Decrease in platelet count in patients with AKI and its association with major adverse kidney events.

INTRODUCTION: A reduction in platelet count in critically ill patients is a marker of severity of the clinical condition. However, whether this association holds true in acute kidney injury (AKI) is unknown. We analyzed the association between platelet reduction in patients with AKI and major adverse kidney events (MAKE). METHODS: In this retrospective cohort, we included AKI patients at the Hospital Civil of Guadalajara, in Jalisco, Mexico. Patients were divided according to whether their platelet count fell >21% during the first 10 days. Our objectives were to analyze the associations between a platelet reduction >21% and MAKE at 10 days (MAKE10) or at 30-90 days (MAKE30-90) and death. RESULTS: From 2017 to 2023, 400 AKI patients were included, 134 of whom had a > 21% reduction in platelet count. The mean age was 54 years, 60% were male, and 44% had sepsis. The mean baseline platelet count was 194 x 103 cells/µL, and 65% of the KDIGO3 patients met these criteria. Those who underwent hemodialysis (HD) had lower platelet counts. After multiple adjustments, a platelet reduction >21% was associated with MAKE10 (OR 4.2, CI 2.1-8.5) but not with MAKE30-90. The mortality risk increased 3-fold (OR 2.9, CI 1.1-7.7, p = 0.02) with a greater decrease in the platelets (<90 x 103 cells/µL). As the platelets decreased, the incidence of MAKE was more likely to increase. These associations lost significance when accounting for starting HD. CONCLUSION: In our retrospective cohort of patients with AKI, a > 21% reduction in platelet count was associated with MAKE. Our results are useful for generating hypotheses and motivating us to continue studying this association with a more robust design.

A reduction in platelet count in critically ill patients has been associated with a worse prognosis, but it is not yet known whether this relationship also exists in patients with acute kidney injury, who are more susceptible to platelet decrease due to the syndrome or due to the onset of hemodialysis. In our study of acute kidney injury patients, we found that those whose platelet count decreased >21% during the first days were more likely to experience a major kidney event. In addition, the greater the decrease in platelet count was, the more likely these events were to occur. The significance of this association was lost in patients who start hemodialysis. Our conclusions could serve to generate hypotheses about this interesting relationship.

Blood transfusion reactions and risk of acute kidney injury and major adverse kidney events.

BACKGROUND: Blood transfusion reactions may have a negative impact on organ function. It is unknown whether this association holds true for acute kidney injury (AKI). Therefore, we conducted a cohort study to assess the association between transfusion reactions and the incidence of AKI and major adverse kidney events. METHODS: In this retrospective cohort study, we included patients who received transfusion of blood products during hospitalization at the Hospital Civil of Guadalajara. We analyzed them according to the development of transfusion reactions, and the aim was to assess the association between transfusion reactions and AKI during long-term follow-up. RESULTS: From 2017 to 2021, 81,635 patients received a blood product transfusion, and 516 were included in our study. The most common transfusion was red blood cell packaging (50.4%), fresh frozen plasma (28.7%) and platelets (20.9%); of the 516 patients, 129 (25%) had transfusion reactions. Patients who had transfusion reactions were older and had more comorbidities. The most common type of transfusion reaction was allergic reaction (70.5%), followed by febrile nonhemolytic reaction (11.6%) and anaphylactoid reaction (8.5%). Most cases were considered mild. Acute kidney injury was more prevalent among those who had transfusion reactions (14.7%) than among those who did not (7.8%), p = < 0.01; those with AKI had a higher frequency of diabetes, vasopressors, and insulin use. Transfusion reactions were independently associated with the development of AKI (RR 2.1, p = < 0.02). Major adverse kidney events were more common in those with transfusion reactions. The mortality rate was similar between subgroups. CONCLUSION: In our retrospective cohort of patients who received blood product transfusions, 25% experienced transfusion reactions, and this event was associated with a twofold increase in the probability of developing AKI and some of the major adverse kidney events during long follow-up.

Introduction of Breast Implants through the Abdominal Route: Analysis of a Cohort.

BACKGROUND: Simultaneous breast reshaping and abdominoplasty offer patients the opportunity to undergo body reshaping in a single surgical session involving one anesthesia induction and one incision. In Latin America, abdominal implant placement is an infrequently used technique, likely because there is little evidence on its efficacy and safety. This study aimed to evaluate the efficacy and safety of implant placement through the abdominal route. METHODS: A retrospective cohort was analyzed, including 350 records of patients who underwent abdominal breast implants from 2013 to 2021 with a minimum follow-up of 1 year. The procedure was performed under epidural anesthesia. RESULTS: No intraoperative complications were reported. After a minimum 12-month follow-up, complications were detected in 5% of cases; the most frequent was asymmetry (4.6%), followed by abdominal migration and one case of symmastia. During the follow-up period, no capsular contracture was detected in any case. A satisfaction percentage of 98.1% was obtained. The only independent factor associated with complications was distance from the sternal notch to the nipple-areola complex greater than 21 cm. CONCLUSION: In this case series, mammaplasty with abdominal implant placement was an effective and safe procedure, with reduced risk of infection or capsular contracture and no scarring in or near the breasts for patients with properly selected comorbidities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4-5.

INTRODUCTION: In patients with chronic kidney disease stages 4 and 5 (CKD stages 4-5) without dialysis and arterial hypertension, it is unknown if the values of systolic blood pressure (SBP) considered in control (<120 mm Hg) are associated with kidney replacement therapy (KRT) and mortality. METHODS: In this retrospective cohort study, hypertensive CKD stages 4-5 patients attending the Renal Health Clinic at the Hospital Civil de Guadalajara were enrolled. We divided them into those that achieved SBP <120 mm Hg (controlled group) and those who did not (>120 mm Hg), the uncontrolled group. Our primary objective was to analyze the association between the controlled group and KRT; the secondary objective was the mortality risk and if there were subgroups of patients that achieved more benefit. Data were analyzed using Stata software, version 15.1. RESULTS: During 2017-2022, a total of 275 hypertensive CKD stages 4-5 patients met the inclusion criteria for the analysis: 62 in the controlled group and 213 in the uncontrolled group; mean age 61 years; 49.82% were male; SBP was significantly lower in the controlled group (111 mm Hg) compared to the uncontrolled group (140 mm Hg); eGFR was similar between groups (20.41 mL/min/1.73 m2). There was a tendency to increase the mortality risk in the uncontrolled group (HR 6.47 [0.78-53.27]; p = 0.082) and an association by the Kaplan-Meir analysis (Log-rank p = 0.043). The subgroup analysis for risk of KRT in the controlled group revealed that patients ≥61 years had a lower risk of KRT (HR 0.87 [95% CI, 0-76-0.99]; p = 0.03, p of interaction = 0.005), but no differences were found in the subgroup analysis for mortality. In a follow-up of 1.34 years, no association was found in the risk of KRT according to the controlled or uncontrolled groups in a multivariate Cox analysis. CONCLUSION: In a retrospective cohort of patients with CKD stages 4-5 and hypertension, SBP >120 mm Hg was not associated with risk of KRT but could be associated with the risk of death. Clinical trials are required in this group of patients to demonstrate the impact of reaching the SBP goals recommended by the KDIGO guidelines.

Fractura, más allá del trauma / Fracture, beyond trauma

Se expone el caso de un paciente de 19 años, sin antecedentes médicos, con historia de traumatismo en el muslo derecho, que tuvo acortamiento, edema, rotación del miembro inferior derecho y dolor. En la radiografía se identificó una fractura en el tercio proximal de fragmentos múltiples de la diáfisis con engrosamiento y reacción perióstica que generaron una sospecha de un tumor óseo. La resonancia magnética confirmó una neoplasia ósea de características malignas en el tercio superior del fémur con destrucción de la cortical e invasión del canal endomedular sin signos de lesiones metastásicas. La biopsia confirmó el diagnóstico de sarcoma de Ewing localizado. El manejo intrahospitalario consistió en antiinflamatorios e inmovilización del miembro inferior derecho por 21 días. Luego, recibió tres ciclos de quimioterapia con el esquema para sarcoma de Ewing fase I. Además, se indicó terapia física, tratamiento ambulatorio con analgésico, radioterapia y finalmente se practicará la resección parcial de cadera. Se evidenció disminución del edema local, control del dolor con medicamentos orales y recuperación de la movilidad, aunque mantuvo la limitación funcional del miembro inferior derecho que imposibilita la bipedestación y la deambulación

A 19-year-old patient, with no previous medical history, with a history of trauma to the right thigh, presented with shortening, edema, rotation of the right lower limb and pain. Radiography identified a fracture in the proximal third of multiple fragments of the diaphysis with thickening and periosteal reaction that generated a suspicion of a bone tumor. MRI confirmed a bone neoplasm of malignant characteristics in the upper third of the femur with destruction of the cortex and invasion of the end medullary canal without signs of metastatic lesions. The biopsy confirmed the diagnosis of localized Ewing's sarcoma. The intrahospital management consisted of anti-inflammatory drugs and immobilization of the right lower limb for 21 days. Then, she received three cycles of chemotherapy with the Ewing sarcoma phase 1 scheme. In addition, physical therapy, outpatient treatment with analgesic, radiotherapy and finally partial hip resection was indicated. There was a decrease in local edema, pain control with oral medications, mobility was recovered, although the functional limitation of the right lower limb was maintained, making it impossible to stand and walk

Innovative and thorough practice to certify reference materials for sensory defects of olive oil.

An important problem in the olive sector is the occasional mismatch of results obtained by different tasting panels when the same olive oil sample is analysed. These discrepancies could be minimised by using reference materials (RM) for taster training. A comprehensive protocol based on the combined use of sensory and instrumental analysis for the certification of olive oil batches as RMs, developed within the framework of the project 'Operational Group INTERPANEL', is proposed. Similarity indices (R2, cosθ and NEAR) applied on GC-MS fingerprints, allow a successful homogeneity and stability assessment of produced batches. Furthermore, the use of robust statistics combined with a set of instructions developed to remove outliers were applied with excellent results on sensory data set provided by supra-panel composed by more than 100 qualified tasters. This work is the first to provide a comprehensive protocol for certification of real olive oil samples as RM for sensory analysis.

Homogeneity assessment of reference materials for sensory analysis of liquid foodstuffs. The virgin olive oil as case study.

Sensory properties are critical characteristics that determine quality and can be evaluated by trained tasting panels. The panels function as multi-sensor measuring instrument and need the use of reference materials (RMs) for training. The homogeneity between units packaged from a batch of RM can be evaluated by gas chromatography coupled to flame ionization detection (GC-FID), using this instrumental technique as an alternative to sensory analysis. For this purpose, the fingerprint methodology is applied, taking into account that the homogeneity assessment will be based on evaluating the similarity between the fingerprints of the fraction of volatile organic compounds acquired from samples representative of the batch. The proposed methodology is applied with good results to evaluate the homogeneity of several RMs for sensory analysis of virgin olive oil samples, using similarity indices, control charts and exploratory analysis of multivariate data to observe the grouping RM and fingerprint regions representative of each defect.

La enfermedad pulmonar obstructiva crónica infradiagnosticada y su severidad en adultos de 40 a 70 años con infecciones respiratorias a repetición ligados o no al tabaquismo en el Hospital Nacional General de Neumología y Medicina Familiar "Dr. José Antonio Saldaña" en el periodo de junio a diciembre de 2017 / Underdiagnosed chronic obstructive pulmonary disease and its severity in adults aged 40 to 70 years with recurrent respiratory infections linked or not to smoking at the "Dr. José Antonio Saldaña" National General Hospital of Pneumology and Family Medicine in the period from June to December of 2017

La enfermedad pulmonar obstructiva crónica (EPOC) está infra diagnosticada y causa morbilidad y mortalidad alrededor del mundo. Adultos de edad media y adultos mayores con cualquier tipo de enfermedad respiratoria y con historia de tabaquismo tienen una alta probabilidad de tener EPOC infra diagnosticado. El presente estudio tiene por objeto establecer la presencia de Enfermedad Pulmonar Obstructiva Crónica (EPOC) infra diagnosticada y su severidad en adultos mayores de 40 años con infecciones respiratorias a repetición ligados o no al tabaquismo en el Hospital Nacional General de Neumología y Medicina Familiar Saldaña "Dr. José Antonio Saldaña" periodo de junio a diciembre de 2017. Se realizará una investigación de tipo descriptiva de corte transversal en una muestra de 136 pacientes por muestreo no probabilístico de tipo consecutivo. El análisis se realizara con estadística descriptiva en Excel 2010. Los datos obtenidos nos permitirán establecer la prevalencia de una patología que se percibe como infra diagnosticada. Todo paciente que cumplió criterios de inclusión se le realizo espirometrias como método diagnóstico, el cual nos da como resultado en 74.50 % positivas, de las cuales el 84.21 % tienen un patrón obstructivo, siendo el 50.00 % con severidad moderada a la limitación del flujo aéreo, además entre mayor sea la edad mayor es el riesgo de presentar infecciones respiratorias a repetición has

Multivariate approaches for stability control of the olive oil reference materials for sensory analysis - part I: framework and fundamentals.

BACKGROUND: Virgin olive oil is the only food product for which sensory analysis is regulated to classify it in different quality categories. To harmonize the results of the sensorial method, the use of standards or reference materials is crucial. The stability of sensory reference materials is required to enable their suitable control, aiming to confirm that their specific target values are maintained on an ongoing basis. Currently, such stability is monitored by means of sensory analysis and the sensory panels are in the paradoxical situation of controlling the standards that are devoted to controlling the panels. RESULTS: In the present study, several approaches based on similarity analysis are exploited. For each approach, the specific methodology to build a proper multivariate control chart to monitor the stability of the sensory properties is explained and discussed. CONCLUSION: The normalized Euclidean and Mahalanobis distances, the so-called nearness and hardiness indices respectively, have been defined as new similarity indices to range the values from 0 to 1. Also, the squared mean from Hotelling's T2 -statistic and Q2 -statistic has been proposed as another similarity index. © 2018 Society of Chemical Industry.

Multivariate approaches for stability control of the olive oil reference materials for sensory analysis - part II: applications.

BACKGROUND: The organoleptic quality of virgin olive oil depends on positive and negative sensory attributes. These attributes are related to volatile organic compounds and phenolic compounds that represent the aroma and taste (flavour) of the virgin olive oil. The flavour is the characteristic that can be measured by a taster panel. However, as for any analytical measuring device, the tasters, individually, and the panel, as a whole, should be harmonized and validated and proper olive oil standards are needed. RESULTS: In the present study, multivariate approaches are put into practice in addition to the rules to build a multivariate control chart from chromatographic volatile fingerprinting and chemometrics. Fingerprinting techniques provide analytical information without identify and quantify the analytes. This methodology is used to monitor the stability of sensory reference materials. CONCLUSION: The similarity indices have been calculated to build multivariate control chart with two olive oils certified reference materials that have been used as examples to monitor their stabilities. This methodology with chromatographic data could be applied in parallel with the 'panel test' sensory method to reduce the work of sensory analysis. © 2018 Society of Chemical Industry.

Medication errors: electronic vs. paper-based prescribing. Experience at a tertiary care university hospital.

PURPOSE: It has been estimated that medication errors (ME) are responsible for 7000 deaths each year. Some studies show that electronic prescribing systems have achieved health benefits and patient safety, resulting in a saving of resources. Other studies suggest that they may increase adverse events. OBJECTIVE: The objective of this study was to compare medication errors between electronic and paper-based prescription detected during pharmacovigilance. METHODS: This was an observational, cross-sectional comparative study of 600 randomized medical records that were systematically reviewed by a pharmacovigilance team, with a deliberate search for ME. Each error was classified according to its severity, National Coordinating Council for Medication Error and Prevention taxonomy and high-risk medications. The number of errors was calculated per 100 prescribed medications, number of errors per record and number of records with an error as a quality indicator. RESULTS: A total of 229 ME were found with a mean per record of 0.38 (SD = 0.7), of which 155 corresponded to the paper-based method (1.04, SD = 1.67) and 74 to the electronic-based method (0.29, SD = 0.57) P = <0.001. The use of the electronic method was associated with an OR of 0.59 (95% CI 0.41-0.85) for the recording of at least one ME (P = 0.005), but to a greater severity of ME (<0.001). CONCLUSION: The use of the electronic system was associated with a reduction in ME, compared with the paper-based method. Despite this, it was associated with more severe ME.

Consumo de alcohol en la adolescencia: Consideraciones médicas y orientaciones educativas / Alcohol consumption during adolescence: Medical considerations and educational counseling

El consumo de alcohol por parte de los adolescentes supera en España el consumo de otras sustancias psicoactivas. Los daños que el cerebro humano sufre a causa del etanol, especialmente en la etapa de la adolescencia, son objeto de muchos estudios y se centran principalmente en cómo se afecta la neurotransmisión. Además, la vulnerabilidad del cerebro de los adolescentes a la influencia del alcohol ofrece rasgos peculiares por cuanto se encuentra en una etapa de intensa actividad de remodelación sináptica. Es necesario unir fuerzas, conocimientos y recursos dirigidos a un mejor conocimiento, tanto de los efectos biológicos del alcohol en el individuo adolescente como de los derivados del consumo en los ámbitos emocional, social y familiar, para diseñar actuaciones educativas que faciliten la modificación o erradicación de hábitos no saludables relacionados con la ingesta de alcohol. La evaluación previa se dirige a promover la calidad de vida en la Educación Secundaria, una etapa crucial en el desarrollo global del ser humano.

Alcohol is the most commonly consumed psychoactive drug among Spanish adolescents. The effects of alcohol on human brain, specifically on neurotransmission, are broadly studied. The adolescent brain is especially vulnerable to the effects of alcohol due to the intense and active processes of synapses restructuring ocurring during this period. To achieve and establish educational interventions directed to facilitate and eradicate harmful habits related to alcohol consumption during adolescence, it is necessary to join resources, knowledge and forces focused on a better understanding of the biological effects of alcohol and the harm produced in the emotional, social and familiar realms. Here, we discuss that intervention needs previous evaluation and should focus on Secondary Education, a crucial period in human development.

Multivariate analysis of HT/GC-(IT)MS chromatographic profiles of triacylglycerol for classification of olive oil varieties.

The ability of multivariate analysis methods such as hierarchical cluster analysis, principal component analysis and partial least squares-discriminant analysis (PLS-DA) to achieve olive oil classification based on the olive fruit varieties from their triacylglycerols profile, have been investigated. The variations in the raw chromatographic data sets of 56 olive oil samples were studied by high-temperature gas chromatography with (ion trap) mass spectrometry detection. The olive oil samples were of four different categories ("extra-virgin olive oil", "virgin olive oil", "olive oil" and "olive-pomace" oil), and for the "extra-virgin" category, six different well-identified olive oil varieties ("hojiblanca", "manzanilla", "picual", "cornicabra", "arbequina" and "frantoio") and some blends of unidentified varieties. Moreover, by pre-processing methods of chemometric (to linearise the response of the variables) such as peak-shifting, baseline (weighted least squares) and mean centering, it was possible to improve the model and grouping between different varieties of olive oils. By using the first three principal components, it was possible to account for 79.50% of the information on the original data. The fitted PLS-DA model succeeded in classifying the samples. Correct classification rates were assessed by cross-validation.