Regioselective Synthesis of the Tetrahydrocarbazole Core of Akuammiline Alkaloids via Palladium-Catalyzed Intramolecular Arylation Reaction.

Tetrahydrocarbazole is the central core for several biologically active alkaloids, and regioselective synthesis of this core is a challenging task. Herein, we report an efficient strategy for the synthesis of this core involving palladium-catalyzed intramolecular arylation reaction with excellent regioselectivity (>99%) starting from N-phenyl-bromoalkene without having any relocation of double bonds via competitive palladium-catalyzed isomerization reaction. Broad functional group tolerance and exclusive regioselectivity have been observed for meta-substituted halide substrates. Furthermore, this reaction can be scalable on the gram scale.

Molecular Diagnosis of Facioscapulohumeral Muscular Dystrophy in Patients Clinically Suspected of FSHD Using Optical Genome Mapping.

Background and Objectives: Facioscapulohumeral muscular dystrophy (FSHD) represents the third most common muscular dystrophy in the general population and is characterized by progressive and often asymmetric muscle weakness of the face, upper extremities, arms, lower leg, and hip girdle. In FSHD type 1, contraction of the number of D4Z4 repeats to 1-10 on the chromosome 4-permissive allele (4qA) results in abnormal epigenetic derepression of the DUX4 gene in skeletal muscle. In FSHD type 2, epigenetic derepression of the DUX4 gene on the permissive allele (4qA) with normal-sized D4Z4 repeats (mostly 8-20) is caused by heterozygous pathogenic variants in chromatin modifier genes such as SMCHD1, DNMT3B, or LRIF1. We present validation of the optical genome mapping (OGM) platform for accurate mapping of the D4Z4 repeat size, followed by diagnostic testing of 547 cases with a suspected clinical diagnosis of FSHD and next-generation sequencing (NGS) of the SMCHD1 gene to identify cases with FSHD2. Methods: OGM with Bionano Genomics Saphyr and EnFocus FSHD analysis software was used to identify FSHD haplotypes and D4Z4 repeat number and compared with the gold standard of Southern blot-based diagnosis. A custom Agilent SureSelect enrichment kit was used to enrich SMCHD1, followed by NGS on an Illumina system with 100-bp paired-end reads. Copy number variants were assessed using NxClinical software. Results: We performed OGM for the diagnosis of FSHD in 547 patients suspected of FSHD between December 2019 and December 2022, including 301 male (55%) and 246 female patients (45%). Overall, 308 of the referred patients were positive for D4Z4 contraction on a permissive haplotype, resulting in a diagnosis of FSHD1. A total of 252 of 547 patients were referred for concurrent testing for FSHD1 and FSHD2. This resulted in the identification of FSHD2 in 9/252 (3.6%) patients. In our FSHD2 cohort, the 4qA allele size ranged from 8 to 18 repeats. Among FSHD1-positive cases, 2 patients had biallelic contraction and 4 patients had homozygous contraction and showed early onset of clinical features. Nine of the 308 patients (3%) positive for 4qA contraction had mosaic 4q alleles with contraction on at least one 4qA allele. The overall diagnostic yield in our cohort was 58%. Discussion: A combination of OGM to identify the FSHD haplotype and D4Z4 repeat number and NGS to identify sequence and copy number variants in the SMCHD1 gene is a practical and cost-effective option with increased precision for accurate diagnosis of FSHD types 1 and 2.

ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update.

Vertebral compression fractures (VCFs) can have a variety of etiologies, including trauma, osteoporosis, or neoplastic infiltration. Osteoporosis related fractures are the most common cause of VCFs and have a high prevalence among all postmenopausal women with increasing incidence in similarly aged men. Trauma is the most common etiology in those >50 years of age. However, many cancers, such as breast, prostate, thyroid, and lung, have a propensity to metastasize to bone, which can lead to malignant VCFs. Indeed, the spine is third most common site of metastases after lung and liver. In addition, primary tumors of bone and lymphoproliferative diseases such as lymphoma and multiple myeloma can be the cause of malignant VCFs. Although patient clinical history could help raising suspicion for a particular disorder, the characterization of VCFs is usually referred to diagnostic imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Targeting mTOR and Survivin Concurrently Potentiates Radiation Therapy in Renal Cell Carcinoma by Suppressing DNA Damage Repair and Amplifying Mitotic Catastrophe.

Background: Renal cell carcinoma (RCC) was historically considered to be less responsive to radiation therapy (RT) compared to other cancer indications. However, advancements in precision high-dose radiation delivery through single-fraction and multi-fraction stereotactic ablative radiotherapy (SABR) have led to better outcomes and reduced treatment-related toxicities, sparking renewed interest in using RT to treat RCC. Moreover, numerous studies have revealed that certain therapeutic agents including chemotherapies can increase the sensitivity of tumors to RT, leading to a growing interest in combining these treatments. Here, we developed a rational combination of two radiosensitizers in a tumor-targeted liposomal formulation for augmenting RT in RCC. The objective of this study is to assess the efficacy of a tumor-targeted liposomal formulation combining the mTOR inhibitor everolimus (E) with the survivin inhibitor YM155 (Y) in enhancing the sensitivity of RCC tumors to radiation. Experimental Design: We slightly modified our previously published tumor-targeted liposomal formulation to develop a rational combination of E and Y in a single liposomal formulation (EY-L) and assessed its efficacy in RCC cell lines in vitro and in RCC tumors in vivo. We further investigated how well EY-L sensitizes RCC cell lines and tumors toward radiation and explored the underlying mechanism of radiosensitization. Results: EY-L outperformed the corresponding single drug-loaded formulations E-L and Y-L in terms of containing primary tumor growth and improving survival in an immunocompetent syngeneic mouse model of RCC. EY-L also exhibited significantly higher sensitization of RCC cells towards radiation in vitro than E-L and Y-L. Additionally, EY-L sensitized RCC tumors towards radiation therapy in xenograft and murine RCC models. EY-L mediated induction of mitotic catastrophe via downregulation of multiple cell cycle checkpoints and DNA damage repair pathways could be responsible for the augmentation of radiation therapy. Conclusion: Taken together, our study demonstrated the efficacy of a strategic combination therapy in sensitizing RCC to radiation therapy via inhibition of DNA damage repair and a substantial increase in mitotic catastrophe. This combination therapy may find its use in the augmentation of radiation therapy during the treatment of RCC patients.

Use of disposable needle hub for decompression of large dentigerous cyst: A case report.

Developmental cysts are commonly seen in children, dentigerous cyst is one among them. Cysts associated with vital structures like erupting permanent teeth have to be treated more conservatively. Marsupialization or decompression is more routinely done procedures; the only hitch is maintaining the patency of the window. Various materials are being tried like customized acrylic stents, plastic tubings, disposable suction tips, etc. We want to present a case of decompression of maxillary dentigerous cyst with the use of readily available disposable syringe hub. Syringe hub is cut and trimmed to adapt to the edges of the window created for decompression and stabilized with sutures. It causes less tissue trauma and the larger outer rim provides retention for the stent. Disposable anesthetic syringe hubs can be additional material for decompression with better handling and usage.

Comparative study of tissue adhesive therapy versus band ligation in control of actively bleeding esophageal varices.

BACKGROUND AND STUDY AIMS: Bleeding esophageal varices is a common life-threatening emergency that carries a significant morbidity and mortality. Acute variceal bleeding is considered active when spurting and/or oozing varix is seen at the time of endoscopy, or inactive in the presence of large esophageal varices with blood in the stomach with no other bleeding source at the time of endoscopy. Aim: comparing endoscopic variceal ligation (EVL) versus cyanoacrylate injection (CI) in active esophageal variceal bleeding control. PATIENTS AND METHODS: a retrospective single tertiary center study from April 2014 to February 2018, including 401 patients with active esophageal variceal bleeding. RESULTS: Endoscopic hemostasis was achieved by both endoscopic variceal ligation in 182 patients (91.9%) and cyanoacrylate injection in 197 patients (97.05%) without significant difference (P value 0. 15). Re-bleeding occurred more frequently in EVL group 20 patients (10.1%) compared to 14 patients (6.9%) in CI (P value 0.01). Early six-week Mortality was higher among EVL group (20.7%) compared to CI (17.2%) without statistical significance (P value 0.3). CONCLUSION: Both EVL and CI are almost as effective in achieving endoscopic hemostasis. CI is more effective, feasible, and could be used as a salvage therapy and/or spared for risky active bleeding esophageal varices.

Operational Global Actual Evapotranspiration: Development, Evaluation and Dissemination.

Satellite-based actual evapotranspiration (ETa) is becoming increasingly reliable and available for various water management and agricultural applications from water budget studies to crop performance monitoring. The Operational Simplified Surface Energy Balance (SSEBop) model is currently used by the US Geological Survey (USGS) Famine Early Warning System Network (FEWS NET) to routinely produce and post multitemporal ETa and ETa anomalies online for drought monitoring and early warning purposes. Implementation of the global SSEBop using the Aqua satellite's Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature and global gridded weather datasets is presented. Evaluation of the SSEBop ETa data using 12 eddy covariance (EC) flux tower sites over six continents indicated reasonable performance in capturing seasonality with a correlation coefficient up to 0.87. However, the modeled ETa seemed to show regional biases whose natures and magnitudes require a comprehensive investigation using complete water budgets and more quality-controlled EC station datasets. While the absolute magnitude of SSEBop ETa would require a one-time bias correction for use in water budget studies to address local or regional conditions, the ETa anomalies can be used without further modifications for drought monitoring. All ETa products are freely available for download from the USGS FEWS NET website.

Comparison between antral resection in laparoscopic sleeve gastrectomy and classical laparoscopic sleeve gastrectomy

Background: Laparoscopic sleeve gastrectomy (LSG) is essentially a restrictive bariatric operation. Weight loss is achieved by drastically reducing the gastric volume, which in turn leads to reduced food intake. In addition, a series of hormonal changes occurring postoperatively in bariatric patients, contribute to decreased appetite, reduced food intake and long-term weight loss. To date there is a lack of standardization regarding the surgical technique of LSG, which may affect the long-term outcome of the patients. Our study aimed to assess the difference in short and long- term weight loss and complications between antral resection in laparoscopic sleeve gastrectomy and classical laparoscopic sleeve gastrectomy with antral preservation. Patients and Methods: This is a controlled clinical trial held in Ain Shams University Hospital including 40 patients with BMI >30, of them 20 underwent antral resection in laparoscopic sleeve gastrectomy, and the other 20 patients underwent classical laparoscopic sleeve gastrectomy, with antral preservation. Results: Our study showed mild increase in weight loss and BMI reduction after 12 months in the antral resection group compared with the antral preservation group with mean weight loss 70.5kg in antral resection group versus 75.05kg in antral preservation group and mean BMI 27.7% in antral resection group versus 27.9% in antral preservation group, but did not reach statistical significant values. Conclusion: Our study showed that antral resection in laparoscopic sleeve gastrectomy resulted in non-significant better weight loss in the first postoperative year than classical laparoscopic sleeve gastrectomy

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Clinical utility of PCA3 assay in patients with suspicious prostate cancer

Background: this study evaluated the clinical utility of the PCA3 assay in guiding initial biopsy decisions in prostate cancer. Subjects and Methods: this study was conducted on fifty patients selected from the Urology Department at Ain Shams University Hospitals and scheduled for prostate biopsy after digital rectal examination first catch urine was collected. PCA3 scores were determined using RT-PCR and compared to biopsy outcome. The diagnostic accuracy of PCA3 was compared to total prostate specific antigen and %free prostate specific antigen. Results: the best cutoff for PCA3 was 4.6 folds (RQ). This cutoff had a diagnostic sensitivity of 94.7%, specificity 95% and area under the curve (AUC) was 0.978. Total PSA at the cutoff 10 ng/mL had a diagnostic sensitivity 68%, specificity 70% and AUC was 0.766. At cut off 19%, f/t PSA ratio had a diagnostic sensitivity 38%, diagnostic specificity 90 %, and AUC was 0.529. Conclusions: the PCA3 assay can aid in guiding biopsy decisions. It is superior to total prostate specific antigen and %free prostate specific antigen in predicting initial biopsy outcome, and may be indicative of prostate cancer aggressiveness

Moment to moment variability in functional brain networks during cognitive activity in EEG data.

Functional brain networks (FBNs) are gaining increasing attention in computational neuroscience due to their ability to reveal dynamic interdependencies between brain regions. The dynamics of such networks during cognitive activity between stimulus and response using multi-channel electroencephalogram (EEG), recorded from 16 healthy human participants are explored in this research. Successive EEG segments of 500[Formula: see text]ms duration starting from the onset of cognitive stimulation have been used to analyze and understand the cognitive dynamics. The approach employs a combination of signal processing techniques, nonlinear statistical measures and graph-theoretical analysis. The efficacy of this approach in detecting and tracking cognitive load induced changes in EEG data is clearly demonstrated using graph metrics. It is revealed that most cognitive activity occurs within approximately 500[Formula: see text]ms of the stimulus presentation in addition to temporal variability in the FBNs. It is shown that mutual information (MI), a nonlinear measure, produces good correlations between the EEG channels thus enabling the construction of FBNs which are sensitive to cognitive load induced changes in EEG. Analyses of the dynamics of FBNs and the visualization approach reveal hard to detect subtle changes in cognitive function and hence may lead to a better understanding of cognitive processing in the brain. The techniques exploited have the potential to detect human cognitive dysfunction (impairments).

Nutritional composition of two wild mushrooms consumed by the tribals of the Western Ghats of India.

This study provides the nutritional qualities of two wild mushrooms (Agaricus abruptibulbus and Termitomyces globulus) commonly consumed by the tribals of Kaiga forests of the Western Ghats of India. Both mushrooms composed of high quantity of crude protein, crude fibre, calorific value and low quantity of crude lipid. Potassium and selenium contents were high, while sodium, calcium and phosphorus contents were low. Except for three essential amino acids (EAAs: leucine, tyrosine and lysine), the rest of the amino acids in both mushrooms were comparable to soybean and wheat. Based on the EAA standards of FAO-WHO, these mushrooms composed of high quantity of threonine, isoleucine and histidine. The EAA score of isoleucine in cooked A. abruptibulbus and threonine, isoleucine, phenylalanine, histidine and sulphur amino acids in cooked T. globulus were substantially high. Oleic acid constitutes a major unsaturated fatty acid in these mushrooms, which was significantly increased in cooked A. abruptibulbus. Cooking also increased the ratio of TUFA/TSFA in A. abruptibulbus, while it was opposite in T. globulus. Cooking significantly increased the linoleic acid in A. abruptibulbus and eicosadienoic acid in T. globulus.

Cubosomes as targeted drug delivery systems - a biopharmaceutical approach.

Cubosomes are reversed bicontinuous cubic phases and possess unique physicochemical properties. These special systems are receiving much attention for the delivery of various hydrophilic, hydrophobic and amphiphilic drugs with enhanced bioavailability and high loading capacity. A wide variety of drugs are applicable for cubosome formulation for various routes of delivery. The lipids used in cubosome formulation are more stable and offer stability to the formulation during shelf-life. The article reviews about the back ground, techniques of cubosome preparation such as high pressure homogenization, probe ultrasonication and automated cubosome preparation; and also methods of cubosomes preparation such as top down, bottom up and other methods with pictorial presentation. This article emphasizes the phase transition and also targeted approaches of cubosomes. The characterization studies for cubosomes such as cryo transmission electron microscopy, differential scanning calorimetry and scanning electron microscopy followed by in-vitro and in-vivo evaluation studies of cubosomes were explained with appropriate examples. Recent applications of cubosomes were explained with reference to flurbiprofen, odorranalectin, diazepam and dexamethasone. The advantages, disadvantages and limitations of cubosomal technology were emphasized.

Hürthle cell thyroid carcinoma presenting as a "hot" nodule.

OBJECTIVE: To report an unusual clinical scenario and a rare histopathologic finding of Hürthle cell thyroid carcinoma in a patient with an autonomous thyroid nodule. METHODS: We describe the presentation and clinical course leading to the surprising histopathologic diagnosis of Hürthle cell carcinoma in a pediatric patient who was diagnosed with hyperthyroidism presenting as a solitary toxic nodule. RESULTS: A 13-year-old white girl presented with a recent history of a palpable thyroid nodule during a routine primary care clinic visit. She was asymptomatic, and thyroid function tests revealed a suppressed thyrotropin concentration, high-normal free thyroxine concentration, and elevated triiodothyronine concentration. The patient underwent dedicated thyroid ultrasonography revealing a 3.5-cm complex mass in the left lobe with increased central vascularity. Iodine 123 imaging of the thyroid demonstrated homogenous, hyperintense activity in the left lobe. The right lobe was not visualized. A solitary toxic nodule was diagnosed, and, considering her age, she was referred for surgical management. The patient underwent a left lobectomy with isthmusectomy. Pathologic examination revealed a 5-cm, encapsulated, well-differentiated Hürthle cell carcinoma with negative margins and no lymphovascular invasion. The patient underwent subsequent completion thyroidectomy with no evidence of residual carcinoma in the right thyroid lobe. CONCLUSIONS: Malignancy in autonomously functioning thyroid nodules is rare. Most of the thyroid nodules presenting as "hot" on radioiodine scintigraphy are benign follicular adenomas. However, this case represents a rare clinical entity, and it highlights the need for clinicians to be vigilant and aware that occasionally carcinomas can masquerade as scintigraphic "hot" nodules.

The spatial distribution of fungi on decomposing woody litter in a freshwater stream, Western Ghats, India.

We mapped filamentous fungal association with mechanically "hard" and "soft" woody litter naturally deposited in a stream of the Western Ghats of India. Using a durometer (rubber hardness tester), the toughness of surface of wood collected from stream was determined by considering durometer reading from 60-72 to 30-37 as hardwood and softwood, respectively. From each wood (1.5 cm diameter), two segments each of 3 cm length were excised and vertically cut into nine sections comprising eight marginal and one central section. From three stream locations, hardwood and softwood sections were assessed for the occurrence of lignicolous and Ingoldian fungi. A first set of wood sections was incubated in damp chambers up to 4 months with periodical screening (every 2 weeks) for lignicolous fungi. Another set was incubated in bubble chambers up to 72 h to ascertain colonization of Ingoldian fungi. In hardwood sections, 17 lignicolous fungi (ascomycetes, four; mitosporic fungi, 13; mean, 6.8; range, 6-8/section) and ten Ingoldian fungi (mean, 2; range, 0-4/section) comprising nine lignicolous (11.1-40.7%) and three Ingoldian (11.1-14.8%) fungi as core-group taxa were recovered. In softwood, ten lignicolous fungi (ascomycetes, 0; mitosporic fungi, ten; mean, 3.8; range, 2-5/section) and 26 Ingoldian fungi (mean, 8.1; range, 5-10/section) comprising six lignicolous (11.1-85.2%) and 12 Ingoldian (11.1-88.9%) fungi as core-group taxa were recovered. The ratio of lignicolous fungi/Ingoldian fungi was higher in hardwood than softwood (1.7 vs. 0.4). The spore output of Ingoldian fungi was higher in softwood (mean, 901 g(-1); range, 80-2546 g(-1)) than hardwood (mean, 21 g(-1); range, 0-140 g(-1)). The Shannon diversity of lignicolous fungi was higher in hardwood than softwood (3.604 vs. 2.665), whereas it was opposite for Ingoldian fungi (3.116 vs. 3.918). The overall fungal diversity was higher in softwood than hardwood (4.413 vs. 4.219). The range of Jaccard's index of similarity among wood sections was higher in lignicolous fungi (8-71% and 13-75%) than Ingoldian fungi (0-50% and 8-55%) in hardwood and softwood. The rarefaction indices of expected number of taxa against hardwood sections revealed higher and persistent lignicolous fungi than the Ingoldian fungi, while the Ingoldian fungi were persistent in softwood sections, although they were lower than lignicolous fungi. Our study demonstrated the dominance of lignicolous fungi and Ingoldian fungi in hardwood and softwood, respectively.

Inpatient glycemic control: an evolving paradigm.

In 2001, Van den Berghe et al published a landmark study of intensive insulin therapy in the setting of a surgical intensive care unit (ICU). Increased attention was also focused on the observational evidence indicating that hyperglycemia is associated with increased morbidity and mortality among diverse patient populations. Because of the dramatic reduction in mortality with normalization of glucose levels in the single center, the Van den Berghe study led to widespread adoption of this practice in ICUs worldwide. Hospitals also began to implement rational subcutaneous insulin protocols based on the American Diabetes Association technical review, replacing the ineffective practice of sliding-scale insulin. Logistical challenges have included coordination of multiple hospital departments and achieving multidisciplinary consensus on goals and methods. Subsequent to the initial Van den Berghe study, other multicenter trials have been fraught with an increased frequency of hypoglycemia and have failed to consistently demonstrate improved outcomes with intensive insulin therapy. Hospitals and expert panels are in the process of examining the combined evidence and considering modifying treatment goals. We recommend continued focus on avoiding hyperglycemia with less aggressive glycemic targets in the critically ill and rational subcutaneous insulin in the noncritically ill, avoiding a return to the obsolescence of sliding-scale insulin.

Retinoic acid can induce markers of endocrine transdifferentiation in pancreatic ductal adenocarcinoma: preliminary observations from an in vitro cell line model.

BACKGROUND AND HYPOTHESIS: The pancreatic ductal adenocarcinoma (HPAF) cells have a multipotent stem cell potential. It was hypothesised that all-trans-retinoic acid (atRA) can induce transdifferentiation of these cells into cells with an endocrine phenotype. MATERIAL AND METHODS: To explore this hypothesis, an in vitro system of cells was established. Some cells were treated with atRA at concentrations of 100 nmol/l (non-apoptosis-inducing) and 5 micromol/l (apoptosis-inducing) and harvested. Cells were examined for cell cycle kinetics, apoptosis (terminal deoxynucleotidyl transferase assay and p53 protein expression) and immunomorphological features of redifferentiation (MUC1 and DUPAN-2) and endocrine transdifferentiation (insulin, somatostatin, glucagon, neurone-specific enolase) by using immunoperoxidase staining methods. Levels of insulin, transforming growth factor (TGF) beta2, TGFalpha and epidermal growth factor receptor (EGFR) were measured by enzyme-linked immunosorbent assay (ELISA). The vehicle-treated cells served as a control group. RESULTS: When compared with untreated cells, cells treated with 100 nmol/l and 5 micromol/l atRA were observed to show (1) decreased proliferative activity (cpm) as indicated by decreased incorporation of thymidine labelled with hydrogen-3; (2) cell cycle arrest; (3) increased apoptotic activity associated with p53 protein overexpression; (4) upregulated expression of the transdifferentiation and redifferentiation markers; (5) morphological changes indicative of transdifferentiation (increased cell size and appearance of dendrites); (6) decreased production of EGFR; (7) upregulation of TGFalpha and TGFbeta2; and (8) increase in basal and glucose-induced insulin secretion. CONCLUSIONS: Functional endocrine transdifferentiation can be induced in HPAF lines by atRA. Further investigations are mandated to explore the underlying mechanisms of this transdifferentiation and to explore its in vivo extrapolation.

Device-related nosocomial infection in intensive care units of Alexandria University Students Hospital.

We studied the magnitude and determinants of device-related nosocomial infections in intensive care units (ICU) and identified the predominant microorganisms involved. Sputum, urine, blood cultures and chest X-ray were taken from each patient on admission and on appearance of any sign/symptom of infection. Out of 400 patients admitted to 3 units during the study, 45 (11.3%) developed nosocomial infections. The most important determinants of infection were previous admission to an ICU, whether in the same or another hospital, and duration of stay. Overall, 38 patients developed 43 device-related nosocomial infections (1.13 episodes per patient). The main infectied association with invasive procedures were ventilator-associated pneumonia followed by catheter-related urinary tract infection and bloodstream infections.

Device-related nosocomial infection in intensive care units of Alexandria University Students Hospital

We studied the magnitude and determinants of device-related nosocomial infections in intensive care units [ICU] and identified the predominant microorganisms involved. Sputum, urine, blood cultures and chest X-ray were taken from each patient on admission and on appearance of any sign/symptom of infection. Out of 400 patients admitted to 3 units during the study, 45 [11.3%] developed nosocomial infections. The most important determinants of infection were previous admission to an ICU, whether in the same or another hospital, and duration of stay. Overall, 38 patients developed 43 device-related nosocomial infections [1.13 episodes per patient]. The main infectied association with invasive procedures were ventilator-associated pneumonia followed by catheter-related urinary tract infection and bloodstream infections