Streptomyces profundus sp. nov., a novel marine actinobacterium isolated from deep-sea sediment of Madeira Archipelago, Portugal.

A novel strain, MA3_2.13T, was isolated from deep-sea sediment of Madeira Archipelago, Portugal, and characterized using a polyphasic approach. This strain produced dark brown soluble pigments, bronwish black substrate mycelia and an aerial mycelium with yellowish white spores, when grown on GYM 50SW agar. The main respiratory quinones were MK-10(H4), MK-10(H6) and MK-10(H8). Diphosphatidylglycerol, phosphatidylethanolamine, three unidentified phospholipids and two glycophospholipids were identified as the main phospholipids. The major cellular fatty acids were iso-C16 : 1, iso-C16 : 0, anteiso-C17 : 1 and anteiso-C17 : 0. Phylogenetic analyses based on 16S rRNA gene showed that strain MA3_2.13T is a member of the genus Streptomyces and was most closely related to Streptomyces triticirhizae NEAU-YY642T (NR_180032.1; 16S rRNA gene similarity 97.9 %), Streptomyces sedi YIM 65188T (NR_044582.1; 16S rRNA gene similarity 97.4 %), Streptomyces mimosae 3MP-10T (NR_170412.1; 16S rRNA gene similarity 97.3 %) and Streptomyces zhaozhouensis NEAU-LZS-5T (NR_133874.1; 16S rRNA gene similarity 97.0 %). Genome pairwise comparisons with closest related type strains retrieved values below the threshold for species delineation suggesting that strain MA3_2.13T represents a new branch within the genus Streptomyces. Based on these results, strain MA3_2.13T (=DSM 115980T=LMG 33094T) is proposed as the type strain of a novel species of the genus Streptomyces, for which the name Streptomyces profundus sp. nov. is proposed.

Impact of ozone therapy on mouse liver mitochondrial function and antioxidant system.

Ozone therapy's efficacy might stem from the regulated and mild oxidative stress resulting from ozone's interactions with various biological elements. The present work aimed to characterize the hepatic mitochondrial response to ozone treatment and its relationship with the antioxidant system response. Two groups of mice were used: one control group and another injected intraperitoneally with an O3/O2 mixture (80 ml/kg) for 5 days. Mitochondrial respiration supported by different substrates was significantly inhibited, as well as complexes I and II/III, but not complex IV. The analysis of the electron transport chain complex activity showed significant inhibitions in complexes I and II/III but not in complex IV. These inhibitions can prevent mitochondrial reactive oxygen species (ROS) production. Additionally, there was a decline in glutathione content, unaccompanied by a rise in its oxidized form. The ozone-treated groups showed a significant increase in the activity of superoxide dismutase and glutathione peroxidase, while catalase and glutathione reductase experienced no significant alterations. Adenine nucleotides increased in the ozone group, but only the increase in adenosine diphosphate is significant, so the cell's energy charge is unaffected. This study shows that mitochondria may play a crucial role in ozone treatment. However, it also highlights the need for further studies to understand the molecular mechanism.

Foliar application of nettle and Japanese knotweed extracts on Vitis vinifera: impact on phenylpropanoid biosynthesis and antioxidant activity during veraison and harvest of cv. Touriga Franca.

BACKGROUND: Plant-based extracts have been recently used as sustainable tools to improve biotic and abiotic stress tolerance and increase grape (Vitis vinifera L.) quality. However, knowledge about the effect of these extracts on secondary metabolism compounds, that are fundamental for grape and wine quality, is still scarce. In this study, a trial was installed in an experimental vineyard with the variety Touriga Franca located at University of Trás-os-Montes e Alto Douro, Baixo Corgo sub-region of the Douro Demarcated Region, Portugal in two growing seasons: 2019 and 2020. The aim was to evaluate the effect of foliar application of nettle (Urtica spp.) extract (NE) and Japanese knotweed (Reynoutria japonica) extract (JKE) on grapevines leaves and berries bioactive compounds contents and antioxidant activity, at veraison and harvest. RESULTS: The application of NE increased the total carotenoids in leaves and the total phenolics content and the antioxidant activity (ferric reducing antioxidant power, FRAP) in berries while JKE increased flavonoids content in leaves and the antioxidant activity (2,2-diphenyl-1-picrylhydrazyl, DPPH) in berries. CONCLUSION: These extracts seem to have a stimulatory effect on grapevine, enhancing bioactive compounds contents and antioxidant capacity and, consequently, the physiological performance of the plant and the quality of the berries. © 2024 Society of Chemical Industry.

Oral Gastric Heterotopia: First Reported Case in the Hard Palate.

Gastric heterotopia is characterized by the presence of mature gastric tissue outside the stomach, yet its occurrence in the palate has not been previously documented. We describe a case of gastric heterotopia in the hard palate of an elderly female patient, presenting as a swollen mass with associated secretion. Given the patient's age and clinical symptoms, a presumptive diagnosis of a malignant tumor originating from the minor salivary glands was made. An incisional biopsy of the mass revealed gastric heterotopia. Subsequently, the extended excision of the lesion was performed, leading to the full resolution of the patient's symptoms. After a two-year follow-up period, no evidence of recurrence was observed. The importance of this case, underscored by the unprecedented location of gastric heterotopia, emphasizes the critical need for thorough evaluation to avert misdiagnosis, as well as the complete surgical excision of the lesion to prevent recurrence.

First contact with the health system: a survey study in northern Portugal.

OBJECTIVE: The objective of this study is to characterise the self-reported first contact with the health system and the reasons stated for each choice, testing associations with population characteristics. DESIGN: Cross-sectional survey. SETTING: Primary care department of a local health unit in northern Portugal. PARTICIPANTS: Random sample of 4286 persons, retrieved from all registered adults. OUTCOMES: Participants who stated they usually see the same doctor when a health problem arises were considered to adopt first-contact care and were asked to identify their regular doctor. Participants were asked why they adopt first-contact care or why they choose to do otherwise. Associations between personal characteristics and the adoption of first-contact care were tested using logistic regression. RESULTS: There were 808 valid questionnaires received (19% response rate). The mean age of respondents was 53 years, 58% were women and 60% had a high school or higher degree. Most (71%) stated always seeing the same doctor when facing a health problem. This was a general practitioner (GP) in 84%. The main reasons were previous knowledge and trust in the doctor. When this doctor was not a GP, the main reason was the need to obtain an appointment quickly. Participants who chose first-contact care were less likely to have university degrees than those who did not (OR 0.31; 95% CI 0.13 to 0.76). Being registered with the same GP for over 1 year increased the odds of adopting first-contact care: twice as likely for those registered for 1-4 years with the same GP (2.07; 95% CI 1.04 to 4.11), and three times more likely for those registered for over 10 years (3.21; 95% CI 1.70 to 6.08). CONCLUSIONS: The high adoption of first-contact care and the reasons given for this suggest a strong belief in primary care in this population. The longer patients experience continuity, the more they adopt first-contact care. The preferences of higher-educated patients regarding first-contact care deserve reflection.

Ascophyllum nodosum Extract and Glycine Betaine Preharvest Application in Grapevine: Enhancement of Berry Quality, Phytochemical Content and Antioxidant Properties.

The Douro Demarcated Region (DDR) has peculiar edaphoclimatic characteristics that provide a suitable terroir for premium wine production. As climate change effects continue to emerge, ensuring productivity and quality becomes increasingly important for viticulturists, as those directly determine their profits. Cultural approaches, such as the use of biostimulants, are actively being developed to mitigate abiotic stress. The main objective of this work was to assess the effect of foliar sprays of a seaweed (Ascophyllum nodosum)-based extract (ANE) and glycine betaine (GB) on grape berry quality, bioactive compounds, and antioxidant activity. A trial was installed in a commercial vineyard (cv. 'Touriga Franca') in the Douro Superior (Upper Douro) sub-region of the Douro Demarcated Region. In 2020 and 2021, three foliar sprayings were performed during the growing season, namely at pea size, bunch closure, and veraison. There was a positive effect of both biostimulants (ANE and GB) on the physiological and biochemical performance of cv. 'Touriga Franca' exposed to summer stress. In general, the GB 0.2% spraying was the most promising treatment for this grape cultivar, as it increased berry quality, the concentration of bioactive compounds (total phenolics, flavonoids, and ortho-diphenols), and the antioxidant activity. These results revealed the efficacy of biostimulant sprayings as a sustainable viticultural practice, improving berry quality under summer stress conditions.

Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal.

Consumption of antimicrobials is an important driver of antimicrobial resistance. There is limited knowledge of the key determinants of antimicrobial prescribing behavior in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in Antimicrobial Stewardship Programs (ASP). This study aimed to describe the main factors that influence the doctor's decision on antimicrobials prescribing and to identify the behaviors that drive physicians' decision making. A structured web-based questionnaire focused on behavioral components of antimicrobial prescription was applied to the medical staff of three different departments-Internal Medicine, General Surgery, and Intensive Care Medicine-of a university hospital. All doctors agreed that inadequate use of antimicrobials increases AMR. A total of 77% of the surgeons and 100% of the internists and intensivists perceived antimicrobial prescription as a priority in the department. Full autonomy in antimicrobial prescription was preferred by internists (64%) but not by surgeons (18%) and intensivists (24%). Most physicians were keen to have ASP advice, but most did not want advice from colleagues of the same service. Almost all surgeons ask for advice when prescribing, but only 68% of the internists do it. Less than half of all physicians and only 25% of the surgeons felt free to prescribe contrary to guidelines. Most physicians, particularly in Intensive Care Medicine (94%), adopt the "wait and see" strategy when no microbiologic confirmation is available, but 27% of the surgeons start empirical therapy. In conclusion, the context of antimicrobial prescription, autonomy, and confidence in antimicrobial prescription demonstrated heterogeneity between the three departments and this should be considered when planning ASP.

Access to General Practitioners during the COVID-19 pandemic in Portugal-A survey study of patient experiences in an urban setting.

BACKGROUND: In 2020, Portugal had high levels of unmet health care needs. Primary Care was reported as the main source of unmet needs. OBJECTIVES: To describe face-to-face and remote access to GPs in Portugal during the COVID-19 pandemic. To discover patient experiences and attitudes to access to care. To identify determinants of access to care. METHODS: A survey of a random sample of 4,286 adults registered in a group of Family Practices was conducted in 2021. Paper questionnaires were sent by post to patients who had no e-mail address registered with the practice. Patients with an e-mail address were sent a link to an online questionnaire. Outcomes were reported waiting times for face-to-face and remote contacts with GPs, dichotomized to ascertain compliance with standards. Associations between participant characteristics and outcome variables were tested using logistic regression. RESULTS: Waiting times for face-to-face consultations with GPs during the pandemic often exceeded the maximum waiting times (MWT) set by the National Health Service. Remote contacts were mostly conducted within acceptable standards. Waiting times for speaking with the GP over the phone were rated as 'poor' by 40% and 27% reported requests for these calls as unmet. The odds of getting care over MWT increased for participants who reported poorer digital skills. Participants were less likely to get non-urgent consultations over MWT if they found it easy to use the online patient portal to book appointments (odds ratio 0.24; 99% confidence intervals 0.09-0.61), request prescriptions (0.18; 0.04-0.74) or insert personal data (0.18; 0.04-0.95). CONCLUSION: Patient reported access to GPs during the pandemic was uneven in Portugal. Obtaining non-urgent consultations and remote contacts over MWT affected mainly those patients with poor digital skills. Telephone access to GPs received the worse ratings. Access through traditional pathways must remain available, to prevent the widening of inequities.

Impact of Donor Age on Long-Term Outcomes in Simultaneous Pancreas-Kidney Transplantation.

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for type 1 diabetes patients with end-stage renal disease. Donor characteristics are determinants of graft and patient survival. We aimed to study the impact of donor age on outcomes in SPKT. METHODS: We retrospectively studied 254 patients submitted to SPKT between 2000 and 2021. Patients were classified as "younger donor" (donor age <40 years) and "older donor" (donor age ≥40 years). RESULTS: Fifty-three patients received grafts from older donors. Pancreas graft survival rates at 1, 5, 10, and 15 years were 89%, 83%, 77%, and 73% in the younger donor group, respectively, and 77%, 73%, 67%, and 62% in the older donor group, respectively (P = .052). Older donors and previous major adverse cardiovascular events (MACEs) were associated with pancreas graft failure at 15 years. Kidney transplant survival (1, 5, 10, and 15 years) was lower in the older donor cohort (94%, 92%, 69%, 60% vs 97%, 94%, 89%, and 84%, respectively; P = .004). Older donor, recipient age, and previous MACE predicted kidney graft failure at 15 years. Patient survival rates at 1, 5, 10, and 15 years were 98%, 95%, 91%, and 81% in the younger donor group, respectively, versus 92%, 90%, 84%, and 72% in the older donor group, respectively (P = .127). CONCLUSIONS: The kidney graft survival rate was lower in the older donor group, whereas pancreas graft survival and patient survival did not differ significantly. Multivariate analysis showed that a donor age of ≥40 years was an independent predictor of pancreas and kidney graft failure at 15 years in SPKT patients.

Surveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors.

OBJECTIVE: The incidence of surgical site infection (SSI) is highest after colorectal surgery. We assessed the impact of risk factors for SSI using the population attributable fraction (PAF). DESIGN: Retrospective cohort study. SETTING: Portuguese hospitals performing regular surveillance. PATIENTS: We identified patients who underwent colorectal procedures in hospitals that reported colorectal surgeries every year between 2015 and 2019. Among 42 reporting hospitals, 18 hospitals were included. METHODS: Risk-factor incidence was estimated using the National Epidemiological Surveillance platform from 2015 to 2019. This platform follows the methodology recommended by the European Centre for Disease Prevention and Control. American Society of Anaesthesiologists (ASA) physical classification, wound classification, open surgery, urgent operation, antibiotic prophylaxis, operation time, and male sex were included as risk factors. Measures of association were retrieved from published meta-analyses. PAFs were calculated using the Levin formula. To account for interaction between risk factors, communality of risk factors was used in a weighted-sum approach, providing a combined value that serves as a measure of the comprehensiveness of surveillance. RESULTS: Among 11,219 reported procedures, the cumulative SSI incidence was 16.8%. The proportion of SSI attributed to all risk factors was 61%. Modifiable variables accounted for 31% of procedures; the highest was laparotomy (16.8%), and urgent operations (2.7%) had the lowest value. Nonmodifiable factors accounted for 28.7%; the highest was wound classification (14.3%). CONCLUSIONS: A relevant proportion (39%) of SSI remains unaccounted for by current surveillance. Almost one-third of SSI cases have potentially modifiable factors. Interventions focusing on shorter, less invasive procedures may be optimally effective in reducing the SSI incidence.

Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors.

BACKGROUND: The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS: All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS: A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS: Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.

Pregnancy in kidney transplantation women: perinatal outcomes and impact on kidney function.

OBJECTIVES: This study aimed to evaluate maternal and perinatal outcomes in pregnancies after kidney transplant (KT) and the impact of pregnancy on graft function. METHODS: A descriptive and retrospective case-control study included 43 pregnancies in women after KT, followed in our institution, from January 1991 to December 2019. The control group included 200 non-transplanted pregnant women. Statistical analysis used SPSS 25.0 (SPSS Inc., Chicago, IL), and a p value of .05 was considered statistically significant. RESULTS: We studied 43 pregnancies in 37 KT women. The live birth rate of KT pregnant was 81.4%. The mean interval between transplantation and pregnancy was 4.6 years (range 1-16). We found a higher rate of obstetric complications in pregnancies after KT: miscarriage (14.0%, OR 6.7 (2.0-22.1), p < .001), preeclampsia (31.4%, OR 25.7 (7.7-85.3), p < .001), and fetal growth restriction (37.1%, OR 37.6 (9.9-142.3), p < .001). The rate of urogenital infections and anemia during pregnancy was higher in the KT group (p < .001). The gestational age at delivery was 35.0 ± 2.8 weeks and premature delivery was observed in 24 (68.6%) cases. The cesarean rate was higher in the KT group (p < .001). In the KT group, there were two neonatal deaths due to prematurity complications. Renal function deterioration, measured by serum creatinine levels, was observed in two pregnancies. Immunosuppressive therapy was used in all pregnancies after KT, and dosage escalation of immunosuppressive therapy was necessary for 69.8%. CONCLUSIONS: A higher rate of adverse obstetric outcomes was found in KT pregnant. Kidney function remained stable in most pregnancies. An antenatal and postpartum multidisciplinary approach is essential to improve outcomes and minimization of complications.

Responses Presented by Adult Patients with COVID-19, Based on the Formulated Nursing Diagnoses: A Scoping Review.

(1) Background: this review aims to identify the human responses exhibited by adult patients with COVID-19, by listing the corresponding nursing diagnoses. Nursing diagnosis it's a clinical analysis of human responses to a person, family, or community. Therefore, it is possible to state that nursing diagnoses represent human responses. (2) Methods: a scoping review was conducted following recommendations provided by the Joanna Briggs Institute (JBI) and the research was carried out between December 2020 and 15 January, 2021, via CINAHL Complete, Complementary Index, MEDLINE, Science Direct, Academic Search Complete, Science Citation Index, Directory of Open Access Journals, Scopus, Social Sciences Citation Index, Business Source Complete, eBook Index (by B-on), and the Cochrane Database of Systematic Reviews (by Cochrane Library). (3) Results: with respect to studies using the NANDA-I taxonomy, the findings have shown that "impaired gas exchange" was the most highlighted nursing diagnosis. ICNP taxonomy, the relevant nursing diagnosis is "cough present". (4) Conclusions: concurrently, as suggested by the human responses documented in this review, throughout the pandemic, the requirements for adequate care provision have been constantly updated, to improve the quality of life of those patients, as much as possible.

Complete Genome Sequence of Two Deep-Sea Streptomyces Isolates from Madeira Archipelago and Evaluation of Their Biosynthetic Potential.

The deep-sea constitutes a true unexplored frontier and a potential source of innovative drug scaffolds. Here, we present the genome sequence of two novel marine actinobacterial strains, MA3_2.13 and S07_1.15, isolated from deep-sea samples (sediments and sponge) and collected at Madeira archipelago (NE Atlantic Ocean; Portugal). The de novo assembly of both genomes was achieved using a hybrid strategy that combines short-reads (Illumina) and long-reads (PacBio) sequencing data. Phylogenetic analyses showed that strain MA3_2.13 is a new species of the Streptomyces genus, whereas strain S07_1.15 is closely related to the type strain of Streptomyces xinghaiensis. In silico analysis revealed that the total length of predicted biosynthetic gene clusters (BGCs) accounted for a high percentage of the MA3_2.13 genome, with several potential new metabolites identified. Strain S07_1.15 had, with a few exceptions, a predicted metabolic profile similar to S. xinghaiensis. In this work, we implemented a straightforward approach for generating high-quality genomes of new bacterial isolates and analyse in silico their potential to produce novel NPs. The inclusion of these in silico dereplication steps allows to minimize the rediscovery rates of traditional natural products screening methodologies and expedite the drug discovery process.

Beyond the operating room: do hospital characteristics have an impact on surgical site infections after colorectal surgery? A systematic review.

BACKGROUND: Hospital characteristics have been recognized as potential risk factors for surgical site infection for over 20 years. However, most research has focused on patient and procedural risk factors. Understanding how structural and process variables influence infection is vital to identify targets for effective interventions and to optimize healthcare services. The aim of this study was to systematically review the association between hospital characteristics and surgical site infection in colorectal surgery. MAIN BODY: A systematic literature search was conducted using PubMed, Scopus and Web of Science databases until the 31st of May, 2021. The search strategy followed the Participants, Exposure/Intervention, Comparison, Outcomes and Study design. The primary outcome of interest was surgical site infection rate after colorectal surgery. Studies were grouped into nine risk factor typologies: hospital size, ownership affiliation, being an oncological hospital, safety-net burden, hospital volume, surgeon caseload, discharge destination and time since implementation of surveillance. The STROBE statement was used for evaluating the methodological quality. A total of 4703 records were identified, of which 172 were reviewed and 16 were included. Studies were published between 2008 and 2021, and referred to data collected between 1996 and 2016. Surgical site infection incidence ranged from 3.2 to 27.6%. Two out of five studies evaluating hospital size adjusted the analysis to patient and procedure-related risk factors, and showed that larger hospitals were either positively associated or had no association with SSI. Public hospitals did not present significantly different infection rates than private or non-profit ones. Medical school affiliation and higher safety-net burden were associated with higher surgical site infection (crude estimates), while oncological hospitals were associated with higher incidence independently of other variables. Hospital caseload showed mixed results, while surgeon caseload and surveillance time since implementation appear to be associated with fewer infections. CONCLUSIONS: Although there are few studies addressing hospital-level factors on surgical site infection, surgeon experience and the implementation of a surveillance system appear to be associated with better outcomes. For hospitals and services to be efficiently optimized, more studies addressing these variables are needed that take into account the confounding effect of patient case mix.

Recent Advances in the Molecular Effects of Biostimulants in Plants: An Overview.

As the world develops and population increases, so too does the demand for higher agricultural output with lower resources. Plant biostimulants appear to be one of the more prominent sustainable solutions, given their natural origin and their potential to substitute conventional methods in agriculture. Classified based on their source rather than constitution, biostimulants such as humic substances (HS), protein hydrolysates (PHs), seaweed extracts (SWE) and microorganisms have a proven potential in improving plant growth, increasing crop production and quality, as well as ameliorating stress effects. However, the multi-molecular nature and varying composition of commercially available biostimulants presents challenges when attempting to elucidate their underlying mechanisms. While most research has focused on the broad effects of biostimulants in crops, recent studies at the molecular level have started to unravel the pathways triggered by certain products at the cellular and gene level. Understanding the molecular influences involved could lead to further refinement of these treatments. This review comprises the most recent findings regarding the use of biostimulants in plants, with particular focus on reports of their molecular influence.

Increase of Antimicrobial Consumption in a Tertiary Care Hospital during the First Phase of the COVID-19 Pandemic.

Background: The COVID-19 pandemic poses novel challenges in antimicrobial consumption metrics and stewardship strategies. COVID-19 patients became the major cause of hospital admission during the first wave of the pandemic, often leading to an antimicrobial prescription upon admission or treatment for superinfections. The aim of this study was to understand how antimicrobial consumption was impacted at the beginning of the pandemic in a tertiary care hospital, a reference center for COVID-19. Materials and Methods: A retrospective before-and-after study was done. Descriptive statistics of discharges, patient-days, and antimicrobial use indicators (defined daily doses (DDD)/100 discharges, DDD/100 patient-days) for various groups were calculated for the first three months of the pandemic (March, April, and May 2020) as a quarterly value, and for each year in 2011-2019, and their annual percentage changes were used to estimate 95% confidence intervals. The indicators were compared to patient type (medical/surgical), type of admission (urgent/elective), and age groups using Spearman's correlation coefficient. Results: Statistically significant increases occurred in 2020 for total antibacterials, macrolides, cephalosporins, amoxicillin/clavulanic acid, carbapenems, meropenem, and third-generation cephalosporins, while a reduction was seen in cefazolin/cefoxitin. A correlation was found between antibacterial consumption and patient or admission type. In 2020, unlike in pre-pandemic years, there was a different impact in DDD/100 discharges and DDD/100 patient-days due to increased lengths-of-stay and longer antimicrobial therapy. Conclusions: The COVID-19 pandemic led to an increase in antimicrobial consumption with a different impact in DDD/100 discharges and DDD/100 patient-days. This highlights the need to use both indicators simultaneously to better understand the causes of antimicrobial consumption variation and improve the design of effective antimicrobial stewardship interventions.

Systemic inflammation as a risk factor for portal vein thrombosis in cirrhosis: a prospective longitudinal study.

BACKGROUND AND AIMS: Various risk factors for portal vein thrombosis (PVT) development in patients with cirrhosis have been identified, but the role of systemic inflammatory reaction is unknown. The study aims to assess the association between markers of systemic inflammation and PVT in cirrhosis. METHODS: Between January 2014 and October 2015, 107 outpatients with cirrhosis and no PVT were recruited, and followed till February 2017. White blood cell count, serum concentrations of high-sensitive C-reactive protein, ferritin, tumor necrosis factor-alpha and interleukin-6 (IL-6) were evaluated at baseline and every 3 or 6 months till PVT diagnosis or end of follow-up. RESULTS: Median age, model for end-stage liver disease (MELD) score and follow-up period of the studied population was 55 years (IQR 46-62 years), 9.6 points (IQR 7.5-12 points) and 19 months (12-24 months), respectively. PVT developed in 10.3% of the patients. Lymphocyte count below 1.2 ´ 109/L [hazard ratio, 6.04; 95% confidence interval (CI), 1.29-28.2; P = 0.022], IL-6 above 5.5 pg/mL (hazard ratio, 5.64; 95% CI, 1.21-26.33; P = 0.028) and neutrophil-to-lymphocyte ratio (hazard ratio, 1.46; 95% CI, 1.04-2.04; P = 0.028) were associated with a higher risk of PVT development. IL-6 and lymphopenia remained associated with subsequent PVT development after adjustment for nonselective beta-blockers, spleen size, portosystemic collaterals, oesophageal varices (grade ≥2) and ascites, but also with alcohol as the cause for cirrhosis and MELD ≥13. CONCLUSION: In patients with cirrhosis, markers of systemic inflammation IL-6 and lymphopenia are predictive of PVT independently of markers of portal hypertension. These results draw our attention on a factor so far overlooked in the pathogenesis of PVT.

Estimation of Missing Baseline Serum Creatinine for Acute Kidney Injury Diagnosis in Hospitalized Patients.

INTRODUCTION: In hospitalized patients, information on preadmission kidney function is often missing, impeding timely and accurate acute kidney injury (AKI) detection and affecting results of AKI-related studies. OBJECTIVE: In this study, we provided estimates of preadmission serum creatinine (SCr), based on a multivariate linear regression (Model 1) and random forest model (Model 2) built with different parametrizations. Their accuracy for AKI diagnosis was compared with the accuracy of commonly used surrogate methods: (i) SCr at hospital admission (first SCr) and (ii) SCr back-calculated from the assumed estimated glomerular filtration rate of 75 mL/min/1.73 m2 (eGFR 75). METHODS: From 44,670 unique adult admissions to a tertiary referral centre between 2013 and 2015, we analysed 8,540 patients with preadmission SCr available. To control for differences in characteristics of patients with and without SCr, we used an inverse probability weighting technique. RESULTS: Estimates of SCr were likely to be higher than true preadmission SCr in a low Cr concentration and undervalued in high concentrations although for Model 2 Complete-SCr these differences were smallest. The true cumulative incidence of AKI was 14.8%. Model 2 Complete-SCr had the best agreement for AKI diagnosis (kappa 0.811, 95% CI 0.787-0.835), while surrogate methods resulted in the lowest agreement: (kappa 0.553, 0.516-0.590) and (0.648, 0.620-0.676) for first SCr and eGFR 75, respectively. CONCLUSIONS: Multivariable imputation of preadmission SCr, taking into account elementary admission data, improved accuracy in AKI diagnosis over commonly used surrogate methods. Random forest-based models can serve as an effective tool in research.