Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic

INTRODUCTION

Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients.

METHODS

Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥ 460 ms in women and ≥450 ms in men. The incidence and type of arrhythmias during the same period were recorded.

RESULTS

A total of 77 patients with a mean age of 62 ± 13 years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI > 30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc.

CONCLUSIONS

In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.

Carriage of multidrug-resistant Gram-negative bacilli: duration and risk factors

Identification of risk factors influencing the duration of carriage of multidrug-resistant Gram-negative bacilli (MDR-GNB) may be useful for infection control. The aim of this study is to estimate the impact of several factors collected for routine hospital surveillance on the duration of carriage of selected MDR-GNB. From January 2015 to July 2021, patients with at least two clinical/surveillance samples positive for MDR-GNB different from ESBL-producing E. coli or AmpC - exclusively producing Enterobacterales were assessed. Microorganisms, age, number of admissions, clinical or rectal sample, sex, and admission service were evaluated as risk factors. Multivariate analysis was performed by a Cox proportional hazard model. A total of 1981 episodes of colonization were included. Involved microorganisms were ESBL-Klebsiella pneumoniae (KP) in 1057 cases (53.4%), other ESBL-non-E. coli Enterobacterales in 91 (4.6%), OXA-48-KP in 263 (13.3%), KPC-KP in 90 (4.5%), VIM-KP in 29 (1.5%), carbapenemase-producing non-KP Enterobacterales (CP-non-KP) in 124 (6.3%), and MDR Pseudomonas aeruginosa (MDR-PAER) in 327 (16.5%). No differences in duration of colonization were observed among ESBL-KP (median colonization time 320 days), ESBL-non-E. coli Enterobacterales (226 days), OXA48-KP (305 days), and MDR-PAER (321 days). For each group, duration of colonization was significantly longer than that of KPC-KP (median colonization time 60 days), VIM-KP (138 days), and CP-non-KP (71 days). Male sex (HR = 0.88; 95% CI 0.78-0.99), detection in Hepatology-Gastroenterology (HR = 0.71; 95% CI 0.54-0.93), clinical sample (HR = 0.61; 95% CI 0.53-0.69), and > 2 admissions after first detection (HR = 0.47; 95% CI 0.42-0.52) were independent predictors of longer carriage, whereas VIM-KP (HR = 1.61; 95% CI 1.04-2.48), KPC-KP (HR = 1.85; 95% CI 1.49-2.3), and CP-non-KP (HR = 1.92; 95% CI 1.49-2.47) were associated with shorter colonization time. Duration of colonization was significantly longer for ESBL-KP, other ESBL-non-E. coli Enterobacterales, OXA-48-KP, and MDR-PAER. For these microorganisms, prolonging surveillance up to 2.5-3 years should be considered. Male sex, clinical sample, multiple readmissions, admission service, and type of microorganism are independent predictors of the duration of carriage.

Lower uterine segment thickness assessed by transvaginal ultrasound before labor induction: reproducibility analysis and relationship with delivery outcome

OBJECTIVES

To evaluate the reproducibility of lower uterine segment (LUS) thickness measurement before induction of labor (IOL), and to assess the relationship between LUS thickness and IOL outcomes.

METHODS

This was a prospective cohort study of pregnant women undergoing IOL at term, conducted in a single tertiary hospital between July 2014 and February 2017. Women with a singleton pregnancy at ≥ 37 weeks' gestation, with a live fetus in cephalic presentation and a Bishop score of ≤ 6, were eligible for inclusion. Both nulliparous and parous women, and those with a previous Cesarean section (CS), were eligible. All women underwent transvaginal ultrasound assessment before IOL admission, and cervical length and LUS thickness were measured offline after delivery. Maternal and obstetric characteristics and Bishop score were recorded. The main outcome was the overall rate of CS after IOL, and secondary outcomes were CS for either failure to progress in the active phase of labor or failed IOL, and CS for failed IOL only. Interobserver agreement for measurement of LUS thickness between two operators was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis with the ANOVA test to evaluate systematic bias. Univariable and multivariable analysis were employed to evaluate the relationship between clinical and sonographic characteristics and IOL outcomes.

RESULTS

Of 265 women included in the analysis, 195 (73.6%) had a vaginal delivery and 70 (26.4%) required a CS after IOL. Reproducibility analysis showed excellent interobserver agreement for the measurement of LUS thickness (ICC, 0.96 (95% CI, 0.93-0.98)). On Bland-Altman analysis, the mean difference in LUS thickness between the two operators was 0.15 mm (95% limits of agreement, -1.84 to 2.14 mm), and there was no evidence of systematic bias (ANOVA test, P = 0.46). Univariable analysis showed that LUS thickness was associated significantly with overall CS (P = 0.002), CS for failure to progress in the active phase of labor or failed IOL (P = 0.03) and CS for failed IOL (P = 0.037). On multivariable logistic regression analysis, LUS thickness was an independent predictive factor for overall CS (odds ratio (OR), 1.149 (95% CI, 1.031-1.281)) and CS for failure to progress in the active phase of labor or failed IOL (OR, 1.226 (95% CI, 1.039-1.445)).

CONCLUSIONS

In women undergoing IOL at term, measurement of LUS thickness is feasible and reproducible, and is associated significantly with IOL outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Unravelling groundwater and surface water sources in the Esteros del Iberá Wetland Area: An isotopic approach

In the Esteros del Iberá Wetland Area (EIWA, NE Argentina), the southern sector of the transboundary Guarani Aquifer System (SAG) is overlain by the Ramsar listed Iberá Wetlands and several rivers, that combined extend across 37,930 km² and represent one of the largest freshwater systems on the South American continent. Previous hydrogeological studies encompassing the entire SAG proposed preferential discharge of groundwater of various origins and ages to the EIWA. In this study, a multi-tracer study using major ionic species, δ¹⁸O, δ²H and ²²²Rn was conducted in lagoons, rivers, wells, and boreholes in the EIWA to confirm if discharge from the transboundary SAG is contributing to the surface water system. End-member Mixing Analysis (EMMA) determined the existence of four main end-members: groundwater from the SAG, more saline groundwater from the deeper Pre-SAG, and two poorly mineralised end-members from shallow, Post-SAG. EMMA calculations clearly illustrated complex binary and ternary mixing patterns involving the four end-members and highlighted the role of geological structures, specifically regional steep faults, in controlling the mixing patterns. ²²²Rn activities allowed in-situ identification of preferential deep groundwater discharge into both surface waters and shallow groundwaters. These findings provide strong evidence for the widespread existence of upward flows along major faults in this sector of the SAG, inducing complex mixing flow patterns and explaining the presence of old groundwater in shallow aquifers. Mapping the sources of water and the hydrological interactions are relevant for improving water balance estimates and develop management policies towards the preservation of these wetlands.

POS1446 CREATINE KINASE COULD BE A MARKER OF CHRONIC INFLAMMATION-INDUCED SARCOPENIA IN FRAIL PATIENTS

Background

Frailty is a hallmark of unhealthy ageing characterized by a decline in the general physiological state, strength and endurance of the patient and consequently, a greater vulnerability to endogenous and/or exogenous stressors. Behind this condition there are multiple pathophysiological processes affecting different systems, such as the musculoskeletal, reflected in sarcopenia, where anabolism is reduced in turn of catabolism. Underlying these processes, chronic inflammation is a well-known but not properly dissected mechanism that contributes to frailty. Although several studies suggest an association of TNF-α, IL-6, IL1-β with systemic inflammation in frail patients, the results are not conclusive. Some authors have explored other molecules related to inflammation, including creatine kinase (CK), a muscle enzyme involved in energy metabolism. Decreased serum CK levels have been observed in chronic inflammatory diseases associated with sarcopenia such as rheumatoid arthritis. In turn, CK is increased not only after myocardial infarction and post-traumatic myolysis, but also associated with muscle mass anabolism.

Objectives

To study the clinical significance of CK levels and their association with other inflammatory and anabolic regulators in frail patients.

Methods

We randomly selected 152 individuals (76 frail and 76 robust) that were 80.86 (±5.49) years and 50% were female, from the second wave of Toledo Study of Healthy Aging cohort (1). CK was measured by routine analysis; serum TNF-α, sgp130, Growth Differentiation Factor (GDF)-15, soluble IL-6R (sIL-6R) and IGF-1 by Multiplex-Luminex. Serum C-Reactive Protein (CRP) and Myostatin (MSTN) were assessed by ELISA. Differences between robust and frail patients were tested using Mann-Whitney and Kruskal-Wallis test for continuous variables and Chi-square test for discrete variables. For each variable, normality was tested using Shapiro-Wilk normality and Kolmogorv-Smirnov tests. Non-normal variables were natural logarithm transformed to achieve normality. The association between each biomarker and frailty was assessed using multivariate logistic models. Additionally, a sensitivity analysis was performed including a second biomarker in the model in order to detect those biomarkers that influenced the association. All analyses were done using R.

Results

Inflammatory markers CRP and GDF-15 were increased in frail patients, OR (95% CI) 1.59 (1.22-2.05; p<0,001) and OR 1.93 (1.01-3.68; p=0,006), respectively, in comparison to robust. There were no significant changes in the inflammatory parameters TNF-α, sgp130, sIL-6R between groups. The anabolic marker IGF-1 did not change significantly between groups, while the anti-anabolic mediator MSTN was reduced in frail patients, OR 0.40 (0.19-0.86; p=0.02). Finally, CK levels were decreased in frail patients when compared to robust subjects, OR 0.37 (0.18-0.76; p=0.007). In sensitivity analysis, this association remained statistically significant with ORs ranging from 0.33 to 0.40 regardless of a second biomarker.

Conclusion

We identified chronic inflammation in a cohort of frail patients given the significant increase in CRP and GDF-15, although we did not find association with other inflammation parameters such as TNF-α, sgp130 or sIL-6R, highlighting the difficulty of characterize the status of systemic inflammation. The decrease in CK levels in frailty suggest that this marker could be an indicator of cumulative muscle mass loss due to chronic inflammation. Since CRP can be sensitive and altered by a multitude of pathological conditions in frail patients, we propose CK as a more specific marker of inflammation-induced muscle impairment.

References

[1]The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging. Garcia-Garcia FJ et al. J Nutr Health Aging. 15:852-6, 2011

Disclosure of Interests

None declared

Effect of Sex in Systemic Psoriasis Therapy: Differences in Prescription, Effectiveness and Safety in the BIOBADADERM Prospective Cohort

The effect of sex on systemic therapy for psoriasis has not been well studied. The aim of this study was to analyse a large multicentre Spanish cohort of 2,881 patients with psoriasis (58.3% males), followed from January 2008 to November 2018, to determine whether sex influences prescription, effectiveness of therapy, and the risk of adverse events. The results show that women are more likely than men to be prescribed biologics. There were no differences between men and women in effectiveness of therapy, measured in terms of drug survival. Women were more likely to develop adverse events, but the difference in risk was small and does not justify different management. Study limitations include residual confounding and the use of drug survival as a proxy for effectiveness.

Dermatologists' Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations

Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice.

Una mirada actualizada sobre los ambientes alimentarios y obesidad

La obesidad es considerada por la Organización Mundial de la Salud como un gra¬ve problema de salud pública. En Chile los datos de la Encuesta Nacional de Salud 2016-2017 muestran que 7 de cada 10 chilenos presentan sobrepeso u obesidad y, según datos del Ministerio de Educación, en los niños que ingresan a la enseñanza básica, la prevalencia de obesidad no ha logrado bajar del 25%. En los últimos años ha habido un reconocimiento mundial sobre la influencia que tienen los Ambien-tes Alimentarios en el comportamiento de las personas y en el estado nutricional de las poblaciones. Recientemente en el país se han identificado los Ambientes Ali¬mentarios predominantes y sus factores condicionantes, lo que ha culminado con la elaboración de la Política Nacional de Alimentación y Nutrición y los lineamientos que permiten avanzar en diferentes estrategias para modificar dichos ambientes. En Chile se han implementado medidas individuales y estructurales que han tenido gran relevancia tanto a nivel nacional como internacional, aunque está pendiente la ela-boración de instrumentos que midan de manera objetiva y confiable los Ambientes Alimentarios

Linguistic and Cultural Adaptation to Spanish of the Screening Tool Psoriatic Arthritis UnclutteRed Screening Evaluation (PURE4)

BACKGROUND AND OBJECTIVE

The 4-item Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) questionnaire is a useful tool for identifying patients with suspected psoriatic arthritis before referring them to a rheumatology department for confirmation. The original English version has good discriminant validity (sensitivity, 85.7%; specificity, 83.6%). We aimed to produce an adapted Spanish version of the PURE-4 for validation and use in Spain.

MATERIAL AND METHOD

We applied the method recommended by the International Society for Pharmacoeconomic and Outcome Research for the cultural adaptation of patient-centered measurement tools. The phases in the processes involved forward translation, reconciliation, back translation review, harmonization, cognitive debriefing and review, and proofreading.

RESULTS

We obtained the permission of the author of the original questionnaire. Two native-speaking translators translated the questionnaire into Spanish. Small changes, mainly in the way the items were expressed, were then made in order to reconcile the 2 translations. The questionnaire was then back translated to English and revised to achieve a version equivalent to the original. A Spanish translation derived from the revision was tested for understandability in 7 patients, and the final Spanish version was then produced. During the translation phases, the project manager and a scientific committee made up of a dermatologist and a rheumatologist reviewed the different versions. Team members exchanged information throughout the process, providing for harmonization and the quality control that guaranteed conceptual equivalence.

CONCLUSIONS

This adaptation of the PURE-4 questionnaire for use in Spain has been the first step toward using it in routine clinical practice. The standardized method we used ensures that the Spanish and the original versions are equivalent.

Relevant Infections in Inflammatory Bowel Disease, and Their Relationship With Immunosuppressive Therapy and Their Effects on Disease Mortality

BACKGROUND AND AIMS

There is controversy as to whether the risk of relevant infection in IBD is related to immunosuppressants or the disease itself. The aims of this study were to evaluate: [1] the life-long prevalence and types of relevant infections in patients with IBD related to immunosuppressive treatment, and [2] the relationship of both infection and patient comorbidity to mortality.

METHODS

Observational multicentre retrospective study of IBD patients that presented a relevant infection. For each case, four periods of infection exposure were analysed: P1: pre-IBD diagnosis, P2: from IBD diagnosis to immunosuppressant initiation, P3: during immunosuppressant therapy, and P4: after treatment withdrawal.

RESULTS

The life-long prevalence of relevant infection in the total cohort of patients [6914] was 3%, and 5% in immunosuppressed patients [4202]. 366 relevant infections were found in 212 patients [P1: 9, P2: 17, P3: 334, and P4: 6]. Differences between periods were significant [p < 0.0001]. The most frequent types of infection were respiratory, intestinal and urinary. The most frequent opportunistic infections were tuberculosis [prevalence: 2.6/1000] and herpes zoster [prevalence: 3.9/1000]. Herpes zoster infection was associated with thiopurines alone or in combination with anti-TNF in 75% of the cases, whereas tuberculosis was associated with anti-TNF in 94% of patients. The overall mortality was 4.2%. Infection-related mortality was 2.8% and it was not influenced by comorbidity.

CONCLUSIONS

Relevant infections in IBD patients are rare and appear to be related to immunosuppression. Relevant infection is a major cause of death in IBD.

Donor Risk Index Has an Impact in Intraoperative Measure of Hepatic Artery Flow and in Clearance of Indocyanine Green: An Observational Cohort Study

BACKGROUND

The increase in indications for liver transplantation has led to acceptance of donors with expanded criteria. The donor risk index (DRI) was validated with the aim of being a predictive model of graft survival based on donor characteristics. Intraoperative arterial hepatic flow and indocyanine green clearance (plasma clearance rate of indocyanine green [ICG-PDR]) are easily measurable variables in the intraoperative period that may be influenced by graft quality. Our aim was to analyze the influence of DRI on intraoperative liver hemodynamic alterations and on intraoperative dynamic liver function testing (ICG-PDR).

METHODS

This investigation was an observational study of a single-center cohort (n = 228) with prospective data collection and retrospective data analysis. Measurement of intraoperative flow was made with a VeriQ flowmeter based on measurement of transit time (MFTT). The ICG-PDR was obtained from all patients with a LiMON monitor (Pulsion Medical Systems AG, Munich, Germany). DRI was calculated using a previously validated formula. Normally distributed variables were compared using Student's t test. Otherwise, the Mann-Whitney U test or Kruskal-Wallis test was applied, depending on whether there were 2 or more comparable groups. The qualitative variables and risk measurements were analyzed using the chi-square test. P < .05 was considered statistically significant.

RESULTS

DRI score (mean ± SD) was 1.58 ± 0.31. The group with DRI >1.7 (poor quality) had an intraoperative arterial flow of 234.2 ± 121.35 mL/min compared with the group having DRI < 1.7 (high quality), with an intraoperative arterial flow of 287.24 ± 156.84 mL/min (P = .02). The group with DRI >1.70 had an ICG-PDR of 14.75 ± 6.52%/min at 60 minutes after reperfusion compared to the group with DRI <1.70, with an ICG-PDR of 16.68 ± 6.47%/min at 60 minutes after reperfusion (P = .09).

CONCLUSION

Poor quality grafts have greater susceptibility to ischemia-reperfusion damage. Decreased intraoperative hepatic arterial flow may represent an increase in intrahepatic resistance early in the intraoperative period.

Hydrological and hydrochemical behavior of a riparian zone in a high-order flatland stream

Hydrological and hydrochemical processes occurring within riparian zones in temperate mid-latitudes flatland areas have significant implications for water management by controlling nutrient transfer between the watershed and the stream system. The riparian zone in a high-order flatland stream located within a 7063-km² agricultural watershed in Argentina was investigated to study its hydrological connectivity to upland zones, interactions with the stream, and their implications for groundwater hydrochemistry. The analysis was based on 9-year-long time series of groundwater/stream water levels collected along a 220-m-long transect comprising six piezometers, a river stage sensor, and hydrochemical information from 37 groundwater/stream water sampling campaigns. Samples were analyzed for electrical conductivity (EC), Cl^-, SO₄⁺², (Ca⁺² + Mg⁺²), pH, and redox potential (ORP). Data were interpreted using descriptive statistics, statistical tests, groundwater flux calculations, and identification of hydrological patterns and associated hydrochemical responses. The system was hydrologically controlled by shallow groundwater. Three representative landscape hydrological patterns were identified: disconnected, incipient-weakly connected, and fully connected. Groundwater hydrochemistry was closely linked to hydrological connectivity, which played an important role in the mobilization and fluxes of solutes. Overall, groundwater EC, Cl^-, SO₄⁺², and (Ca⁺² + Mg⁺²) concentrations decreased from upland to lowland. For full connectivity, Cl^- concentrations reduced 33%, while SO₄⁺² reduced 42%, demonstrating the system's buffering capacity. This investigation constitutes the first attempt to formulate the riparian zone functioning in this agricultural region and has contributed to the understanding on the complex interactions between hydrologic regimes of large flatland-high-order streams and shallow groundwater systems in fine-texture sediments.

Pain in children and adolescents hospitalized in a center of reference

INTRODUCTION

The evaluation and treatment of pain in hospitalized is still an important health pro blem.

OBJECTIVE

To know the prevalence, characteristics and approaches to pain management in children and adolescents hospitalized in the Pediatric Hospital of the Pereira Rossell Center (HP-CH- PR), a pediatric reference center in Uruguay.

PATIENTS AND METHOD

Cross-sectional study, through survey and review of clinical records on 09/13/16. All hospitalized children under the age of 19 were included.

VARIABLES

age, gender, reason for admission, presence of cognitive disorder, the prevalen ce of pain at some time during hospitalization, in the last 24 hours and during the interview, cause of maximum pain, intensity, pharmacological and non-pharmacological treatment.

RESULTS

97.4% (152/156) hospitalized children were included. Pain prevalence at some point during hospitalization: 51.3% (78/152, 95% CI: 43.2-59.3); in the previous 24 hours: 39.5% (60/152, 95% CI: 31.7-47.2); during the interview: 15.8% (24/152, 95% CI: 10-21.5). Intensity: mild 13/24, moderate-severe 11/24. Maximum pain referred during hospitalization: needle punctures 48.5% (38/78). They had some analgesic prescription 47.3% of them had some analgesic prescription. Inadequate interdose inter val: 45.8%; adequate dose 98.9%; intravenous administration: 43.7%; contraindication to oral route: 40.5%.

CONCLUSIONS

Regarding children and adolescents hospitalized, 39.5% reported pain 24 hours before being the interviewed and 15.8% reported pain during the interview. The maximum pain reported during hospitalization was due to needle punctures. Children in pain with inappropriate analgesic prescriptions are still detected.

Epitaxial Growth of SrTiO3 Films on Cube-Textured Cu-Clad Substrates by PLD at Low Temperature Under Reducing Atmosphere

The growth of epitaxial {001}<100> SrTiO₃ (STO) on low-cost cube-textured Cu-based clad substrate at low temperature was carried out by means of pulsed laser deposition (PLD). STO film was deposited in one step under a reducing atmosphere (5% H₂ and 95% Ar mixture) to prevent the oxidation of the metal surface. The optimization of PLD parameters leads to a sharpest biaxial texture at a temperature as low as 500 °C and a thickness of 500 nm with a (100) STO layer. The upper limit of highly textured STO thickness was also investigated. The maximum thickness which retains the best quality {001}<100> texture is 800 nm, since the texture is preserved not only through the layer but also on the surface. Atomic force microscopy (AFM) and scanning electron microscopy (SEM) measurements showed that STO films are continuous, dense, and smooth with very low roughness (between 5 and 7 nm). This paper describes the development of STO layer by means of PLD in absence of oxygen throughout the process, suggesting an alternative and effective method for growing highly {001}<100> textured STO layer on low-cost metal substrates.

Usefulness of Transcriptional Blood Biomarkers as a Non-invasive Surrogate Marker of Mucosal Healing and Endoscopic Response in Ulcerative Colitis

BACKGROUND AND AIMS

Ulcerative colitis [UC] is a chronic inflammatory disease of the colon. Colonoscopy remains the gold standard for evaluating disease activity, as clinical symptoms are not sufficiently accurate. The aim of this study is to identify new accurate non-invasive biomarkers based on whole-blood transcriptomics that can predict mucosal lesions and response to treatment in UC patients.

METHODS

Whole-blood samples were collected for a total of 152 UC patients at endoscopy. Blood RNA from 25 UC individuals and 20 controls was analysed using microarrays. Genes that correlated with endoscopic activity were validated using real-time polymerase chain reaction in an independent group of 111 UC patients, and a prediction model for mucosal lesions was evaluated. Responsiveness to treatment was assessed in a longitudinal cohort of 16 UC patients who started anti-tumour necrosis factor [TNF] therapy and were followed up for 14 weeks.

RESULTS

Microarray analysis identified 122 genes significantly altered in the blood of endoscopically active UC patients. A significant correlation with the degree of endoscopic activity was observed in several genes, including HP, CD177, GPR84, and S100A12. Using HP as a predictor of endoscopic disease activity, an accuracy of 67.3% was observed, compared with 52.4%, 45.2%, and 30.3% for C-reactive protein, erythrocyte sedimentation rate, and platelet count, respectively. Finally, at 14 weeks of treatment, response to anti-TNF therapy induced alterations in blood HP, CD177, GPR84, and S100A12 transcripts that correlated with changes in endoscopic activity.

CONCLUSIONS

Transcriptional changes in UC patients are sensitive to endoscopic improvement and appear to be an effective tool to monitor patients over time.

Co-culturing of Fungal Strains Against Botrytis cinerea as a Model for the Induction of Chemical Diversity and Therapeutic Agents

New fungal SMs (SMs) have been successfully described to be produced by means of in vitro-simulated microbial community interactions. Co-culturing of fungi has proved to be an efficient way to induce cell–cell interactions that can promote the activation of cryptic pathways, frequently silent when the strains are grown in laboratory conditions. Filamentous fungi represent one of the most diverse microbial groups known to produce bioactive natural products. Triggering the production of novel antifungal compounds in fungi could respond to the current needs to fight health compromising pathogens and provide new therapeutic solutions. In this study, we have selected the fungus Botrytis cinerea as a model to establish microbial interactions with a large set of fungal strains related to ecosystems where they can coexist with this phytopathogen, and to generate a collection of extracts, obtained from their antagonic microbial interactions and potentially containing new bioactive compounds. The antifungal specificity of the extracts containing compounds induced after B. cinerea interaction was determined against two human fungal pathogens (Candida albicans and Aspergillus fumigatus) and three phytopathogens (Colletotrichum acutatum, Fusarium proliferatum, and Magnaporthe grisea). In addition, their cytotoxicity was also evaluated against the human hepatocellular carcinoma cell line (HepG2). We have identified by LC-MS the production of a wide variety of known compounds induced from these fungal interactions, as well as novel molecules that support the potential of this approach to generate new chemical diversity and possible new therapeutic agents.

Colorectal cancer risk factors in patients with serrated polyposis syndrome: a large multicentre study

OBJECTIVE

Serrated polyposis syndrome (SPS) is associated with an increased colorectal cancer (CRC) risk, although the magnitude of the risk remains uncertain. Whereas intensive endoscopic surveillance for CRC prevention is advised, predictors that identify patients who have high CRC risk remain unknown. We performed a multicentre nationwide study aimed at describing the CRC risk in patients with SPS and identifying clinicopathological predictors independently associated with CRC.

DESIGN

From March 2013 through September 2014, patients with SPS were retrospectively recruited at 18 Spanish centres. Data were collected from medical, endoscopy and histopathology reports. Multivariate logistic regression was performed to identify CRC risk factors.

RESULTS

In 296 patients with SPS with a median follow-up time of 45 months (IQR 26-79.7), a median of 26 (IQR 18.2-40.7) serrated polyps and 3 (IQR 1-6) adenomas per patient were detected. Forty-seven patients (15.8%) developed CRC at a mean age of 53.9±12.8, and 4 out of 47 (8.5%) tumours were detected during surveillance (cumulative CRC incidence 1.9%). Patients with >2 sessile serrated adenomas/polyps (SSA/Ps) proximal to splenic flexure and ≥1 proximal SSA/P with high-grade dysplasia were independent CRC risk factors (incremental OR=2, 95% CI 1.22 to 3.24, p=0.006). Patients with no risk factors showed a 55% decrease in CRC risk (OR=0.45, 95% CI 0.24 to 0.86, p=0.01).

CONCLUSIONS

Patients with SPS have an increased risk of CRC, although lower than previously published. Close colonoscopy surveillance in experienced centres show a low risk of developing CRC (1.9% in 5 years). Specific polyp features (SSA/P histology, proximal location and presence of high-grade dysplasia) should be used to guide clinical management.

Investigating nitrate dynamics in a fine-textured soil affected by feedlot effluents

Feedlots concentrate large volumes of manure and effluents that contain high concentrations of nitrate, among other constituents. If not managed properly, pen surfaces run-off and lagoons overflows may spread those effluents to surrounding land, infiltrating into the soil. Soil nitrate mobilization and distribution are of great concern due to its potential migration towards groundwater resources. This work aimed at evaluating the migration of nitrate originated on feedlots effluents in a fine-textured soil under field conditions. Soil water constituents were measured during a three-year period at three distinct locations adjacent to feedlot retention lagoons representing different degrees of exposure to water flow and manure accumulation. A simple statistical analysis was undertaken to identify patterns of observed nitrate and chloride concentrations and electrical conductivity and their differences with depth. HYDRUS-1D was used to simulate water flow and solute transport of Cl^-, NO₄⁺N, NO₃^-N and electrical conductivity to complement field data interpretation. Results indicated that patterns of NO₃^-N concentrations were not only notoriously different from electrical conductivity and Cl^- but also ranges and distribution with depth differed among locations. A combination of dilution, transport, reactions such as nitrification/denitrification and vegetation water and solute uptake took place at each plots denoting the complexity of soil-solution behavior under extreme polluting conditions. Simulations using the concept of single porosity-mobile/immobile water (SP-MIM) managed structural controls and correctly simulated ^-all species concentrations under field data constrains. The opposite was true for the other two locations experiencing near-saturation conditions, absence of vegetation and frequent manure accumulation and runoff from feedlot lagoons. Although the results are site specific, findings are relevant to advance the understanding of NO₃^-N dynamics resulting from FL operations under heavy soils.

[Intestinal cleaning for colonoscopy in children: effectiveness, adherence and adverse effects of schemes differentiated by age]

Adequate intestinal cleanliness is crucial to achieve optimal colonoscopy performance. Several bowel preparation (BP) schemes have been proposed, but there is still no consensus as regards which is the most suitable in paediatric patients.

OBJECTIVE

To describe the effectiveness, adherence, and adverse effects of BP protocols differentiated by age group in paediatric patients subjected to colonoscopy.

PATIENTS AND METHOD

Prospective, study that included patients < 18 years subjected to colonoscopy. BP protocols differentiated by age group were indicated as follows: < 6 m (glycerine suppository); 6 m-3y 11 m (poly-ethylene-glycol (PEG 3350 without electrolytes); 4y-9y 11 m (PEG 3350 without electrolytes + bisacodyl); 10 y-18 y (PEG 3350 with electrolytes). Demographic, clinical information, adherence and adverse effects were registered. Effectiveness was determined using a validated scale (Boston modified) during colonoscopy.

RESULTS

A total of 159 patients were included, of which 87 (55%) were males, and with a median age of 4 years (range 1 m-17 years). Seventy eight percent of patients achieved successful BP. The higher effectiveness was observed in the groups of < 6 m (96%) and 10-18 y (91%). Constipation was significantly more frequent (29%) in the 4 yo-9 yo 11 m in which lower effectiveness was observed (69%). Good adherence was observed in 87% of patients. Adverse effects were observed in a third of patients, although they were mild and did not lead to the suspension of the BP.

CONCLUSIONS

Satisfactory results were achieved with the BP schemes used, with a successful BP being obtained in 4 out of 5 patients. Results were different between groups, which is probably related to previous bowel transit and indicated medication.

[Pharmacotherapy follow-up of Chilean inpatients with HIV/AIDS in a high complexity hospital during one year]

BACKGROUND

Pharmaceutical follow-up consists on the detection, prevention, and resolution of drug-related problems (DRP) in a continuous, systematized, and documented way. DRP is a health problem connected to pharmacotherapy, which can interfere with the expected health outcomes in the patient.

AIM

To make a pharmacotherapeutic surveillance in HIV/AIDS inpatients attended at "Hospital San Juan de Dios" throughout a year prospective study (January to December 2012).

RESULTS

88.6% (93/105) of patients were in stage AIDS with a median of CD4+ lymphocytes of 29 cells/mm³ and a viral load of 107,000 RNA copies/mL. The 16.2% were admitted to a intensive care unit ICU. 296 DRP (DRP 2.8 per patient) were detected, 72% of DRP (n; 213) were associated with treatment safety, 94 were adverse reactions, 19 required dose adjustments, and 6 interactions had a negative clinical impact; 23.3% (n: 69) experimented the necessity to add or remove a drug and 4.7% (n: 14) presented problems associated with effectiveness. A statistically significant relation was observed when associating the number of DRP with admittance to the ICU and the use of more than six drugs.

CONCLUSION

The results allow the conclusion that inpatients present drug-related problems mainly related to toxicity, becoming risk factors for the development of them admittance to ICU, and concomitant use of more than 6 drugs.

Au(i) N-heterocyclic carbenes from bis-imidazolium amphiphiles: synthesis, cytotoxicity and incorporation onto gold nanoparticles

Bis-imidazolium amphiphiles capable of forming Au(i) N-heterocyclic carbenes and gold nanoparticles for potential cancer therapy.

Water and chloride transport in a fine-textured soil in a feedlot pen

Cattle feeding in feedlot pens produces large amounts of manure and animal urine. Manure solutions resulting from surface runoff are composed of numerous chemical constituents whose leaching causes salinization of the soil profile. There is a relatively large number of studies on preferential flow characterization and modeling in clayed soils. However, research on water flow and solute transport derived from cattle feeding operations in fine-textured soils under naturally occurring precipitation events is less frequent. A field monitoring and modeling investigation was conducted at two plots on a fine-textured soil near a feedlot pen in Argentina to assess the potential of solute leaching into the soil profile. Soil pressure head and chloride concentration of the soil solution were used in combination with HYDRUS-1D numerical model to simulate water flow and chloride transport resorting to the concept of mobile/immobile-MIM water for solute transport. Pressure head sensors located at different depths registered a rapid response to precipitation suggesting the occurrence of preferential flow-paths for infiltrating water. Cracks and small fissures were documented at the field site where the % silt and % clay combined is around 94%. Chloride content increased with depth for various soil pressure head conditions, although a dilution process was observed as precipitation increased. The MIM approach improved numerical results at one of the tested sites where the development of cracks and macropores is likely, obtaining a more dynamic response in comparison with the advection-dispersion equation.

Protective effects of isolecanoric acid on neurodegenerative in vitro models

Parkinson's disease (PD) and Amyotrophic lateral sclerosis (ALS), are neurodegenerative disorders characterized by loss of dopaminergic or motor neurons, respectively. Although understanding of the PD and ALS pathogenesis remains incomplete, increasing evidence from human and animal studies has suggested that aberrant GSK3β, oxidative stress and mitochondrial damage are involved in their pathogenesis. Using two different molecular models, treatment with L-BMAA for ALS and rotenone for PD the effect of isolecanoric acid, a natural product isolated from a fungal culture, was evaluated. Pre-treatment with this molecule caused inhibition of GSK3β and CK1, and a decrease in oxidative stress, mitochondrial damage, apoptosis and cell death. Taken together, these results indicated that isolecanoric acid might have a protective effect against the development of these neurodegenerative disorders.

La relación de <i>Helicobacter pylori</i> con la displasia y el cáncer gástrico en Costa Rica

Se comparó la incidencia de labaéteria Hdicobacter pylori en un lugar pe baja incidencia de cáncer gástrico, Poás ( 15. 13%) y otro de incidencia muy alta, Puriscal (83. 53%) Se eligió a 185 adultos de cada cantón, similares en edad y sexo y se practicó un estudio serológico para buscar anticuerpos IgG para H. pylori, y una gastroscopía para tomar dos biopsias por caso. Los resultados no apoyan la existencia de una fuerte relación entre H. pylori y cáncer gástrico

Susceptibility of Tetranychus urticae Koch to an ethanol extract of Cnidoscolus aconitifolius leaves under laboratory conditions

One of the main pests of commercial rose crops in Colombia is the phytophagous mite Tetranychus urticae Koch. To manage this pest, synthetic chemicals have traditionally been used, some of which are well known to be potentially toxic to the environment and humans. Therefore, alternative strategies for pest management in greenhouse crops have been developed in recent years, including biological control with natural enemies such as parasitoids, predators and entomopathogenic microorganisms as well as chemical control using plant extracts. Such extracts have shown toxicity to insects, which has positioned them as a common alternative in programs of integrated pest management. The objective of this study was to evaluate the effect of an unfractionated ethanolic extract of Cnidoscolus aconitifolius leaves on adult females of T. urticae under laboratory conditions. The extract was chemically characterized by recording its metabolic profile via liquid chromatography coupled to mass spectrometry, along with tentative metabolite identification. The immersion technique and direct application to rose leaves were used to evaluate the effects of seven doses (10–2,000 µg/mL) of the ethanol extract of C. aconitifolius leaves on T. urticae females under laboratory conditions. The mortality and oviposition of individuals were recorded at 24, 48 and 72 h. It was found that the C. aconitifolius leaf extract reduced fertility and increased mortality in a dose-dependent manner. The main metabolites identified included flavonoid- and sesquiterpene-type compounds, in addition to chromone- and xanthone-type compounds as minor constituents with potential acaricidal effects.

Estimación de la curva de crecimiento en machos bubalinos en una empresa cubana

Para la caracterización de la curva de crecimiento se utilizaron los datos de 11 pesajes mensuales (1188 observaciones), desde los 8 hasta los 18 meses de edad correspondientes a 108 búfalos de la raza mestizo de Bufalipso que se encontraban en prueba de comportamiento entre los años 2007 y 2012, los cuales vinieron de 16 rebaños localizados en una empresa de la región occidental de Cuba. Los pesos individuales de cada animal fueron ajustados a las edades que correspondieron a cada uno de los pesajes, y además se utilizó un modelo mixto para corregir los mismos a los efectos mes y año de destete. En la estimación de la curva de crecimiento y sus parámetros (β0, β1 y β2) de los animales se utilizaron los modelos Brody, Gompertz, Von Bertalanffy y Logístico. La bondad de ajuste y discriminación entre los modelos utilizados demostraron un alto ajuste en los cuatros modelos, con R2 por encima de 90 %. El modelo Logístico fue el de mejor ajuste para describir la curva de crecimiento en machos bubalinos mestizos Bufalipso según los criterios estadísticos evaluados bajo estas condiciones.

Neonatal hyperthyroidism on rat heart: interrelation with nitric oxide and sex

PURPOSE

To clarify the mechanism mediating the effect of hyperthyroidism on cardiac function during the second month of life in rats.

METHODS

Male and female Sprague-Dawley rats were assigned to a control or to a triiodothyronine (T3)-treated group. Treatment of each group was started on the third day after birth. Control rats (Eut) received 0.9 NaCl [0.1 ml/100 g body weight (BW)] every second day during 60 days and T3-treated rats (Hyper) received subcutaneous (SC) T3 injections every second day during 60 days.

RESULTS

Hyperthyroidism decreased left ventricle volume only in male rats. Female euthyroid rats presented higher atrial nitric oxide synthase (NOS) activity than male rats and hormonal treatment decreased this enzyme's activity in both sexes. Euthyroid male and female rats had similar atrial NOS protein levels, but females had higher caveolin (cav) 3 protein levels. T3 treatment increased this protein only in males. Female rats had lower ventricular NOS activity than male rats; hyperthyroidism increased NOS activity in both sexes but this effect was associated with lower cav 3 protein levels. Hyperthyroidism did not change cav 1 protein levels in both male and female rats.

CONCLUSIONS

The results of this study demonstrating clinically relevant sex-related differences in the pathophysiology of the hyperthyroid heart have raised new questions regarding the mechanisms responsible for the observed differences. This study suggests that sex-related intrinsic factors such as nitric oxide may modulate the response to hyperthyroidism that leads to cardiovascular dysfunction.

High-throughput screening platform for natural product-based drug discovery against 3 neglected tropical diseases: human African trypanosomiasis, leishmaniasis, and Chagas disease

African trypanosomiasis, leishmaniasis, and Chagas disease are 3 neglected tropical diseases for which current therapeutic interventions are inadequate or toxic. There is an urgent need to find new lead compounds against these diseases. Most drug discovery strategies rely on high-throughput screening (HTS) of synthetic chemical libraries using phenotypic and target-based approaches. Combinatorial chemistry libraries contain hundreds of thousands of compounds; however, they lack the structural diversity required to find entirely novel chemotypes. Natural products, in contrast, are a highly underexplored pool of unique chemical diversity that can serve as excellent templates for the synthesis of novel, biologically active molecules. We report here a validated HTS platform for the screening of microbial extracts against the 3 diseases. We have used this platform in a pilot project to screen a subset (5976) of microbial extracts from the MEDINA Natural Products library. Tandem liquid chromatography-mass spectrometry showed that 48 extracts contain potentially new compounds that are currently undergoing de-replication for future isolation and characterization. Known active components included actinomycin D, bafilomycin B1, chromomycin A3, echinomycin, hygrolidin, and nonactins, among others. The report here is, to our knowledge, the first HTS of microbial natural product extracts against the above-mentioned kinetoplastid parasites.

Chilean complementary feeding program reduces anemia and improves iron status in children aged 11 to 18 months

BACKGROUND

Iron deficiency is the most prevalent nutritional deficiency in the world, primarily affecting infants, young children, and women of childbearing age.

OBJECTIVE

To evaluate the impact of the National Complementary Feeding Program (NCFP) on anemia and iron status in Chilean children aged 11 to 18 months.

METHODS

Two studies were performed. The first study was performed at one public outpatient health center in Santiago, using data collected in 1999 (n = 128) and 2000 (n = 125), before and after the national introduction of iron-fortified milk. Subsequently, a study of a representative sample (n = 320) from the two most populated areas of the country was performed in 2009.

RESULTS

One year after fortification, the prevalence of anemia was 9%; significantly lower (p < .001) than the 27% prevalence observed 1 year before. Ten years after fortification, 14% of children were anemic and 77% of children with anemia (12% of all children) suffered from iron-deficiency anemia. In 2009, 11% of children consuming iron-fortified milk delivered by the NCFP (73%) were anemic, significantly lower (p = .028) than the 21% prevalence of anemia observed in children without consumption. Consumption of iron-fortified milk was positively associated with hemoglobin concentration (r = 0.28, p = .022) and was associated with a lower prevalence of anemia after adjusting for confounding factors (odds ratio, 0.50; 95% CI, 0.26 to 0.96).

CONCLUSIONS

In Chile, the NCFP has had an impact on the reduction of anemia and improved the iron status of children aged 11 to 18 months. Increasing the consumption of this iron-fortified milk could enhance the impact of the NCFP.

[Incidence of adverse drug reactions in patients initiating or changing antiretroviral therapy]

BACKGROUND

In the Chilean AIDS Cohort, the 15.9% of the patients change the first scheme of HAART because of toxicity, which is also the cause of 47% suspensions of treatment occurred in the first months of therapy.

AIM

To analyze the incidence and causality of adverse drug reactions in patients initiating or changing antiretroviral therapy.

MATERIALS AND METHODS

92 patients who started or changed antiretroviral treatment in a period from May to July 2011 were followed to detect adverse drug reactions.

RESULTS

75% (n: 69) of patients had at least one adverse event. From a total of 76 adverse drug reactions detected the most frequent ones were diarrhea (21.1%, n: 16) and hyperbilirubinemia (19.7% n: 15). 85.9% of the adverse events where grade depending on its seriousness, 34.1% had grade 1 toxicity, 32.9% grade 2, 9.4% grade 3 and only 3.5% grade 4. Only 22 patients (31.8%) required a treatment change. The most frequent causes for changing treatment were because of anaemia by AZT (45.4%, n: 10) and diarrhea associated with the use of LPV/r (27.3%, n: 6).

CONCLUSION

Knowing the real incidence rate of adverse drug reactions may help the health team giving proper management and monitoring of these reactions in the patient, in order to avoid an early change of HAART. Defining a multidisciplinary team which includes a pharmacist is essential for proper pharmacosurveillance.