Association between diastolic dysfunction and fluid balance in critically ill patients during weaning from mechanical ventilation / Asociación entre la disfunción diastólica y el balance de hídrico en pacientes críticos durante el destete de la ventilación mecánica

Objective: To assess the role of diastolic dysfunction and fluid balance in weaning failure. Design: Prospective, observational, single center. Setting: Intensive care unit of a university hospital. Patients: Adult patients on mechanical ventilation for more than 48 h who underwent a spontaneous breathing trial (SBT). Interventions: Echocardiography was performed immediately before and at the end of SBT. Patients were classified into two groups according to weaning outcome. Main variable of interest: Weaning failure. Results: Among 89 patients included, weaning failure occurred in 33 patients (37%). Isolated diastolic dysfunction at the end of the SBT was more frequent in the failure group (39.3% vs. 17.8%, p = 0.025). Average daily fluid balance from ICU admission until first SBT was less negative in patients who failed than in those who succeed in the weaning (−648 mL [−884 to -138] vs. −893 mL [−1284 to −501], p = 0.007). Average daily fluid balance from the first SBT until the ICU discharge was more negative in the weaning failure than in the success group (−973 mL [−1493 to −201] vs. −425 mL [−1065 to 12], p = 0.034). Cox regression analysis showed that diastolic dysfunction was not an independent factor related to weaning failure but needed the association of positive fluid balance and age. Conclusions: Weaning failure due to diastolic dysfunction is highly related to fluid balance, and the deleterious effect of fluid balance on diastolic function is associated with age The timing of fluid removal could play a key role in this scenario. (AU)

Objetivo: Evaluar el papel de la disfunción diastólica (DD) y el balance hídrico en el fracaso del destete de la ventilación mecánica. Diseño: Prospectivo, observacional.Ámbito: Unidad de cuidados intensivos hospital universitario. Pacientes: Pacientes adultos con ventilación mecánica más de 48 h sometidos a una prueba de respiración espontánea (SBT).Intervenciones: Ecocardiografía antes y al final del SBT. Los pacientes se clasificaron en dos grupos según el resultado del destete. Variable de interés principal: Fracaso del destete. Resultados: Se incluyeron 89 pacientes, el fracaso del destete ocurrió en 33 (37%). La DD al final de la SBT fue más frecuente en el grupo de fracaso (39,3% vs 17,8%, p = 0,025). El balance hídrico diario desde el ingreso en UCI hasta la SBT fue menos negativo en los pacientes que fracasaron que en los que tuvieron éxito del destete (−648 mL [-884 a -138] vs −893 mL [-1284 a -501], p = 0,007). El balance hídrico diario desde el primer SBT hasta el alta de UCI fue más negativo en el grupo de fracaso que en el de éxito (−973 ml [−1493 a −201] vs. −425 ml [−1065 a 12], p = 0,034). La regresión de Cox mostró que la DD no era un factor independiente relacionado con el fracaso, necesitando la asociación del balance hídrico y la edad. Conclusiones: El fracaso del destete debido a DD se relaciona con el balance hídrico, incrementando su efecto nocivo con la edad. El momento de inicio del balance hídrico negativo puede jugar un papel clave en el fracaso. (AU)

Nitrogen forms and dissolved organic matter optical properties in bulk rainfall, canopy throughfall, and stormwater in a subtropical urban catchment.

The study of nitrogen (N) transformation in urban ecosystems is crucial in the protection of coastal water bodies because excess N may fuel harmful algae blooms (HABs). The purpose of this investigation was to study and identify the forms and concentrations of N in rainfall, throughfall, and stormwater runoff for 4 storm events in a subtropical urban ecosystem and to use fluorescence spectroscopy to evaluate the optical properties and expected lability of dissolved organic matter (DOM) in the same samples. The rainfall contained both inorganic and organic N pools, and organic N as nearly 50 % of total dissolved N in the rainfall. As water moved through the urban water cycle, from rainfall to stormwater and from rainfall to throughfall, it was enriched in total dissolved N, with most of the enrichment coming from dissolved organic N. Throughfall fluxes of total dissolved N were as high as 0.67 kg ha-1, compared to 0.44 kg ha-1 from rainfall, suggesting that the urban tree canopy can facilitate anthropogenic subsidies of N to the urban water cycle. Through analysis of sample optical properties, we saw that the throughfall presented the highest humification index and the lowest biological index when compared to rainfall, suggesting throughfall likely consists of higher molecular weight compounds of greater recalcitrance. This study highlights the importance of the dissolved organic N fraction of urban rainfall, stormwater, and throughfall and shows how the chemical composition of dissolved organic nutrients can change as rainfall is transformed into throughfall in the urban tree canopy.

Association between diastolic dysfunction and fluid balance in critically ill patients during weaning from mechanical ventilation.

OBJECTIVE: To assess the role of diastolic dysfunction and fluid balance in weaning failure. DESIGN: Prospective, observational, single center. SETTING: Intensive care unit of a university hospital. PATIENTS: Adult patients on mechanical ventilation for more than 48 h who underwent a spontaneous breathing trial (SBT). INTERVENTIONS: Echocardiography was performed immediately before and at the end of SBT. Patients were classified into two groups according to weaning outcome. MAIN VARIABLE OF INTEREST: Weaning failure. RESULTS: Among 89 patients included, weaning failure occurred in 33 patients (37%). Isolated diastolic dysfunction at the end of the SBT was more frequent in the failure group (39.3% vs. 17.8%, p = 0.025). Average daily fluid balance from ICU admission until first SBT was less negative in patients who failed than in those who succeed in the weaning (-648 mL [-884 to -138] vs. -893 mL [-1284 to -501], p = 0.007). Average daily fluid balance from the first SBT until the ICU discharge was more negative in the weaning failure than in the success group (-973 mL [-1493 to -201] vs. -425 mL [-1065 to 12], p = 0.034). Cox regression analysis showed that diastolic dysfunction was not an independent factor related to weaning failure but needed the association of positive fluid balance and age. CONCLUSIONS: Weaning failure due to diastolic dysfunction is highly related to fluid balance, and the deleterious effect of fluid balance on diastolic function is associated with age The timing of fluid removal could play a key role in this scenario.

Effects of Lactobacillus fermentum Administration on Intestinal Morphometry and Antibody Serum Levels in Salmonella-Infantis-Challenged Chickens.

There are no studies reporting the effects of Salmonella enterica subsp. enterica serovar Infantis (S. Infantis) on intestinal architecture and immunoglobulin serum levels in chickens. Here, we measured these parameters and hypothesized whether probiotic administration could modulate the observed outcomes. Two-hundred 1-day-old COBB 500 male chicks were allocated into four groups: (I) the control, (II) the group treated with L. fermentum, (III) the group exposed to S. Infantis, and (IV) the group inoculated with both bacteria. At 11 days post infection, blood was gathered from animals which were then euthanized, and samples from the small intestine were collected. Intestinal conditions, as well as IgA and IgM serum levels, were assessed. S. Infantis reduced villus-height-to-crypt-depth (VH:CD) ratios in duodenal, jejunal, and ileal sections compared to control conditions, although no differences were found regarding the number of goblet cells, muc-2 expression, and immunoglobulin concentration. L. fermentum improved intestinal measurements compared to the control; this effect was also evidenced in birds infected with S. Infantis. IgM serum levels augmented in response to the probiotic in infected animals. Certainly, the application of L. fermentum elicited positive outcomes in S. Infantis-challenged chickens and thus must be considered for developing novel treatments designed to reduce unwanted infections.

Eficacia de la fisioterapia sobre la ansiedad y depresión en pacientes con dolor crónico: una revisión sistemática / Efficacy of physiotherapy on the anxiety and depression in patients with chronic pain: a systematic review

Introducción: En la actualidad, presentar síntomas de ansiedad y depresión parece ser el común denominador entre la población que padece algún tipo de dolor crónico. Son muchas las estrategias que desde la fisioterapia se han venido implementando en el tratamiento sobre el mismo; actualmente existe un creciente interés por conocer la eficacia de estas intervenciones disciplinares, las cuales respondan a las múltiples necesidades del paciente con dolor crónico. El propósito de este estudio es conocer y describir cuál es la eficacia de la fisioterapia sobre la ansiedad y la depresión en pacientes con dolor crónico. Metodología: Se realizó una búsqueda en las bases de datos PubMed, Scopus, Clinicalkey y ScienceDirect para ensayos clínicos controlados aleatorios publicados entre 2015-2021. Los estudios se filtraron por lectura de título y abstract, arbitraje por pares a través del software Ryan, lectura del artículo en texto completo y selección de artículos según criterios CONSORT. El riesgo de sesgo y la calidad metodológica de los ensayos incluidos fueron evaluados de manera independiente utilizando la herramienta de evaluación del riesgo de sesgo de Cochrane (RoB) y la escala PEDro. Resultados: En total se incluyeron 20 ensayos clínicos. La revisión sistemática encontró efectos clínicamente significativos en las múltiples estrategias de intervenciones que desde la fisioterapia se emplean para el manejo de ansiedad y depresión en pacientes con dolor crónico. Conclusiones: Según lo hallado en esta revisión sistemática se puede demostrar la eficacia de la fisioterapia entre las variables de ansiedad y depresión entre pacientes con dolor crónico.(AU)

Introduction: Nowadays, presenting symptoms of anxiety and depression seems to be the common denominator among the population suffering from some type of chronic pain. There are many strategies that have been implemented in the treatment of physical therapy; Currently, there is a growing interest in knowing the effectiveness of these disciplinary interventions which respond to the multiple needs of the patient with chronic pain. The purpose of this study is to know and describe the effectiveness of physical therapy on anxiety and depression in patients with chronic pain. Methodology: A search was performed in PubMed, Scopus, Clinicalkey and ScienceDirect databases for randomized controlled clinical trials published between 2015 - 2021. The studies were filtered by title and abstract reading, peer review through the Ryan software, reading the article in full text and selection of articles according to CONSORT criteria. The risk of bias and the methodological quality of the included trials were independently evaluated using the Cochrane Bias Risk Assessment Tool (RoB) and the PEDro scale. Results: A total of 20 clinical trials were included. The systematic review found clinically significant effects in the multiple intervention strategies employed since physiotherapy for the management of anxiety and depression in patients with chronic pain. Conclusions: As found in this systematic review, the efficacy of physiotherapy among anxiety and depression variables among patients with chronic pain can be demonstrated.(AU)

An On-Line Cross-Sectional Questionnaire to Assess Knowledge of COVID-19 Pandemic among Citizens Tested for the SARS-CoV-2 Virus in Quito and Ibarra, Ecuador.

Several public health measures have been implemented to contain the SARS-CoV-2 outbreak. The adherence to control measures is known to be influenced by people's knowledge, attitudes and practices with regard to the disease. This study aimed at assessing COVID-19 knowledge in individuals who were tested for the virus. An online cross-sectional survey of 32 items, adapted to the national context, was conducted among 1656 Ecuadorians. The mean knowledge score was 22.5 ± 3 out of 28, with significant differences being observed with regard to educational attainment. People with postgraduate training scored higher than those with college, secondary and elementary instruction. Indeed, multiple linear regression revealed that lower scores were associated significantly with the latter three levels of education. Interviewees were knowledgeable about the symptoms, detection, transmission and prevention of the disease. However, they were less assertive regarding the characteristics of the virus as well as the usefulness of traditional and unproven treatments. These outcomes indicated a lack of knowledge in fundamental aspects of virus biology, which may limit the effectiveness of further prevention campaigns. Conclusively, educational and communicational programs must place emphasis on explaining the basic molecular characteristics of SARS-CoV-2; such information will certainly contribute to improve the public's adherence to control measures.

Oomycete metabarcoding reveals the presence of Lagenidium spp. in phytotelmata.

The oomycete genus Lagenidium, which includes the mosquito biocontrol agent L. giganteum, is composed of animal pathogens, yet is phylogenetically closely related to the well characterized plant pathogens Phytophthora and Pythium spp. These phylogenetic affinities were further supported by the identification of canonical oomycete effectors in the L. giganteum transcriptome. In this study, culture-independent, metabarcoding analyses aimed at detecting L. giganteum in bromeliad phytotelmata (a proven mosquito breeding ground) microbiomes were performed. Two independent and complementary microbial detection strategies based on the amplification of cox1 DNA barcodes were used and produced globally concordant outcomes revealing that two distinct Lagenidium phylotypes are present in phytotelmata. A total of 23,869 high quality reads were generated from four phytotelmata, with 52%, and 11.5% of these reads taxonomically associated to oomycetes, and Lagenidium spp., respectively. Newly designed Lagenidium-specific cox1 primers combined with cloning/Sanger sequencing produced only Lagenidium spp. sequences, with a majority of variants clustering with L. giganteum. High throughput sequencing based on a Single Molecule Real Time (SMRT) approach combined with broad range cox1 oomycete primers confirmed the presence of L. giganteum in phytotelmata, but indicated that a potentially novel Lagenidium phylotype (closely related to L. humanum) may represent one of the most prevalent oomycetes in these environments (along with Pythium spp.). Phylogenetic analyses demonstrated that all detected Lagenidium phylotype cox1 sequences clustered in a strongly supported, monophyletic clade that included both L. giganteum and L. humanum. Therefore, Lagenidium spp. are present in phytotelmata microbiomes. This observation provides a basis to investigate potential relationships between Lagenidium spp. and phytotelma-forming plants, and reveals phytotelmata as sources for the identification of novel Lagenidium isolates with potential as biocontrol agents against vector mosquitoes.

Multidrug-resistant Escherichia coli isolated from canine faeces in a public park in Quito, Ecuador.

OBJECTIVES: This study focused on estimating the prevalence of extended-spectrum ß-lactamases (ESBLs), plasmid-mediated AmpC ß-lactamases, carbapenemases and MCR-1-producing Escherichia coli in canine faeces from a public park in Quito, Ecuador. METHODS: Phenotypic and genotypic characterisation of E. coli isolated from 50 canine faecal samples recovered from a city park in Quito was performed. In addition, a multiple choice survey was conducted among 50 dog owners. RESULTS: Of the 50 faecal samples, 20 (40.0%) presented E. coli resistant to ceftriaxone. Moreover, 23 E. coli isolates were recovered for further analysis. All of the isolates showed as multidrug-resistant (MDR) phenotype (resistant to three or more antibiotic families). Resistance to carbapenems, tigecycline and amikacin was not observed. No major clonal relatedness was observed among the resistant isolates. The ESBL genes blaCTX-M-15, blaCTX-M-55 and blaCTX-M-65 were the most common. Two isolates harboured the blaCMY-2 gene and one isolate harboured both mcr-1 and blaCTX-M-65. Statistical analysis showed that older people were more conscious of collecting and disposing of dog faeces than subjects aged <35 years (P < 0.05). CONCLUSION: The finding of MDR E. coli in dog faeces in a city park in Ecuador illustrates the importance of analysing canine faeces in public settings (e.g. parks, playgrounds) as part of surveillance programmes for MDR E. coli. In addition, this research might be a sentinel sampling method to gain a better understanding of community sources of antibiotic-resistant Enterobacteriaceae at human-animal-environment interfaces.

Congenital rubella syndrome, hyper-IgM syndrome and autoimmunity in an 18-year-old girl.

Congenital rubella syndrome can be associated with disgammaglobulinaemia and autoimmune phenomena in adult and paediatric population. The aim of this article is to present the association between a congenital rubella syndrome with hypogammaglobulinaemia and hyper IgM diagnosed at the age of 8 months and autoimmune manifestations in an 18-year-old girl. A medical chart review of this patient since admission at our institution at 8 months of age was carried out. During infancy she presented the classical manifestations of a rubella syndrome (sensorineural deafness and brain calcifications in basal ganglia) with respiratory and gastrointestinal infections. She was also diagnosed of localised scleroderma and thyroiditis. She has been on intravenous immunoglobulin since diagnosis, with rapid normalisation of IgG and IgM levels, decreased incidence of infectious processes, but with persistent autoimmune phenomena. At 18 years of age she was admitted because of a thyroid mass. Fine needle aspiration biopsy was not conclusive and thyroidectomy was performed. Pathology studies showed no malignancy. She is now on replacement therapy with thyroid hormones. Our aim is to emphasise the importance of the association between autoimmune phenomena in patients with immunodeficiencies, even secondary to some infections, and the increased frequency of malignancies owing to the persistent immunologic defect in this syndrome.

Nena de 2 anys amb tumoració en extremitat superior detra i febre / Two year-old girl with a right upper extremity mass and febrile illness

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