Nuevos modelos predictivos de bacteriemia en el servicio de urgencias: un paso adelante

La atención de pacientes con sospecha de un proceso infeccioso en los servicios de urgencias hospitalarios(SUH) se ha incrementado en la última década hasta suponer alrededor del 15-20% de todas las atenciones diarias. En la valoración inicial de estos enfermos se toman muestras para los distintos estudios microbiológicos en un 45% de los casos, donde predomina la obtención de hemocultivos (HC), en el 14,6% de todos ellos. La rentabilidad diagnóstica de estos HC es muy variable (2-20%). Los focos o procesos infecciosos más frecuentes sospechados o confirmados de las bacteriemias verdaderas(BV) en los SUH son la infección del tracto urinario (45%) y la infección respiratoria (25%). Por todo ello, la sospecha y confirmación de la BV tiene un relevante significado diagnóstico, pronóstico y obliga a cambiar algunas de las decisiones más importantes a tomar en el SUH. Entre otras, indicar el alta o ingreso, extraer HC y administrar el antimicrobiano adecuado y precoz. La intención de esta revisión es poner de manifiesto las evidencias científicas publicadas en los últimos cinco años, aclarar las controversias existentes actuales y comparar la capacidad para predecir bacteriemia de los últimos modelos predictivos publicados desde el año 2017 con los ya existentes en esa fecha, año en el que se publicó una revisión que dejaba abierta la propuesta de seguir buscando un modelo con un rendimiento adecuado para los SUH. Y así, a partir de ella, generar distintas recomendaciones que ayuden a definir el papel que pueden tener estos modelos o escalas en la mejora de la indicación de obtención de los HC, así como en la toma inmediata de otras decisiones diagnóstico-terapéuticas (administración precoz y adecuada del tratamiento antibiótico, solicitud de estudios complementarios y otras muestras microbiológicas, intensidad del soporte hemodinámico, necesidad de ingreso, etc.)     

Evaluation of the multimorbidity network and its relationship with clinical phenotypes in chronic obstructive pulmonary disease: The GALAXIA study

BackgroundChronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition, in which taking into consideration clinical phenotypes and multimorbidity is relevant to disease management. Network analysis, a procedure designed to study complex systems, allows to represent connections between the distinct features found in COPD.MethodsNetwork analysis was applied to a cohort of patients with COPD in order to explore the degree of connectivity between different diseases, taking into account the presence of two phenotypic traits commonly used to categorize patients in clinical practice: chronic bronchitis (CB⁺/CB⁻) and the history of previous severe exacerbations (Ex⁺/Ex⁻). The strength of association between diseases was quantified using the correlation coefficient Phi (ɸ).ResultsA total of 1726 patients were included, and 91 possible links between 14 diseases were established. Although the four phenotypically defined groups presented a similar underlying comorbidity pattern, with special relevance for cardiovascular diseases and/or risk factors, classifying patients according to the presence or absence of CB implied differences between groups in network density (mean ɸ: 0.098 in the CB⁻ group and 0.050 in the CB⁺ group). In contrast, between‐group differences in network density were small and of questionable significance when classifying patients according to prior exacerbation history (mean ɸ: 0.082 among Ex⁻ subjects and 0.072 in the Ex⁺ group). The degree of connectivity of any given disease with the rest of the network also varied depending on the selected phenotypic trait. The classification of patients according to the CB⁻/CB⁺ groups revealed significant differences between groups in the degree of conectivity between comorbidities. On the other side, grouping the patients according to the Ex⁻/Ex⁺ trait did not disclose differences in connectivity between network nodes (diseases).ConclusionsThe multimorbidity network of a patient with COPD differs according to the underlying clinical characteristics, suggesting that the connections linking comorbidities between them vary for different phenotypes and that the clinical heterogeneity of COPD could influence the expression of latent multimorbidity. Network analysis has the potential to delve into the interactions between COPD clinical traits and comorbidities and is a promising tool to investigate possible specific biological pathways that modulate multimorbidity patterns.     

Timing of Breastfeeding Initiation Mediates the Association between Delivery Mode,Source of Breastfeeding Education,and Postpartum Depression Symptoms

Background: Emergency cesarean section (EMCS) and breastfeeding difficulties increase the risk of postpartum depressive (PPD) symptoms. Early initiation of breastfeeding (EIBF) may not only alleviate PPD symptoms but also facilitate subsequent breastfeeding success. EMCS is a risk factor for not practicing EIBF. Therefore, it is important to understand the relationship between EMCS, EIBF, and PPD symptoms. Methods: We conducted a prospective cohort study in three areas of China. At baseline, a total of 965 mothers completed electronic questionnaires within 72 h postpartum. Women were screened for PPD symptoms using the Edinburgh Postpartum Depression Scale (EPDS). Multivariate logistic regression was used to identify the determinants of PPD symptoms. Mediation analysis was used to determine if EIBF mediated the relationship between delivery mode or breastfeeding education source and PPD symptoms. Results: The prevalence of EIBF was 40.6%; 14% of 965 mothers experienced EMCS, and 20.4% had PPD symptoms. The risk factors for developing PPD symptoms were excessive gestational weight gain (adjusted odds ratio [aOR] = 1.55, confidence interval [95% CI]: 1.03–2.33, p = 0.037) and EMCS (aOR = 2.05, 95% CI: 1.30–3.25, p = 0.002). The protective factors for developing PPD symptoms were monthly household income over CNY 10000 (aOR = 0.68, 95% CI: 0.47–0.97, p = 0.034), EIBF (aOR = 0.49, 95% CI: 0.34–0.72, p < 0.001), and prenatal breastfeeding education from nurses (aOR = 0.46, 95% CI: 0.29–0.73, p = 0.001). EIBF indirectly affected PPD symptoms in patients who had undergone EMCS (percentage mediated [PM] = 16.69, 95% CI: 7.85–25.25, p < 0.001). The source of breastfeeding education through EIBF also affected PPD symptoms (PM = 17.29, 95% CI: 3.80–30.78, p = 0.012). Conclusion: The association between EMCS on PPD symptoms was mediated by EIBF. By providing breastfeeding education, nurses could also help alleviate PPD symptoms.     

Rational design of large flat nitrogen-doped graphene oxide quantum dots with green-luminescence suitable for biomedical applications

Rational synthesis and simple methodology for the purification of large (35–45 nm in lateral size) and flat (1.0–1.5 nm of height) nitrogen-doped graphene oxide quantum dots (GOQDs) are presented. The methodology allows robust metal-free and acid-free preparation of N-GOQDs with a yield of about 100% and includes hydrothermal treatment of graphene oxide with hydrogen peroxide and ammonia. It was demonstrated that macroscopic impurities can be separated from N-GOQD suspension by their coagulation with 0.9% NaCl solution. Redispersible in water and saline solutions, particles of N-GOQDs were characterized using tip-enhanced Raman spectroscopy (TERS), photoluminescent, XPS, and UV-VIS spectroscopies. The size and morphology of N-GOQDs were studied by dynamic light scattering, AFM, SEM, and TEM. The procedure proposed allows nitrogen-doped GOQDs to be obtained, having 60–51% of carbon, 34–45% of oxygen, and up to 7.2% of nitrogen. The N-GOQD particles obtained in two hours of synthesis contain only pyrrolic defects of the graphene core. The fraction of pyridine moieties grows with the time of synthesis, while the fraction of quaternary nitrogen declines. Application of TERS allows demonstration that the N-GOQDs consist of a graphene core with an average crystallite size of 9 nm and an average distance between nearest defects smaller than 3 nm. The cytotoxicity tests reveal high viability of the monkey epithelial kidney cells Vero in the presence of N-GOQDs in a concentration below 60 mg L⁻¹. The N-GOQDs demonstrate green luminescence with an emission maximum at 505 nm and sedimentation stability in the cell culture medium.

This paper reveals the methodology for robust preparation of purified nitrogen-doped graphene oxide quantum dots with non-cytotoxic activity against monkey epithelial kidney cells (Vero ATCC® CCL-81™).     

Evaluation of the genotoxic potential of dimethyl sulfoxide (DMSO) in meristematic cells of the root of Vicia faba

Dimethyl sulfoxide (DMSO) is an organic solvent with several biological applications. It is extensively used to dissolve compounds that hardly dissolve in water to detect their genotoxic activity in vitro. In this study DMSO will be tested to determine its genotoxic potential. The effect of DMSO on the frequency of chromosomal aberrations in anaphase as well as DNA fragmentation through the comet assay has been evaluated in the meristematic cells of the root tips of Vicia faba. It has been observed that the frequency of chromosomal aberrations increases when the concentration of DMSO increases, reaching its maximum value with 20% of DMSO and decreasing at 30 and 40% of DMSO, in comparison to this maximum value, but significantly higher than the values observed in the control. Similarly, the percentage of fragmentation and damage index evaluated through the comet assay showed the same behavior; some of the possible mechanisms of action are discussed.     

Recurrent nephrogenic adenoma in bladder diverticulum: case report and literature review

Nephrogenic adenoma is an uncommon benign lesion of the urinary tract induced by chronic irritation of the vesical mucosa, due to infection, trauma, surgery, calculi, foreign bodies and chemical agents. A 68-year-old male was admitted to our linic for a periodical cystoscopic evaluation as part of a follow-up initiated due to a past transitional cell carcinoma. The scheduled cystoscopy revealed, within a bladder diverticulum, an unexpected and completely asymptomatic nephrogenic adenoma that we removed by transurethral resection. We followed up the patient at 24 months, then later we made the diagnosis of nephrogenic adenoma. During this time, the patient experienced three relapses within the same diverticulum, always involving a nephrogenic adenoma we persistently treated by transurethral resections. As the nephrogenic adenoma is considered a benign lesion without any direct evidence of a possible evolution to an overt cancer, we successful attempted a half-yearly cystoscopic follow-up to control the growth of a highly recurrent benign entity, interposing between controls a periodical imaging. This paper represents the second report of a nephrogenic adenoma within a bladder diverticulum, but the first case of a nephrogenic adenoma highly recurrent within the same diverticulum and managed conservatively by regular transurethral resection scheduled over the time.     

Induction of Apoptosis in HT-29 Cells by Extracts from Isothiocyanates-rich Varieties of Brassica Oleracea

Among the vegetables with anti-carcinogenic properties, members of the genus Brassica are the most effective at reducing the risk of cancer. This property may be explained by their principle bioactive compounds, isothiocyanates (ITCs). The aim of this study was to measure the amounts of ITCs in extracts from vegetables of the Brasssica genus and assay them for potency of induction of apoptosis in a colorectal cancer cell line (HT-29). ITCs were determined by the cyclocondensation assay with 1,2-benzenedithiol and induction of apoptosis by assessment of cell viability, caspase-3 activity and DNA fragmentation. Purple cabbage extract showed the highest ITC concentration per gram, fresh weight, followed by black cabbage and Romanesco cauliflower. At ITC concentrations of 7.08 μ g/mL these extracts decreased cell viability and induced caspase-3 and DNA fragmentation at 48h. Brussels sprouts showed the strongest effects on cell viability and caspase-3 activity. Varieties of Brassica Oleracea are rich sources of ITCs that potently inhibit the growth of colon cancer cells by inducting apoptosis. All the extracts showed anticancer activity at ITC concentrations of between 3.54 to 7.08 μ g/mL, which are achievable in vivo. Our results showed that ITC concentration and the chemopreventive responses of plant extracts vary among the varieties of Brassica Oleracea studied and among their cultivars.     

The Effect of Body Mass Index on the Outcome of Critically Ill Surgical Patients

Background: The incidence of obesity is rising, and an increasing number of obese patients are admitted to surgical intensive care units (SICUs). However, it is not clear whether obesity is an independent risk factor for increased morbidity and mortality in SICU patients. We examined the effect of obesity on morbidity and mortality in patients admitted to the SICU in this study. Method: We reviewed prospectively acquired SICU data in normal and obese patients with an SICU length of stay >24 hours. Comparability of the groups was assessed using a χ² test or Fisher exact test, as appropriate, for categorical variables and analysis of variance (ANOVA) or the Kruskal‐Wallis test, as appropriate, for continuous variables. Results: Of the 1792 consecutive patients evaluated, 711 had a normal body mass index (BMI), and 993 were either preobese or obese. There was no statistically significant difference across the 5 BMI groups with respect to any of the 3 comorbidity indices (Acute Physiology and Chronic Health Evaluation III [APACHE III], Simplified Acute Physiology Score, or Multiple Organ Dysfunction Score). There was no statistically significant difference in the intensive care unit (ICU) length of stay and hospital length of stay or time‐to‐ICU mortality (log‐rank test P = .054) among the 5 BMI groups. A Cox regression analysis and backward elimination algorithm selected APACHE III to be the most important explanatory variable for survival time. Conclusion: Obesity does not affect the mortality of patients admitted to the SICU. We conclude that obesity cannot be used as an independent predictive mortality outcome variable in patients admitted to the SICU.