Fungemia in Hospitalized Adult Patients with Hematological Malignancies: Epidemiology and Risk Factors.

Fungemia in hematologic malignancies (HM) has high mortality. This is a retrospective cohort of adult patients with HM and fungemia between 2012 and 2019 in institutions of Bogotá, Colombia. The epidemiological, clinical, and microbiological characteristics are described, and risk factors related to mortality are analyzed. One hundred five patients with a mean age of 48 years (SD 19.0) were identified, 45% with acute leukemia and 37% with lymphomas. In 42%, the HM was relapsed/refractory, 82% ECOG > 3, and 35% received antifungal prophylaxis; 57% were in neutropenia, with an average duration of 21.8 days. In 86 (82%) patients, Candida spp. was identified, and other yeasts in 18%. The most frequent of the isolates were non-albicans Candida (61%), C. tropicalis (28%), C. parapsilosis (17%), and C. krusei (12%). The overall 30-day mortality was 50%. The survival probability at day 30 in patients with leukemia vs. lymphoma/multiple myeloma (MM0 group was 59% (95% CI 46-76) and 41% (95% CI 29-58), p = 0.03, respectively. Patients with lymphoma or MM (HR 1.72; 95% CI 0.58-2.03) and ICU admission (HR 3.08; 95% CI 1.12-3.74) were associated with mortality. In conclusion, in patients with HM, non-albicans Candida species are the most frequent, and high mortality was identified; moreover, lymphoma or MM and ICU admission were predictors of mortality.

Molecular and Clinical Data of Antimicrobial Resistance in Microorganisms Producing Bacteremia in a Multicentric Cohort of Patients with Cancer in a Latin American Country.

Patients with cancer have a higher risk of severe bacterial infections. This study aims to determine the frequency, susceptibility profiles, and resistance genes of bacterial species involved in bacteremia, as well as risk factors associated with mortality in cancer patients in Colombia. In this prospective multicenter cohort study of adult patients with cancer and bacteremia, susceptibility testing was performed and selected resistance genes were identified. A multivariate regression analysis was carried out for the identification of risk factors for mortality. In 195 patients, 206 microorganisms were isolated. Gram-negative bacteria were more frequently found, in 142 cases (68.9%): 67 Escherichia coli (32.5%), 36 Klebsiella pneumoniae (17.4%), and 21 Pseudomonas aeruginosa (10.1%), and 18 other Gram-negative isolates (8.7%). Staphylococcus aureus represented 12.4% (n = 25). Among the isolates, resistance to at least one antibiotic was identified in 63% of them. Genes coding for extended-spectrum beta-lactamases and carbapenemases, blaCTX-M and blaKPC, respectively, were commonly found. Mortality rate was 25.6% and it was lower in those with adequate empirical antibiotic treatment (22.0% vs. 45.2%, OR: 0.26, 95% CI: 0.1-0.63, in the multivariate model). In Colombia, in patients with cancer and bacteremia, bacteria have a high resistance profile to beta-lactams, with a high incidence of extended-spectrum beta-lactamases and carbapenemases. Adequate empirical treatment diminishes mortality, and empirical selection of treatment in this environment of high resistance is of key importance.

Effect of pesticides on cognitive and motor performance in habitants of rural areas of Tolima / Efecto de los pesticidas sobre el rendimiento cognitivo y motor en habitantes de zonas rurales del Tolima

Resumen. Los pesticidas organofosforados pueden generar deterioro cognitivo. No obstante, el agricultor emplea diferentes pesticidas en todas las fases de un mismo cultivo. El objetivo de este estudio fue analizar el efecto de los pesticidas en serie en el rendimiento cognitivo y motor en una muestra de personas expuestas, expuestas indirectas y no expuestas. En el estudio de tipo exploratorio con diseño transversal, participaron en total 135 pequeños agricultores del sector informal. Se administró el Mini-Mental, el Trail Making Test, la Figura Compleja de Rey-Osterrieth, Retención de Dígitos, el Test de aprendizaje verbal de Hopkins y el Grooved Pegboard. Los resultados muestran que la mayor exposición en serie ocurre con el Glifosato, Lorsban, Furadan y Paraquat. El grupo con exposición directa a los pesticidas presentó menor rendimiento en memoria de trabajo, memoria explícita verbal, praxias constructivas y control motor fino mano derecha, que el grupo expuesto indirectamente y el no expuesto. En conclusión, la exposición directa y en serie a los pesticidas, genera deterioro neuropsicológico y motor en los agricultores del sector informal, se recomienda el desarrollo de políticas públicas que promuevan prácticas saludables y seguras, para minimizar los riesgos por el uso de estas sustancias.

Abstract. Organophosphate pesticides can cause cognitive impairment. However, the farmer uses different pesticides in all phases of the same crop. The aim of this study was to analyze the effect of serial pesticides on cognitive and motor performance in samples of exposed, indirectly exposed, and unexposed people. In the exploratory study with a cross-sectional design, a total of 135 small farmers from the informal sector participated. Mini-Mental, Trail Making, Rey-Osterrieth Complex Figure, Digit Retention, Hopkins Verbal Learning and the Grooved Pegboard tests were administered. The results show that the highest serial exposure occurs with Glyphosate, Lorsban, Furadan and Paraquat. The group with direct exposure to pesticides presented a lower performance in working memory, explicit verbal memory, constructive praxis and fine motor control of the right hand, than the indirectly exposed group and the unexposed group. In conclusion, direct and serial exposure to pesticides generates neuropsychological and motor impairment in informal sector farmers, it is recommended the development of public politics that promote healthy and safe practices, to minimize the risks due to the use of these substances.

Optimizing the residency application process: insights from neurological surgery during the pandemic virtual application cycle.

OBJECTIVE: In this article, the authors describe the impact of the COVID-19 virtual match cycle and discuss approaches to optimize future cycles through applicant and neurosurgical education leadership insights. METHODS: Anonymous surveys of neurosurgery program leaders (program directors and program chairs), program administrators (PAs), and 2020-2021 neurosurgery residency match applicants were distributed by the SNS, in conjunction with the Association of Resident Administrators in Neurological Surgery and AANS Young Neurosurgeons Committee. RESULTS: Responses were received from 77 (67.0%) of 115 PAs, 119 (51.7%) of 230 program leaders, and 124 (44.3%) of 280 applicants representing geographically diverse regions. During the virtual application cycle relative to the previous year, programs received more Electronic Residency Application Service applications (mean 314.8 vs 285.3, p < 0.0001) and conducted more applicant interviews (mean 45.2 vs 39.9, p = 0.0003). More than 50% of applicants applied to > 80 programs; 60.3% received ≤ 20 interview invitations, and 9% received > 40 invitations. Overall, 65% of applicants completed ≤ 20 interviews, whereas 34.7% completed > 20 interviews. Program leaders described one 4-week home subinternship (93.3%) and two 4-week external subinternships (68.9%) as optimal neurosurgical exposure; 62.8% of program leaders found the standardized letter of recommendation template to be somewhat (47.5%) or significantly (15.3%) helpful. Applicants, PAs, and program leaders all strongly preferred a hybrid model of in-person and virtual interview options for future application cycles over all in-person or all virtual options. Ninety-three percent of applicants reported matching within their top 10-ranked programs, and 52.9% of programs matched residents within the same decile ranking as in previous years. CONCLUSIONS: Optimizing a national strategy for the neurosurgery application process that prioritizes equity and reduces costs, while ensuring adequate exposure for applicants to gain educational opportunities and evaluate programs, is critical to maintain a successful training system.

Comparación de los procesos de la cognición social entre adultos con trauma craneoencefálico leve moderado y severo / Comparison of the of social cognition process among in adults with mild, moderate and severe traumatic brain injure

Resumen El objetivo de esta investigación consistió en comparar los procesos de la cognición social en adultos con trauma craneoencefálico (TCE) leve, moderado y severo. Es un estudio de tipo descriptivo, comparativo, transversal, a partir de la valoración de tres procesos de la cognición social: teoria de la mente, reconocimiento emocional y juicio moral de 126 adultos con TCE con edades entre los 18 y 52 años, medidos a través de tres instrumentos: Test Faux Pas, Test de las miradas y dilemas morales. Se encontraron diferencias significativas en el Faux Pas (Historia de Andres p=.016) y en el test de las miradas (Miradas p = .046). Se concluye que las personas con TCE evaluadas presentan alteración en la teoría de la mente y un desempeño promedio en el reconocimiento emocional y en los dilemas morales.

Abstract The aim of this research was to compare the processes of social cognition in adults with mild, moderate and severe Traumatic Brain Injury (TBI). It was a descriptive, comparative, cross - sectional study, based on the evaluation of three processes of social cognition: Theory of mind, Emotional recognition and Moral judgment of 126 adults with TBI, with ages between 18-52 years evaluated in three cities of Colombia measured through three instruments: Faux Pas Test, Reading the Mind in the Eyes Test and moral dilemmas. Significant differences were found in the Faux Pas and in the eye test. It is concluded that people with TBI evaluated have an alteration in the theory of the mind and an average performance in emotional recognition and moral dilemmas.

Relación entre depresión y rasgos de personalidad en jóvenes y adultos con conducta intencional suicida de Ibagué, Colombia / Correlation between depression and personality traits in suicidal behavior among adolescents and adults from Ibagué, Colombia

Resumen Introducción. La conducta intencional suicida es una de las condiciones médicas más preocupantes y peligrosas en el mundo. Se presume que por cada muerte autoinfligida, se presentan alrededor de 20 intentos de suicidio. Objetivo. Identificar la relación entre depresión y rasgos de personalidad en personas con intento de suicidio. Materiales y métodos. Estudio correlacional de corte transversal en el que participaron 25 personas entre 18 y 40 años de edad, quienes intentaron suicidarse durante el 2014 y 2015 en Ibagué, Colombia. Se empleó una ficha de datos sociodemográficos, el cuestionario "Big Five" y el Inventario de depresión Estado-Rasgo. Resultados. Se evidencia que en los participantes existen correlaciones significativas de carácter negativo, por un lado, entre la subdimensión de la personalidad, el control de emociones y la depresión como estado y, por el otro, entre esta misma subdimensión y la distimia como estado. Esto sugiere que a mayor depresión como estado o como rasgo, menor estabilidad emocional. Otras correlaciones identificadas aluden a una relación moderada entre la dimensión de la personalidad, la estabilidad emocional y la depresión. Conclusión. Las variables empleadas (depresión y estabilidad emocional) cobran gran importancia al momento de diseñar acciones preventivas en salud.

Abstract Introduction: Intentional suicidal behavior is one of the most troubling and dangerous medical conditions in the world. It is presumed that for each self-inflicted death, about 20 suicide attempts occur. Objective: To identify the correlation between depression and personality traits in patients who have attempted suicide. Materials and methods: Cross-sectional correlational study involving 25 people aged between 18 and 40 who attempted suicide during 2014 and 2015 in Ibagué, Colombia. A sociodemographic data sheet, the "Big Five" questionnaire and the State-Trait Depression Inventory were used for the analysis. Results: Significant negative correlations are evident in the analyzed sample regarding the personality sub-dimension, the control of emotions and depression as a state, on the one hand, and between the same sub-dimension and dysthymia as a state, on the other. This suggests a lower emotional stability in the presence of depression as a state or as a trait. Other correlations identified refer to a moderate relation between the personality dimension, emotional stability and depression. Conclusion: The variables considered in this study (depression and emotional stability) are of great importance when designing preventive health actions.

Susceptibilidad antibiótica de Helicobacter pylori: un estudio de prevalencia en pacientes con dispepsia en Quito, Ecuador / Susceptibility of Helicobacter Pylori to Antibiotics: a Study of Prevalence in Patients with Dyspepsia in Quito, Ecuador

Resumen Introducción: el Helicobacter pylori se asocia con patologías gastrointestinales, el incremento en la resistencia a los antibióticos utilizados para su erradicación es alarmante a nivel mundial. En este estudio se determinó la susceptibilidad a 5 antibióticos utilizados en la terapia de erradicación de H. pylori aislado de una población adulta con dispepsia recurrente en Quito, Ecuador. Materiales y métodos : previa aceptación del consentimiento informado, se tomaron biopsias de cuerpo y fondo gástrico de 210 pacientes con dispepsia y mediante cultivo se recuperaron los aislados de H. pylori identificado mediante pruebas bioquímicas. La susceptibilidad al metronidazol, claritromicina, amoxicilina, tetraciclina y levofloxacina se realizó por concentración mínima inhibitoria (CMI). Todos los cultivos se correlacionaron con el estudio histopatológico. Resultados: se recuperaron 89 aislados de H. pylori. Se obtuvo un kappa de 0,9 entre el cultivo y el estudio histopatológico. El porcentaje de cepas con resistencia antibiótica fue: metronidazol (63%), claritromicina (66%), amoxicilina (43%), tetraciclina (36%) y levofloxacina (54%). Conclusión: estos hallazgos demuestran la alta resistencia a los antibióticos usados para la erradicación de H. pylori, varios factores como el consumo indiscriminado de antibióticos, terapia previa, entre otros podrían estar involucrados.

Abstract Introduction: Worldwide, helicobacter pylori is associated with gastrointestinal pathologies, but increasing resistance to antibiotics used for its eradication is causing alarm. This study determined susceptibility of H. pylori to five antibiotics used in eradication therapy in an adult population with recurrent dyspepsia in Quito, Ecuador. Materials and methods: After patients provided informed consent, biopsies were taken from the gastric corpus and fundus of 210 patients with dyspepsia. H. pylori isolates identified by biochemical tests were recovered from cultures of biopsy samples. Minimal inhibitory concentrations (MIC) of metronidazole, clarithromycin, amoxicillin, tetracycline and levofloxacin were tested to indicate susceptibility. All cultures were correlated with the histopathological study. Results: H. pylori isolates were recovered from 89 cultures. A kappa of 0.9 was obtained between the culture and the histopathological study. The percentage of strains with antibiotic resistance were 63% for metronidazole, 66% for clarithromycin, 43% for amoxicillin, 36% for tetracycline and 54% for levofloxacin. Conclusion: These findings demonstrate high levels of resistance to the antibiotics used for eradication of H. pylori. Several factors including indiscriminate consumption of antibiotics and previous therapy may be involved.

Model based design of a microfluidic mixer driven by induced charge electroosmosis.

Mixing chemical or biological samples with reagents for chemical analysis is one of the most time consuming operations on microfluidic platforms. This is primarily due to the low rate of diffusive transport in liquid systems. Additionally, much research has focused on detection, rather than sample preparation. In response, we describe a mixer for microfluidic sample preparation based on the electrokinetic phenomenon of induced-charge-electroosmosis (ICEO). ICEO creates microvortices within a fluidic channel by application of alternating current (AC) electric fields. The microvortices are driven by electrostatic forces acting on the ionic charge induced by the field near polarizable materials. By enabling mixing to be turned on or off within a channel of fixed volume, these electronically controlled mixers prevent sample dilution-a common problem with other strategies. A three-dimensional model based on the finite volume method was developed to calculate the electric field, fluid flow, and mass transport in a multi-species liquid. After preliminary experiments, the model was used to rapidly prototype a wide range of designs. A new microfabrication process was developed for devices with vertical sidewalls having conductive metal coatings and embedded electrodes. Mixing experiments were carried out in the devices and the results were compared to the model.

Environmental risks of nanotechnology: National Nanotechnology Initiative funding, 2000-2004.

By considering risk in the early stages of a technology, costs of identifying important health and environmental impacts after a technology has widely diffused can be avoided. Nanotechnology, involving materials and objects less than 100 nm in size, is an important case in point. In this paper we analyze the research priorities discussed by various interest groups concerned with the environmental risks of nanotechnology, evaluate the distribution of federal environmental nanotechnology R&D funding, and discuss research in this field. Overall federal environmental R&D funding to date is limited and focuses more on the positive environmental applications of nanotechnology than on basic knowledge/research, tools for nanoenvironmental research, or the potential risks of nanotechnology. The situation began to change in 2004 when a significant increase occurred in federal R&D funding for the environmental implications of engineered nanomaterials. Though literature exits on the exposure, transport, and toxicity of incidental nanoparticles, little work has been published on the environmental risks of engineered nanoparticles.

Influence of surface potential on aggregation and transport of titania nanoparticles.

To investigate the effect of pH on nanoparticle aggregation and transport in porous media, we quantified nanoparticle transport in two-dimensional structures. Titania was used as a model compound to explore the effects of surface potential on particle mobility in the subsurface. Results show that pH, and therefore, surface potential and aggregate size, dominate nanoparticle interactions with each other and surfaces. In each solution, nanoparticle aggregate size distributions were bimodal or trimodal, and aggregate sizes increased as the pH approached the pH of the point of zero charge (pHzpc). Over 80% of suspended particles and aggregates were mobile over the pH range of 1-12, except close to the pHzpc of the surfaces, where the particles are highly aggregated. The effect of pH on transport is not symmetric around the pHzpc of the particles due to charging of the channel surfaces. However, transport speed of nanoparticle aggregates did not vary with pH. The surface element integration technique, which takes into account the effect of curvature of particles on interaction energy, was used to evaluate the ability of theory to predict nanoparticle transport.