Target sign in COVID-19, radiological interpretation and diagnostic contribution of digital thoracic tomosynthesis.

INTRODUCTION: Our objectives are: To describe the radiological semiology, clinical-analytical features and prognosis related to the target sign (TS) in COVID-19. To determine whether digital thoracic tomosynthesis (DTT) improves the diagnostic ability of radiography. MATERIAL AND METHODS: Retrospective, descriptive, single-centre, case series study, accepted by our ethical committee. Radiological, clinical, analytical and follow-up characteristics of patients with COVID-19 and TS on radiography and DTT between November 2020 and January 2021 were analysed. RESULTS: Eleven TS were collected in 7 patients, median age 35 years, 57% male. All TS presented with a central nodule and a peripheral ring, and in at least 82%, the lung in between was of normal density. All TS were located in peripheral, basal regions and 91% in posterior regions. TS were multiple in 43%. Contiguous TS shared the peripheral ring. Other findings related to pneumonia were associated in 86% of patients. DTT detected 82% more TS than radiography. Only one patient underwent a CT angiography of the pulmonary arteries, positive for acute pulmonary thromboembolism. Seventy-one per cent presented with pleuritic pain. No distinctive laboratory findings or prognostic worsening were detected. CONCLUSIONS: TS in COVID-19 predominates in peripheral and declining regions and can be multiple. Pulmonary thromboembolism was detected in one case. It occurs in young people, frequently with pleuritic pain and does not worsen the prognosis. DTT detects more than 80 % of TS than radiography.

Performance in prognostic capacity and efficiency of the Thoracic Care Suite GE AI tool applied to chest radiography of patients with COVID-19 pneumonia.

OBJECTIVE: Rapid progression of COVID-19 pneumonia may put patients at risk of requiring ventilatory support, such as non-invasive mechanical ventilation or endotracheal intubation. Implementing tools that detect COVID-19 pneumonia can improve the patient's healthcare. We aim to evaluate the efficacy and efficiency of the artificial intelligence (AI) tool GE Healthcare's Thoracic Care Suite (featuring Lunit INSIGHT CXR, TCS) to predict the ventilatory support need based on pneumonic progression of COVID-19 on consecutive chest X-rays. METHODS: Outpatients with confirmed SARS-CoV-2 infection, with chest X-ray (CXR) findings probable or indeterminate for COVID-19 pneumonia, who required a second CXR due to unfavorableclinical course, were collected. The number of affected lung fields for the two CXRs was assessed using the AI tool. RESULTS: One hundred fourteen patients (57.4±14.2 years, 65-57%-men) were retrospectively collected. Fifteen (13.2%) required ventilatory support. Progression of pneumonic extension ≥0.5 lung fields per day compared to pneumonia onset, detected using the TCS tool, increased the risk of requiring ventilatory support by 4-fold. Analyzing the AI output required 26s of radiological time. CONCLUSIONS: Applying the AI tool, Thoracic Care Suite, to CXR of patients with COVID-19 pneumonia allows us to anticipate ventilatory support requirements requiring less than half a minute.

Inter-observer agreement on levels of evidence in radiology articles.

Levels of evidence (LE) are established through a hierarchical classification of studies according to their design. At present, there are many heterogeneous LE classifications, and this hampers their applicability. Our study aims to identify which LE classification has the best interobserver concordance for radiology articles. For this purpose, an interobserver agreement analysis were performed on 105 original articles applying two NE scales (Oxford Center of Evidence Based Medicine (OCEBM) y National Health and Medical Research Council (NHMRC)). The inter-rater agreement of the LE assigned after reading the abstracts was good when using the OCEBM scale (K = 0.679), and somewhat lower with the NHMRC (K = 0.577 -moderate-). All differences were statistically significant (P < .000). So, in conclusion, of the two scales analysed (OCEBM and NHMRC), the OCEBM led to the strongest level of inter-rater agreement.

Dengue importado y autóctono en España / Imported and autochthonous dengue in Spain

El dengue es, globalmente, la arbovirosis más importante. Está causado por el virus del dengue y transmitido generalmente por la picadura de mosquitos del género Aedes (Ae aegypti o Ae albopictus). En España fue inicialmente erradicado en el siglo xx, junto con el vector Aeaegypti, y en la actualidad la mayoría de los casos notificados en España son importados por viajeros procedentes de países con transmisión de dengue (dengue importado). Sin embargo, en los últimos años se han descrito casos de dengue de personas residentes en España que no habían viajado a zonas con transmisión conocida del virus (dengue autóctono), transmitidos por Aedes albopictus (el denominado mosquito tigre), presente especialmente en la cuenca mediterránea. Se requiere por lo tanto un buen conocimiento de esta enfermedad, ya que puede dar lugar a cuadros clínicos graves, de modo que pueda ser diagnosticada precozmente y manejada correctamente, disminuyendo con ello su mortalidad, así como su eventual transmisión autóctona (AU)

Dengue is globally the most important arboviral infection. It is caused by the dengue virus and it is generally transmitted by Aedes mosquitoes’ bites (Ae aegypti or Ae albopictus). In Spain it was initially eradicated in the 20th century, together with the Ae aegypti vector, and currently most of the cases reported in Spain are imported by travelers from countries with dengue transmission (imported dengue). However, in recent years, cases of dengue have been described in people residing in Spain who had not traveled to areas with known transmission (autochthonous dengue), transmitted by Aedes albopictus (the so-called tiger mosquito), present especially in the Mediterranean basin. Therefore, a good knowledge of this potentially severe disease is required, so that it can be diagnosed early, and managed correctly, thus reducing its mortality, as well as its eventual autochthonous transmission (AU)

Imported and autochthonous dengue in Spain.

Dengue is globally the most important arboviral infection. It is caused by the dengue virus and it is generally transmitted by Aedes mosquitoes' bites (Ae aegypti or Ae albopictus). In Spain it was initially eradicated in the 20th century, together with the Ae aegypti vector, and currently most of the cases reported in Spain are imported by travelers from countries with dengue transmission (imported dengue). However, in recent years, cases of dengue have been described in people residing in Spain who had not traveled to areas with known transmission (autochthonous dengue), transmitted by Aedes albopictus (the so-called tiger mosquito), present especially in the Mediterranean basin. Therefore, a good knowledge of this potentially severe disease is required, so that it can be diagnosed early, and managed correctly, thus reducing its mortality, as well as its eventual autochthonous transmission.

Determination of synthetic cannabinoids in oral fluids by liquid chromatography with fluorescence detection after solid-phase extraction.

Synthetic cannabinoids are one of the most consumed new psychoactive substances, being absolutely necessary the development of analytical methodologies for the determination of these substances in biological fluids. In this study, a liquid chromatography with fluorescence detection (LC-FD) method has been developed for the analysis of 8 synthetic cannabinoids in oral fluids. The method has been validated in terms of linearity, precision and extraction recoveries, giving limits of detection as low as 0.7 µg L-1, and limits of quantification of 2.6 µg L-1. Different silica and polymeric commercial solid sorbents such as C18, Supel-Select HLB, EB2 ExtrabondⓇ and SampliQ-OPT were tested, concluding that Supel-Select HLB provided quantitative recoveries for the extraction of synthetic cannabinoids in oral fluids.•Analysis of synthetic cannabinoids in oral fluids.•Analytical procedure based on liquid chromatography with fluorescence detection.•Sample treatment based on solid phase extraction with HLB cartridges.

Schematic approach to the diagnosis of multifocal lung opacities in the emergency department.

Radiologists in the emergency department must be prepared to deal with any type of disease in any organ at any time. Many entities involving the chest can result in patients' presenting at the emergency department. This chapter deals with entities that manifest with multifocal lung opacities and that can be mistaken for pneumonia. To facilitate their identification, this chapter approaches these entities by considering their most characteristic distribution on chest X-rays, the main diagnostic modality used for thoracic problems in the emergency department. Our schematic approach includes the key findings in patients' personal histories, clinical examination, laboratory tests, and imaging studies that can be available during the initial workup.

Combining microfluidic paper-based platform and metal-organic frameworks in a single device for phenolic content assessment in fruits.

A microfluidic paper-based device (µPAD) has been combined with metal-organic frameworks (MOFs) for total phenolic compounds (TPC) quantification in fruit samples for the first time. The performance of the µPAD, based upon the vertical flow approach, was enhanced in order to determine the TPC content with high accuracy in fruit samples. The method was based on the traditional Folin-Ciocalteu Index using gallic acid or oenotannin as reference phenolic compounds. This novel design and construction of the device are in agreement with the principles of Green Chemistry avoiding wax technology (lower toxicity). The analytical parameters that affect the colorimetric method (using digital imaging of the colored zone) performance were optimized including design, sample volume, and MOF amount. Then, the analytical features of the developed method were investigated such as dynamic range (1.6-30 mg L-1), limit of detection (0.5 mg L-1), and precision (RSD < 9%). Besides, the in-field analysis is achievable with a color stability up to 6 h after the loading process of the sample and storage stability for at least 15 days without performance losses (under vacuum at - 20 °C). Furthermore, the MOF ZIF-8@paper was characterized to study its composition and the successful combination. The feasibility of the proposed method was demonstrated by determining the TPC in 5 fruit samples using oenotannin as reference solute. The accuracy was validated by comparison of the data with the results obtained with the recommended protocol proposed by the International Organisation of Vine and Wine (OIV).

Development of paper-immobilized molecularly imprinted polymers by laser pointer activation for methamphetamine extraction with analysis by ion mobility spectrometry.

A fast, simple, cheap, and versatile strategy has been proposed for the synthesis of paper-immobilized molecularly imprinted polymers (MIPs) by photoactivated bulk polymerization over a piece of nitrocellulose using a 405 nm laser pointer. Polymerization was carried out using a mixture of methacrylic acid and ethylene glycol dimethacrylate, using methamphetamine as template molecule and bis(2,4,6-trimethylbenzoyl)phenylphosphine oxide as radical initiator. After investigation of different polymerization parameters, the following experimental conditions were found to give best results: size of nitrocellulose strip (13.5 × 4.0 × 0.8 mm), type of porogen (acetonitrile), polymerization mixture volume (75 µL), and irradiation times (10 min). Experimental conditions (such as sample pH, extraction and desorption time, and type and volume of desorption solvent) were also adjusted for the extraction of methamphetamine using the proposed paper-MIP. Methamphetamine determination was carried out by ion mobility spectrometry providing a limit of detection of 14 µg L-1 and quantitative recoveries from 81 to 95% using spiked urine and oral fluid samples. The proposed paper-immobilized MIP device allows a simple and selective sample extraction procedure for the determination of methamphetamine in oral fluids and urine with a high portability, minimal solvent consumption, and reduced costs compared to other conventional approaches.

Synergistic Effect of SOS Response and GATC Methylome Suppression on Antibiotic Stress Survival in Escherichia coli.

The suppression of the SOS response has been shown to enhance the in vitro activity of quinolones. Furthermore, Dam-dependent base methylation has an impact on susceptibility to other antimicrobials affecting DNA synthesis. Here, we investigated the interplay between these two processes, alone and in combination, in terms of antimicrobial activity. A genetic strategy was used employing single- and double-gene mutants for the SOS response (recA gene) and the Dam methylation system (dam gene) in isogenic models of Escherichia coli both susceptible and resistant to quinolones. Regarding the bacteriostatic activity of quinolones, a synergistic sensitization effect was observed when the Dam methylation system and the recA gene were suppressed. In terms of growth, after 24 h in the presence of quinolones, the Δdam ΔrecA double mutant showed no growth or delayed growth compared to the control strain. In bactericidal terms, spot tests showed that the Δdam ΔrecA double mutant was more sensitive than the ΔrecA single mutant (about 10- to 102-fold) and the wild type (about 103- to 104-fold) in both susceptible and resistant genetic backgrounds. Differences between the wild type and the Δdam ΔrecA double mutant were confirmed by time-kill assays. The suppression of both systems, in a strain with chromosomal mechanisms of quinolone resistance, prevents the evolution of resistance. This genetic and microbiological approach demonstrated the enhanced sensitization of E. coli to quinolones by dual targeting of the recA (SOS response) and Dam methylation system genes, even in a resistant strain model.

RecA inactivation as a strategy to reverse the heteroresistance phenomenon in clinical isolates of Escherichia coli.

RecA inhibition could be an important strategy to combat antimicrobial resistance because of its key role in the SOS response, DNA repair and homologous recombination contributing to bacterial survival. This study evaluated the impact of RecA inactivation on heteroresistance in clinical isolates of Escherichia coli and their corresponding recA-deficient isogenic strains to multiple classes of antimicrobial agents. A high frequency (>30%) of heteroresistance was observed in this collection of clinical isolates. Deletion of the recA gene led to a marked reduction in heteroresistant subpopulations, especially against quinolones or ß-lactams. The molecular basis of heteroresistance was associated with an increase in copy number of plasmid-borne resistance genes (blaTEM-1B) or tandem gene amplifications (qnrA1). Of note, in the absence of the recA gene, the increase in copy number of resistance genes was suppressed. This makes the recA gene a promising target for combating heteroresistance.

Activity of fosfomycin and amikacin against fosfomycin-heteroresistant Escherichia coli strains in a hollow-fiber infection model.

Objectives:To evaluate human-like intravenous doses of fosfomycin (8g/Q8h) and amikacin (15mg/kg/Q24h) efficacy in monotherapy and in combination against six fosfomycin-heteroresistant Escherichia coli isolates using a hollow-fiber infection model (HFIM).Materials and methods:Six fosfomycin-heteroresistant E. coli isolates (4 with strong mutator phenotype) and the control strain E. coli ATCC 25922 were used. Mutant frequencies for rifampin (100mg/L), fosfomycin (50 and 200mg/L) and amikacin (32mg/L) were determined. Fosfomycin and amikacin MICs were assessed by agar dilution (AD), gradient strip (GSA) and broth microdilution (BMD) assays. Fosfomycin and amikacin synergies were studied by checkerboard and time-kill assays at different concentrations. Fosfomycin (8g/Q8h) and amikacin (15mg/kg/Q24h) efficacy alone and in combination were assessed using a HFIM.Results:Five isolates were resistant to fosfomycin by AD and BMD, but all susceptible by GSA. All isolates were considered susceptible to amikacin. Antibiotic combinations were synergistic in two isolates and no antagonism was detected. In time-kill assays, all isolates survived under fosfomycin at 64mg/L, although, at 307mg/L, only the normomutators and two hypermutators survived. Four isolates survived under 16mg/L amikacin and none at 45mg/L. No growth was detected under combination conditions. In HFIM, fosfomycin and amikacin monotherapies failed to sterilise bacterial cultures, however, fosfomycin and amikacin combination showed a rapid eradication.Conclusions.There may be a risk of treatment failure of fosfomycin-heteroresistant E. coli isolates using either amikacin or fosfomycin in monotherapy. These results support that the combination amikacin-fosfomycin can rapidly decrease bacterial burden and prevent the emergence of resistant subpopulations against fosfomycin-heteroresistant strains.

Navigating Barriers and Challenges to Achieving Critical Career Milestones Among Faculty Mentees.

For faculty members, job satisfaction, compensation, and career advancement hinge on achieving 'critical' career milestones (e.g., external funding, tenure). Faculty face unique barriers to achieving career milestones (Bagley et al., 2018), and therefore must employ tailored strategies to overcome challenges. The current project extends research on barriers to career milestones (Soller et al., 2022) to examine strategies faculty employ to overcome barriers in the pursuit of critical career milestones. Thirty-seven faculty members participated across eight US academic institutions, including 22 under-represented minorities in science (URM-S; women or racial/ ethnic minorities). Respondents identified critical career milestones they achieved or will pursue within the next 24 months and then discussed strategies used and suggestions for achieving milestones during semi-structured qualitative interviews. The research team conducted a thematic, qualitative, descriptive analysis of qualitative data using NVivo software in a systematic, interactive, team-based process. Four key strategies emerged for navigating barriers in the pursuit of critical career milestones: 1) Careful engagement of mentors and allies; 2) Collaborate and network; 3) Set boundaries and prioritize; and 4) Reflect on values and use personal strengths. Administrators should aim to remove structural barriers, particularly those that reduce equity (Davis et al., 2022). Identifying strategies that faculty employ to overcome challenges can enhance mentoring by helping mentors understand how mentees overcome unique challenges, particularly those that are not easily addressed through structural interventions.

Prevalencia de legionella en instalaciones de suministro de agua en España: revisión sistemática y meta-análisis / Prevalence of legionella species in water supply facilities of Spain: a systematic review and meta-analysis

Antecedentes: Las especies de Legionella tienen su hábitat natural o reservorio primario en las aguas dulces superficiales de lagos, ríos, estanques y aguas termales, desde donde a través de los sistemas de suministro colonizan el agua de consumo. El presente estudio pretende investigar la prevalencia de Legionella en instalaciones de agua de consumo de España. Métodos: Se realizó una revisión sistemática mediante la búsqueda en bases de datos electrónicas de información científica de estudios observacionales sobre contaminación de agua de consumo por Legionella, con resultados de análisis de muestras de agua obtenidos entre enero de 2001 y abril de 2021. Se efectuó meta-análisis mediante el software MetaXL© en la hoja de cálculo Microsoft Excel. Resultados: Se seleccionaron un total de 21 estudios. La prevalencia de Legionella en España fue de 21,8 % (IC 95 %: 15,0-29,6). La especie más comúnmente aislada fue L. pneumophila serogrupos 2-15 (44,4 %, IC 95 %: 29,5-59,8). Los valores más altos se hallaron en puntos terminales de las redes de agua caliente sanitaria (31,7 %, IC 95 %: 21,6-42,9), y en las comunidades autónomas de Aragón (24,7 %, IC 95 %: 8,8-44,9) y Cataluña (21,3 %, IC 95%: 4,4-44,8).Conclusiones: La prevalencia global de Legionella obtenida puede compararse con los estudios de otros autores, siendo en líneas generales cercana a la obtenida a nivel mundial, con variaciones en relación a otros países. Las instalaciones con mayor prevalencia han resultado ser las de mayor riesgo de proliferación y dispersión de la bacteria según la normativa vigente, y aquellas situadas en la mitad oriental de España.(AU)

Background: Legionella species have their natural habitat or primary reservoir in the fresh surface waters of lakes, rivers, ponds and hot springs, from where they colonize drinking water through supply systems. The present study aims to investigate the prevalence of Legionella in drinking water facilities in Spain.Methods: A systematic review was performed by searching in electronic databases of scientific information for observational studies on contamination of drinking water by Legionella, with results of analysis of water samples obtained between January 2001 and April 2021. Meta-analysis was carried out using the MetaXL© software in the Microsoft Excel spreadsheet. Results: A total of 21 studies were selected. The prevalence of Legionella in Spain was 21.8 % (95 % CI: 15.0-29.6). The most commonly isolated species were L. pneumophila serogroups 2-15 (44.4 %, 95 % CI: 29.5-59.8). The highest values were found at terminal points of the sanitary hot water networks (31.7 %, 95 % CI: 21.6-42.9), and in the autonomous regions of Aragon (24.7 %, 95 % CI: 8.8-44.9) and Catalonia (21.3 %, 95 % CI: 4.4-44.8). Conclusions: The overall prevalence of Legionella obtained can be compared to studies performed by other authors, being in general terms close to that obtained worldwide, with variations in relation to other countries. The facilities with the highest prevalence have turned out to be those with the highest risk of proliferation and dispersal of the bacteria according to current regulations, and those located in the eastern half of Spain.(AU)