Estenosis arterial del injerto renal: evaluación de la incidencia mediante ecografía doppler, factores de riesgo y análisis de las complicaciones que pueden afectar a la supervivencia del injerto / Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes

Introducción y objetivos La estenosis de la arteria del injerto renal (EAR) es una complicación vascular del trasplante renal cuya incidencia estimada es del 13%, la cual puede causar hipertensión arterial refractaria, disfunción renal y muerte prematura en los receptores. Métodos Se realizó un estudio retrospectivo que incluyó a todos los pacientes sometidos a trasplante renal entre 2014 y 2020. Los pacientes fueron evaluados mediante ecografía doppler renal sistemática tras el trasplante. Para identificar los factores de riesgo independientes de la estenosis de la arteria renal tras el trasplante, realizamos un análisis multivariante. Resultados Se incluyeron 724 trasplantes renales, el 12% eran de donante vivo y el 88% de donante fallecido. La edad media en los receptores era de 54,8 años y en los donantes era de 53. Se diagnosticó estenosis de la arteria del injerto renal en 70 (10%) receptores, la mayoría durante los primeros 6 meses después de la intervención. El 51% de los pacientes con estenosis de la arteria del injerto renal se manejaron de manera conservadora. El análisis multivariante mostró que la diabetes mellitus, el rechazo del injerto, la resutura arterial y el índice de masa corporal del donante eran factores de riesgo independientes de estenosis de la arteria renal después del trasplante. La supervivencia de los injertos con estenosis de la arteria del injerto renal fue del 98% a los 6 meses y del 95% a los 2 años. Conclusiones El uso sistemático de la ecografía doppler en el período inmediatamente posterior al trasplante permitió diagnosticar un 10% de estenosis de la arteria del injerto renal en nuestra cohorte. A pesar de los factores de riesgo mencionados anteriormente, un seguimiento y tratamiento adecuados podrían reducir el riesgo de pérdida del injerto en pacientes con estenosis de la arteria del injerto renal. (AU)

Introduction and objectives Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. Methods We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. Results Seven hundred twenty-four kidney transplants were included, 12% were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. The 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. Conclusions The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis. (AU)

Filtro de vena cava inferior ante diagnóstico de trombosis venosa profunda en gestante en trabajo de parto. A propósito de un caso clínico / Inferior vena cava filter before diagnosis of deep venous thrombosis in a pregnant woman in labor: A case report

Introducción: El embarazo representa un estado procoagulante que aumenta el riesgo de fenómenos trombóticos en la mujer. Al igual que en la población no gestante, deberemos diagnosticar y tratar lo más precozmente posible dichos eventos para evitar la migración del trombo a otras localizaciones. La anticoagulación constituye la medida terapéutica de primera línea. Sin embargo, ciertas situaciones de aumento de sangrado como el trabajo de parto pueden suponer una contraindicación para iniciar dicha anticoagulación. En el siguiente artículo se desarrolla un caso clínico en el que el diagnóstico de trombosis venosa profunda tuvo lugar al inicio del trabajo de parto. Principales síntomas y/o hallazgos clínicos: Aumento de diámetro de miembro inferior izquierdo, con enrojecimiento del mismo y aumento de temperatura local. La paciente describía dolor a nivel de dicha extremidad desde hacía 15 días. No presentaba disnea y la saturación de oxígeno era del 100%. Diagnósticos principales: Trombosis venosa profunda, trabajo de parto. Intervenciones terapéuticas: La contraindicación de anticoagulación y la necesidad de un tratamiento inmediato plantearon el filtro de vena cava inferior como la opción más razonable. Resultados: Tras la colocación del filtro, el parto cursó sin incidencias; no migró el émbolo y el filtro se retiró a los 29 días del parto sin complicaciones. Conclusión: Pese a nuestra escasa experiencia clínica en el manejo de estos casos, podemos afirmar que el filtro de vena cava inferior representa una opción razonable y segura en los casos de trombosis de miembros inferiores en mujeres en trabajo de parto.(AU)

Introduction: Pregnancy represents a procoagulant state that increases women's risk of thrombotic phenomena. As in the non-pregnant population, we must diagnose and treat these events as early as possible to avoid the migration of the thrombus to other locations. Anticoagulation is the first-line therapeutic measure. However, certain situations of increased bleeding such as labor may be a contraindication to initiate such anticoagulation. The following article develops a clinical case in which the deep vein thrombosis diagnosis occurred at the onset of labor. Main symptoms and/or clinical findings: Increase in diameter of the left lower limb, with redness of the same and increase in local temperature. The patient described pain at the level of this limb for 15 days. He had no dyspnea and oxygen saturation was 100%. Main diagnoses: Deep vein thrombosis, labor. Therapeutic interventions: The contraindication of anticoagulation and the need for immediate treatment raised the inferior vena cava filter as the most reasonable option. Results: After the placement of the filter, the delivery proceeded without incident. The plunger did not migrate and the filter was removed 29 days after delivery without complications. Conclusion: Despite our limited clinical experience in the management of these cases, we can affirm that the inferior vena cava filter represents a reasonable and safe option in cases of thrombosis of the lower limbs in women in labor.(AU)

Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes.

INTRODUCTION AND OBJECTIVES: Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. METHODS: We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. RESULTS: Seven hundred twenty-four kidney transplants were included, 12% ​​were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. CONCLUSIONS: The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.

Protocolo para la evaluación de una intervención de alfabetización en salud sobre morbimortalidad y calidad de vida en pacientes con insuficiencia cardíaca / Protocol for the evaluation of an efficacy of a health literacy intervention in decreasing mortality, morbidity and improving the quality of life of patients with heart failure

Fuandamentos: La insuficiencia cardiaca (IC) es un síndrome clínico complejo con una sintomatología bien definida que constituye un problema de Salud Pública por su impacto en la morbi-mortalidad. El manejo del paciente con IC requiere el trabajo de equiposespecializados multidisciplinares que enfaticen en los hábitos cardiovasculares y el autocuidado. Conocer el grado alfabetización ensalud (AeS) de estos pacientes es una buena herramienta para prestarles una atención holística, basada en necesidades individuales,así como para fomentar su empoderamiento. Se ha diseñado un protocolo con el objetivo de evaluar la eficacia de una intervenciónen AeS en la mejora de su calidad de vida, así como en la disminución de la morbi/mortalidad. Métodos: Se llevará a cabo un estudio clínico controlado aleatorio a dos brazos multicéntrico, con ocultación del reparto aleatorio.Se incluirán pacientes con diagnóstico de IC atendidos en consultas de cardiología y medicina interna de cinco hospitales de España.(AU)

Background: Heart failure (HF) is a complex clinical syndrome that impairs the ability to achieve proper filling or ejection, inwhich patients have typical symptoms and signs. It is a major Public Health problem with a high incidence and prevalence associatedwith high morbidity and mortality. The management of the patient with HF is complex, requiring in its treatment the work of specialized multidisciplinary teams in which the management of cardiac-healthy habits and self-care will play a leading role. Knowingthe health literacy (HL) level of patients is a fundamental piece that will help us to provide a holistic attention, based on individualneeds, promoting in this way the empowerment of the patient. Our aim will be to evaluate the effectiveness of an HL intervention forimproving quality of life and decreasing morbidity/mortality.Methods: A two-arm randomized controlled clinical trial will be conducted, with concealment of randomization. Patients with diagnosis of HF attended in cardiology and internal medicine consultations of 5 hospitals in Spain will be included.(AU)

Modified Mach-Zehnder interferometer for spatial coherence measurement.

Spatial coherence of light sources is usually obtained by using the classical Young's interferometer. Although the original experiment was improved upon in successive works, some drawbacks still remain. For example, several pairs of points must be used to obtain the complex coherence degree (normalized first-order correlation function) of the source. In this work, a modified Mach-Zehnder interferometer which includes a pair of lenses and is able to measure the spatial coherence degree is presented. With this modified Mach-Zehnder interferometer, it is possible to measure the full 4D spatial coherence function by displacing the incoming beam laterally. To test it, we have measured only a 2D projection (zero shear) of the 4D spatial coherence, which is enough to characterize some types of sources. The setup has no movable parts, making it robust and portable. To test it, the two-dimensional spatial coherence of a high-speed laser with two cavities was measured for different pulse energy values. We observe from the experimental measurements that the complex degree of coherence changes with the selected output energy. Both laser cavities seem to have similar complex coherence degrees for the maximum energy, although it is not symmetrical. Thus, this analysis will allow us to determine the best configuration of the double-cavity laser for interferometric applications. Furthermore, the proposed approach can be applied to any other light sources.

Accuracy and Limitations of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients with Positive Nodes.

Background: Axillary surgical management in patients with node-positive breast cancer at the time of diagnosis converted to negative nodes through neoadjuvant chemotherapy (NAC) remains unclear. Removal of more than two sentinel nodes (SLNs) in these patients may decrease the false negative rate (FNR) of sentinel lymph node biopsies (SLNBs). We aim to analyse the detection rate (DR) and the FNR of SLNB assessment according to the number of SLNs removed. Methods: A retrospective study was performed from October 2012 to December 2018. Patients with invasive breast cancer who had a clinically node-positive disease at diagnosis and with a complete axillary response after neoadjuvant chemotherapy were selected. Patients included underwent SLNB and axillary lymph node dissection (ALND) after NAC. The SLN was considered positive if any residual disease was detected. Descriptive statistics were used to describe the clinicopathologic features and the results of SLNB and ALND. The DR of SLNB was defined as the number of patients with successful identification of SLN. Presence of residual disease in ALND and negative SLN was considered false negative. Results: A total of 368 patients with invasive breast cancer who underwent surgery after complete NAC were studied. Of them, 85 patients met the eligibility criteria and were enrolled in the study. The mean age at diagnosis was 50.8 years. Systematic lymphadenectomy was performed in all patients, with an average of 10 lymph nodes removed. The DR of SLNB was 92.9%, and the FNR was 19.1. The median number of SLNs removed was 3, and at least, three SLNs were obtained in 42 patients (53.2%). When at least three sentinel nodes were removed, the FNR decreased to 8.7%. Conclusions: In this cohort, the SLN assessment was associated with an adequate DR and a high FNR. Removing three or more SLNs decreased the FNR from 19.1% to 8.7%. Complementary approaches may be considered for axillary lymph node staging after neoadjuvant chemotherapy. The study was approved by our institution's ethics committee (Instituto de Investigacion Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain) (https://clinicaltrials.gov/ct2/show/NCEI:20/0048).

Carbon Monoxide poisoning and Air Embolism following Hysteroscopic Myomectomy: a case report.

INTRODUCTION: Uterine myomas are the most common benign uterine tumors. Hysteroscopic myomectomy has grown as a standard minimally invasive surgical procedure, but this technique is not free from complications. CASE: An hysteroscopic myomectomy was performed on a 38 years-old woman. During the awakening after the procedure, she presented focal neurological deficits, thus arterial blood gas test and total body computerized tomography (CT) scan were urgently carried out. They revealed a very high carboxyhemoglobin level and abdominal venous air embolism. The patient stayed in Trendelenburg position and under mechanical ventilation with 100% oxygen concentration. Fortunately, a few hours later she was fully awake and was able to be successfully extubated, being discharged to the surgical ward three days later fully recovered. CONCLUSION: Carbon monoxide poisoning during hysteroscopic resection is a rare but potentially fatal complication that anesthetists, gynecologists, and critical care physicians should be aware of.

Prevalencia de Fasciola hepatica y Paramphistomidae en bovinos de doble propósito en una hacienda del trópico bajo andino colombiano / Prevalence of Fasciola hepatica and Paramphistomidae in dual purpose cattle in a farm in the Colombian low Andean tropic

RESUMEN En muchos países la fasciolosis y la paramfistomosis representan un grave problema para la salud del sector pecuario. En Colombia hay registros de ambas distomatosis en bovinos, la mayoría en el trópico alto andino, las cuales generan pérdidas econômicas anuales cercanas a 40 000 000 000 COP. El objetivo de esta investigación fue determinar la prevalencia de fasciolosis y paramfistomosis en vacunos de la hacienda La Candelaria, Caucasia (Colombia), y la presencia de caracoles hospederos intermediarios. Para cumplirlo, se realizó un estudio descriptivo de corte transversal con muestreo no probabilístico por conveniencia. Se recolectaron heces de los animales y se hizo el diagnóstico mediante la técnica modificada de Dennis. Se establecieron las prevalencias de los digeneos de acuerdo con el sexo, peso, edad y raza. Se recolectaron caracoles dulciacuícolas en la zona estudiada y se identificaron por morfologia. Se analizaron 466 muestras fecales de 178 bovinos, de las razas Cebú (Bos indicus), BON (blanco orejinegro) y del cruce entre ellas. Se diagnosticaron F. hepatica y Paramphistomidae con prevalencias del 2,2% y 30,9%, respectivamente. En el 1,1% de los vacunos se diagnosticó coinfección. Ambas trematodosis prevalecieron en las hembras (p = 0,03). Se identificaron moluscos dulciacuícolas Ampullariidae, Physidae y Planorbidae sin estadios larvarios de digeneos. Se concluyó que los bovinos de doble propósito de la hacienda La Candelaria están expuestos a F. hepatica y Paramphistomidae, y, probablemente, se infectan en los predios de la hacienda. Paramphistomidae es más prevalente que F. hepatica, lo cual concuerda con lo descrito en algunos estudios realizados en hatos del trópico alto andino colombiano. Paramphistomidae se encontró en todos los grupos etarios.

ABSTRACT Fasciolosis and paramphistomosis are a major health problem for the livestock economy worldwide. In Colombia, both distomatosis are reported in cattle, particularly in high Andean tropics, with annual economic losses close to COP 40 billion. The goal of this study was to determine the prevalence of fasciolosis and paramphistomosis in cattle from La Candelaria farm, Caucasia (Colombia), and the presence of intermediate host snails. A descriptive cross-sectional study was carried out with non-probability convenience sampling. Stool samples were collected from the animals and the diagnosis was made using the modified Dennis technique. Digenea prevalence were determined according to sex, weight, age, and race. Freshwater snails were collected in the studied area and were identified by morphology. 400 and 66 fecal samples from 178 bovines of the Zebu (Bos indicus), BON (white-eared white) breeds and the cross between them were analyzed. Fasciola hepatica and Paramphistomidae were diagnosed with a prevalence of 2,2% and 30,9%, respectively. Coinfection was diagnosed in 1,1% of the cattle. Both trematodosis were most frequent in females (p = 0,03). Freshwater molluscs Ampullariidae, Physidae and Planorbidae without digenea larval stages were identified. It was concluded that dual-purpose cattle from La Candelaria farm are exposed to F. hepatica and Paramphistomidae and are probably infected on the farm grounds. Paramphistomidae was more prevalent than F. hepatica, which agrees with other studies in herds from the Colombian high Andean tropics. Paramphistomidae was found in all age groups.

Peripheral blood lymphocyte phenotypes in Alzheimer and Parkinson's diseases.

INTRODUCTION: Neuroinflammation is involved in the pathophysiology of various neurological disorders, in particular Alzheimer disease (AD) and Parkinson's disease (PD). Alterations in the blood-brain barrier may allow peripheral blood lymphocytes to enter the central nervous system; these may participate in disease pathogenesis. OBJECTIVE: To evaluate the peripheral blood lymphocyte profiles of patients with AD and PD and their association with the disease and its progression. METHODS: The study included 20 patients with AD, 20 with PD, and a group of healthy individuals. Ten of the patients with AD and 12 of those with PD were evaluated a second time 17 to 27 months after the start of the study. Lymphocyte subpopulations and their activation status were determined by flow cytometry. All patients underwent neurological examinations using internationally validated scales. RESULTS: Compared to healthy individuals, patients with AD and PD showed significantly higher levels of activated lymphocytes, lymphocytes susceptible to apoptosis, central memory T cells, and regulatory T and B cells. As the diseases progressed, there was a significant decrease in activated cells (CD4+ CD38+ and CD8+ CD38+ in PD and AD, CD4+ CD69+ and CD8+ CD69+ in PD), T cells susceptible to apoptosis, and some regulatory populations (CD19+ CD5+ IL10+ in PD and AD, CD19+ CD5+ IL10+ FoxP3+, CD4+ FoxP3+ CD25+ CD45RO+ in PD). In patients with AD, disease progression was associated with lower percentages of CD4+ CD38+ cells and higher percentages of effector CD4 cells at the beginning of the study. Significant differences were observed between both diseases. CONCLUSIONS: This study provides evidence of changes in peripheral blood lymphocyte phenotypes associated with AD and PD and their severity. Considering effective blood-brain communication, our results open new avenues of research into immunomodulation therapies to treat these diseases.

Fenotipos de linfocitos periféricos en las enfermedades de Alzheimer y Parkinson / Peripheral blood lymphocyte phenotypes in Alzheimer and Parkinson's diseases

Introducción: La neuroinflamación está involucrada en la fisiopatología de diferentes trastornos neurológicos, en particular la enfermedad de Alzheimer (EA) y la enfermedad de Parkinson (EP). Las alteraciones en la barrera hematoencefálica pueden permitir la entrada al sistema nervioso central de linfocitos periféricos, los cuales pueden participar en la patología de las enfermedades. Objetivo: Evaluar el perfil de linfocitos periféricos en pacientes con EA y EP y su asociación con la enfermedad y su progresión. Métodos: Se incluyeron 20 pacientes con EA, 20 pacientes con EP y un grupo de individuos sanos. Diez de los pacientes con EA y 12 de los pacientes con EP fueron evaluados una segunda vez de 17 a 27 meses después del inicio del estudio. Las subpoblaciones de linfocitos y su estado de activación se determinaron mediante citometría de flujo. Todos los pacientes fueron evaluados neurológicamente utilizando escalas validadas internacionalmente. Resultados: Los pacientes con EA y EP mostraron un aumento significativo en los niveles de linfocitos activados, linfocitos susceptibles a la apoptosis, células T de memoria central y células T y B reguladoras con respecto a los sujetos sanos. A medida que las enfermedades progresaron se observó una disminución significativa de las células activadas (CD4+ CD38+ y CD8+ CD38+ en EP y EA; CD4+ CD69+ y CD8+ CD69+ en EP), de las células T susceptibles a la apoptosis y de algunas poblaciones reguladoras (CD19+ CD5+ IL10+ en EP y EA; CD19+ CD5+ IL10+ FoxP3+, CD4+ FoxP3+ CD25+ CD45RO+ en EP). En pacientes con EA la progresión de la enfermedad se asoció con porcentajes más bajos de CD4 + CD38 + y mayores porcentajes de células CD4 efectoras al comienzo del estudio. Se observaron diferencias significativas entre ambas enfermedades. Conclusiones: Este estudio proporciona evidencia de cambios en los fenotipos de linfocitos periféricos asociados a EA y EP y a su gravedad. [...] (AU)

Introduction: Neuroinflammation is involved in the pathophysiology of various neurological disorders, in particular Alzheimer disease (AD) and Parkinson's disease (PD). Alterations in the blood-brain barrier may allow peripheral blood lymphocytes to enter the central nervous system; these may participate in disease pathogenesis. Objective: To evaluate the peripheral blood lymphocyte profiles of patients with AD and PD and their association with the disease and its progression. Methods: The study included 20 patients with AD, 20 with PD, and a group of healthy individuals. Ten of the patients with AD and 12 of those with PD were evaluated a second time 17 to 27 months after the start of the study. Lymphocyte subpopulations and their activation status were determined by flow cytometry. All patients underwent neurological examinations using internationally validated scales. Results: Compared to healthy individuals, patients with AD and PD showed significantly higher levels of activated lymphocytes, lymphocytes susceptible to apoptosis, central memory T cells, and regulatory T and B cells. As the diseases progressed, there was a significant decrease in activated cells (CD4+ CD38+ and CD8+ CD38 + in PD and AD, CD4+ CD69+ and CD8+ CD69+ in PD), T cells susceptible to apoptosis, and some regulatory populations (CD19+ CD5+ IL10+ in PD and AD, CD19+ CD5+ IL10+ FoxP3+, CD4+ FoxP3+ CD25+ CD45RO+ in PD). In patients with AD, disease progression was associated with lower percentages of CD4+ CD38+ cells and higher percentages of effector CD4 cells at the beginning of the study. Significant differences were observed between both diseases. Conclusions: This study provides evidence of changes in peripheral blood lymphocyte phenotypes associated with AD and PD and their severity. Considering effective blood-brain communication, our results open new avenues of research into immunomodulation therapies to treat these diseases. (AU)

Acylase enzymes disrupting quorum sensing alter the transcriptome and phenotype of Pseudomonas aeruginosa, and the composition of bacterial biofilms from wastewater treatment plants.

Biofilms represent an essential way of life and colonization of new environments for microorganisms. This feature is regulated by quorum sensing (QS), a microbial communication system based on autoinducer molecules, such as N-acyl-homoserine lactones (AHLs) in Gram negative bacteria. In artificial ecosystems, like Wastewater Treatment Plants (WWTPs), biofilm attachment in filtration membranes produces biofouling. In this environment, the microbial communities are mostly composed of Gram-negative phyla. Thus, we used two AHLs-degrading enzymes, obtained from Actinoplanes utahensis (namely AuAAC and AuAHLA) to determine the effects of degradation of QS signals in the biofilm formation, among other virulence factors, of a Pseudomonas aeruginosa strain isolated from a WWTP, assessing molecular mechanisms through transcriptomics. Besides, we studied the possible effects on community composition in biofilms from activated sludge samples. Although the studied enzymes only degraded the AHLs involved in one of the four QS systems of P. aeruginosa, these activities produced the deregulation of the complete QS network. In fact, AuAAC -the enzyme with higher catalytic efficiency- deregulated all the four QS systems. However, both enzymes reduced the biofilm formation and pyocyanin and protease production. The transcriptomic response of P. aeruginosa affected QS related genes, moreover, transcriptomic response to AuAAC affected mainly to QS related genes. Regarding community composition of biofilms, as expected, the abundance of Gram-negative phyla was significantly decreased after enzymatic treatment. These results support the potential use of such AHLs-degrading enzymes as a method to reduce biofilm formation in WWTP membranes and ameliorate bacterial virulence.

IL-1α Modulates IFN-γ-Induced Production of CXCL9/MIG during Herpes Simplex Virus Type-1 Corneal Infection.

PURPOSE: Investigating the modulation of neutrophil production of MIG and IP-10 during the inflammatory response to HSV-1 infection. MATERIALS AND METHODS: An ex vivo model of human corneal infection by HSV-1 was used for this study. This model permits the study of cytokine production by human corneal buttons in the presence, or absence, of gradient purified human neutrophils, under conditions of HSV-1 infection. All experimental samples were stimulated with a baseline concentration of recombinant human IFN-γ at 1 ng/mL. The relative levels of production for 12 pro-inflammatory mediators were screened using a multi-analyte ELISA assay. Neutrophil production of chemokines MIG and IP-10, under conditions of IFN-γ and/or HSV-1 stimulation were measured by quantitative ELISA. Lastly, antibody neutralization (goat IgG anti-human IL-1α, 2 µg/mL) of de novo production of IL-1α by corneal tissue was performed to investigated the effect on MIG and IP-10 production in the ex vivo model for HSV-1 infection. RESULTS: Four of the 12 pro-inflammatory mediators screened (IL-8, IL-6, IL-1α and IL-1ß) demonstrated elevated levels of production during corneal cell infection with HSV-1 and communication with neutrophils. Neutrophils were demonstrated to produce significant levels of both MIG and IP-10 under conditions of IFN-γ stimulation, and production of MIG was further upregulated by co-stimulation with IFN-γ and HSV-1. Neutralization of de novo IL-1α production in the model resulted in increased production of the chemokine production MIG but had no observable effect on IP-10 production. CONCLUSIONS: Our data provide evidence demonstrating the potential for expression patterns of MIG and IP-10 to be modulated by IL-1α, during the inflammatory response to HSV-1 corneal infection. Both corneal cells and neutrophils contribute to the production of T cell recruiting chemokines. However, IL-1α has the potential to upregulate MIG production by corneal cells while down-regulating MIG production by neutrophils.

A review of the impact of xenobiotics from dietary sources on infant health: Early life exposures and the role of the microbiota.

Xenobiotics are worldwide distributed and humans are unavoidably exposed to multiple chemical compounds during life, from preconception to adulthood. The human microbiota is mainly settled during early life and modulate host health and fitness. One of the main routes for chemical exposure is by intake of contaminated food and water. Thus, the interplay between diet-xenobiotics-microbiota during pregnancy and perinatal period may have relevant consequences for infant and adult health. Maternal exposure to metal(oid)s, persistent organic pollutants, and some food additives can modify the infant's microbiota with unknown consequences for child or adult health. Toxicants' exposure may also modulate the maternal transfer of microorganisms to the progeny during birth and breastfeeding; however, scarce information is available. The rapid increase in releasing novel chemicals to the environment, the exposure to chemical mixtures, the chronic/low dose scenario, and the delay in science-stakeholders action call for novel and groundbreaking approaches to improve a comprehensive risk assessment in sensitive population groups like pregnant women and neonates, with emphasis on microbiota as modulating factor and target-organ of xenobiotic's toxicity.

Perinatal environment shapes microbiota colonization and infant growth: impact on host response and intestinal function.

BACKGROUND: Early microbial colonization triggers processes that result in intestinal maturation and immune priming. Perinatal factors, especially those associated with birth, including both mode and place of delivery are critical to shaping the infant gut microbiota with potential health consequences. METHODS: Gut microbiota profile of 180 healthy infants (n = 23 born at home and n = 157 born in hospital, 41.7% via cesarean section [CS]) was analyzed by 16S rRNA gene sequencing at birth, 7 days, and 1 month of life. Breastfeeding habits and infant clinical data, including length, weight, and antibiotic exposure, were collected up to 18 months of life. Long-term personalized in vitro models of the intestinal epithelium and innate immune system were used to assess the link between gut microbiota composition, intestinal function, and immune response. RESULTS: Microbiota profiles were shaped by the place and mode of delivery, and they had a distinct biological impact on the immune response and intestinal function in epithelial/immune cell models. Bacteroidetes and Bifidobacterium genus were decreased in C-section infants, who showed higher z-scores BMI and W/L during the first 18 months of life. Intestinal simulated epithelium had a stronger epithelial barrier function and intestinal maturation, alongside a higher immunological response (TLR4 route activation and pro-inflammatory cytokine release), when exposed to home-birth fecal supernatants, compared with CS. Distinct host response could be associated with different microbiota profiles. CONCLUSIONS: Mode and place of birth influence the neonatal gut microbiota, likely shaping its interplay with the host through the maturation of the intestinal epithelium, regulation of the intestinal epithelial barrier, and control of the innate immune system during early life, which can affect the phenotypic responses linked to metabolic processes in infants. TRIAL REGISTRATION: NCT03552939 . Video Abstract.

[Blood-glucose control in eldely patients with type 2 diabetes. Interventions to avoid risks]. / Control glucémico en pacientes diabéticos tipo 2 de edad avanzada. Intervención para evitar riesgos.

OBJECTIVE: To evaluate blood-glucose control in elderly patients with type 2 diabetes mellitus (T2DM), who are receiving various anti-diabetic treatments, and to analyse the effect of an intervention. MATERIAL AND METHODS: Cross-sectional, descriptive, and observational study of prevalence that included patients who were ≥75 years old with T2DM and being treated with two or more antidiabetic drugs. The adequacy of treatments following current recommendations for this population group was analysed, together with the prevalence of macro- and micro-vascular complications, dementia, and hypoglycaemia, the treatments used, and adherence. An intervention was carried out to optimise prescription. RESULTS: A total of 215 patients were included, of which 54.4% were women. The mean age was 82.0±4.1, and 77.2% had micro- and/or macrovascular complications, and 7.4% had dementia. Inadequacy was detected in 67.9% due to an overly intensive blood glucose control (55.6% HbA1c<7.5%), or that the dosage was not adapted to glomerular filtration (51.0%). The large majority (81.4%) were being treated with drugs with a risk of producing hypoglycaemia (2.3% had recorded episodes). The HbA1c mean was higher in non-adherent patients (8.1±1.6% vs 7.5±1.3%, P<.05). After the intervention, the intensity of hypoglycaemic treatment was reduced in 36.2% of patients, and the dosage of drugs that required adjustment was corrected in 23.1%. The percentage of overtreatment decreased to 40.0% (P<.01). CONCLUSIONS: More than half of the elderly patients with T2DM and important comorbidities had an overly strict glycaemic control. The launch of an intervention programme has allowed for an improvement in safety and for the optimisation of treatments.

COVID-19 en el enfermo renal. Revisión breve / COVID-19 in renal patient. Brief Review

En diciembre de 2019 se identificó en China una nueva subespecie de coronavirus al que denominaron SARS-CoV-2, responsable de la enfermedad posterior a la que la OMS llamó COVID-19. La enfermedad se ha propagado rápidamente provocando una pandemia mundial. Todavía se desconoce mucho del SARS-CoV-2, pero las primeras investigaciones respaldan la hipótesis de que la gravedad de la COVID-19 viene condicionada por la respuesta hiperinflamatoria que se produce en nuestro organismo al contacto con el SARS-CoV-2. La gravedad del cuadro se relaciona con la insuficiencia respiratoria que provoca, no obstante, existen estudios que no limitan la afectación pulmonar. Investigaciones apuntan a que el mecanismo de acceso del SARS-CoV-2 al organismo está muy relacionado con la enzima ACE2. Enzima que entre otros tejidos, se puede encontrar en el epitelio de las células tubulares renales. Esta es la causa por la que existen datos de pacientes con COVID-19 que tienen una gran afectación en la función renal y pueden cursar con IRA (factor de mal pronóstico). Por este motivo, unido a que las comorbilidades asociadas con una mayor mortalidad durante la infección COVID-19 son comunes en los pacientes con enfermedad renal crónica, creemos necesario conocer los resultados que aportan los diferentes estudios realizados sobre esa materia

In December 2019, a new subspecies of coronavirus was identified in China, which was named SARS-CoV-2, responsible for the disease that WHO called COVID-19. The disease has spread rapidly causing a global pandemic. Much is still unknown about SARS-CoV-2, but the first findings support the hypothesis that the severity of COVID-19 is conditioned by the hyperinflammatory response, which occurs in our body after contacting SARS-CoV-2. The severity of the symptoms is conditioned by the respiratory failure caused, however there are studies that are not limited to lung involvement. Evidence suggests that the access mechanism of the SARS-CoV-2 virus is closely related to the ACE2 enzyme. An enzyme that, among other tissues, can be found in the epithelium of renal tubular cells. For this reason, there are data on patients with COVID-19 who are severely affected in kidney function and may have acute kidney failure (a poor prognostic factor). For this reason, together with the fact that the comorbidities associated with a higher mortality during COVID-19 infection are common in patients with chronic kidney disease, it is necessary to know the available evidence on this matter

The Effect of Decision Training, from a Cognitive Perspective, on Decision-Making in Volleyball: A Systematic Review and Meta-Analysis.

Over the past few decades there has been great interest in the study of cognitive processes, and specifically decision-making, from a cognitive perspective. The aim of the present study was to systematically review the scientific literature on the effect of decision training interventions/programs, from a cognitive perspective, on the decision-making of volleyball players. The systematic search was carried out in five scientific electronic databases according to PRISMA guidelines Web of Science (WOS), Pubmed (Medline), Scopus, SportDiscus and Google Scholar. A total of eight studies met the inclusion criteria. The main finding of the meta-analysis was that the use of decision-making training programs/interventions led to significant improvements in volleyball players' decision-making (Standardized mean difference = 0.94 with 95% confidence interval from 0.63 to 1.25), compared to normal active volleyball training. In addition, the heterogeneity of the interventions was low (I2 = 0%). From the results of the studies analyzed, we recommend using decisional interventions or training, both as part of normal active training or complementary to it, to improve the decision-making of the players, thus optimizing their ability to perceive and process relevant stimuli, and then generate quick and effective responses. These findings can be useful in the process of sports training.

Guías de práctica clínica basadas en la evidencia para el manejo de la sedoanalgesia y delirium en el paciente adulto críticamente enfermo / Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients

Dada la importancia del manejo de la sedación, analgesia y delirium en las unidades de cuidados intensivos, y con el fin de actualizar las guías publicadas anteriormente, se decidió elaborar una nueva guía de práctica clínica con los soportes, manejos e intervenciones más relevantes acordes con las publicaciones recientes. Para elaborar esta guía, se reunió un grupo de 24 intensivistas procedentes de 9 países de la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva. Se acogió la propuesta del Grading of Recommendations Assessment, Development and Evaluation Working Group para emitir el grado de recomendación y evaluar la calidad de la evidencia. Se realizó una búsqueda sistemática de la literatura utilizándose: MEDLINE, las siguientes bases de datos de la biblioteca Cochrane: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects, National Health Service Economic Evaluation Database, y la base de datos de Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). Finalmente, se seleccionaron 438 referencias, permitiendo realizar 47 recomendaciones fuertes con evidencia alta y moderada, 14 recomendaciones condicionales con evidencia moderada y 65 recomendaciones condicionales con evidencia baja. Se confirma la importancia del manejo inicial y multimodal del dolor, se hace énfasis en la disminución de los niveles de sedación y la utilización de sedación profunda solo en casos específicos. Aumenta la evidencia y recomendaciones para el uso de medicamentos como dexmedetomidina, remifentanil, ketamina, entre otros

Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented