Gastrointestinal colonization with multidrug-resistant Gram-negative bacteria during extracorporeal membrane oxygenation: effect on the risk of subsequent infections and impact on patient outcome

Background: In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G 12) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G 12 bacteria, and risk of subsequent infections in patients undergoing ECMO. Methods: This is a retrospective analysis of prospectively collected data: 105 consecutive patients, treated with ECMO, were admitted to the ICU of an Italian tertiary referral center (San Gerardo Hospital, Monza, Italy) from January 2010 to November 2015. Rectal swabs for MDR G 12 bacteria were cultured at admission and twice a week. Only colonization and NIs by MDR G 12 bacteria were analyzed. Results: Ninety-one included patients [48.5 (37\u201356) years old, 63% male, simplified acute physiology score II 37 (32\u201347)] underwent peripheral ECMO (87% veno-venous) for medical indications (79% ARDS). Nineteen (21%) patients were colonized by MDR G 12 bacteria. Male gender (OR 4.03, p = 0.029) and duration of mechanical ventilation (MV) before ECMO > 3 days (OR 3.57, p = 0.014) were associated with increased risk of colonization. Colonized patients had increased odds of infections by the colonizing germs (84% vs. 29%, p < 0.001, OR 12.9), longer ICU length of stay (LOS) (43 vs. 24 days, p = 0.002), MV (50 vs. 22 days, p < 0.001) and ECMO (28 vs. 12 days, p < 0.001), but did not have higher risk of death (survival rate 58% vs. 67%, p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p < 0.001, OR 4.11). Conclusions: In patients undergoing ECMO for respiratory and/or circulatory failure, colonization by MDR G 12 bacteria is frequent and associated with more the tenfold odds for subsequent infection. Those infections are associated with an increased risk of death

Computational Design of Enantiocomplementary Epoxide Hydrolases for Asymmetric Synthesis of Aliphatic and Aromatic Diols

The use of enzymes in preparative biocatalysis often requires tailoring enzyme selectivity by protein engineering. Herein we explore the use of computational library design and molecular dynamics simulations to create variants of limonene epoxide hydrolase that produce enantiomeric diols from meso-epoxides. Three substrates of different sizes were targeted: cis-2,3-butene oxide, cyclopentene oxide, and cis-stilbene oxide. Most of the 28 designs tested were active and showed the predicted enantioselectivity. Excellent enantioselectivities were obtained for the bulky substrate cis-stilbene oxide, and enantiocomplementary mutants produced (S,S)- and (R,R)-stilbene diol with >97 % enantiomeric excess. An (R,R)-selective mutant was used to prepare (R,R)-stilbene diol with high enantiopurity (98 % conversion into diol, >99 % ee). Some variants displayed higher catalytic rates (kcat) than the original enzyme, but in most cases KM values increased as well. The results demonstrate the feasibility of computational design and screening to engineer enantioselective epoxide hydrolase variants with very limited laboratory screening

Alveolar pentraxin 3 as an early marker of microbiologically confirmed pneumonia: a threshold-finding prospective observational study

Introduction: Timely diagnosis of pneumonia in intubated critically ill patients is rather challenging. Pentraxin 3 (PTX3) is an acute-phase mediator produced by various cell types in the lungs. Animal studies have shown that, during pneumonia, PTX3 participates in fine-tuning of inflammation (for example, microbial clearance and recruitment of neutrophils). We previously described an association between alveolar PTX3 and lung infection in a small group of intubated patients. The aim of the present study was to determine a threshold level of alveolar PTX3 with elevated sensitivity and specificity for microbiologically confirmed pneumonia. Methods: We recruited 82 intubated patients from two intensive care units (San Gerardo Hospital, Monza, Italy, and Massachusetts General Hospital, Boston, MA, USA) undergoing bronchoalveolar lavage (BAL) as per clinical decision. We collected BAL fluid and plasma samples, together with relevant clinical and microbiological data. We assayed PTX3 and soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) in BAL fluid and PTX3, sTREM-1, C-reactive protein (CRP) and procalcitonin (PCT) in plasma. Two blinded independent physicians reviewed patient data to confirm pneumonia. We determined the PTX3 threshold in BAL fluid for pneumonia and compared it to other biomarkers. Results: Microbiologically confirmed pneumonia of bacterial (n =12), viral (n =4) or fungal (n =8) etiology was diagnosed in 24 patients (29%). PTX3 levels in BAL fluid predicted pneumonia with an area under the receiving operator curve of 0.815 (95% CI =0.710 to 0.921, P <0.0001), whereas none of the other biomarkers were effective. In particular, PTX3 levels ≥1 ng/ml in BAL fluid predicted pneumonia in univariate analysis (β =2.784, SE =0.792, P <0.001) with elevated sensitivity (92%), specificity (60%) and negative predictive value (95%). Net reclassification index PTX3 values ≥1 ng/ml in BAL fluid for pneumonia indicated gain in sensitivity and/or specificity vs. all other mediators. These results did not change when we limited our analyses only to confirmed cases of bacterial pneumonia. Moreover, when we considered only the 70 patients who fulfilled the clinical criteria for the diagnosis of pneumonia at BAL fluid sampling, the diagnostic accuracy of PTX levels was confirmed in univariate and ROC curve analysis. Conclusions: In this hypothesis-generating convenience sample, a PTX3 level ≥1 ng/ml in BAL fluid was discriminative of microbiologically confirmed pneumonia in mechanically ventilated patients. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0562-5) contains supplementary material, which is available to authorized users

La responsabilidad social del contador público en el ejercicio de su profesión en la República Argentina

El presente trabajo de investigación pretende recopilar, analizar y reflexionar sobre los casos y situaciones en las que el Contador Público ha actuado o no con la responsabilidad social que su tarea le exige, y sobre las consecuencias positivas o negativas que su actuación ha tenido sobre la sociedad. El Contador Público tiene responsabilidades derivadas de las normas emitidas por los distintos Consejos Profesionales de Ciencias Económicas, sin embargo, tiene una responsabilidad mucho mayor frente a la comunidad que confía en su buen desempeño profesional. En la época actual esta tarea resulta muy compleja debido a que debe mediar no solamente entre los distintos intereses que se contraponen sino también con los valores sociales que han cambiado. La técnica y la ética son dos racionalidades diferenciadas pero interdependientes, ambas estás unidas en la actuación del profesional. Estas dos realidades son analizadas en este estudio, orientadas a considerar la responsabilidad social del Contador Público. Al respecto, se pretende dilucidar si el contador público con toda su formación académica, está capacitado para desempeñarse con Responsabilidad Social en los distintos roles que desempeña frente a las diversas situaciones que plantea la realidad. Para ello, este estudio enfocará tanto la formación académica, como la formación ética. La finalidad de este Proyecto es elaborar material útil para los profesionales, los estudiantes y para todos aquellos que se vinculan con la tarea del Contador Público, y que su lectura ayude a tomar conciencia del compromiso social que implica la tarea profesional del Contador Público en la República Argentina.Fil: García, Domingo. Universidad Nacional de La Matanza; Argentina.Fil: Belic, Ana María. Universidad Nacional de La Matanza; Argentina.Fil: Benvenuto, Olver Oscar. Universidad Nacional de La Matanza; Argentina.Fil: Bombino, María Alejandra. Universidad Nacional de La Matanza; Argentina.Fil: Branca, Ángela Lorena. Universidad Nacional de La Matanza; Argentina.Fil: Carro, Roberto Ricardo. Universidad Nacional de La Matanza; Argentina.Fil: Cipcic, Mariana. Universidad Nacional de La Matanza; Argentina.Fil: Fernández, Luis Alberto. Universidad Nacional de La Matanza; Argentina.Fil: Mallo, Liliana Mónica. Universidad Nacional de La Matanza; Argentina.Fil: Rumbo, Jorge Ángel. Universidad Nacional de La Matanza; Argentina

Use of barley straw residues to avoid high erosion and runoff rates on persimmon plantations in Eastern Spain under low frequency-high magnitude simulated rainfall events

[EN] Soil and water losses due to agricultural mismanagement are high and non-sustainable in many orchards. An experiment was set up with rainfall simulation at 78 mm h(-1) over 1 hour on 20 paired plots of 2 m(2) (bare and straw covered) in new persimmon plantations in Eastern Spain. Effects of straw cover on the control of soil and water losses were assessed. An addition of 60% straw cover (75 gm(-2)) resulted in delayed ponding and runoff generation and consequently reduced water losses from 60% to 13% of total rainfall. The straw cover reduced raindrop impact and thus sediment detachment from 1014 to 47 g plot(-1) h(-1). The erosion rate was reduced from 5.1 to 0.2 Mg ha-(1) h(-1). The straw mulch was found to be extremely efficient in reducing soil erosion rates.The research projects GL2008-02879/BTE, LEDDRA 243857 and RECARE-FP7 (no. 603498, http://recare-project.eu/) supported this research.Cerdà, A.; González-Pelayo, Ó.; Giménez Morera, A.; Jordán, A.; Pereira, P.; Novara, A.; Brevik, EC.... (2016). Use of barley straw residues to avoid high erosion and runoff rates on persimmon plantations in Eastern Spain under low frequency-high magnitude simulated rainfall events. Soil Research. 54(2):154-165. https://doi.org/10.1071/SR15092S15416554

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p &lt; 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted