Complicaciones relacionadas con la traqueotomía en pacientes pos-COVID-19 tratados con distintos dispositivos de oxigenoterapia / Tracheostomy-related complications in post-COVID-19 patients treated with different oxygen therapy devices

Objetivo: conocer las complicaciones relacionadas con la traqueotomía en pacientes pos-COVID-19 tratados con distintos dispositivos de oxigenoterapia y los factores asociados. Métodos: se llevó a cabo un estudio observacional retrospectivo en pacientes adultos portadores de una traqueotomía pos-COVID-19, que estuvieron ingresados en la Unidad de Semicríticos de Neumología del Hospital Universitario de Bellvitge (Madrid, España), de agosto de 2021 a mayo de 2022. Variables: sociodemográficas, clínicas, comorbilidades, relacionadas con la traqueotomía y sistemas de oxigenación, complicaciones. Se realizó análisis descriptivo y comparación de variables para identificar factores de riesgo asociados a dichas complicaciones.Resultados: se incluyeron a 28 pacientes. El 85,7% fue hombre. La mediana de edad fue de 65,50. La mediana de días de ingreso en UCI fue de 61,5 días. Las principales comorbilidades: hipertensión arterial (42,9%) y diabetes (35,7%). El 78,6% llevaba dispositivo alto flujo. El 32,1% presentó complicaciones relacionadas con el manejo de la traqueotomía. Las complicaciones más frecuentes fueron la presencia de tapón mucoso (33,3%) y la alteración en la consistencia de secreciones (33,3%). Presentaron más complicaciones los hombres que las mujeres (88,9% vs.11,1%), los pacientes con antecedentes de hábito tabáquico (66,7% vs. 33,3%, p= 0,028). Los pacientes que eran portadores de un dispositivo de alto flujo no presentaron casi ninguna complicación (94,7% frente a 5,3%, p= 0,007). Conclusiones: el uso de dispositivos de oxigenoterapia que incorporen humidificación activa y control de la temperatura es una alternativa útil para reducir las complicaciones asociadas a la pérdida de esta función fisiológica de la anatomía nasofaríngea en los pacientes con traqueotomía.(AU)

Objectives: to understand tracheostomy-related complications in post-COVID-19 patients treated with different oxygen therapy devices and their associated factors.Methods: an observational retrospective study was conducted in adult patients with post-COVID-19 tracheostomy, who were hospitalized at the Respiratory Semi-critical Care Unit of the Bellvitge University Hospital (Barcelona, Spain), from August 2021 to May 2022. The variables were: sociodemographic, clinical, comorbidities, associated with tracheostomy and oxygenation systems, complications. Descriptive analysis was conducted, as well as comparison of variables in order to identify the risk factors associated with said complications. Results: the study included 28 patients; 85.7% were male. Their median age was 65.50. The median number of hospitalization days at ICU was 61.5 days. Their main comorbidities: hypertension (42.9%) and diabetes (35.7%). High-flow devices were used by 78.6% of patients; 32.1% of them presented complications associated with tracheostomy management. The most frequent complications were the presence of mucous plug (33.3%) and an alteration in consistency of secretions (33.3%). Male patients presented more complications than female patients (88.9% vs.11.1%), as well as patients with a smoking history (66.7% vs. 33.3%, p= 0.028). Patients who were carriers of high-flow devices presented almost no complications (94.7% vs. 5.3%, p= 0.007). Conclusions: the use of oxygen therapy devices incorporating active humidification and temperature control is a useful option in order to reduce those complications associated with the loss of this physiological function of the nasopharyngeal anatomy in patients with tracheostomy.(AU)

Incidencia de complicaciones y factores de riesgo asociados en pacientes intervenidos de neumonectomía / Incidence of complications and associated risk factors in patients undergoing pneumonectomy

Objetivo: conocer la incidencia de complicaciones e identificar los factores de riesgo asociados a complicaciones post-operatorias desarrolladas tras una neumonectomía.Método: se llevó a cabo un estudio observacional retrospectivo, cuya muestra se obtuvo del total de pacientes, mayores de 18 años, que estuvieron hospitalizados en el Servicio de Neumología y Cirugía Torácica del Hospital Universitario de Bellvitge (Barcelona), entre enero de 2016 y junio de 2020, que habían sido intervenidos de neumonectomía (derecha o izquierda). Variables de estudio: complicaciones durante la hospitalización, comorbilidades y factores de riesgo, además de otras variables demográficas y clínicas. Los datos se recogieron mediante una revisión de historias clínicas electrónicas. Se realizó análisis descriptivo y analítico. Se consideró significativa la diferencia si p< 0,05.Resultados: se incluyeron 24 pacientes, 75% varones (n=1 8). El 46% era fumador. La edad media (rango intercuatílico) fue de 66 (62-74) años. Las principales comorbilidades identificadas fueron: hipertensión arterial (46%; n= 11), diabetes mellitus (25%; n= 6) y EPOC (25%; n= 6). 83% (n= 20) intervenidos mediante toracotomía. 79% (n= 19) sometidos a neumonectomía izquierda y 42% (n= 10) con complicaciones post-operatorias. La complicación con mayor incidencia fue la arritmia cardiaca (17%; n= 4). La neumonectomía derecha se asoció con la aparición de complicaciones (p= 0,05). La media de días de estancia hospitalaria fue mayor en el grupo con complicaciones (9,5 frente a 7; p= 0,005).Conclusión: se detectaron complicaciones post-operatorias en cuatro de cada diez sujetos, siendo la más frecuente la arritmia cardiaca. La neumonectomía derecha se asoció significativamente a la aparición de complicaciones.(AU)

Objective: to understand the incidence of complications, and identify the risk factors associated with post-surgical complications developed after pneumonectomy.Method: a retrospective observational study was conducted; the sample was obtained from the group of >18-year-old patients hospitalized at the Pulmonology and Thoracic Surgery Unit of the Hospital Universitario de Bellvitge (Barcelona), between January, 2016 and June, 2020, who had undergone pneumonectomy (right or left). Study variables: complications during hospitalization, comorbidities and risk factors, besides other demographical and clinical variables. Data were collected through review of electronic clinical records. Descriptive and analytical analysis was conducted. The difference was considered significant if p< 0.05.Results: the study included 24 patients: 75% were male (n=1 8); 46% were smokers; and their mean age (interquartile range) was 66 (62-74) years. The main comorbidities detected were: hypertension (46%; n= 11), diabetes mellitus (25%; n= 6) and COPD (25%; n= 6); 83% (n= 20) underwent thoracotomy, and 79% (n= 19) underwent left pneumonectomy; 42% (n= 10) presented post-surgical complications. The complication with the highest incidence was cardiac arrythmia (17%; n= 4). Right pneumonectomy was associated with the development of complications (p= 0,05). The mean hospital stay was higher in the group with complications (9.5 vs. 7 days; p= 0.005).Conclusion: post-surgical complications were detected in 4 out of each ten subjects; the most frequent was cardiac arrythmia. Right pneumonectomy was significantly associated with the development of complications.(AU)

Puntos clave en el fast-track a los pacientes intervenidos de cirugía torácica / Fast-track key points for patients undergoing thoracic surgery

OBJETIVO: conocer los puntos clave del fast-track en los pacientes intervenidos de cirugía torácica MÉTODO: revisión narrativa. Se usaron las bases de datos: CINHAL, Pubmed y Cochrane Library Plus. Términos de búsqueda: fast-track, thoracic surgery and ERAS. CRITERIOS DE INCLUSIÓN: estudios que trataran sobre fast-track en cirugía torácica (no resección traqueal ni cirugías de mediastino), mayores de 18 años, publicados en los 10 últimos años, idiomas inglés o español. RESULTADOS: se seleccionaron 17 artículos. Los resultados se dividieron en tres partes: 1) Periodo prequirúrgico, en el cual se da mucha importancia a la deshabituación tabáquica, la información que se le proporciona al paciente sobre la cirugía y su proceso evolutivo, el concepto "prehabilitación", el cribaje de malnutrición, enfermedades pulmonares y anemia, entre otros. 2) Proceso intraoperatorio, muy enfocado a la minimización de las técnicas quirúrgicas más agresivas, utilizar técnicas anestésicas más favorecedoras para el paciente, mantener la normotermia del paciente, hacer una ventilación protectora y reducir la carga de sueroterapia. 3) Periodo postquirúrgico, donde se reduce el tiempo de dieta absoluta del paciente, se favorece la movilización, se intenta controlar el dolor para evitar complicaciones, conocer los criterios de alta y ayudar a aumentar el empoderamiento del paciente para su correcta recuperación y evolución. CONCLUSIÓN: es importante conocer el papel de la figura enfermera en la implementación de un protocolo fast-track, ya que ayuda a reducir el estrés quirúrgico, disminuye los costes y la estancia hospitalaria, favorece al empoderamiento del paciente mediante una recuperación postquirúrgica precoz y trata al enfermo desde una perspectiva enfermera más holística

OBJECTIVE: to understand the fast-track key points in patients undergoing thoracic surgery. METHOD: a narrative review. The following databases were used: CINHAL, Pubmed and Cochrane Library Plus. Search terms: fast-track, thoracic surgery and ERAS. Inclusion criteria: studies dealing with fast-track in thoracic surgery (neither tracheal resection nor mediastinum surgery), >18-year-old, published in the past 10 years, in English or Spanish. RESULTS: seventeen (17) articles were selected. Results were classified into three parts: 1) Preoperative stage, assigning high importance to smoking cessation, information provided to patients about the surgery and its evolution process, the concept of "prehabilitation", screening for malnutrition, pulmonary conditions and anaemia, among others; 2) Intraoperative process, highly focused on minimizing the most aggressive surgical techniques, using anesthetic techniques more beneficial for patients, maintaining the patient in normothermia, conducting protective ventilation, and reducing the saline therapy load; 3) Postoperative period, where the time of absolute diet for the patient is reduced, mobilization is encouraged, pain is controlled to some extent in order to prevent complications, discharge criteria are understood, and patient empowerment is encouraged for their correct recovery and evolution. CONCLUSION: it is important to understand the role of the nurse in the implementation of a fast-track protocol, because it helps to reduce surgical stress, there is a reduction in cost and hospital stay, patient empowerment is encouraged through early postsurgical recovery, and the patient is treated from a more holistic nursing perspective

Análisis de las complicaciones postquirúrgicas tras cirugía de resección traqueal / Analysis of post-surgical complications after tracheal resection surgery

OBJETIVO: analizar la incidencia de las complicaciones postquirúrgicas de los pacientes intervenidos de resección traqueal o cricotraqueal, y los factores asociados a dichas complicaciones. MÉTODO: se llevó a cabo un estudio observacional analítico retrospectivo de todos los pacientes que ingresaron por resección traqueal en el Servicio de Cirugía Torácica del Hospital Universitario de Bellvitge (Barcelona) (periodo 2017-2019). Se revisaron las historias clínicas electrónicas: variables clínicas y presencia de complicaciones postquirúrgicas. Se realizó análisis descriptivo y bivariante. RESULTADOS: se incluyeron un total de 13 pacientes. La edad media fue de 65,6. El 54% fue mujer. Principales comorbilidades: hipertensión arterial (76,9%), diabetes (23%) y obesidad (34%). La estancia media en el servicio fue de 14,2 días. El 46% se so-metió a una resección cricotraqueal y el 54% a una resección traqueal. Los pacientes sometidos a una resección traqueal presentaron más complicaciones (71,4%) que las resecciones cricotraqueales (28,6%). El 53,8% de los pacientes tuvo complicaciones. En los sujetos con obesidad hubo un porcentaje de complicaciones superior a los no obesos. Los pacientes con complicaciones tuvieron una estancia media hospitalaria superior a los que no presentaron complicaciones (17,57 vs. 10,33 días). CONCLUSIONES: más de la mitad de los pacientes intervenidos de resección traqueal o cricotraqueal presentaron complicaciones postquirúrgicas, aunque con una incidencia baja: infección de la herida quirúrgica, disfagia, cambios en la voz, hematoma, reintubación y sangrado. Se objetivó mayor proporción de complicaciones en las personas con obesidad

OBJECTIVE: to analyze the incidence of post-surgical complications in patients undergoing tracheal or cricotracheal resection, and the factors associated with said complications. METHOD: an observational analytical retrospective study conducted in all patients admitted for tracheal resection at the Thoracic Surgery Unit of the Hospital Universitario de Bellvitge (period from 2017 to 2019). There was a review of electronic clinical records: sociodemographical variables, background and associated comorbidities, clinical variables, and presence of post-surgical complications. Descriptive and bivariate analysis was conducted. RESULTS: in total, 13 patients were included: their mean age was 65.6 years, and 54% were female. Main comorbidities: hypertension (76.9%), diabetes (23%) and obesity (34%). The mean stay at the Unit was 14.2 days. Of these patients, 46% underwent cricotracheal resection, and 54% underwent tracheal resection. Patients who underwent tracheal resection presented more complications (71.4%) than those with cricotracheal resections (28.6%). In total, 53.8% of patients presented complications. Obese patients presented a higher proportion of complications vs. non-obese patients. Patients with complications had a higher mean hospital stay vs. those who did not present complications (17.57 vs. 10.33 days). CONCLUSIONS: more than half of patients undergoing tracheal or cricotracheal resection presented post-surgical complications, though with a low incidence: surgical wound infection, dysphagia, changes in voice, bruising, reintubation, and bleeding. A higher proportion of complications was observed in patients with obesity

Cuidados enfermeros para prevenir las complicaciones asociadas a la resección traqueal / Nursing care to prevent the complications associated with tracheal resection

Objetivo: describir las principales complicaciones asociadas a la cirugía de resección laringotraqueal e identificar los cuidados de Enfermería orientados a reducir las complicaciones asociadas. Método: revisión narrativa, se buscaron artículos en las bases de datos: Pubmed, CINAHL, Cochrane Library Plus y Cuiden, con los términos libres: "estenosis laringotraqueal", "estenosis traqueal", "complicaciones", "cirugía" y "cuidados". Limitados en idioma: inglés o español, edades superiores a 18 años y publicados en los últimos 10 años. Resultados: de un total de 143 artículos encontrados, 12 fueron seleccionados. Se identificaron las complicaciones postoperatorias: las anastomóticas (formación de tejido de granulación, re-estenosis, separación de la anastomosis o la aparición de fístula); y las no anastomóticas (edema laríngeo y la disfunción glótica). Cuidados derivados de la revisión: mantenimiento de la hiperflexión cervical temporal, evitar las náuseas y los vómitos, fomentar la movilización y la deambulación, y el control de los signos de alarma. Mediante estos cuidados se pretende reducir las variaciones inapropiadas de la práctica y promover una atención de calidad basada en la evidencia científica. Conclusiones: la necesidad de estandarizar los cuidados enfermeros a estos pacientes es fundamental para conseguir llevar a cabo un manejo óptimo y seguro para evitar complicaciones asociadas y disminuir el consumo de recursos sanitarios. El personal enfermero es un pilar importante para detectar estas complicaciones de forma precoz, ayudar a prevenir su aparición y favorecer a la autonomía del personal de Enfermería

Objective: to describe the main complications associated with laryngotracheal resection surgery, and to identify the Nursing care measures required to reduce the complications associated. Method: a narrative review. There was a search for articles in the following databases: Pubmed, CINAHL, Cochrane Library Plus and Cuiden, with the free terms: "estenosis laringotraqueal" ("laryngotracheal stenosis"), "estenosis traqueal" ("tracheal stenosis"), "complicaciones" ("complications"), "cirugía" ("surgery") and "cuidados" ("care"). Limited in language: English or Spanish; >18 years and published in the last 10 years. Results: twelve (12) articles were selected from the 143 articles found. Post-surgical complications were identified: anastomotic (granulation tissue formation, restenosis, anastomosis separation or development of fistula); and non-anastomotic (laryngeal oedema and glottic insufficiency). Care measures derived from the review: sustained temporary cervical hyperflexion, prevention of nausea and vomiting, encouraging mobility and ambulation, and control of warning signs. These care measures are intended to reduce any inappropriate variations in practice, and promote quality care based on scientific evidence. Conclusions: there is an essential need to standardize the nursing care for these patients, in order to achieve an optimal and safe management to avoid any complications associated and reduce the use of healthcare resources. Nursing staff plays an important role in the early detection of these complications, to help preventing their development, and to encourage the autonomy of the Nursing staff

Cuidados para el manejo seguro de los pacientes con espondilitis infecciosa / Care measures for the safe management of patients with infectious spondylitis

Objetivo: identificar los principales cuidados de Enfermería de los pacientes que han sido diagnosticados de una espondilitis infecciosa para prevenir sus posibles complicaciones. Metodo: se realizó una revisión narrativa a través de las bases de datos: Pubmed, CINAHL, Cochrane Library Plus y Cuiden, con los términos libres: infectious spondylitis, spondylodiscitis, vertebral osteomielitis AND care; espondilitis infecciosa, espondilodiscitis, osteomielitis vertebral. Limitados en idioma: inglés o español, pacientes adultos y publicados entre 2008 y 2018. Resultados: de un total de 138 artículos encontrados en la búsqueda finalmente se seleccionaron 18. Los cuidados identificados fueron: vigilancia de síntomas inespecíficos como el dolor de espalda en pacientes de riesgo (edad avanzada, inmunodeprimidos, usuarios de drogas por vía parenteral, portadores de catéter central), manipulación estéril de catéteres de hemodiálisis, realización de hemocultivos, vigilancia del dolor y manejo del mismo con utilización de corsés ortopédicos, mantener reposo absoluto las dos primeras semanas de tratamiento antibiótico, vigilancia de complicaciones neurológicas (sintomatología neurológica), meningitis o endocarditis, controlar la evolución de la sintomatología y vigilancia de la fiebre. Conclusión: conocer la evolución de esta enfermedad y puntos clave de su tratamiento desde el enfoque enfermero ayuda a adecuar los cuidados, a evitar las complicaciones o a saberlas identificar de manera precoz antes de que sean irreversibles

Objective: to identify the main Nursing care measures for patients diagnosed with infectious spondylitis, in order to prevent its potential complications. Method: a narrative review was conducted through the following databases: Pubmed, CINAHL, Cochrane Library Plus and Cuiden, using the free terms: Infectious spondylitis, spondylodiscitis, vertebral osteomyelitis AND care; "espondilitis infecciosa", "espondilodiscitis", "osteomielitis vertebral". Language limitations: English or Spanish; adult patients, and published between 2008 and 2018. Results: out of the 138 articles in total retrieved in the search, 18 were finally selected. The care measures identified were: watching for unspecific symptoms such as back pain in patients at risk (advanced age, immunosuppressed, parenteral drug users, carriers of a central catheter), sterile handling of hemodialysis catheters, conducting blood cultures, watching for pain and its management through the use of back braces, maintaining complete rest during the first two weeks of antibiotic treatment, watching for neurological complications (neurological symptomatology), meningitis or endocarditis, watching the evolution of symptomatology, and watching for high temperature. Conclusion: to understand the evolution of this disease and the key points for its treatment from a nursing approach will help to adapt care measures, to prevent complications, or to detect them earlier before they become irreversible

Dopamine Binding and Analysis in Undiluted Human Serum and Blood by the RNA-Aptamer Electrode.

Specific analysis of such neurotransmitters as dopamine by the aptamer electrodes in biological fluids is detrimentally affected by nonspecific adsorption of media, particularly pronounced at positive charges of the electrode surface at which dopamine oxidizes. Here, we show that dopamine analysis at the RNA-aptamer/cysteamine-modified electrodes is strongly inhibited in undiluted human serum and blood due to nonspecific interfacial adsorption of serum and blood components. We demonstrate that nonspecific adsorption of serum proteins (but not of blood components) could be minimized when analysis is performed in a flow and injections of serum samples are followed by washing steps in a phosphate buffer solution (PBS) carrier. Under those conditions, the dopamine-aptamer binding affinity in whole human serum of (1.9 ± 0.3) × 104 M-1 s-1 was comparable to the (3.7 ± 0.3) × 104 M-1 s-1 found in PBS, and the dopamine oxidation signal linearly depended on the dopamine concentration, providing a sensitivity of analysis of 73 ± 3 nA µM-1 cm-2 and a LOD of 114 ± 8 nM. The flow-injection apatmer-electrode system was used for direct analysis of basal levels of dopamine in undiluted human serum samples, without using any physical separators (membranes) or filtration procedures. The results suggest a simple strategy for combatting biosurface fouling, otherwise most pronounced at positive electrode potentials used for dopamine detection, and assist in designing more efficient antifouling strategies for biomedical applications.

Beneficios y cuidados enfermeros en el uso de cánula nasal de alto flujo en el paciente con insuficiencia respiratoria aguda / Benefits and nursing care in the use of high-flow nasal cannula for patients with acute respiratory failure

OBJETIVO: identificar los beneficios y los principales cuidados del dispositivo de cánula nasal de alto flujo como tratamiento en los pacientes diagnosticados de insuficiencia respiratoria aguda (IRA). MÉTODO: se ha realizado una revisión narrativa. Se buscaron artículos en las siguientes bases de datos: PubMed, Cinhal, Cochrane Library Plus y Cuiden, con los siguientes términos libres de búsqueda: oxigenoterapia alto flujo; insuficiencia respiratoria aguda y cuidados enfermeros. Limitados con idioma inglés o español, edad +18 años y publicados en los últimos 10 años (2007-2017). RESULTADOS: se incluyeron 19 documentos. El principal beneficio del tratamiento con dispositivo de cánula nasal de alto flujo es la mejora de la oxigenación. La terapia utiliza un sistema de humidificación térmica que favorece la función mucociliar, facilita la expulsión de secreciones y reduce la aparición de atelectasias pulmonares. Además, mediante la humidificación del aire inspirado se reducen las molestias de la sequedad bucal relacionadas con la oxigenoterapia convencional. Puede llegar a aliviar asincronías, reducir la frecuencia respiratoria y mejorar la eficacia también de los esfuerzos respiratorios incrementando la ventilación alveolar. CONCLUSIONES: el uso de la cánula nasal de alto flujo es un tratamiento beneficioso en los pacientes diagnosticados de insuficiencia respiratoria aguda

OBJECTIVE: to identify the benefits and main care measures for the high-flow nasal cannula as treatment for patients diagnosed with acute respiratory failure. METHOD: a narrative review was conducted; there was a search for articles in the following databases: PubMed, Cinhal, Cochrane Library Plus and Cuiden, with the following free search terms: "oxigenoterapia alto flujo" (high-flow oxygen therapy); "insuficiencia respiratoria aguda" (acute respiratory failure) and "cuidados enfermeros" (nursing care).The search was limited to articles in English or Spanish, >18-year-old, and published within the past 10 years (2007-2017). RESULTS: nineteen (19) articles were included. The main benefit of the treatment with high-flow nasal cannula was an improvement in oxygenation. This therapy involves a thermal humidification system that boosts the mucociliary function, encourages the discharge of secretions, and reduces the development of pulmonary atelectasis. Moreover, through the humidification of the air inhaled, there is a reduction in the mouth dryness discomfort associated with traditional oxygen therapy. It can even alleviate asynchrony, reduce the respiratory frequency, and improve also the efficacy of respiratory efforts, by increasing alveolar ventilation. CONCLUSIONS: the use of high-flow nasal cannula is a beneficial treatment for patients diagnosed with acute respiratory failure

Point-of-need simultaneous electrochemical detection of lead and cadmium using low-cost stencil-printed transparency electrodes.

In this work, we report a simple and yet efficient stencil-printed electrochemical platform that can be integrated into the caps of sample containers and thus, allows in-field quantification of Cd(II) and Pb(II) in river water samples. The device exploits the low-cost features of carbon (as electrode material) and paper/polyester transparency sheets (as substrate). Electrochemical analysis of the working electrodes prepared on different substrates (polyester transparency sheets, chromatographic, tracing and office papers) with hexaammineruthenium(III) showed that their electroactive area and electron transfer kinetics are highly affected by the porosity of the material. Electrodes prepared on transparency substrates showed the best electroanalytical performance for the simultaneous determination of Cd(II) and Pb(II) by square-wave anodic stripping voltammetry. Interestingly, the temperature and time at which the carbon ink was cured had significant effect on the electrochemical response, especially the capacitive current. The amount of Cd and Pb on the electrode surface can be increased about 20% by in situ electrodeposition of bismuth. The electrochemical platform showed a linear range comprised between 1 and 200 µg/L for both metals, sensitivity of analysis of 0.22 and 0.087 µA/ppb and limits of detection of 0.2 and 0.3 µg/L for Cd(II) and Pb(II), respectively. The analysis of river water samples was done directly in the container where the sample was collected, which simplifies the procedure and approaches field analysis. The developed point-of-need detection system allowed simultaneous determination of Cd(II) and Pb(II) in those samples using the standard addition method with precise and accurate results.

A DNA sequence obtained by replacement of the dopamine RNA aptamer bases is not an aptamer.

A unique specificity of the aptamer-ligand biorecognition and binding facilitates bioanalysis and biosensor development, contributing to discrimination of structurally related molecules, such as dopamine and other catecholamine neurotransmitters. The aptamer sequence capable of specific binding of dopamine is a 57 nucleotides long RNA sequence reported in 1997 (Biochemistry, 1997, 36, 9726). Later, it was suggested that the DNA homologue of the RNA aptamer retains the specificity of dopamine binding (Biochem. Biophys. Res. Commun., 2009, 388, 732). Here, we show that the DNA sequence obtained by the replacement of the RNA aptamer bases for their DNA analogues is not able of specific biorecognition of dopamine, in contrast to the original RNA aptamer sequence. This DNA sequence binds dopamine and structurally related catecholamine neurotransmitters non-specifically, as any DNA sequence, and, thus, is not an aptamer and cannot be used neither for in vivo nor in situ analysis of dopamine in the presence of structurally related neurotransmitters.

Electrochemical Label-Free Aptasensor for Specific Analysis of Dopamine in Serum in the Presence of Structurally Related Neurotransmitters.

Cellular and brain metabolism of dopamine can be correlated with a number of neurodegenerative disorders, and as such, in vivo analysis of dopamine in the presence of structurally related neurotransmitters (NT) represents a holy grail of neuroscience. Interference from those NTs generally does not allow selective electroanalysis of dopamine, which redox transformation overlaps with those of other catecholamines. In our previous work, we reported an electrochemical RNA-aptamer-based biosensor for specific analysis of dopamine (Analytical Chemistry, 2013; Vol. 85, p 121). However, the overall design of the biosensor restricted its stability and impeded its operation in serum. Here, we show that specific biorecognition and electroanalysis of dopamine in serum can be performed by the RNA aptamer tethered to cysteamine-modified gold electrodes via the alkanethiol linker. The stabilized dopamine aptasensor allowed continuous 20 h amperometric analysis of dopamine in 10% serum within the physiologically important 0.1-1 µM range and in the presence of catechol and such dopamine precursors and metabolites as norepinephrine and l-DOPA. In a flow-injection mode, the aptasensor response to dopamine was ∼1 s, the sensitivity of analysis, optimized by adjusting the aptamer surface coverage, was 67 ± 1 nA µM(-1) cm(-2), and the dopamine LOD was 62 nM. The proposed design of the aptasensor, exploiting both the aptamer alkanethiol tethering to the electrode and screening of the catecholamine-aptamer electrostatic interactions, allows direct monitoring of dopamine levels in biological fluids in the presence of competitive NT and thus may be further applicable in biomedical research.

Surface state of the dopamine RNA aptamer affects specific recognition and binding of dopamine by the aptamer-modified electrodes.

Specific monitoring of dopamine, in the presence of structurally related neurotransmitters, is critical for diagnosis, treatment and mechanistic understanding of a variety of human neuropathologies, but nevertheless the proper tools are scarce. Recently, an electrochemical aptasensor for specific analysis of dopamine, exploiting dopamine biorecognition by the RNA aptamer electrostatically adsorbed onto a cysteamine-modified electrode, has been reported (Analytical Chemistry 85 (2013) 121). However it was not clear which way dopamine biorecognition and binding by such aptamer layers proceed and if they can be improved. Here, we show that the aptamer surface state, in particular the aptamer surface density, in a bell-shaped manner affects the dopamine binding, being maximal for the 3.5 ± 0.3 pmol cm(-2) monolayer coverage of the aptamer molecules lying flat on the surface. Therewith, the aptamer affinity for dopamine increases one order of magnitude due to electrostatically regulated immobilization, with the aptamer-dopamine dissociation constant of 0.12 ± 0.01 µM versus 1.6 ± 0.17 µM shown in solution. Under optimal conditions, 0.1-2 µM dopamine was specifically and 85.4 nA µM(-1) cm(-2) sensitively detected, with no interference from structurally related catecholamines. The results allow improvement of the robustness of dopamine monitoring by aptamer-modified electrodes in biological systems, within the 0.01-1 µM dopamine fluctuation range.

Poly (acrylic acid) microchannel modification for the enhanced resolution of catecholamines microchip electrophoresis with electrochemical detection.

A new modification of glass electrophoresis microchips based on poly (acrylic) acid immobilization has been performed. It is based on the reaction of PAA with an amine functionalized surface, obtained through the bifunctional reagent 3-aminopropyl triethoxysilane. Parameters affecting all the three steps involved: surface activation, silanization and polymer immobilization were optimized employing soda-lime glass plates. Characterization by SEM and XPS was carried out. Application of the modified microchips to the separation of a model system: dopamine (D), epinephrine (E) and norepinephrine (NE), that on the other hand are of high clinical relevance was performed employing amperometric detection. Modification is necessary for obtaining partial resolution of all the three analytes in a microchip with an effective separation length of 30 mm. Situation changes from no resolution (Rs) at all (only one peak was achieved for the mixture) to a partial resolution (Rs D-NE and Rs NE-E are 0.25 and 0.24 respectively). Microchips with 60 mm of separation channel were also modified, implying this procedure a resolution enhancement (Rs of 0.49 and 0.28 for D-NE and NE-E respectively), even when methanol is employed as organic modifier (Rs values of 0.70 (D-NE) and 0.66 (NE-E) for a 3% MeOH).

Use of quinoline alkaloids as markers of the floral origin of chestnut honey.

To identify potential floral markers of chestnut honey, the phytochemicals present in chestnut floral nectar collected by bees were analyzed. Two nitrogen-containing compounds were detected, isolated, and identified as 4-hydroxyquinaldic acid (kynurenic acid) and 4-quinolone-2-carboxylic acid by (1)H NMR and (13)C NMR. In addition, chestnut nectar contained the monoterpene 4-(1-hydroxy-1-methylethyl)cyclohexa-1,3-diene-1-carboxylic acid, its gentiobioside ester, and the flavonol quercetin 3-pentosylhexoside. These nectar markers were found in different chestnut unifloral honey samples, although the flavonol was not detected in all samples analyzed. The terpenoid derivatives had previously been found in linden and tilia honeys. These results show that quinoline alkaloids are potentially good markers of chestnut honey, as they were not detected in any other unifloral honey analyzed so far. They are present at concentrations ranging from 34 to 65 mg/100 g of honey in the samples analyzed. In addition, the terpenoid and flavonoid derivatives present in nectar, although not exclusively characteristic of this floral origin, are good complementary markers for the determination of the floral origin of chestnut honey.

Complication of surgery for scoliosis in children with surgically corrected congenital cardiac malformations.

INTRODUCTION: There is a high incidence of scoliosis in patients who have undergone cardiothoracic surgery for correction of congenital cardiac disease, this risk being 10 times higher than in the general population. MATERIALS AND METHODS: So as to analyse the surgical and postoperative complications, we designed a retrospective study to include every child who underwent spinal orthopaedic surgery, and who had previously undergone cardiothoracic surgery because of a congenital cardiac malformation. We excluded those patients who had syndromes associated with the development of scoliosis. RESULTS: We identified 18 patients with surgically treated congenital cardiac disease who had undergone surgery for scoliosis over a period of 7 years. This group came from a total number of 87 patients undergoing spinal fusion over the same period. Of those with congenitally malformed hearts, 61% had acyanotic lesions, with ventricular septal defect being the most frequent single lesion, present in 40%. All the patients needed blood transfusions during the surgery, with aprotinin used in 73% to reduce the bleeding, and inotropes needed for 4 children. During the immediate postoperative period, 1 patient died in the first 24 hours, while 7 (39%) had different complications, pneumonia in 4, pleural effusions in 2, and rhabdomyolysis in the other, as opposed to a rate of complications of 27% in patients without heart disease. CONCLUSION: The surgical and postoperative complications in these patients depend on the specific cardiac lesion. A multidisciplinary team with experience in the treatment of congenitally malformed hearts is essential for appropriate management of these patients.

Risk factors for candidemia in pediatric patients with congenital heart disease.

OBJECTIVE: To identify the main risk factors for the acquisition of candidemia in children with congenital heart disease (CHD) in order to improve the clinical management of these patients. DESIGN: A case-control study. SETTING: A large tertiary-care referral center in Spain with a pediatric intensive care unit (PICU) to which more than 500 children with CHD are admitted annually. PATIENTS: All patients had CHD and were admitted to the PICU during 1995-2000. Case patients were defined as patients with candidemia, and control patients were defined as patients without candidemia. RESULTS: Twenty-eight case patients and 47 control subjects were included in the study. Case patients were younger (mean age [+/-SD], 12.5+/-32.0 vs 38.0+/-48.0 months; P<.01) and had a longer median PICU stay (19 vs 4 days; P<.01), and a greater percentage of case patients previously had Candida species isolated from specimens other than blood (eg, bronchial aspirates, urine, or skin specimens) (39% vs 4%; P<.01). Severity of clinical condition, as measured by the Therapeutic Intervention Scoring System (TISS) 1 week after PICU admission (odds ratio, 1.15; 95% confidence interval, 1.05-1.26; P<.01), and receipt of antibiotic treatment for more than 5 days (odds ratio, 13.42; 95% confidence interval, 1.31-137.13; P=.03) were independently associated with the development of candidemia. CONCLUSIONS: Patients with CHD who have a high TISS score 1 week after PICU admission and patients who have received prolonged antibiotic therapy should be considered at high risk for candidemia. Our results suggest that shorter courses of antibiotic therapy, routine surveillance culture for Candida species, and initiation of preemptive or empirical antifungal treatment could help in the clinical management of these patients.

Candidemia in pediatric patients with congenital heart disease.

Candidemia is an important problem in pediatrics. In our hospital, highest candidemia rates were documented among children with congenital heart disease (CHD). A series was conducted to describe the clinical and mortality features of candidemia in these patients. Fifty-two cases (1988-2000) included very young infants (median age, 2 months) who received long-term antibiotic treatment (median, 20.5 days). Candida parapsilosis predominated (54%). Endovascular infections occurred in 11.5%. In-hospital mortality was 39% and related mortality 14%. Maintenance of catheter (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.0-37.2; P = .05) and severity of patients as measured with the Pediatric Risk Score of Mortality I (OR, 1.1, 95% CI, 1.0-1.3; P = .05) were independently associated with mortality. In summary, candidemia in children with CHD is diagnosed to very young infants with prolonged antibiotic therapy. Mortality is high but, in most cases, is not related to candidemia. Optimal management may include exclusion of endocarditis, early antifungal treatment, and catheter removal.

Morphotypic and genotypic characterization of sequential Candida parapsilosis isolates from an outbreak in a pediatric intensive care unit.

Candidemia outbreaks that due to cross-infection are an emerging problem in hospitals. Typing of microorganisms is an essential tool for understanding the epidemiologic aspects of the infection. Techniques based on phenotypic characteristics are inexpensive and easy to perform but are limited by their lack of reproducibility. This study assessed the value of several phenotypic and genotypic techniques that are used in epidemiologic investigations of Candida parapsilosis in clinical practice and used a combination of these methods to analyze outbreak of C. parapsilosis candidemia. Random amplification of polymorphic DNA polymerase chain reaction with several primers was unsatisfactory because it lacked discriminatory power. By simplifying the reading of the morphotypes, we increased their reproducibility for each malt agar and 2,3,5-triphenyltetrazolium media (97% and 90%) and thus their suitability for its use. The combination of electrophoretic karyotype and the simplified morphotypes was rapid and practical to characterize the different clusters involved in the intensive care unit outbreak.

Prognosis of child recipients of hematopoietic stem cell transplantation requiring intensive care.

OBJECTIVE: To determine prognostic factors in child recipients of hematopoietic stem cell transplantation from blood or bone marrow (BMT) requiring critical care. DESIGN: Retrospective study of a cohort of patients. SETTING: Pediatric Intensive Care Unit (PICU) in a university tertiary care center. PATIENTS AND PARTICIPANTS: Child recipients of BMT requiring PICU admission. MEASUREMENTS AND RESULTS: Of the 151 children receiving transplants in our institution, 44 (29.1%) had 49 admissions to the PICU. Mechanical ventilation (MV) was required in 34 patients (69.4% of all admissions). Overall mortality was 31/44 (70.4%). Mortality in patients requiring MV and not requiring MV was 26/34 (76.5%) and 5/10 (50%), respectively. The following variables were significantly associated with mortality in the univariate analysis: male gender (P=0.02), older age (P=0.03), acute graft versus host disease (aGVHD) grades III or IV (P=0.01), severe hemorrhagic cystitis (P=0.01), the diagnosis of lung injury (P=0.04), the need for MV (P=0.03) or for renal replacement therapy (P=0.02), the presence of respiratory (P=0.003), cardiovascular (P=0.009) or gastrointestinal (P=0.01) failures, and the failure of > or =3 organs (P=0.01). In the multivariate analysis, the presence of aGVHD grades III or IV, male gender, severe hemorrhagic cystitis, and the failure of > or =3 organs were found to be independent predictors of mortality. CONCLUSIONS: The need for intensive care is common among child recipients of a BMT. These patients have a high mortality rate but some complications are reversible with critical care support. Certain clinical parameters are useful to establish a realistic prognosis and to optimize the use of the available resources.