intrahospitalaria se incrementó significativamente en el grupo con ITG/G ≥ 8.96. El análisis de regresión logística reveló que el ITG/G fue un marcador predictor independiente de mortalidad (RM = 2.959, IC 95 % = 1.457-6.010, p = 0.003). El modelo multivariado que incluyó el ITG/G elevó su capacidad predictiva (área bajo la curva de 0.917, p < 0.001). Las curvas de Kaplan-Meier mostraron diferencias significativas entre los grupos de pacientes (p < 0.001). CONCLUSIONES: El ITG/G constituye un factor de riesgo independiente de mortalidad intrahospitalaria por infarto agudo del miocardio con elevación del segmento ST.

Design and implementation of a device based on an off-axis parabolic mirror to perform luminescence experiments in a scanning tunneling microscope.

We present the design, implementation, and illustrative results of a light collection/injection strategy based on an off-axis parabolic mirror collector for a low-temperature Scanning Tunneling Microscope (STM). This device allows us to perform STM induced Light Emission (STM-LE) and Cathodoluminescence (STM-CL) experiments and in situ Photoluminescence (PL) and Raman spectroscopy as complementary techniques. Considering the Étendue conservation and using an off-axis parabolic mirror, it is possible to design a light collection and injection system that displays 72% of collection efficiency (considering the hemisphere above the sample surface) while maintaining high spectral resolution and minimizing signal loss. The performance of the STM is tested by atomically resolved images and scanning tunneling spectroscopy results on standard sample surfaces. The capabilities of our system are demonstrated by performing STM-LE on metallic surfaces and two-dimensional semiconducting samples, observing both plasmonic and excitonic emissions. In addition, we carried out in situ PL measurements on semiconducting monolayers and quantum dots and in situ Raman on graphite and hexagonal boron nitride (h-BN) samples. Additionally, STM-CL and PL were obtained on monolayer h-BN gathering luminescence spectra that are typically associated with intragap states related to carbon defects. The results show that the flexible and efficient light injection and collection device based on an off-axis parabolic mirror is a powerful tool to study several types of nanostructures with multiple spectroscopic techniques in correlation with their morphology at the atomic scale and electronic structure.

Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents.

BACKGROUND: Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. METHODS: Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. RESULTS: Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. CONCLUSIONS: Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population.

Impacto del índice triglicéridos-glucemia en la mortalidad intrahospitalaria por infarto agudo del miocardio. Resultados del registro multicéntrico RECUIMA / Triglycerides-glucose index impact on in-hospital mortality in acute myocardial infarction. Results from the RECUIMA multicenter registry

Resumen Introducción: El índice triglicéridos-glucemia (ITG/G) es considerado un nuevo marcador de resistencia a la insulina y está relacionado con el desarrollo de enfermedades cardiovasculares. Objetivo: Evaluar la capacidad del ITG/G para predecir mortalidad intrahospitalaria en los pacientes con infarto agudo del miocardio con elevación del segmento ST. Métodos: Estudio multicéntrico de cohorte que incluyó a 1123 pacientes del Registro Cubano de Infarto del Miocardio Agudo entre enero de 2018 y junio de 2021. Resultados: El punto de corte óptimo del ITG/G para predecir mortalidad fue 8.96 (sensibilidad de 65.2 %, especificidad de 62.0 % y área bajo la curva de 0.636; p < 0.001). La mortalidad intrahospitalaria se incrementó significativamente en el grupo con ITG/G ≥ 8.96. El análisis de regresión logística reveló que el ITG/G fue un marcador predictor independiente de mortalidad (RM = 2.959, IC 95 % = 1.457-6.010, p = 0.003). El modelo multivariado que incluyó el ITG/G elevó su capacidad predictiva (área bajo la curva de 0.917, p < 0.001). Las curvas de Kaplan-Meier mostraron diferencias significativas entre los grupos de pacientes (p < 0.001). Conclusiones: El ITG/G constituye un factor de riesgo independiente de mortalidad intrahospitalaria por infarto agudo del miocardio con elevación del segmento ST.

Abstract Introduction: The triglycerides-glucose (TyG) index is considered a new marker of insulin resistance, and is associated with the development of cardiovascular diseases. Objective: To evaluate the capability of TyG index to predict in-hospital mortality in patients with acute ST-elevation myocardial infarction. Methods: Multicenter cohort study that enrolled 1123 patients included in the Cuban Registry of Acute Myocardial Infarction between January 2018 and June 2021. Results: TyG index optimal cutoff point to predict mortality was 8.96 (sensitivity, 65.2%; specificity, 62.0%; area under the curve; 0.636; p < 0.001). In-hospital mortality was significantly higher in the group with TyG index ≥ 8.96. The logistic regression analysis revealed that the TyG index was an independent mortality predictor (OR = 2.959; 95% CI = 1.457-6.010; p = 0.003). When the TyG index was included in the multivariate model, it increased its predictive capacity (area under the curve, 0.917, p < 0.001). Kaplan-Meier curves showed significant differences between patient groups (p < 0.001). Conclusions: The TyG index constitutes an independent risk factor of in-hospital mortality in patients with acute ST-elevation myocardial infarction.

Epidemiología de la transfusión sanguínea en los Servicios de Medicina Intensiva en España: «Transfusion Day» / Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day»

Objective: To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines). Design: Prospective, cross-sectional, multi-centre study. Scope: Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain. Participants: 1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7 ± 3.8 and average stay of 10.62 ± 17.49 days. Variables: Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act. Results: Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8 g/dL (95% CI: 6-9-8.5) and 9.8 g/dL (95% CI: 8.5–11.2) before and after the transfusion, respectively, p < 0.001. The transfusion units had a mean of 2.5 ± 2.4 per patient. The most commonly used blood product was red blood cell concentrate (CH) (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p = 0.006). 5.4% (7/129) of patients who received CH died compared to 2.4% (31/1302) who did not (p = 0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant. Conclusions: In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish Critical Care Units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher (AU)

Objetivo: Describir la práctica transfusional en las UCIs de España, acorde con recomendaciones (guidelines) nacionales e internacionales. Diseño: Estudio prospectivo, transversal y multicéntrico. Ámbito: La recogida de datos se realizó mediante una encuesta enviada electrónicamente a los médicos intensivistas de 111 UCIs de España. Participantes: Se incluyeron 1.448 pacientes, de 61,8 (DE 15,7) años, el 66,2% varones, con un SOFA de 4,7 ± 3,8 y estancia media de 10,62 ± 17,49 días. Variables: Se recogieron variables demográficas y clínicas de los pacientes, así como variables relacionadas con el propio acto transfusional. Resultados: De los 1.448 pacientes, el 9,9% recibieron al menos una transfusión de cualquier hemocomponente, 3,7% de plasma fresco, 3,9% de plaquetas y 8,9% de concentrado de hematíes, siendo la causa principal el umbral transfusional basado en la hemoglobina (36,2%). La hemoglobina tuvo una media de 7,8 g/dL (IC 95%: 6,9–8,5), y de 9.8 g/dl (IC95%: 8,5–11,2) antes y después de la transfusión respectivamente (p < 0,001). Las unidades transfundas tuvo una media por paciente de 2,5 ± 2,4 por paciente. El hemoderivado más utilizado fue el concentrado de hematíes (CH) (90,2%). Los pacientes ingresados por motivos quirúrgicos tuvieron una tasa de transfusión mayor (14,4%) respecto a los ingresados por patología médica (8,9%) (p = 0,006). El 5,4% (7/129) de los pacientes que recibieron CH fallecieron respecto el 2,4% (31/1302) que no lo recibieron (p = 0,04). La tasa de transfusión en la mayor parte de hospitales fue de 5% al 20%, habiendo 18 hospitales (16.21%) con tasas de transfusión entre el 20% y el 50%. Los hospitales con programas PBM y programas de transfusión masiva tuvieron una menor tasa de transfusión, aunque sin ser significativa. Conclusiones: En este estudio multicéntrico de corte transversal se observó una prevalencia transfusional en las unidades de críticos españolas del 9,9% (AU)

Acute Intrathoracic Tuberculosis in Children and Adolescents with Community-Acquired Pneumonia in an Area with an Intermediate Disease Burden.

Tuberculosis (TB) in the pediatric population is a major challenge. Our objective was to describe the clinical and microbiological characteristics, radiological patterns, and treatment outcomes of children and adolescents (from 1 month to 17 years) with community-acquired pneumonia (CAP) caused by TB. We performed a prospective cohort study of a pediatric population between 1 month and 17 years of age and hospitalized in Medellín, Colombia, with the diagnosis of radiologically confirmed CAP that had ≤ 15 days of symptoms. The mycobacterial culture of induced sputum was used for the bacteriological confirmation; the history of TB contact, a tuberculin skin test, and clinical improvement with treatment were used to identify microbiologically negative TB cases. Among 499 children with CAP, TB was diagnosed in 12 (2.4%), of which 10 had less than 8 days of a cough, 10 had alveolar opacities, 9 were younger than 5 years old, and 2 had close contact with a TB patient. Among the TB cases, 50% (6) had microbiological confirmation, 8 had viral and/or bacterial confirmation, one patient had multidrug-resistant TB, and 10/12 had non-severe pneumonia. In countries with an intermediate TB burden, Mycobacterium tuberculosis should be included in the etiological differential diagnosis (as a cause or coinfection) of both pneumonia and severe CAP in the pediatric population.

Induced sputum as an adequate clinical specimen for the etiological diagnosis of community-acquired pneumonia (CAP) in children and adolescents.

OBJECTIVES: This study aimed to evaluate the utility of induced sputum (IS) for the diagnosis of community-acquired pneumonia (CAP) in pediatric population. METHODS: This cross-sectional study included pediatric population aged between 1 month and 17 years who were hospitalized with a diagnosis of CAP in 13 hospitals in Colombia, in whom an IS sample was obtained. Gram staining, aerobic bacterial and mycobacterial culture tests, and polymerase chain reaction (PCR) for 6 atypical bacteria and 15 respiratory viruses were performed. We evaluated the quality of IS samples. RESULTS: IS samples were collected in 516 of 525 children included in this study. The median age was 32 months, 38.6% were younger than 2 years, and 40.9% were between 2 and 5 years. Two patients had transient hypoxemia during the procedure. The quality of the IS obtained was good in 48.4% and intermediate in 24.5%. Identification of a respiratory pathogen was achieved with an IS sample (with Gram staining, culture test, and PCR) in 372 of 516 children with CAP. CONCLUSION: Our study shows that IS is an adequate sample for the diagnosis of CAP in pediatric population that required hospitalization. The procedure was safe, well tolerated, and with better diagnostic yields compared with the rest of the samples obtained.

Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day¼.

OBJECTIVE: To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines). DESIGN: Prospective, cross-sectional, multi-centre study. SCOPE: Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain. PARTICIPANTS: 1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7 ±â€¯3.8 and average stay of 10.62 ±â€¯17.49 days. VARIABLES: Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act. RESULTS: Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8 g/dL (95% CI: 6-9-8.5) and 9.8 g/dL (95% CI: 8.5-11.2) before and after the transfusion, respectively, p < 0.001. The transfusion units had a mean of 2.5 ±â€¯2.4 per patient. The most commonly used blood product was red blood cell concentrate (CH) (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p = 0.006). 5.4% (7/129) of patients who received CH died compared to 2.4% (31/1302) who did not (p = 0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant. CONCLUSIONS: In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish Critical Care Units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher.

Is It Possible to Differentiate Pneumocystis jirovecii Pneumonia and Colonization in the Immunocompromised Patients with Pneumonia?

Respiratory sample staining is a standard tool used to diagnose Pneumocystis jirovecii pneumonia (PjP). Although molecular tests are more sensitive, their interpretation can be difficult due to the potential of colonization. We aimed to validate a Pneumocystis jirovecii (Pj) real-time PCR (qPCR) assay in bronchoscopic bronchoalveolar lavage (BAL) and oropharyngeal washes (OW). We included 158 immunosuppressed patients with pneumonia, 35 lung cancer patients who underwent BAL, and 20 healthy individuals. We used a SYBR green qPCR assay to look for a 103 bp fragment of the Pj mtLSU rRNA gene in BAL and OW. We calculated the qPCR cut-off as well as the analytical and diagnostic characteristics. The qPCR was positive in 67.8% of BAL samples from the immunocompromised patients. The established cut-off for discriminating between disease and colonization was Ct 24.53 for BAL samples. In the immunosuppressed group, qPCR detected all 25 microscopy-positive PjP cases, plus three additional cases. Pj colonization in the immunocompromised group was 66.2%, while in the cancer group, colonization rates were 48%. qPCR was ineffective at diagnosing PjP in the OW samples. This new qPCR allowed for reliable diagnosis of PjP, and differentiation between PjP disease and colonization in BAL of immunocompromised patients with pneumonia.