Endodontic variables in patients with SARS-CoV-2 infection (COVID-19) in relation to the severity of the disease.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. It has been hypothesized oral health may be related to the severity and complications of COVID-19. The aim of this study was to analyze the prevalence of apical periodontitis and the frequency of root canal treatment in a sample of patients with SARS-CoV-2 infection (COVID-19), correlating them with the severity of the disease. MATERIAL AND METHODS: This retrospective study was conducted following the Strengthening Reporting Observational Studies in Epidemiology (STROBE) guidelines. The study examined 280 patients with positive real time PCR COVID-19 test whose treatment was performed in our hospital. Fifty-two patients aged 52.3 ± 17.3 years, including 30 males and 22 females, who had an orthopantomography in their clinical record, performed in the last 2 years, were included. Patients with SARS-CoV-2 infection were grouped as mild or moderate (MM) and severe or critical (SC) illness groups, according to the NIH COVID-19 Treatment Guidelines (Wu & McGoogan 2020). Radiographic records were analyzed and apical periodontitis (AP) was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student's t test, χ2 test and multivariate logistic regression were used in the statistical analysis. RESULTS: The number of carious teeth was significantly higher in the SC group (3.4 ± 4.1), which showed more than twice as many teeth with carious lesions than the MM group (1.4 ± 1.8) (p = 0.02). Multivariate regression analysis showed association between the number of carious teeth and the severity of SARS-CoV-2 disease (OR = 1.5; 95% CI = 1.1-2.1; p = 0.017). Endodontic status (OR = 7.12; 95% CI = 1.2-40.9; p = 0.027) also correlated with the disease severity. CONCLUSIONS: The results suggest that the oral health status of COVID-19 patients correlated with the severity of the SARS-CoV-2 virus infection. Significant association has been found between the severity of COVID-19 disease and the presence of a greater number of teeth with caries lesions, as well as with endodontic status.

Reduction of low temperature engine pollutants by understanding the exhaust species interactions in a diesel oxidation catalyst.

The interactions between exhaust gas species and their effect (promotion or inhibition) on the light-off and activity of a diesel oxidation catalyst (DOC) for the removal of pollutants are studied, using actual engine exhaust gases from the combustion of diesel, alternative fuels (rapeseed methyl ester and gas-to-liquid fuel) and diesel/propane dual fuel combustion. The activity of the catalyst was recorded during a heating temperature ramp where carbon monoxide (CO) and hydrocarbon (HC) light-off curves were obtained. From the catalyst activity tests, it was found that the presence of species including CO, medium-heavy HC, alkenes, alkanes, and NOx and their concentration influence the catalyst ability to reduce CO and total HC emissions before release to the atmosphere. CO could inhibit itself and other species oxidation (e.g., light and medium-heavy hydrocarbons) while suffering from competitive adsorption with NO. Hydrocarbon species were also found to inhibit their own oxidation as well as CO through adsorption competition. On the other hand, NO2 was found to promote low temperature HC oxidation through its partial reduction, forming NO. The understanding of these exhaust species interactions within the DOC could aid the design of an efficient aftertreatment system for the removal of diesel exhaust pollutants.

Finding synergies in fuels properties for the design of renewable fuels--hydroxylated biodiesel effects on butanol-diesel blends.

This article describes the effects of hydroxylated biodiesel (castor oil methyl ester - COME) on the properties, combustion, and emissions of butanol-diesel blends used within compression ignition engines. The study was conducted to investigate the influence of COME as a means of increasing the butanol concentration in a stable butanol-diesel blend. Tests were compared with baseline experiments using rapeseed methyl esters (RME). A clear benefit in terms of the trade-off between NOX and soot emissions with respect to ULSD and biodiesel-diesel blends with the same oxygen content was obtained from the combination of biodiesel and butanol, while there was no penalty in regulated gaseous carbonaceous emissions. From the comparison between the biodiesel fuels used in this work, COME improved some of the properties (for example lubricity, density and viscosity) of butanol-diesel blends with respect to RME. The existence of hydroxyl group in COME also reduced further soot emissions and decreased soot activation energy.

Time to positivity of blood culture association with clinical presentation, prognosis and ESBL-production in Escherichia coli bacteremia.

The time to positivity (TTP) of blood cultures has been associated with increased mortality in bacteremia caused by several microorganisms. The aim of this study is to evaluate the relationship between TTP and prognosis, clinical presentation and extended spectrum B-lactamase (ESBL)-production in patients with Escherichia coli bacteremia. This is a retrospective observational study involving 226 adult patients with E. coli bacteremia. Data collected included underlying diseases, clinical presentation, prognosis factors, TTP, ESBL-production and outcome. Thirty-one (14%) patients had severe sepsis and 29 (13%) septic shock at presentation. Thirty-three (14%) strains were ESBL-producers. Thirty-nine (17%) patients died during admission and 17 (7.5%) within 48 hours. The median TTP was 8.3 hours (range, 0.42­76.5). It was significantly shorter in patients with septic shock (6.23 h, range 1.12­47.29 h vs. 8.51 h, range 0.42­76.50 h; p = 0.018). Rapid growth of E. coli, Pitt index >1.5, non-urinary source and Charlson score >2 were selected as independent risk factors of in-hospital mortality by the multivariate analysis. ESBL-production was not associated with modifications in TTP. Lower TTP is an independent risk factor for septic shock and poor outcome in episodes of E. coli bacteremia. The TTP in E. coli bacteremia is not significantly modified by ESBL-production.

Preemptive therapy for cytomegalovirus disease in allogeneic stem cell transplant recipients.

Cytomegalovirus (CMV) infection causes high morbidity and mortality among allogeneic stem cell transplant recipients. Preemptive therapy with oral valganciclovir or intravenous ganciclovir has replaced universal prophylaxis. We prospectively studied 19 consecutive adult recipients of allogeneic peripheral blood stem cell transplants from May 2005 through February 2007 to analyze the safety and efficacy of preemptive therapy for the treatment of CMV infection. The antigenemia test was persistently negative in 8 patients (42%) and positive at least once in 11 (58%). Eight patients were treated with oral valganciclovir on an outpatient basis and they all became CMV negative after the first week of treatment. The other 3 patients received intravenous ganciclovir and were also CMV negative after the first week of treatment. No patient abandoned treatment, no severe secondary toxicity was noted, and there was no CMV-associated mortality.

Review of the evidence on handling drugs and hazardous products in Urology Departments. Consensus document between the Spanish Urological Association and the Spanish Society of Hospital Pharmacy. / Revisión de la evidencia sobre el manejo de medicamentos y productos peligrosos en los servicios de Urología. Documento de consenso entre la Asociación Española de Urología y la Sociedad Española de Farmacia Hospitalaria.

BACKGROUND: The intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments. METHODS: We reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level. RESULTS: There is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers. DISCUSSION: Following the strategic lines of the European Parliament for 2014-2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products. CONCLUSIONS: After this review, 19 recommendations were established for handling dangerous drug products, which can be summarised as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programmes and optimise available resources.

Administration of taurolidine-citrate lock solution for prevention of central venous catheter infection in adult neutropenic haematological patients: a randomised, double-blinded, placebo-controlled trial (TAURCAT).

BACKGROUND: Catheter-related bloodstream infection (CRBSI) is one of the most frequent complications in patients with cancer who have central venous catheters (CVCs) implanted and is associated with substantial morbidity and mortality. Taurolidine is a non-antibiotic agent with broad-spectrum antimicrobial activity, which has been used as a lock solution to prevent CRBSI in some settings. However, little is known about its usefulness in high-risk adult neutropenic patients with cancer. This prospective randomised clinical trial aims to test the hypothesis that taurolidine-citrate lock solution is more effective than placebo for preventing catheter infection in neutropenic haematological patients. METHODS: This study is a prospective, multicentre, randomised, double-blinded, parallel, superiority, placebo-controlled trial. Patients with haematological cancer who are expected to develop prolonged neutropenia (> 7 days) and who have a non-tunnelled CVC implanted will be randomised to receive prophylactic taurolidine-citrate-heparin solution using a lock technique (study group) or heparin alone (placebo group). The primary endpoint will be bacterial colonisation of the CVC hubs. The secondary endpoints will be the incidence of CRBSI, CVC removal, adverse events, and 30-day case-fatality rate. DISCUSSION: The lock technique is a preventive strategy that inhibits bacterial colonisation in the catheter hubs, which is the initial step of endoluminal catheter colonisation and the development of infection. Taurolidine is a nontoxic agent that does not develop antibiotic resistance because it acts as an antiseptic rather than an antibiotic. Taurolidine has shown controversial results in the few trials conducted in cancer patients. These studies have important limitations due to the lack of data on adult and/or high-risk neutropenic patients, the type of catheters studied (tunnelled or ports), and the lack of information regarding the intervention (e.g. dwelling of the solution, time, and periodicity of the lock technique). If our hypothesis is proven, the study could provide important solid evidence on the potential usefulness of this preventive procedure in a population at high risk of CRBSI, in whom this complication may significantly impair patient outcome. TRIAL REGISTRATION: ISRCTN, ISRCTN47102251 . Registered on 9 September 2015.

[Cardiac and vascular homograft valves transplant]. / Trasplante de homoinjertos valvulares cardiacos y vasculares.

The advances in the manipulation of human tissues, the development of cryobiology, paediatric cardiac surgery, the impossibility of obtaining an ideal prosthetic cardiac valve and the surgical treatment of cardiovascular infections have revived interest in the use of homografts. The donors of these homografts can be: a) Live donors: aortic and pulmonary valve of the recipient of a heart transplant; b) Multiorgan donors with a diagnosis of death according to neurological criteria, whose heart is rejected for heart transplant; c) Cadaver donors with asystolia of less than 8 hours. Homograft cardiac valves are the substitute of choice in aortic valve endocarditis, patients with counter-indications for anticoagulation, reconstruction of the outflow tract of the right ventricle, aortic valve replacement in children and young adults through the Ross operation, and an optional indication is the aortic valve and/or rising aorta replacement in patients over 60 years of age. Although there are not sufficiently broad series of homogratfs with arterial substitutes, with respect to the number of patients and time of evolution, the results suggest that this can benefit patients with vascular infection, immunodepressed patients or complex patients whose technique during the operation might require a homograft.

Platelet rich plasma in ocular surface. / Plasma rico en plaquetas en superficie ocular.

The use of platelet-rich preparations has experienced a significant increase in recent years due to its role in tissue-repair and regeneration. The aim of this study is to examine the available evidence regarding the application of plasma rich in growth factors, and its variations, on the ocular surface. A review is also presented on the effects of platelet-derived growth factors, the implications of the preparation methods, and the existing literature on the safety and efficacy of these therapies in ocular surface diseases. Despite the widespread use of platelet preparations there is no consensus on the most appropriate preparation method, and growth factors concentration vary with different systems. These preparations have been used in the treatment of ocular surface diseases, such as dry eye or persistent epithelial defects, among others, with good safety and efficacy profiles, but further studies are needed to compare to the currently available alternatives.

[Common law study of the legal responsibility of health care staff related to drug reformulation]. / Estudio jurisprudencial de la responsabilidad legal del personal sanitario en la reformulación de medicamentos.

OBJECTIVE: To analyze the responsibility of health care staff in drug reformulation (change of dose, pharmaceutical form or route of administration of medicinal products) based on the common law of the High Court and the National Court. METHOD: Search and analysis of common law and legal studies included in databases "El Derecho", "Difusión Jurídica" and "Indret". RESULTS: Health care staff has means--not outcomes--obligations according to the care standards included in the "Lex Artis" that can go beyond the mere legal standards. Failure to apply these care standards, denial of assistance or disrespect to the autonomy of the patient can be negligent behavior. We found 4 cases in common law. In the two cases in which care standards were complied with, including reformulation, health care professionals were acquitted, whereas in the other two cases in which reformulations were not used even though the "Lex Artis" required them, the professionals were condemned. CONCLUSIONS: Reformulation of medicinal products, as set forth in the Lex Artis, is a practice accepted by the High Court and the National Court and failure to use it when the scientific knowledge advises so is a cause for conviction.

Intracardiac thrombi after orthotopic heart transplantation: clinical significance and etiologic factors.

The frequency and clinical significance of intracardiac thrombi after orthotopic heart transplantation are still not fully understood. The aim of this article is to present five patients with heart transplants with intracardiac thrombi and to subject the possible cause, methods of diagnosis, and treatment of this phenomenon to scrutiny. The frequency of intracardiac thrombi may well be higher than anticipated, with emboli occurring only in a small proportion of cases. Hematologic, anatomic, and hemodynamic factors seem to have a bearing on thrombogenesis. Further multicenter studies are required to gain a better understanding of this disorder.

Blunt traumatic rupture of the right hemidiaphragm and Budd-Chiari syndrome.

We present 2 cases of delayed diagnosis of rupture of the right hemidiaphragm caused by blunt thoracic trauma, in which herniation of the liver toward the thoracic cavity had occurred. Both patients showed signs of noncardiogenic hepatic venous outflow obstruction. Venous outflow returned to normal on reintroduction of the liver into the abdominal cavity and closure of the defect in the diaphragm. The pathogenesis, diagnosis, and treatment of this problem are discussed.

Spontaneous and isolated dissection of the common iliac artery.

A patient with isolated dissection of the common iliac artery is presented. A 56-year-old man was admitted because of sudden intermittent claudication of the left lower limb. Angiography showed a left popliteal artery interruption associated with an asymptomatic dissection of the right common iliac artery. The patient was treated with a left femoropopliteal bypass and a right aortofemoral bypass. The etiology of primary dissections of peripheral arteries is discussed.

Primary graft failure after heart transplantation. Successful recovery with pneumatic biventricular assistance.

A 41-year-old male underwent orthotopic heart transplantation complicated by intraoperative acute allograft failure. The patient required immediate placement of a pneumatic biventricular assist device which was kept for 49 days until graft recovery resulted in successful explantation of the device. The patient was discharged from hospital on postoperative day 112. Management of primary cardiac allograft failure with mechanical ventricular assistance is discussed.

[The expression of atrial natriuretic peptide in the cardiomyocytes of left ventricular aneurysms]. / Expresión del péptido natriurético auricular en los cardiomiocitos de aneurismas de ventrículo izquierdo.

We report three patients with left ventricular aneurysm who underwent coronary artery bypass grafting and resection of the ventricular aneurysm. The walls of the aneurysms were immunohistochemically investigated to study whether atrial natriuretic peptide was present or not. Immunoreactivity for atrial natriuretic peptide was observed in some of the viable cardiomyocytes within the scar tissue. Mechanisms of regulation of the expression of atrial natriuretic peptide are discussed.

[Alternatives to solid pharmacutical forms usually given by enteral nutrition tubes]. / Alternativas a las formas farmacéuticas sólidas administradas habitualmente por sondas de nutrición enteral.

We analyze which drugs of those administered through an enteral nutrition tube, present problems which are inherent to the pharmaceutical forms. The study is conducted with a sample of 40 patients who have a feeding tube, who received a total of 48 different medications. 38 (78.3%) were in a solid pharmaceutical form, and 10 (21.7%) were liquid. Among the most used medications, ranitidine stands out in 12 patients, paracetamol in 8, and phenytoin in 7. We note the use of the solid forms of phenytoin, nifedipine, and controlled release morphine, as having the greatest interest due to their contraindication. For all the studied cases, we propose alternatives and we note those drugs for which we did not find any. The hospitalary pharmaceutical guides should include liquid pharmaceutical forms of those drugs which should not be ground up. There is little information on the wards about the administration of drugs through feeding tubes.