Guidelines for inhaled sedation in the ICU.

INTRODUCTION AND OBJECTIVES: Sedation is used in intensive care units (ICU) to improve comfort and tolerance during mechanical ventilation, invasive interventions, and nursing care. In recent years, the use of inhalation anaesthetics for this purpose has increased. Our objective was to obtain and summarise the best evidence on inhaled sedation in adult patients in the ICU, and use this to help physicians choose the most appropriate approach in terms of the impact of sedation on clinical outcomes and the risk-benefit of the chosen strategy. METHODOLOGY: Given the overall lack of literature and scientific evidence on various aspects of inhaled sedation in the ICU, we decided to use a Delphi method to achieve consensus among a group of 17 expert panellists. The processes was conducted over a 12-month period between 2022 and 2023, and followed the recommendations of the CREDES guidelines. RESULTS: The results of the Delphi survey form the basis of these 39 recommendations - 23 with a strong consensus and 15 with a weak consensus. CONCLUSION: The use of inhaled sedation in the ICU is a reliable and appropriate option in a wide variety of clinical scenarios. However, there are numerous aspects of the technique that require further study.

[Efficacy, effectiveness and safety of the adjuvanted influenza vaccine in the population aged 65 or over]. / Eficacia, efectividad y seguridad de la vacuna antigripal adyuvada en población de 65 o más años de edad.

Most of the complications and deaths related to seasonal flu occur in the elderly population (≥65 years) with comorbidities, and the influenza vaccine is the most effective way to prevent them. Immunization is less effective in older adults due to immunosenescence. MF59-adjuvanted vaccines, designed to improve the magnitude, persistence and amplitude of the immune response in elderly people, have been used in clinical practice since 1997 in their trivalent formulation and, since 2020, in their tetravalent formulation. Data from various studies show that these vaccines are not only safe for all age groups, with a reactogenicity profile similar to that of the conventional vaccine, but also that they are especially effective in boosting the immune response in the population aged 65 or over by increasing antibody titers after vaccination and significantly reducing the risk of hospital admission. Adjuvanted vaccines have been shown to provide cross-protection against heterologous strains and to be as effective as the high-dose vaccine in the population aged 65 or over. In this review, the scientific evidence on the efficacy and effectiveness of the MF59-adjuvanted vaccine in real clinical practice in people ≥65 years of age is analyzed through a narrative and descriptive review of the literature with data from clinical trials, observational studies and systematic reviews or meta-analysis.

Efecto de la hipoxia sobre los tejidos de la cavidad oral: revisión de la literatura / Effect of hypoxia on oral tissues: a review of the literature

La exposición a hipoxia es considerada un estímulo estresante, por lo que el organismo desarrolla meca-nismos de aclimatación para asegurar la homeosta-sis. Si bien el efecto de la hipoxia sobre los distintos sistemas de tejidos y órganos ha sido bien documen-tado, el rol de los bajos niveles de O2 en la cavidad oral no ha recibido el mismo análisis. En este trabajo se revisaron los datos bibliográficos disponibles sobre el efecto de la hipoxia sobre el tejido periodontal, las glándulas salivales, la pulpa dental y el hueso mandi-bular y alveolar. De lo analizado en la bibliografía, re-sulta evidente que los bajos niveles de O2 aumentan el número de mediadores inflamatorios que inducen la progresión de la enfermedad periodontal y, a su vez, la inflamación establecida durante dicha enfermedad agrava aún más las condiciones de hipoxia tisular. Las glándulas salivales también se encuentran afectadas durante la exposición a hipoxia, disminuyendo la can-tidad de saliva secretada, observándose alteraciones ultraestructurales en el parénquima glandular. Por otra parte, se ha establecido que la hipoxia puede te-ner efectos deseados para el cultivo de células madre de la pulpa dental, lo cual resulta útil en el campo de la odontología reparativa y también para el movimien-to dental durante los tratamientos ortodónticos. En conclusión, para determinar los efectos de la hipoxia en la cavidad oral se debe analizar no sólo el tipo de tejido involucrado sino también las condiciones de hi-poxia a las cuales éste es sometido, así también como la duración de la exposición y la modalidad de hipoxia (AU)

Exposure to hypoxia is considered a stressful stimulus, therefore the organism develops acclimation mechanisms to try to ensure homeostasis. Although the effect of hypoxia on different tissues and organs has been very well documented, the role of low levels of O2 in the oral cavity has not received the same analysis. In this review, we analyzed the available bibliographic data concerning the effects of hypoxia on periodontal tissue, salivary glands, and dental pulp. The published evidence demonstrates that low O2 levels increase the number of inflammatory mediators that induce the progression of periodontal disease, and, in turn, the inflammation established during the progression of periodontitis aggravates tissue hypoxia conditions. Salivary glands are also affected during hypoxic exposure, decreasing salivary secretion, and leading to ultrastructural alterations in the glandular parenchyma. On the other hand, hypoxia could also be beneficial in some scenarios. It has been established that dental pulp cells grow better in culture under hypoxic conditions than they do in normoxia. Furthermore, mild hypoxia seems to stimulate periodontal ligament cells proliferation and matrix degradation, key events during for orthodontic treatments. In conclusion, to determine the effects of hypoxia in the oral cavity, it is necessary to analyze not only the type of tissue involved but also the hypoxic conditions to which it is subjected, as well as its duration and modality (AU)

Psychopathology as a Moderator of the Relationship Between Physical Symptoms and Impairment in Fibromyalgia Patients.

BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome that is accompanied by notable psychological distress. However, little research has been done on how the psychopathological profile of FM patients may influence their functional status. METHOD: Using the Symptom Checklist-90-Revised the study examined the psychopathological dimensions of 181 women with FM, and the role of psychopathology as a moderator of the relationship between physical symptoms and impairment of functioning. RESULTS: FM patients exhibited T-scores above the cutoff point ≥60) in all dimensions, and 76.2% were identified as "clinical cases". Somatization was a significant predictor of pain intensity, somatization and obsession-compulsion contributed significantly to predicting poor sleep quality, while somatization, depression and anxiety were significant predictors of impairment. Psychopathology was a statistically significant moderator that increased the impact of poor sleep quality on impairment. CONCLUSIONS: The dysfunctional psychological style is key in the impairment associated with FM. The evaluation of psychopathological profiles can allow the early identification of the patients who are most vulnerable to impaired functioning due to the presence of possible psychopathology, as well facilitating therapeutic adaptations.

Cytotoxicity in Vero cells and cytokines analyses in Balb/c mice as safety assessments of the probiotic mixture Saccharomyces cerevisiae RC016 and Lactobacillus rhamnosus RC007 for use as a feed additive.

The objective was to carry out cytotoxicity assays in Vero cells and cytokines analyses in Balb/c mice as safety assessments to evaluate the probiotic mixture (M) Saccharomyces cerevisiae RC016 (Sc) and Lactobacillus rhamnosus RC007 (Lr) for use as feed additive. Vero cells (104 cells per well) were exposed to Sc (2·08 × 107 , 2·08 × 106 ; 2·08 × 105 cells per ml), Lr (8·33 × 107 ; 8·33 × 106 ; 8·33 × 105 cells per ml) and their M (1 : 1). Sc concentrations did not affect the Vero cells viability; in contrast, they were lower when exposed to Lr (P Ë‚ 0·0001). Vero cells showed increasing viability with M decreasing concentrations (91% viability with M2). Control BALB/c mice received only phosphate buffer saline and the others received the M. The IL-10, IL-6 and TNFα concentrations from intestinal fluid were analysed and no significant differences were observed among treatments. The same occurred with the ratio between IL-10/TNF-α. Beneficial effects of probiotics are associated with the regulation of the excessive inflammatory response; it is desirable they can modulate the cytokines production only under pathological conditions. Here, M administration to healthy mice did not induce negative side effects and expands the knowledge about beneficial effects of using probiotic microorganisms in mixture for feed additives development.

Aflatoxin-degrading Bacillus sp. strains degrade zearalenone and produce proteases, amylases and cellulases of agro-industrial interest.

Zearalenone, an oestogenic mycotoxin produced by Fusarium sp., occurs naturally in agricultural commodities. Economic losses and health concerns associated to mycotoxins has attracted research interest towards exploring novel approaches to detoxify mycotoxin-contaminated food and feed. The aim of the present work was to study the ability of 11 aflatoxin-degrading Bacillus strains to degrade ZEA. In addition, a qualitative assessment of protease, amylase and cellulase activity of the studied Bacillus strains was made. All strains were able to degrade 58-96.9% ZEA after 72 h. Toxicity towards Artemia salina was significantly reduced (P < 0.0001). Degradation extracts fluorescence decreased 50% indicating a probable cleavage of the lactone ring. Strains RC1A, RC3A and RC6A showed a remarkable enzymatic activity, showing potential to be used as feed additives.

[Structure and metric properties of a questionnaire to measure disability in mobility activities in patients with chronic obstructive pulmonary disease (DIAMO-COPD questionnaire)]. / Estructura y propiedades métricas de un cuestionario para medir discapacidad en las actividades de movilidad en pacientes con enfermedad pulmonar obstructiva crónica (cuestionario DIAMO-EPOC).

OBJECTIVE: The aim of this study was to adapt a disability questionnaire in mobility activities (DIAMO-EPOC) incorporating scales based on the conceptual framework of the International Classification of Functioning, Disability and Health, and to examine its structure, reliability and validity in a cohort of patients with COPD. METHODS: A total of 137 patients with stable COPD were recruited. Two scales of 4 items each were designed and their structure was verified by exploratory factor analysis and multitrait scaling analysis. Additionally, reliability indices (internal consistency and test-retest) were calculated. Construct validity was analysed by known groups and convergence-divergence. RESULTS: The questionnaire had 2 scales, with 4 items each, corresponding to the domains of the International Classification of Functioning, Disability and Health "change and maintain the position of the body" and "walk and move". The reliability and internal consistency of the scales were acceptable and the test-retest was excellent with an ICC of 0.86 and 0.94, respectively. The scales showed a moderate association with dyspnoea, health status and muscle strength and a different score among participants with different physical performance in the Short Physical Performance Battery. CONCLUSIONS: The 2 scales of the DIAMO-EPOC questionnaire are one-dimensional and have a solid internal consistency, test-retest stability and validity, allowing the identification of specific areas of limited mobility in patients with COPD.

Probiotic bacteria and yeasts adsorb aflatoxin M1 in milk and degrade it to less toxic AFM1-metabolites.

The presence of contaminants such as aflatoxins (AFs) in dairy products constitutes a serious risk to the health of consumers, especially children who are most sensitive to the adverse effects of AFs. The presence of Aflatoxin M1 (AFM1) in milk is a public health problem since dairy products are massively consumed worldwide. The aim of the present work was to select microorganisms capable of reducing AFM1 entry into the food chain through adsorption/degradation strategies. Moreover, the toxicity of AFM1 degradation products was evaluated. All tested strains had the capacity to adsorb 19%-61% AFM1 in milk. These strains also had the ability to degrade AFM1 into metabolites less toxic than the original toxin. Moreover, this is the first study to report harmless and probiotic Pediococcus pentosaceus and Kluveromyces marxianus have the ability to adsorb and degrade AFM1 to less toxic metabolites in milk.

Presence of aiiA homologue genes encoding for N-Acyl homoserine lactone-degrading enzyme in aflatoxin B1-decontaminating Bacillus strains with potential use as feed additives.

Microbial degradation of aflatoxins (AFs) is an alternative to the use of mycotoxin binders. The lactone ring is a possible target for microbial enzymes and its cleavage reduces AFs toxicity. The aim of this study was to isolate and identify Bacillus strains able to degrade AFB1 to less toxic metabolites and to identify aiiA genes encoding for N-acyl-homoserine lactone (AHL) lactonase to possibly correlate detoxification with the production of this enzyme. Eleven soilborne Bacillus strains were isolated and identified by MALDI-TOF MS. Ten cultures and eight cell free culture supernatants (CFCS) were able to significantly (P < 0.05) degrade 27.78-79.78% AFB1. Cell lysates were also able to degrade AFB1 (P < 0.05). Exposure to 70 and 80 °C did not affect enzyme activity. Aflatoxin B1 toxicity towards Artemia salina was reduced after degradation by each of the Bacillus strains. B. subtilis RC1B, B. cereus RC1C and B. mojavensis RC3B, amplified a fragment of 753 pb corresponding to the aiiA gene encoding for AHL lactonase. AFB1 degradation by the strains tested was due to the extracellular and intracellular enzymes. If demonstrated to be safe, these could be used to detoxify AFB1 in contaminated food or feed.

Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years.

BACKGROUND: Maternal obesity, excessive gestational weight gain (EGWG), gestational diabetes mellitus (GDM) and breastfeeding are four important factors associated with childhood obesity. OBJECTIVES: The objective of the study was to assess the interplay among these four factors and their independent contributions to childhood overweight in a cohort with standard clinical care. METHODS: The cohort included 15 710 mother-offspring pairs delivered in 2011. Logistic regression was used to assess associations between maternal exposures and childhood overweight (body mass index >85th percentile) at age 2 years. RESULTS: Mothers with pre-pregnancy obesity or overweight were more likely to have EGWG, GDM and less likely to breastfeed ≥6 months. Mothers with GDM had 40-49% lower EGWG rates and similar breastfeeding rates compared with mothers without GDM. Analysis adjusted for exposures and covariates revealed an adjusted odds ratio (95% confidence interval) associated with childhood overweight at age 2 years of 2.34 (2.09-2.62), 1.50 (1.34-1.68), 1.23 (1.12-1.35), 0.95 (0.83-1.10) and 0.76 (0.69-0.83) for maternal obesity, overweight, EGWG, GDM and breastfeeding ≥6 months vs. <6 months, respectively. CONCLUSIONS: In this large clinical cohort, GDM was not associated with, but maternal pre-pregnancy obesity or overweight and EGWG were independently associated with an increased risk, and breastfeeding ≥6 months was associated with a decreased risk of childhood overweight at age 2 years.

Modeling Meropenem Treatment, Alone and in Combination with Daptomycin, for KPC-Producing Klebsiella pneumoniae Strains with Unusually Low Carbapenem MICs.

Klebsiella pneumoniae strains producing K. pneumoniae carbapenemase (KPC) cause serious infections in debilitated and immunocompromised patients and are associated with prolonged hospital stays and increased mortality rates. Daptomycin is a lipopeptide used against Staphylococcus aureus infection and considered inactive against Gram-negative bacteria. We investigated the effectiveness of a daptomycin-meropenem combination by synergy kill curve and a pharmacokinetic/pharmacodynamic model. The combination may represent a novel therapeutic strategy against infections caused by KPC-producing K. pneumoniae strains.

Design and application of a 23-gene panel by next-generation sequencing for inherited coagulation bleeding disorders.

INTRODUCTION: Molecular testing of Inherited bleeding coagulation disorders (IBCDs) not only offers confirmation of diagnosis but also aids in genetic counselling, prenatal diagnosis and in certain cases genotype-phenotype correlations are important for predicting the clinical course of the disease and to allow tailor-made follow-up of individuals. Until recently, genotyping has been mainly performed by Sanger sequencing, a technique known to be time consuming and expensive. Currently, next-generation sequencing (NGS) offers a new potential approach that enables the simultaneous investigation of multiple genes at manageable cost. AIM: The aim of this study was to design and to analyse the applicability of a 23-gene NGS panel in the molecular diagnosis of patients with IBCDs. METHODS: A custom target enrichment library was designed to capture 31 genes known to be associated with IBCDs. Probes were generated for 296 targets to cover 86.3 kb regions (all exons and flanking regions) of these genes. Twenty patients with an IBCDs phenotype were studied using NGS technology. RESULTS: In all patients, our NGS approach detected causative mutations. Twenty-one pathogenic variants were found; while most of them were missense (18), three deletions were also identified. Six novel mutations affecting F8, FGA, F11, F10 and VWF genes, and 15 previously reported variants were detected. NGS and Sanger sequencing were 100% concordant. CONCLUSION: Our results demonstrate that this approach could be an accurate, reproducible and reliable tool in the rapid genetic diagnosis of IBCDs.

The effect of five Taraxacum species on in vitro and in vivo antioxidant and antiproliferative activity.

Plants belonging to the genus Taraxacum are considered a nutritious food, being consumed raw or cooked. Additionally, these plants have long been used in folk medicine due to their choleretic, diuretic, antitumor, antioxidant, antiinflammatory, and hepatoprotective properties. This genus, with its complex taxonomy, includes several species that are difficult to distinguish. Its traditional use must be related not only to T. officinale F.H. Wigg., the most studied species, but also to others. The aim of this work is to compare five different common South European species of Taraxacum (T. obovatum (Willd.) DC., T. marginellum H. Lindb., T. hispanicum H. Lindb., T. lambinonii Soest and T. lacistrum Sahlin), in order to find differences between antioxidant and cytotoxic activities among them. Dissimilarities between species in LC/MS patterns, in in vitro and intracellular antioxidant activity and also in the cytotoxicity assay were found. T. marginellum was the most efficient extract reducing intracellular ROS levels although in in vitro assays, T. obovatum was the best free radical scavenger. A relevant cytotoxic effect was found in T. lacistrum extract over HeLa and HepG2 cell lines.

Persistent Desquamation of the Scalp as a Manifestation of Tinea Capitis in Sub-Saharan Children.

Scalp hyperkeratosis of childhood is most often associated with atopic or seborrheic dermatitis. However, in black children can be associated with tinea capitis. We undertook a retrospective study in all Sub-Saharan children presenting with chronic scalp scaling between June 2010 and June 2013, to determine whether chronic desquamation of the scalp is a clinical manifestation of tinea capitis. The criterion used to diagnose tinea capitis was a positive mycolological culture. Of the 23 Sub-Saharan African children attended, 12 (43.4%) presented with chronic scalp flaking. Mycological culture was performed in 9 of the 12 cases. The culture was positive in 6 out of 9, so 26% of the Sub-Saharan African children attended were diagnosed with tinea capitis. In 52.1% of the cases with persistent scalp scaling the culture was positive. In conclusion, chronic scaling of the scalp may well be the sole form of presentation of tinea capitis in Sub-Saharan children.

Attentional deficits in fibromyalgia and its relationships with pain, emotional distress and sleep dysfunction complaints.

Cognitive complaints are common among subjects with fibromyalgia (FM). Yet, few studies have been able to document these deficits with cognitive tasks. A main limitation of existing studies is that attention has been broadly defined and the tasks used to measure attention are not designed to cover all the main components of the attentional system. Research on attention has identified three primary functions of attention, known as alerting, orienting and executive functioning. This study used the attentional network test-interactions task to explore whether and which of the three attentional networks are altered in FM. Results showed that FM patients have impaired executive control (greater interference), reduced vigilance (slower overall reaction time) and greater alertness (higher reduction in errors after a warning cue). Vigilance and alertness showed several relations with depression, anxiety and sleep quality. Sleep dysfunction was a significant predictor for alertness, whereas there were no significant predictors for vigilance. These findings highlight that the treatment of sleep difficulties in FM patients may help with some of their cognitive complaints.

Cognitive-behavioral therapy for insomnia improves attentional function in fibromyalgia syndrome: a pilot, randomized controlled trial.

This pilot, randomized controlled trial analyzed the effects of a cognitive behavioral therapy (CBT, n = 20) for insomnia vs a sleep hygiene (SH, n = 20) program on the three attentional networks (alertness, orienting, and executive function) and other additional outcome measures (sleep, pain, depression, anxiety, and daily functioning) of fibromyalgia patients. The CBT group showed significant improvement in alertness (F(1, 28) = 11.84, p = .0018), executive functioning (F(1, 28) = 15.76, p = .00059), sleep quality ( F(1, 38) = 6.33, p = .016), and a trend to improvement in daily functioning (p > .06), as compared with the SH group. The improvement in executive functioning was significantly related to the changes in sleep (r = 0.40, p = .026). A CBT for insomnia represents a useful intervention in fibromyalgia patients not only regarding sleep disturbance but also attentional dysfunction and probably daily functioning.

The Causative Classification of Stroke system: an international reliability and optimization study.

BACKGROUND: Valid and reliable ischemic stroke subtype determination is crucial for well-powered multicenter studies. The Causative Classification of Stroke System (CCS, available at http://ccs.mgh.harvard.edu) is a computerized, evidence-based algorithm that provides both causative and phenotypic stroke subtypes in a rule-based manner. We determined whether CCS demonstrates high interrater reliability in order to be useful for international multicenter studies. METHODS: Twenty members of the International Stroke Genetics Consortium from 13 centers in 8 countries, who were not involved in the design and development of the CCS, independently assessed the same 50 consecutive patients with acute ischemic stroke through reviews of abstracted case summaries. Agreement among ratings was measured by kappa statistic. RESULTS: The κ value for causative classification was 0.80 (95% confidence interval [CI] 0.78-0.81) for the 5-subtype, 0.79 (95% CI 0.77-0.80) for the 8-subtype, and 0.70 (95% CI 0.69-0.71) for the 16-subtype CCS. Correction of a software-related factor that generated ambiguity improved agreement: κ = 0.81 (95% CI 0.79-0.82) for the 5-subtype, 0.79 (95% CI 0.77-0.80) for the 8-subtype, and 0.79 (95% CI 0.78-0.80) for the 16-subtype CCS. The κ value for phenotypic classification was 0.79 (95% CI 0.77-0.82) for supra-aortic large artery atherosclerosis, 0.95 (95% CI 0.93-0.98) for cardioembolism, 0.88 (95% CI 0.85-0.91) for small artery occlusion, and 0.79 (0.76-0.82) for other uncommon causes. CONCLUSIONS: CCS allows classification of stroke subtypes by multiple investigators with high reliability, supporting its potential for improving stroke classification in multicenter studies and ensuring accurate means of communication among different researchers, institutions, and eras.

Endocrine manifestations of Langerhans cell histiocytosis diagnosed in adults.

Langerhans cell histiocytosis (LCH) is a rare granulomatous disease of unknown etiology. We retrospectively reviewed data from four patients (3 males and 1 female), mean age 33.5 years old (range: 21-40), with histopathological diagnosis of LCH. All of them presented with symptoms suggestive of endocrine involvement. The main complaint was goiter in two patients and polyuria and polydipsia in three. Before the LCH diagnosis, two patients had unevaluated symptoms of diabetes insipidus (DI) and hypogonadism. The mean time from symptoms onset to diagnosis was 6.25 years (range: 2-13). Histopathological diagnosis was established by total thyroidectomy (TT) biopsy in two patients, skin lesion biopsy in one, and pituitary stalk biopsy in the other. In the two-first patients, surgery was indicated after the fine-needle aspiration biopsy (FNAB) showed a false positive result of differentiated thyroid carcinoma and immunohistochemistry was used for diagnosis confirmation. Three cases were treated with chemotherapy; one of them had already received radiation therapy on the hypothalamic-pituitary region, developing post-radiation hypopituitarism.

Hay que evitar la cateterización de las venas femorales siempre que sea posible / Femoral vein catheterization should always be avoided when possible

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