Point of care thoracic ultrasound versus chest computed tomography in the approach of febrile neutropenia patients: A diagnostic accuracy cohort study.

Single-center prospective cohort diagnostic accuracy study. Our study aimed to evaluate the accuracy and reproducibility of Thoracic Ultrasound (TUS) in detecting pulmonary pathology in immunosuppressed patients. We conducted a single-center prospective study. Consecutive patients with febrile neutropenia who underwent CT (Computerized Tomography) underwent TUS evaluation within 24h of CT. Both studies were performed by an expert who was blinded to the clinical information and results of the alternative imaging modalities. 34 patients met the inclusion criteria. The median age was 39.9 years (±17 standard deviation). TUS as a diagnostic test had a sensitivity of 92.9% and specificity of 83.3%, negative predictive value of 71.4%, and positive predictive value of 96.3%. Substantial between-method agreement was demonstrated with a kappa of 0.71 (P = .001) between the TUS and chest CT findings. We obtained a kappa of 1 (P = .001) for the final diagnosis of Pleural Effusion (PE). We concluded that TUS is a promising screening test for immunocompromised individuals. The results showed good diagnostic performance of TUS compared to CT for the detection of pulmonary findings highly suggestive of pathology with high accuracy and reproducibility.

Carbapenemase-Encoding Genes and Colistin Resistance in Gram-Negative Bacteria During the COVID-19 Pandemic in Mexico: Results from the Invifar Network.

In this study, we report the carbapenemase-encoding genes and colistin resistance in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa in the second year of the COVID-19 pandemic. Clinical isolates included carbapenem-resistant K. pneumoniae, carbapenem-resistant E. coli, carbapenem-resistant A. baumannii, and carbapenem-resistant P. aeruginosa. Carbapenemase-encoding genes were detected by PCR. Carbapenem-resistant K. pneumoniae and carbapenem-resistant E. coli isolates were analyzed using the Rapid Polymyxin NP assay. mcr genes were screened by PCR. Pulsed-field gel electrophoresis and whole-genome sequencing were performed on representative isolates. A total of 80 carbapenem-resistant E. coli, 103 carbapenem-resistant K. pneumoniae, 284 carbapenem-resistant A. baumannii, and 129 carbapenem-resistant P. aeruginosa isolates were recovered. All carbapenem-resistant E. coli and carbapenem-resistant K. pneumoniae isolates were included for further analysis. A selection of carbapenem-resistant A. baumannii and carbapenem-resistant P. aeruginosa strains was further analyzed (86 carbapenem-resistant A. baumannii and 82 carbapenem-resistant P. aeruginosa). Among carbapenem-resistant K. pneumoniae and carbapenem-resistant E. coli isolates, the most frequent gene was blaNDM (86/103 [83.5%] and 72/80 [90%], respectively). For carbapenem-resistant A. baumannii, the most frequently detected gene was blaOXA-40 (52/86, 60.5%), and for carbapenem-resistant P. aeruginosa, was blaVIM (19/82, 23.2%). For carbapenem-resistant A. baumannii, five indistinguishable pulsotypes were detected. Circulation of K. pneumoniae New Delhi metallo-ß-lactamase (NDM) and E. coli NDM was detected in Mexico. High virulence sequence types (STs), such as K. pneumoniae ST307, E. coli ST167, P. aeruginosa ST111, and A. baumannii ST2, were detected. Among K. pneumoniae isolates, 18/101 (17.8%) were positive for the Polymyxin NP test (two, 11.0% positive for the mcr-1 gene, and one, 5.6% with disruption of the mgrB gene). All E. coli isolates were negative for the Polymyxin NP test. In conclusion, K. pneumoniae NDM and E. coli NDM were detected in Mexico, with the circulation of highly virulent STs. These results are relevant in clinical practice to guide antibiotic therapies considering the molecular mechanisms of resistance to carbapenems.

Thoracic ultrasound alone or in combination with tracheal amylase as a tool predictor of ventilator-associated pneumonia in neurocritical patients.

In this study, we aim to evaluate whether thoracic ultrasound (TUS) and tracheal amylase (TA) alone or in combination can predict the development of ventilator-associated pneumonia (VAP) in neurocritical patients. Consecutive adult patients with neurocritical disease with normal chest radiographs who required intensive care unit admission and mechanical ventilation between March 2015 and July 2018 were included. TUS and Amylase levels were measured during the first 24 hours and repeated 48 hours after orotracheal intubation. Forty-three patients with a median age of 34 years (17-82) were included. TUS had a sensitivity of 100% and specificity of 96.3% as a predictor of VAP within the first 48 hours when nonpattern A was observed. TA levels > 200 UI/L in the first 48 hours had a sensitivity of 87.5%, and specificity of 63% as a predictor of VAP. Moreover, no benefit of TUS plus TA compared to TUS alone as a predictor of VAP was found. The identification of abnormal TUS patterns in the first 48 hours of orotracheal intubation is a significant predictor of VAP in neurocritical patients.

The effect of chlorhexidine on Acinetobacter baumannii in intensive care units.

Background and Objectives: Measures to prevent the emergence of hospital-acquired infections (HAIs) include a daily bath with chlorhexidine gluconate (CHG). The aim of this study was to determine the effect of patients bathing daily with CHG on the bacterial colonization on patient surfaces, environmental surrounding areas, and attending healthcare workers (HCWs). Materials and Methods: Patients were randomized by a 1:1 in two groups. Patients in group 1 were bathed daily with CHG; patients in group 2 were bathed with a placebo. Microbiological sampling of patients, environment, and HCWs were carried out on days 0, 3, and 10. The clonal relatedness of selected isolates collected was determined through pulsed-field gel electrophoresis. Clinical and demographic data were obtained from medical files. Results: Thirty-three patients were included (18 in group 1 and 15 in group 2). The more common species was Acinetobacter baumannii (n=144), followed by Klebsiella pneumoniae (n=81). A. baumannii was isolated more frequently on environmental surfaces in group 2 than group 1 (day 0 vs. day 3 vs. day 10; p = 0.0388). Twelve clones of A. baumannii were detected, with predominant clone A detected in patients and environmental surfaces. No pathogens were detected in HCWs. Conclusion: Our data support that CHG bathing decreases A. baumannii surviving on the environmental surfaces of critically ill patients.

Pleural Effusions Identified by Point-of-Care Ultrasound Predict Poor Outcomes in Decompensated Cirrhosis.

Chronic liver disease (CLD) may be associated with pleural effusions (PEs). This article prospectively evaluates whether detection of PEs on thoracic ultrasound (TUS) at the bedside independently predicts mortality and length of stay (LOS) in hospitalized patients with a decompensated CLD. A total of 116 consecutive inpatients with decompensated cirrhosis underwent antero-posterior chest radiographs (CXR) and TUS to detect PEs. Their median age was 54 y (interquartile range, 47-62), 90 (70.6%) were male, and 61 (52.6%) fell into the Child-Pugh class C categorization. TUS identified PEs in 58 (50%) patients, half of which were small enough to preclude thoracentesis. CXR failed to recognize approximately 40% of PEs seen on TUS. The identification of PEs by TUS was associated with a longer LOS (10 vs. 5.5 d, p < 0.001) and double mortality (39.7% vs. 20.7%, p = 0.021). In multivariate analysis, PEs were independently related to poor survival (hazard ratio 2.08, 95% confidence interval [CI] 1.02-4.25; p = 0.044). Patients with both Child-Pugh C stage and PEs had the lowest survival rate (70 vs. 317 d, p = 0.001). In conclusion, PEs identified by TUS in hospitalized patients with decompensated CLD independently predict a poor outcome and portend a longer LOS.

Disparities in cystic fibrosis survival in Mexico: Impact of socioeconomic status.

BACKGROUND: Median survival age in cystic fibrosis (CF) has increased in developed countries. Scarce literature exists about survival in Latin America, especially in Mexico. The aim of our study was to assess the median age of survival in CF patients and the impact of risk factors in Mexico over a 20-year period. METHODS: We conducted a retrospective study with all patients registered and followed in the CF Center in Monterrey, Mexico from 2000 to 2020. Median survival age was the primary outcome, assessed with Kaplan-Meier analysis. The influence of clinical, biological, and demographic factors on survival was analyzed with Cox regression model. RESULTS: Two-hundred five patients were included. Median survival for the cohort was 21.37 years (95% confidence interval [CI], 17.20-25.55). In the multivariate Cox regression model, low socioeconomic status (hazard ratio [HR], 4.21; 95% CI, 2.43-7.27), chronic Pseudomonas aeruginosa infection at 6 years (HR, 10.45; 95% CI, 5.66-19.28), and pancreatic insufficiency (HR, 3.13; 1.38-7.13) were independent risk factors for mortality. CONCLUSION: Median survival in Mexican patients with CF is lower than in high-income countries, and socioeconomic status plays a conspicuous role in the disparity. To increase patient survival for those residing in low-middle income countries, public health authorities must design policies that fully cover diagnosis and treatment strategies for the CF population.

Pulmonary Ultrasound and Diaphragmatic Shortening Fraction Combined Analysis for Extubation-Failure-Prediction in Critical Care Patients / Análisis combinado de la fracción de acortamiento diafragmático y la ecografía pulmonar en la predicción del fallo de extubación en pacientes con cuidados intensivos

Introduction: Invasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT). Methods: We prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration - diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure. Results: Eighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.5-0.80] and 0.81 [0.70-0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33-14.98], P < .001). Conclusion: In patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound

Introducción: El soporte respiratorio invasivo constituye una piedra angular en la medicina de cuidados intensivos. Sin embargo, los protocolos para retirar la ventilación mecánica todavía están lejos de ser perfectos. El fallo de extubación ocurre en hasta un 20% de los pacientes, a pesar del éxito en la prueba de respiración espontánea (SBT). Métodos: Se incluyeron de forma prospectiva pacientes con ventilación ingresados en una unidad médica y quirúrgica de cuidados intensivos de un hospital universitario del norte de Méjico. Tras el éxito en una SBT, se midió la fracción de acortamiento diafragmático (DSF) mediante la fórmula: (grosor diafragmático al final de la inspiración - grosor diafragmático al final de la expiración)/grosor diafragmático al final de la expiración × 100, y la presencia de líneas B en cinco regiones del pulmón derecho y del izquierdo. El objetivo primario fue determinar si el análisis de la DSF combinado con la ecografía pulmonar mejora la predicción del fallo de extubación. Resultados: Se incluyeron 82 pacientes, 24 (29,2%) con fallo de extubación. En el análisis univariante, la DSF (Índice de Youden: >30% [sensibilidad y especificidad del 62% y el 50%, respectivamente]) y el número de regiones con líneas B (Índice de Youden: >zona 1 [sensibilidad y especificidad del 66% y el 92%, respectivamente]) se relacionó significativamente con el fallo de extubación (área bajo la curva 0,66 [0,52-0,80] y 0,81 [0,70-0,93] respectivamente). En la regresión logística binaria, solo el número de regiones con líneas B se relacionó significativamente con el fallo de extubación (OR 5,91 [2,33-14,98], p<0,001). Conclusión: En pacientes con éxito en la SBT, la ausencia de líneas B disminuye significativamente la probabilidad de fallo de extubación. La fracción de acortamiento diafragmático no añade valor predictivo respecto al uso de la ecografía pulmonar

Pulmonary Ultrasound and Diaphragmatic Shortening Fraction Combined Analysis for Extubation-Failure-Prediction in Critical Care Patients.

INTRODUCTION: Invasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT). METHODS: We prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration - diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure. RESULTS: Eighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.52-0.80] and 0.81 [0.70-0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33-14.98], P<.001). CONCLUSION: In patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound.

Non-anesthesiologist-administered propofol is not related to an increase in transcutaneous co2 pressure during flexible bronchoscopy compared to guideline-based sedation: a randomized controlled trial / La administración de propofol por parte de no anestesiólogos durante la broncoscopia flexible no se relaciona con aumentos de la presión transcutánea de CO2, en comparación con la sedación según las pautas: ensayo controlado aleatorizado

Introduction: Evidence for the use of non-anesthesiologist-administered propofol for sedation during flexible bronchoscopy is scarce. The main objective of this study was to determine whether non-anesthesiologist-administered propofol balanced sedation was related to higher transcutaneous CO2 pressure compared with current guideline-based sedation (combination midazolam and opioid). Secondary outcomes were post-procedural recuperation time, patient satisfaction and frequency of adverse events. Methods: In this randomized controlled trial we included data from outpatients aged 18 years or older with an indication for flexible bronchoscopy in a university hospital in northern Mexico. Results: Ninety-one patients were included: 42 in the midazolam group and 49 in the propofol group. During 60min of transcutaneous capnometry monitoring, mean transcutaneous CO2 pressure values did not differ significantly between groups (43.6 [7.5] vs. 45.6 [9.6]mmHg, P=.281). Propofol was related with a high Aldrete score at 5, 10, and 15min after flexible bronchoscopy (9 [IQR 6-10] vs. 10 [9,10], P=.006; 9 [8-10] vs. 10 [IQR 10-10], P<.001 and 10 [IQR 9-10] vs. 10 [10], respectively) and with high patient satisfaction on a visual analogue scale of 1 (not satisfied) to 10 (very satisfied) (8.41 [1.25] vs. 8.97 [0.98], P=.03). Frequency of adverse events was similar among groups (30.9% vs. 22.4%, P=.47). Conclusion: Compared with guideline-recommended sedation, non-anesthesiologist-administered propofol balanced sedation is not associated with higher transcutaneous CO2 pressure or with more frequent adverse effects. Propofol use is associated with faster sedation recovery and with high patient satisfaction (AU)

Introducción: Las pruebas disponibles del uso de propofol administrado por no anestesiólogos para la sedación durante la broncoscopia flexible son escasas. El objetivo principal del estudio fue determinar si la sedación equilibrada con propofol administrado por no anestesiólogos estaba relacionada con valores más altos de presión de CO2 transcutánea, en comparación con la sedación según las pautas (una combinación de midazolam y un opiáceo). Las variables secundarias fueron el tiempo de recuperación después del procedimiento, el grado de satisfacción del paciente y la frecuencia de observación de efectos adversos. Métodos: En este ensayo controlado y aleatorizado se incluyeron datos de pacientes ambulatorios mayores de 18 años con indicación de broncoscopia flexible en un hospital universitario del norte de México. Resultados: Se incluyeron 91 pacientes: 42 en el grupo de midazolam y 49 en el grupo de propofol. Durante los 60 min de monitorización de la capnometría transcutánea, no hubo diferencias estadísticamente significativas entre grupos en los valores medios de presión de CO2 transcutánea (43,6 [5,7] vs. 45,6 [6,9]mm Hg, p=0,281). El propofol se asoció con puntuaciones de Aldrete altas a los 5, 10 y 15min después de la broncoscopia flexible (9 [IQR: 6-10] vs. 10 [9,10], p=0,006; 9 [8-10] vs. 10 [IQR 10-10], p<0,001 y 10 [IQR 9-10] vs. 10 [10] puntos, respectivamente) y con un alto grado de satisfacción de los pacientes en una escala visual de 1 (poco satisfecho) a 10 (muy satisfecho) (8,41 [1,25] vs. 8,97 [0,98], p=0,03). No hubo diferencias en la frecuencia de efectos adversos (30,9 vs. 22,4%, p=0,47). Conclusión: En comparación con la pauta de sedación recomendada, la sedación equilibrada con propofol administrado por no anestesiólogos no se asocia con valores más altos de presión de CO2 transcutánea ni con mayor frecuencia de efectos adversos. El uso del propofol se asocia con una recuperación de la sedación más rápida y con un mayor grado de satisfacción del paciente (AU)

Non-anesthesiologist-administered Propofol is not Related to an Increase in Transcutaneous CO2 Pressure During Flexible Bronchoscopy Compared to Guideline-based Sedation: A Randomized Controlled Trial.

INTRODUCTION: Evidence for the use of non-anesthesiologist-administered propofol for sedation during flexible bronchoscopy is scarce. The main objective of this study was to determine whether non-anesthesiologist-administered propofol balanced sedation was related to higher transcutaneous CO2 pressure compared with current guideline-based sedation (combination midazolam and opioid). Secondary outcomes were post-procedural recuperation time, patient satisfaction and frequency of adverse events. METHODS: In this randomized controlled trial we included data from outpatients aged 18 years or older with an indication for flexible bronchoscopy in a university hospital in northern Mexico. RESULTS: Ninety-one patients were included: 42 in the midazolam group and 49 in the propofol group. During 60min of transcutaneous capnometry monitoring, mean transcutaneous CO2 pressure values did not differ significantly between groups (43.6 [7.5] vs. 45.6 [9.6]mmHg, P=.281). Propofol was related with a high Aldrete score at 5, 10, and 15min after flexible bronchoscopy (9 [IQR 6-10] vs. 10 [9,10], P=.006; 9 [8-10] vs. 10 [IQR 10-10], P<.001 and 10 [IQR 9-10] vs. 10 [10], respectively) and with high patient satisfaction on a visual analogue scale of 1 (not satisfied) to 10 (very satisfied) (8.41 [1.25] vs. 8.97 [0.98], P=.03). Frequency of adverse events was similar among groups (30.9% vs. 22.4%, P=.47). CONCLUSION: Compared with guideline-recommended sedation, non-anesthesiologist-administered propofol balanced sedation is not associated with higher transcutaneous CO2 pressure or with more frequent adverse effects. Propofol use is associated with faster sedation recovery and with high patient satisfaction. CLINICAL TRIAL REGISTRATION: NCT02820051.

A High Level of Soluble CD40L Is Associated with P. aeruginosa Infection in Patients with Cystic Fibrosis.

OBJECTIVE: The aim of this study was to evaluate whether the concentration of sCD40L, a product of platelet activation, correlates with the presence of Pseudomonas aeruginosa in the airway of patients with cystic fibrosis (CF) and to determine its possible clinical association. METHODS: Sixty patients with CF, ranging in age from 2 months to 36 years, were studied. The demographics, cystic fibrosis transmembrane conductance regulator (CFTR) genotype, spirometry measurements, radiographic and tomographic scans, platelet count in peripheral blood, sCD40L, IL-6, TNF-α and ICAM1 data were collected. Infection-colonization of the airway was evaluated using sputum and throat swab cultures; the levels of anti-Pseudomonas aeruginosa antibodies (Anti-PaAb) were evaluated. RESULTS: Patients with CF and chronic colonization had anti-PaAb values of 11.6 ± 2.1 ELISA units (EU) and sCD40L in plasma of 1530.9 ±1162.3 pg/mL; those with intermittent infection had 5.7 ± 2.7 EU and 2243.6 ± 1475.9 pg/mL; and those who were never infected had 3.46 ± 1.8 EU (p≤0.001) and 1008.1 ± 746.8 pg/mL (p≤0.01), respectively. The cutoff value of sCD40L of 1255 pg/mL was associated with an area under the ROC (receiver operating characteristic curve) of 0.84 (95% CI, 0.71 to 0.97), reflecting P. aeruginosa infection with a sensitivity of 73% and a specificity of 89%. Lung damage was determined using the Brasfield Score, the Bhalla Score, and spirometry (FVC%, FEV1%) and found to be significantly different among the groups (p≤0.001). CONCLUSION: Circulating sCD40L levels are increased in patients with cystic fibrosis and P. aeruginosa infection. Soluble CD40L appears to reflect infection and provides a tool for monitoring the evolution of lung deterioration.

Fibrosis mediastinal, una causa poco frecuente de quilotórax bilateral: Reporte de caso / Mediastinal Fibrosis. A rare cause of bilateral chylothorax. Case Report

Antecedentes: La presencia de quilotórax se define como un líquido pleural con abundantes concentraciones de quilomicrones, o con niveles elevados de triglicéridos, mayor a 110 mg/dl y bajos de colesterol. Dentro de las causas más frecuentes de quilotórax no traumático o secundario a un abordaje quirúrgico tenemos las neoplasias hematológicas y tumoraciones mediastinales. Objetivo: Reportar el éxito de ésta opción terapéutica ofrecida. Caso clínico: Paciente femenino de 58 años con antecedente de 1 año de evolución con dolor lumbar. La tomografía reporta tumoración mediastinal con derrame pleural bilateral. Se realiza toracocentésis obteniendo calidad del liquido como quilotórax bilateral. Se inicia manejo medico y se procede a realizar toracotomía izquierda y toracoscopía derecha con pleurodesis química con iodopovidona. La paciente evoluciona favorablemente, dependiente de oxígeno. Los resultados finales de patología reportan mediastinitis fibrosante IgG4 negativo. Discusión: Los síntomas de presentación de la enfermedad son poco específicos y depende de la afectación de órganos torácicos. En nuestro caso se trató de afectación del conducto torácico, con la consecuente formación de quilotórax bilateral. Conclusiones: No existe un tratamiento curativo definitivo para esta enfermedad. La mortalidad es variable, reportándose de hasta 30% a 6 años y esta relacionada a la afectación de los órganos intratorácicos.

Background: The prescience of chylothorax is defined as pleural liquid with abundant concentrations of chylomicrons, with high levels of triglycerides, more than 110 mg/dl and low in cholesterol. Between the most frequent causes of non-traumatic chylothorax are secondary to a surgical procedure, hematologic neoplasms and mediastinal tumors. Objective: Report de success rate of the therapeutic technique used in this patient. Clinical Case: A 48-year-old female with history of 1 year of lumbar pain, a computer tomography was performed where mediastinal tumor and bilateral pleural effusion was diagnosed. A thoracentesis was performed diagnosing bilateral chylothorax. Medical treatment was started without improvement, a left thoracotomy and right thoracoscopy with chemical pleurodesis were performed. Patient improved clinically, dependent of oxygen. Final pathologic exam reported IgG4 negative fibrosant mediastinitis. Discussion: The symptoms of presentation of the disease are not specific and depend on the invasion to adjacent thoracic organs, with the consequent formation of bilateral chylothorax. Conclusions: No curative treatment exists for this disease. It presents with variable mortality, some of 30% at 6 years and it is related with intrathoracic organ affection.

Análisis de frecuencias alélicas y genotípicas de las variantes CYP2A6*12 y rs16969968 de CHRNA5 y su asociación con el hábito de fumar y el índice de masa corporal (IMC) en sujetos jóvenes del noreste de México / Association between genotype and allele frequencies of CYP2A6*12 and rs16969968 in CHRNA5 variants with smoking and body mass index in young subjects from Northeast Mexico

Background: Several studies have reported that variants rs16969968 G>A of the CHRNA5 gene and CYP2A6*12 of the CYP2A6 gene are associated with smoking and smoking refusal, respectively. In addition, some studies report that a higher cigarette consumption is associated with low body mass index (BMI). Aim: To analyze the allele and genotypic frequencies of these variants and their impact on smoking and BMI. Material and Methods: A blood sample was obtained and a survey about smoking habits was answered by 319 university students aged 18 to 35 years (127 women, 171 smokers), living in Northeastern Mexico. Genetic variants were studied by polymerase chain reaction/restriction fragment length polymorphism and their frequencies were associated with smoking and BMI. Results: No associations were found between the analyzed variants and smoking in the study groups. However, there was an association among non-smoking subjects between the A allele of rs16969968 and high a BMI (p < 0.01). Conclusions: This last variant may be involved in food-addiction disorders.

Grupo de trabajo para la revisión, modificación y desarrollo de indicadores de calidad para unidades de cuidados intensivos respiratorios en México / No disponible

No disponible

Eosinophil count at intensive care unit admission was not predictor of hospital mortality: results of a case control study.

BACKGROUND: Predicting mortality in the intensive care unit (ICU) is one of the biggest challenges in critical care medicine. Several studies have linked the presence of eosinopenia with adverse outcomes in different populations. METHODS: We performed a case control study to determine whether the eosinophil count at ICU admission was a predictor of hospital mortality. We included data from patients 18 years or older admitted to the medical or surgical ICU in a university hospital in northern of Mexico. Medical records of 86 non-survivors (cases) and 99 discharged alive patients (controls) were randomly reviewed; clinical records of patients with an ICU stay of less than 24 h and those whose information was incomplete were excluded. RESULTS: Median of eosinophil count at ICU admission was 0.013 (interquartile range (IQR) 0.00 to 0.57) K/µL. There was no significant statistical difference in eosinophils at admission between survivors and non-survivors (0.014 [IQR 0.00 to 0.36] vs. 0.010 [IQR 0.00 to 0.57] K/µL, P = 0.35). In the multivariate analysis, APACHE II score at ICU admission and discharge were the only mortality predictors. Survivors had a significantly greater increase in eosinophil count during the first 7 days of ICU stay (0.104 [IQR -0.64 to 0.41] vs. 0.005 [IQR -1.79 to 0.43] K/µL, P = 0.004). CONCLUSIONS: In our study, eosinophil count at ICU admission was not associated with increased hospital mortality. The larger increase in number of eosinophils observed during the first week of ICU stay in surviving patients deserves to be investigated further.

[Association between genotype and allele frequencies of CYP2A6*12 and rs16969968 in CHRNA5 variants with smoking and body mass index in young subjects from Northeast Mexico]. / Análisis de frecuencias alélicas y genotípicas de las variantes CYP2A6*12 y rs16969968 de CHRNA5 y su asociación con el hábito de fumar y el índice de masa corporal (IMC) en sujetos jóvenes del noreste de México.

BACKGROUND: Several studies have reported that variants rs16969968 G>A of the CHRNA5 gene and CYP2A6*12 of the CYP2A6 gene are associated with smoking and smoking refusal, respectively. In addition, some studies report that a higher cigarette consumption is associated with low body mass index (BMI). AIM: To analyze the allele and genotypic frequencies of these variants and their impact on smoking and BMI. MATERIAL AND METHODS: A blood sample was obtained and a survey about smoking habits was answered by 319 university students aged 18 to 35 years (127 women, 171 smokers), living in Northeastern Mexico. Genetic variants were studied by polymerase chain reaction/restriction fragment length polymorphism and their frequencies were associated with smoking and BMI. RESULTS: No associations were found between the analyzed variants and smoking in the study groups. However, there was an association among non-smoking subjects between the A allele of rs16969968 and high a BMI (p < 0.01). CONCLUSIONS: This last variant may be involved in food-addiction disorders.

Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients.

BACKGROUND: Up to 25% of all nosocomial infections (NIs) develop in critically ill patients. Our objective was to evaluate chlorhexidine (CHX) bathing and hand hygiene (HH) compliance in the reduction of NIs in the intensive care unit. METHODS: The study comprised three 6-month periods: preintervention (PIP; soap/water bathing), intervention (IP; bathing with CHX-impregnated wipes), and postintervention (PoIP; soap/water bathing). An HH program was implemented during the IP and PoIP. Primary outcomes were global and specific NI rates. RESULTS: A total of 1007 patients were included. Infection rates per 100 discharges were higher in the PIP compared with the IP and also higher in the PoIP compared with the IP (P = .0004 and .0109, respectively). Global infection rates per 1000 hospital-days were higher in the PIP than in the IP (P = .0268). The rates of ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI) were higher in the PIP than in the IP (P = .036 and .0001, respectively). Isolation of Acinetobacter baumannii from VAP specimens (P = .0204) and isolation of Candida spp from CAUTI specimens (P = .0005) decreased as well. CONCLUSION: The combined intervention reduced global and specific infection rates, including rates of VAP associated with A baumannii and CAUTI associated with Candida spp.