Phages produce persisters.

Arguably, the greatest threat to bacteria is phages. It is often assumed that those bacteria that escape phage infection have mutated or utilized phage-defence systems; however, another possibility is that a subpopulation forms the dormant persister state in a manner similar to that demonstrated for bacterial cells undergoing nutritive, oxidative, and antibiotic stress. Persister cells do not undergo mutation and survive lethal conditions by ceasing growth transiently. Slower growth and dormancy play a key physiological role as they allow host phage defence systems more time to clear the phage infection. Here, we investigated how bacteria survive lytic phage infection by isolating surviving cells from the plaques of T2, T4, and lambda (cI mutant) virulent phages and sequencing their genomes. We found that bacteria in plaques can escape phage attack both by mutation (i.e. become resistant) and without mutation (i.e. become persistent). Specifically, whereas T4-resistant and lambda-resistant bacteria with over a 100,000-fold less sensitivity were isolated from plaques with obvious genetic mutations (e.g. causing mucoidy), cells were also found after T2 infection that undergo no significant mutation, retain wild-type phage sensitivity, and survive lethal doses of antibiotics. Corroborating this, adding T2 phage to persister cells resulted in 137,000-fold more survival compared to that of addition to exponentially growing cells. Furthermore, our results seem general in that phage treatments with Klebsiella pneumonia and Pseudomonas aeruginosa also generated persister cells. Hence, along with resistant strains, bacteria also form persister cells during phage infection.

Regulation of anti-phage defense mechanisms by using cinnamaldehyde as a quorum sensing inhibitor.

Background: Multidrug-resistant bacteria and the shortage of new antibiotics constitute a serious health problem. This problem has led to increased interest in the use of bacteriophages, which have great potential as antimicrobial agents but also carry the risk of inducing resistance. The objective of the present study was to minimize the development of phage resistance in Klebsiella pneumoniae strains by inhibiting quorum sensing (QS) and thus demonstrate the role of QS in regulating defense mechanisms. Results: Cinnamaldehyde (CAD) was added to K. pneumoniae cultures to inhibit QS and thus demonstrate the role of the signaling system in regulating the anti-phage defense mechanism. The QS inhibitory activity of CAD in K. pneumoniae was confirmed by a reduction in the quantitative expression of the lsrB gene (AI-2 pathway) and by proteomic analysis. The infection assays showed that the phage was able to infect a previously resistant K. pneumoniae strain in the cultures to which CAD was added. The results were confirmed using proteomic analysis. Thus, anti-phage defense-related proteins from different systems, such as cyclic oligonucleotide-based bacterial anti-phage signaling systems (CBASS), restriction-modification (R-M) systems, clustered regularly interspaced short palindromic repeat-Cas (CRISPR-Cas) system, and bacteriophage control infection (BCI), were present in the cultures with phage but not in the cultures with phage and CAD. When the QS and anti-phage defense systems were inhibited by the combined treatment, proteins related to phage infection and proliferation, such as the tail fiber protein, the cell division protein DamX, and the outer membrane channel protein TolC, were detected. Conclusion: Inhibition of QS reduces phage resistance in K. pneumoniae, resulting in the infection of a previously resistant strain by phage, with a significant increase in phage proliferation and a significant reduction in bacterial growth. QS inhibitors could be considered for therapeutic application by including them in phage cocktails or in phage-antibiotic combinations to enhance synergistic effects and reduce the emergence of antimicrobial resistance.

Shedding Light on Dark Chemical Matter: The Discovery of a SARS-CoV-2 Mpro Main Protease Inhibitor through Intensive Virtual Screening and In Vitro Evaluation.

The development of specific antiviral therapies targeting SARS-CoV-2 remains fundamental because of the continued high incidence of COVID-19 and limited accessibility to antivirals in some countries. In this context, dark chemical matter (DCM), a set of drug-like compounds with outstanding selectivity profiles that have never shown bioactivity despite being extensively assayed, appears to be an excellent starting point for drug development. Accordingly, in this study, we performed a high-throughput screening to identify inhibitors of the SARS-CoV-2 main protease (Mpro) using DCM compounds as ligands. Multiple receptors and two different docking scoring functions were employed to identify the best molecular docking poses. The selected structures were subjected to extensive conventional and Gaussian accelerated molecular dynamics. From the results, four compounds with the best molecular behavior and binding energy were selected for experimental testing, one of which presented inhibitory activity with a Ki value of 48 ± 5 µM. Through virtual screening, we identified a significant starting point for drug development, shedding new light on DCM compounds.

Safety attributes of Pseudomonas sp. P26, an environmental microorganism with potential application in contaminated environments.

Currently, the selection of non-pathogenic microorganisms that lack clinically relevant antimicrobial resistance is crucial to bioaugmentation strategies. Pseudomonas sp. P26 (P26) is an environmental bacterium of interest due to its ability to remove aromatic compounds from petroleum, but its safety characteristics are still unknown. The study aimed to: a) determine P26 sensitivity to antimicrobials, b) investigate the presence of quinolone and ß-lactam resistance genes, c) determine the presence of virulence factors, and d) evaluate the effect of P26 on the viability of Galleria mellonella (an invertebrate animal model). P26 antimicrobial sensitivity was determined in vitro using the Kirby-Bauer agar diffusion method and the VITEK 2 automated system (BioMerieux®). Polymerase Chain Reaction was employed for the investigation of genes associated with quinolone resistance, extended-spectrum ß-lactamases, and carbapenemases. Hemolysin and protease production was determined in human blood agar and skimmed-milk agar, respectively. In the in vivo assay, different doses of P26 were injected into Galleria mellonella larvae and their survival was monitored daily. Control larvae injected with Pseudomonas putida KT2440 (a strain considered as safe) and Pseudomonas aeruginosa PA14 (a pathogenic strain) were included. Pseudomonas sp. P26 was susceptible to most evaluated antimicrobials, except for trimethoprim-sulfamethoxazole. No epidemiologically relevant genes associated with quinolone and ß-lactam resistance were identified. Hemolysin and protease production was only evidenced in the virulent strain (PA14). Furthermore, the results obtained in the in vivo experiment demonstrated that inocula less than 108 CFU/mL of P26 and P. putida KT2440 did not significantly affect larval survival, whereas larvae injected with the lowest dose of the pathogenic strain P. aeruginosa PA14 experienced instant mortality. The results suggest that Pseudomonas sp. P26 is a safe strain for its application in environmental bioremediation processes. Additional studies will be conducted to ensure the safety of this bacterium against other organisms.

Elastic and inelastic strain in submicron-thick ZnO epilayers grown on r-sapphire substrates by metal-organic vapour phase deposition.

A significant part of the present and future of optoelectronic devices lies on thin multilayer heterostructures. Their optical properties depend strongly on strain, being essential to the knowledge of the stress level to optimize the growth process. Here the structural and microstructural characteristics of sub-micron a-ZnO epilayers (12 to 770 nm) grown on r-sapphire by metal-organic chemical vapour deposition are studied. Morphological and structural studies have been made using scanning electron microscopy and high-resolution X-ray diffraction. Plastic unit-cell distortion and corresponding strain have been determined as a function of film thickness. A critical thickness has been observed as separating the non-elastic/elastic states with an experimental value of 150-200 nm. This behaviour has been confirmed from ultraviolet photoelectron spectroscopy, X-ray photoelectron spectroscopy and high-resolution transmission electron microscopy measurements. An equation that gives the balance of strains is proposed as an interesting method to experimentally determine this critical thickness. It is concluded that in the thinnest films an elongation of the Zn-O bond takes place and that the plastic strained ZnO films relax through nucleation of misfit dislocations, which is a consequence of three-dimensional surface morphology.

Improving phage therapy by evasion of phage resistance mechanisms.

Antibiotic failure is one of the most worrisome threats to global health. Among the new therapeutic efforts that are being explored, the use of bacteriophages (viruses that kill bacteria), also known as 'phages', is being extensively studied as a strategy to target bacterial pathogens. However, one of the main drawbacks of phage therapy is the plethora of defence mechanisms that bacteria use to defend themselves against phages. This review aims to summarize the therapeutic approaches that are being evaluated to overcome the bacterial defence systems, including the most innovative therapeutic approaches applied: circumvention of phage receptor mutations; modification of prophages; targeting of CRISPR-Cas systems and the biofilm matrix; engineering of safer and more efficacious phages; and inhibition of the anti-persister strategies used by bacteria.

Género, infodemia y desinformación en salud. Revisión de alcance global, vacíos de conocimiento y recomendaciones.

OBJETIVO: explorar el estado de la literatura científica sobre los aspectos de infodemia y desinformación en salud vinculados al género y a la interseccionalidad, detectar vacíos de conocimiento y brindar recomendaciones. MÉTODOS: revisión de alcance global, con la detección de vacíos de conocimiento y recomendaciones. Se buscó en ocho bases de datos: MEDLINE (Pubmed), Anthropological Index Online, Studies on Women & Gender Abstracts, LILACS, Scielo, Global Index Medicus, Web of Science, Google académico y se hizo una búsqueda manual en Google de documentos de los últimos 10 años, sin restricciones de idioma y geográficas. Se realizó un análisis de contenido de los estudios incluidos. RESULTADOS: 855 registros fueron identificados y 21 cumplieron con los criterios de inclusión. Predominan los estudios que tuvieron como primer autor/a una mujer (13/21), aunque en la autoría global se destacaron los hombres (10/21). El modelo binario fue el enfoque principal (16/21). La mayoría (18/21) se publicaron a partir del 2020. Se abordaron principalmente temas relacionados con la COVID-19 y la salud sexual y reproductiva (antes de la pandemia), y en menor medida la salud mental. Se identificaron interacciones entre diferencias de sexo/género en la desinformación/infodemia en salud especialmente en mujeres, colectivos de género diverso, personas mayores y población de bajo nivel socioeducativo. CONCLUSIONES: existen brechas de conocimiento en el tema explorado, con escaso número de estudios, y limitaciones de alcances y del enfoque de género y/o feminista (más allá del binario). No obstante, los resultados tentativos constatan la presencia de inequidades de género e interseccionalidad en la desinformación en salud. PALABRAS CLAVE: infodemia, desinformación, género, COVID-19, revisión sistemática.

Single-cell analysis reveals that cryptic prophage protease LfgB protects Escherichia coli during oxidative stress by cleaving antitoxin MqsA.

Although toxin/antitoxin (TA) systems are ubiquitous, beyond phage inhibition and mobile element stabilization, their role in host metabolism is obscure. One of the best-characterized TA systems is MqsR/MqsA of Escherichia coli, which has been linked previously to protecting gastrointestinal species during the stress it encounters from the bile salt deoxycholate as it colonizes humans. However, some recent whole-population studies have challenged the role of toxins such as MqsR in bacterial physiology since the mqsRA locus is induced over a hundred-fold during stress, but a phenotype was not found upon its deletion. Here, we investigate further the role of MqsR/MqsA by utilizing single cells and demonstrate that upon oxidative stress, the TA system MqsR/MqsA has a heterogeneous effect on the transcriptome of single cells. Furthermore, we discovered that MqsR activation leads to induction of the poorly characterized yfjXY ypjJ yfjZF operon of cryptic prophage CP4-57. Moreover, deletion of yfjY makes the cells sensitive to H2O2, acid, and heat stress, and this phenotype was complemented. Hence, we recommend yfjY be renamed to lfgB (less fatality gene B). Critically, MqsA represses lfgB by binding the operon promoter, and LfgB is a protease that degrades MqsA to derepress rpoS and facilitate the stress response. Therefore, the MqsR/MqsA TA system facilitates the stress response through cryptic phage protease LfgB.IMPORTANCEThe roles of toxin/antitoxin systems in cell physiology are few and include phage inhibition and stabilization of genetic elements; yet, to date, there are no single-transcriptome studies for toxin/antitoxin systems and few insights for prokaryotes from this novel technique. Therefore, our results with this technique are important since we discover and characterize a cryptic prophage protease that is regulated by the MqsR/MqsA toxin/antitoxin system in order to regulate the host response to oxidative stress.

A long-term survey of Serratia spp. bloodstream infections revealed an increase of antimicrobial resistance involving adult population.

Serratia spp. is a well-recognized pathogen in neonates; however, limited data are available in adults. We studied microbiological and clinical characteristics of Serratia spp. causing bloodstream infections (BSI) in our institution (January 2005-July 2020). Overall, 141 BSI episodes affecting 139 patients were identified and medical records reviewed. Antimicrobial susceptibility was recovered from our informatics system and 118 isolates from 116 patients were available for further microbiological studies. Whole genome sequencing (WGS) was completed in 107 isolates. Incidence of Serratia BSI was 0.3/1000 overall admissions (range 0.12-0.60), with maximum prevalence (27 episodes, 19.1%) during 2017-2018. Relevant patients' clinical characteristics were 71.9% ≥60 years (n = 100), with high comorbidity rates (49%, ≥2), 23 (74.2%) of them died within 1 month of the BSI episode. WGS identified all isolates as Serratia marcescens when Kraken bioinformatics taxonomic tool was used despite some which were identified as Serratia nematodiphila (32/118) or Serratia ureilytica (5/118) by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Nevertheless, when using MASH distance, Serratia nevei (63/107), S. ureilytica (38/107), and S. marcescens (6/107) were assigned. Carbapenemase (blaVIM-1) and extended-spectrum ß-lactases (ESBL) (blaSHV-12) genes were found in seven and three isolates, respectively, one of them expressing both genes. The worldwide-disseminated IncL/M scaffold plasmid was identified in six VIM producers. Four genotypes were established based on their virulence factors and resistome. Serratia spp. emerged as a relevant nosocomial pathogen causing BSI in elderly patients in our hospital, particularly in recent years with a remarkable increase in antibiotic resistance. ESBL and carbapenemases production related to plasmid dissemination are particularly noteworthy.IMPORTANCESerratia spp. is the third most frequent pathogen involved in outbreaks at neonatal facilities and is primarily associated with bacteremia episodes. In this study, we characterized all causing bloodstream infection (BSI) in patients admitted to our hospital during a 16-year period (2005-2020). Despite having no neonatal intensive care unit in our hospital, this study revealed that Serratia spp. is a relevant pathogen causing BSI in elderly patients with high comorbidity rates. A significant increase of antimicrobial resistance was detected over time, particularly in 2020 and coinciding with the coronavirus disease (COVID-19) pandemic and nosocomial spread of multidrug-resistant Serratia spp. isolates. extended-spectrum ß-lactases and carbapenemases genes associated with plasmid dissemination, typically detected in other Enterobacterales species, were also identified, reinforcing the role of Serratia spp. in the antimicrobial resistance landscape. Additionally, this work highlights the need to reclassify the species of Serratia, since discrepancies were observed in the identification when using different tools.

Use of Galleria mellonella as an Animal Model for Studying the Antimicrobial Activity of Bacteriophages with Potential Use in Phage Therapy.

Interest in phage therapy has increased in the last decade, and animal models have become essential in this field. The larval stage of the wax moth, Galleria mellonella, represents an easy-to-handle model. The larvae have an innate immune response and survive at 37 °C, which is ideal for infection and antimicrobial studies with bacteriophages. In this chapter, we describe the procedures used to study the antimicrobial activity of bacteriophages in a G. mellonella infection model.

P53 expression correlates with low axillary tumor burden in breast cancer.

BACKGROUND: The p53 mutation in breast cancer confers a worse prognosis and is usually associated with p53 overexpression (p53+) on immunohistochemistry. Previous studies have shown that p53+ tumors could be associated with low axillary tumor burden (ATB). OBJECTIVE: We aimed to evaluate the association between p53+ and ATB in a large series of breast cancers as an aid to personalizing axillary surgical treatment. METHODS: We retrieved 1762 infiltrating breast carcinomas from our database that were treated with upfront surgery in Hospital del Mar from 2004 to 2018. We compared p53+ and p53-negative (p53-) tumors in terms of the percentage of cases with high ATB and overall survival. This comparison was made overall and for each immunophenotype. RESULTS: Overall, 18.7% of breast tumors were p53+. High ATB was less common in p53+ tumors than in p53- tumors in the luminal B-Her2-negative immunophenotype (6.2% versus 16.9%, respectively, P = 0.025), but not in the other immunophenotypes or overall. Overall survival was worse in patients with p53+ breast cancer (P = 0.002). CONCLUSION: p53+ breast cancers were associated with worse overall survival. However, low ATB was more common in these tumors than in p53- tumors in the luminal B-Her2-negative subtype. Information on p53 expression could be of use to predict ATB in some breast cancer tumors.

Resistance against two lytic phage variants attenuates virulence and antibiotic resistance in Pseudomonas aeruginosa.

Background: Bacteriophage therapy is becoming part of mainstream Western medicine since antibiotics of clinical use tend to fail. It involves applying lytic bacteriophages that self-replicate and induce cell lysis, thus killing their hosts. Nevertheless, bacterial killing promotes the selection of resistant clones which sometimes may exhibit a decrease in bacterial virulence or antibiotic resistance. Methods: In this work, we studied the Pseudomonas aeruginosa lytic phage φDCL-PA6 and its variant φDCL-PA6α. Additionally, we characterized and evaluated the production of virulence factors and the virulence in a Galleria mellonella model of resistant mutants against each phage for PA14 and two clinical strains. Results: Phage φDCL-PA6α differs from the original by only two amino acids: one in the baseplate wedge subunit and another in the tail fiber protein. According to genomic data and cross-resistance experiments, these changes may promote the change of the phage receptor from the O-antigen to the core lipopolysaccharide. Interestingly, the host range of the two phages differs as determined against the Pseudomonas aeruginosa reference strains PA14 and PAO1 and against nine multidrug-resistant isolates from ventilator associated pneumonia. Conclusions: We show as well that phage resistance impacts virulence factor production. Specifically, phage resistance led to decreased biofilm formation, swarming, and type III secretion; therefore, the virulence towards Galleria mellonella was dramatically attenuated. Furthermore, antibiotic resistance decreased for one clinical strain. Our study highlights important potential advantages of phage therapy's evolutionary impact that may be exploited to generate robust therapy schemes.

Altruismo y apego en madres y padres de acogida: un estudio piloto / Altruisme i aferrament a mares i pares d'acollida: un estudi pilot / Altruism and attachment in foster parents: a pilot study

El objetivo del artículo es valorar las variables de altruismo y apego en padres y madres de acogida en familia ajena. El estudio piloto muestra los resultados de los 71 primeros casos (41 mujeres y 30 hombres) de una investigación que está en proceso, cuyos participantes residen en Barcelona (capital y provincia) y presentan edades comprendidas entre 40 y 68 años. La mayor parte de esta tiene estudios superiores, está casada y tiene algún hijo biológico. Para la recopilación de datos se utilizaron dos escalas cuantitativas: Cuestionario de Apego Adulto (Melero y Cantero, 2008) y Escala de Prosociabilidad Caprara (Caprara, Steca, Zelly y Campanna, 2005).(AU)

The article aims to assess the variables of altruism and attachment in foster parents. The pilot study shows the results of the first 71 cases (41 women and 30 men) of an investigation that is in progress, whose participants live in Barcelona (capital and province) and are aged between 40 and 68 years. Most of them have a University degree, are married, and have a biological child. Two quantitative scales were used for data collection: the Adult Attachment Questionnaire (Melero and Cantero, 2008) and the Caprara Prosociability Scale (Caprara, Steca, Zelly, and Campanna, 2005).(AU)

L’objectiu de l’article és valorar les variables d’altruisme i aferrament en pares i mares d’acollida en família aliena. L'estudi pilot mostra els resultats dels 71 primers casos (41 dones i 30 homes) d'una investigació que està en procés, els participants de la qual resideixen a Barcelona (capital i província) i presenten edats compreses entre 40 i 68 anys. La majoria té estudis superiors, estan casats i té algun fill biològic. Per a la recopilació de dades, es van utilitzar dues escales quantitatives: Qüestionari d'Aferrament Adult (Melero i Cantero, 2008) i Escala de Prosociabilitat Caprara (Caprara, Steca, Zelly iCampanna, 2005).(AU)

Edema mamario unilateral en contexto de insuficiencia cardíaca: presentación de un caso y revisión de la literatura / Unilateral breast edema in context of heart failure: A case report and literature review

El edema mamario unilateral puede aparecer como sintomatología atípica de la insuficiencia cardíaca. Presenta un amplio diagnóstico diferencial, entre el que se incluyen causas benignas, como la mastitis o las enfermedades sistémicas que cursan con edema generalizado; y causas malignas como el carcinoma inflamatorio de mama. Esta última entidad, aunque poco frecuente, presenta mayor agresividad que otros tipos de tumores mamarios y se deberá sospechar su diagnóstico ante la presencia de cambios mamarios unilaterales. En este artículo se presenta un caso de edema mamario unilateral en una paciente con fallo cardíaco congestivo en el que se sopesaron la mastitis y el carcinoma inflamatorio como diagnósticos iniciales. También se incluye una revisión de la literatura de los pocos casos publicados sobre el tema. (AU)

Unilateral breast edema might appear as an infrequent symptom of congestive heart failure. It has a wide range of diagnostic possibilities including benign causes, such as mastitis or systemic diseases causing general edema, and malign causes such as inflammatory breast cancer. This kind of tumor, although uncommon, is more aggressive than other breast tumors. Therefore, it is mandatory to rule it out whenever changes in breast skin occur. We report a case of unilateral breast edema in a patient with congestive heart failure for whom mastitis and inflammatory breast cancer were considered as first diagnostic possibilities. A literature review of the few articles published on the subject is also included. (AU)

Agresiones laborales a profesionales sanitarios e infradeclaración: Caracterización y brechas en el conocimiento para su prevención / Workplace violence on healthcare professionals and underreporting: Characterization and knowledge gaps for prevention

La agresión laboral a profesionales sanitarios por parte de los usuarios del sistema es un fenómeno multidimensional en alza, motivo de preocupación para aquellos que velan por la seguridad y salud de dichos profesionales. Aunque diferentes estudios señalan altos porcentajes de personal sanitario agredido, las estadísticas de declaraciones realizadas revelan datos muy inferiores. La infradeclaración de las agresiones laborales a sanitarios es un hecho conocido y referido en multitud de estudios y se presenta como un gran escollo a la hora de poder proponer medidas preventivas adecuadas, ya que las estadísticas en las que estas pueden basarse no corresponden a la verdadera casuística de todas las agresiones que se producen. Así mismo, dificulta el poder valorar correctamente la utilidad de las medidas preventivas adoptadas. El siguiente artículo hace un recorrido por los últimos estudios realizados sobre el tema, presentando una panorámica general sobre los factores que acompañan a las agresiones, así como de los motivos principales involucrados en que la infradeclaración se produzca. Destaca, además, en la literatura, la falta de instrumentos que hayan sido sometidos a un proceso de validación para medir esta infradeclaración. Por todo ello, es necesario seguir investigando en esta problemática con herramientas validadas que permitan conocer los motivos y circunstancias que acompañan y fomentan la infradeclaración de las agresiones a profesionales sanitarios. Conocer estos motivos es un paso previo para luchar contra la misma y poder conocer la verdadera magnitud del problema, de modo que los servicios de salud laboral puedan contar con datos precisos y desarrollar y evaluar medidas preventivas implementadas.(AU)

Work-related violence against healthcare workers inflicted by healthcare users is a rising multidimensional phenomenon, a cause of concern among those who ensure the safety and health of these professionals. Although different studies indicate high percentages of attacks against healthcare workers, statistics from reports reveal much lower data. Underreporting of occupational violence against healthcare workers is a well-known fact reported in many studies. It is presented as a major obstacle when it comes to proposing adequate preventive measures, because the data on which to base these measures do not correspond to the true incidence of all the assaults that take place. Underreporting also makes it difficult to correctly assess the usefulness of preventive measures implemented. The following article looks at the latest studies carried out on the subject, presenting an overview of the factors accompanying these assaults, as well as the main reasons for this underreporting. It also highlights the lack in the literature of instruments designed to measure underreporting that have undergone a validation process. For all these reasons, this problem requires further study with validated tools to determine the reasons and circumstances that accompany and promote the underreporting of violence against healthcare workers. Knowing these reasons is a preliminary step in the fight against workplace violence and to measure the true magnitude of the problem, to provide the occupational health services with precise data and develop and assess the preventive measures implemented.(AU)

Ventilación no invasiva versus oxigenoterapia convencional tras fracaso de la extubación en pacientes de alto riesgo en una unidad de cuidados intensivos: un ensayo clínico pragmático / Noninvasive ventilation versus conventional oxygen therapy after extubation failure in high-risk patients in an intensive care unit: a pragmatic clinical trial

RESUMEN Objetivo: Determinar la efectividad de la ventilación no invasiva frente a oxigenoterapia convencional en pacientes con insuficiencia respiratoria aguda tras fracaso de la extubación. Métodos: Ensayo clínico pragmático realizado una unidad de cuidados intensivos de marzo de 2009 a septiembre de 2016. Se incluyeron pacientes sometidos a ventilación mecánica > 24 horas, y que desarrollaron insuficiencia respiratoria aguda tras extubación programada, siendo asignados a ventilación no invasiva u oxigenoterapia convencional. El objetivo primario fue reducir la tasa de reintubación. Los objetivos secundarios fueron: mejora de los parámetros respiratorios, reducción de las complicaciones, de la duración de la ventilación mecánica, de la estancia en unidad de cuidados intensivos y hospitalaria, así como de la mortalidad en unidad de cuidados intensivos, hospitalaria y a los 90 días. También se analizaron los factores relacionados con la reintubación. Resultados: De un total de 2.574 pacientes, se analizaron 77 (38 en el grupo de ventilación no invasiva y 39 en el grupo de oxigenoterapia convencional). La ventilación no invasiva redujo la frecuencia respiratoria y cardíaca más rápidamente que la oxigenoterapia convencional. La reintubación fue menor en el grupo de ventilación no invasiva [12 (32%) versus 22(56%) en grupo oxigenoterapia convencional, RR 0,58 (IC95% 0,34 - 0,97), p = 0,039], el resto de los parámetros no mostró diferencias significativas. En el análisis multivariante, la ventilación no invasiva prevenía la reintubación [OR 0,17 (IC95% 0,05 - 0,56), p = 0,004], mientras que el fracaso hepático previo a la extubación y la incapacidad para mantener vía aérea permeable predisponían a la reintubación. Conclusión: El empleo de la ventilación no invasiva en pacientes que fracasa la extubación podría ser beneficiosa frente a la oxigenoterapia convencional.

ABSTRACT Objective: To determine the effectiveness of noninvasive ventilation versus conventional oxygen therapy in patients with acute respiratory failure after extubation failure. Methods: A pragmatic clinical trial was conducted in an intensive care unit from March 2009 to September 2016. Patients on mechanical ventilation > 24 hours who developed acute respiratory failure after scheduled extubation were included and were assigned to noninvasive ventilation or conventional oxygen therapy. The primary objective was to reduce the reintubation rate. The secondary objectives were to improve respiratory parameters and reduce complications, the duration of mechanical ventilation, the intensive care unit stay, the hospital stay, and mortality in the intensive care unit, in the hospital, and 90 days after discharge. Factors correlated with reintubation were also analyzed. Results: Of a total of 2,574 patients, 77 were analyzed (38 in the noninvasive ventilation group and 39 in the conventional oxygen therapy group). Noninvasive ventilation reduced the respiratory and cardiac rates more rapidly than conventional oxygen therapy. Reintubation was less common in the noninvasive ventilation group [12 (32%) versus 22 (56%) in the conventional oxygen therapy group, relative risk 0.58 (95%CI 0.34 - 0.97), p = 0.039]. The rest of the parameters did not show significant differences. In the multivariate analysis, noninvasive ventilation protected against reintubation [OR 0.17 (95%CI 0.05 - 0.56), p = 0.004], while liver failure before extubation and the inability to maintain airway patency predisposed patients to reintubation. Conclusion: The use of noninvasive ventilation in patients who failed extubation could be beneficial compared to conventional oxygen therapy.

Diagnostic utility of new short versions of AUDIT to detect binge drinking in undergraduate students / La utilidad diagnóstica de las nuevas versiones abreviadas del AUDIT para detectar "Binge drinking" en universitarios

This study examines the usefulness of two AUDIT adaptations with a sample of 907 undergraduate alcohol users. On the one hand, it includes the AR2i that encompasses revised A2r and A3r consumption items, and on the other hand—in addition to the two former items—the inclusion of items 4, 8, and 9, which evaluate consequences. The results indicate that both adaptations identify BD more precisely than the traditional scales (AUDIT and AUDIT-C), but the usefulness of each will depend on the clinical purpose they are given. In environments where time is a key factor in detecting high-risk consumption it will be more appropriate to use AR2i, which evaluates the pattern of consumption, whereas to provide feedback to the young person, to increase their awareness, and to highlight the need for change it would be advisable to use the new combination of five items. (AU)

Este estudio examina la utilidad de dos adaptaciones del AUDIT en una muestra de 907 universitarios consumidores de alcohol. Por un lado se incluye el AR2i, que contiene los ítems de consumo A2r y A3r, y por otro lado la incluida en este trabajo, que suma a los ítems anteriores –A2r y A3r– otros tres sobre consecuencias 4, 8 y 9. Los resultados indican que ambas adaptaciones identifican a los BD de manera más precisa que las escalas tradicionales (AUDIT y AUDIT-C), dependiendo su uso de la finalidad clínica con la que se utilicen. En entornos en los que el tiempo es un factor clave para detectar consumos de riesgo será más adecuado utilizar el AR2i, centrado en el patrón de consumo. Si se quiere proporcionar un feedback al joven que permita poner en evidencia la necesidad de cambio y con ello trabajar su toma de conciencia, sería más adecuado utilizar la nueva combinación de 5 ítems. (AU)

Presencia de padres en técnicas invasivas en neonatología: perspectiva de los profesionales en España / Presence of parents during invasive techniques in neonatology: A perspective of spanish professionals

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