Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study.

PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

[Increasing incidence of community-acquired pneumonia caused by atypical microorganisms]. / Aumento de microorganismos no habituales en la neumonía adquirida en la comunidad.

INTRODUCTION: Knowing the most common microorganisms in our environment can help us to make proper empirical treatment decisions. The aim is to identify those microorganisms causing community-acquired pneumonia. PATIENTS AND METHODS: An observational, descriptive and prospective study was conducted, including patients over 14 years with a clinical and radiographic diagnosis of community-acquired pneumonia during a 383 consecutive day period. A record was made of sociodemographic variables, personal history, prognostic severity scales, progress, and pathogenic agents. The aetiological diagnosis was made using blood cultures, detection of Streptococcus pneumoniae and Legionella pneumophila urinary antigens, sputum culture, influenza virus and Streptococcus pyogenes detection. Categorical variables are presented as absolute values and percentages, and continuous variables as their means and standard deviations. RESULTS: Of the 287 patients included in the study (42% women, mean age 66±22 years), 10.45% died and 70% required hospital admission. An aetiological diagnosis was achieved in 43 patients (14.98%), with 16 microorganisms found in 59 positive samples. The most frequently isolated pathogen was Streptococcus pneumonia (24/59, 41%), followed by gram-negative enteric bacilli, Klebsiella pneumonia, Escherichia coli, Serratia marcescens and Enterobacter cloacae isolated in 20% of the samples (12/59), influenza virus (5/59, 9%), methicillin-resistant Staphylococcus aureus (3/59, 5%), Pseudomonas aeruginosa (2/59, 3%), Moraxella catarrhalis (2/59, 3%), Legionella pneumophila (2/59, 3%), and Haemophilus influenza (2/59, 3%). Polymicrobial infections accounted for 14% (8/59). CONCLUSION: A high percentage of atypical microorganisms causing community-acquired pneumonia were found.

[Aortopulmonary fistula complicating aortic arch aneurysm]. / Fistula aorto-pulmonar como complicación de aneurisma de cayado aórtico.

Aortopulmonary fistulas secondary to thoracic aneurysms are difficult to diagnose and few cases are reported in the literature. We describe the case of a patient first admitted to another hospital with a diagnosis of right upper lobe pneumonia. After the patient had been a week in hospital without improving, a computed tomography scan of the chest revealed a saccular aneurysm of the aortic arch measuring 9 cm at its widest diameter. Hemodynamics and respiratory signs deteriorated a few hours after transfer to our hospital. Physical examination revealed a systolic murmur and poor peripheral perfusion. The patient was intubated and inotropic support was provided. Upon insertion of a Swan-Ganz catheter, given suspicion of septic shock, progressive elevation of mixed venous oxygen saturation was observed. Measurement of venous oxygen saturation was 74% in the right atrium and 93% in the pulmonary artery. Left-right shunt was diagnosed and an emergency aortography revealed the aortopulmonary fistula. Emergency surgery was performed with the patient in deep hypothermia and cardiocirculatory arrest. There were no adverse events, and postoperative recovery and clinical course were good.

Estudio comparado de dos selladores (Yodo y solución electrolizada pH neutro) para prevenir mastitis en ganado Holstein / Comparative study of two sealants (Iodine and pH neutral electrolyzed solution) to prevent mastitis in Holstein cattle

Es importante en sistemas de producción, determinar la presencia de mastitis su control para garantizar la calidad, lo que puede realizarse a través del conteo celular somático (CCS). En vacas con ubres sanas, es menor de 200,000 células/ml. La mastitis es factor de influencia en el CCS y cualquier medida para su prevención, favorece la calidad de la leche, como es el sellado de pezones después del ordeño. Considerando que los microorganismos patógenos generan resistencia a los desinfectantes, representa un reto contar con alternativas para su control, como las soluciones de superoxidación. El objetivo del presente trabajo fue determinar la eficacia de dos selladores yodo vs solución electrolizada superoxidada de pH neutro fase semisólida (gel), para prevenir mastitis en ganado Holstein. El trabajo se realizó en Uruétaro, municipio de Tarímbaro Michoacán. El periodo de estudio fue 21 días. La población en estudio estuvo conformada por 32 vacas, considerando número de parto menor a 4 y menor a 305 días en leche. La población objetivo fue de 10 animales, los cuales se distribuyeron al azar en dos grupos. Al grupo 1 se le aplicó yodo y al grupo 2 con gel (100 ml 25 mg cloruro de sodio). Después del ordeño, se procedió a sellar los pezones. Se realizaron 4 muestreos diagnósticos seriados con la técnica de Winsconsin (WMT), con intervalo de 7 días. Los resultados fueron analizados con un diseño completamente al azar utilizando la metodología de mínimos cuadrados generalizados. Las variables consideradas fueron: CCS, producción, número de lactancia y días en leche. El comportamiento de los tratamientos con respecto al inicio y al final del periodo de observación se encontró que el CCS fue de 60.8 por ciento más con respecto al inicio cuando se utilizó el yodo y -42.2 por ciento con el gel. El yodo mostró menos eficacia en relación con gel (p menor que 0.01), observando que el yodo, disminuye su eficacia para el control de CCS en ...

Medios de comunicación y tratamiento del tabaquismo / Communication media and treatment of smoking habit

Teniendo en cuenta la alta prevalencia de fumadores, es evidente queno resulta viable implantar programas clínicos para todos. De ahí que seanecesario realizar intervenciones que abarquen al mayor número de fumadoresposible. Los procedimientos de autoayuda proporcionados através de los medios de comunicación son una alternativa adecuada paralograr este fin. En este artículo se revisan los principales procedimientosde autoayuda para dejar de fumar que llegan a los fumadores a travésde diferentes medios de comunicación, abarcando desde intervencionespuntuales que animan a dejar el hábito durante un día o período corto detiempo, a procedimientos estructurados que se van siguiendo paso a pasoy que abordan tanto el logro de la abstinencia como el mantenimientode la misma. Se concluye que los medios de comunicación, en especialla televisión, tienen grandes posibilidades en el ámbito del tratamientodel tabaquismo y es necesario que se potencie su uso

Taking into account the high prevalence of smokers, it is evidentthat it is not possible treat all of them with clinical programs, thereforeit is necessary to establish interventions that encompass the greatest numberof possible smokers. Self-help procedures by mass media are a meansof achieving this. This paper considers different self-help interventionsfor smoking cessation that are made available to smokers throughthe mass media, ranging from prompt interventions that encourage smokingcessation in a day, or short period of time, to structured proceduresthat are undertaken step by step for achieving and maintaining abstinence.It is concluded that the mass media, especially television, has greatpotential in terms of smoking cessation and this potential needs to beexploited