TRAUMATISMO DE PALADAR BLANDO DURANTE LA INTUBACIÓN CON EL USO DE VIDEOLARINGOSCOPIO.

Paciente femenina de 72 años de edad con antecedentes patológicos personales de Hipertensión arterial, hipotiroidismo e hidrocefalia; solicitada para exploración de válvula ventriculoperitoneal, se realiza inducción mixta e intubación al primer intento con video laringoscopio Marca HugeMed al intentar trasladar el tubo endotraqueal hacia la comisura bucal izquierda se evidencia en el paladar blando un orificio anómalo sin sangrado activo, se informa a tratante de neurocirugía. Se inserta el tubo en correcta posición y se solicita evaluación por cirujano de cabeza y cuello quien indica tratamiento conservador y cierre por segunda intención de forma exitosa. El reporte de este caso tuvo por objetivo analizar, describir y evaluar la técnica correcta durante la laringoscopia y la intubación con video laringoscopio en pacientes con predictores de vía aérea difícil y evitar traumatismo de paladar blando

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

The genetic improvement of farmed tilapias project: Impact and lessons learned

In response to challenges that the developing world confront on food security and malnutrition, the last two decades have witnessed increased efforts in genetic improvement to enhance production traits of commercially important aquatic species. From the 1980s to the present, several institutions in developing countries have been engaged in such R&D activity and it is recognized that the collaborative program on Genetic Improvement of Farmed Tilapias (GIFT) has spurred the development of several tilapia and carp breeding programs that now exist in numerous developing countries. The GIFT is a collaborative R&D program conducted by the WorldFish Center (formerly, International Center for Living Aquatic Resources Management, ICLARM) and its partners from the Philippines and Norway aimed to develop methodologies for the genetic improvement of tropical finfish of aqua-culture importance. The GIFT project has demonstrated that selective breeding is a feasible, cost effective, and sustainable approach to the genetic improvement of tropical finfish, and also confirmed the importance of a multidisciplinary approach that enabled the assessment of economic viability, social acceptability, and environmental compatibility, thus, creating confidence among planners and administrators, all of which facilitated the transfer of research findings to farming systems in a host of countries. The program and its successors, such as the International Network on Genetics in Aquaculture (INGA), demonstrated that networking and partnership building among national institutions in developing countries, advanced scientific institutions, and regional and international organizations can play a major role in accelerating research and the success of R&D

The effect of Brachionus plicatilis grown on three different species of phytoplankton on the ultrastructure of the hepatocytes of Chanos chanos (Forskål) fry.

Contribution No. 143 of the Aquaculture Department of SEAFDEC.The effect of the rotifer, Brachionus plicatilis, grown on unialgal cultures of Isochrysis galbana, Tetraselmis sp. and Chlorella sp. on the hepatocytes of milkfish fry was evaluated by electron microscopy. Rotifers grown on the three different species of phytoplankton brought about different ultrastructural features in milkfish fry hepatocytes. Best results were obtained from fry reared on Isochrysis-fed rotifers. The use of marine Chlorella-fed rotifers as feed for fry resulted in the poorest hepatocyte ultrastructure, indicating that this was nutritionally the least adequate cultured food. None of the three diets, however, produced an optimal hepatocyte ultrastructure similar to that obtained by feeding the fry with a mixture of artificial feed and newly hatched Artemia nauplii

Dentification of the alkaloids of stenomesson aurantiacum(kunth) herb., an amaryllidaceae species from the ecuadorian andes

The plant family Amaryllidaceae presents a group of isoquinoline type alkaloids that have been subject of active research for almost 200 years and many of these compounds have been studied for diverse biomedical activities. This study has been focused on the analysis of Stenomesson aurantiacum from the Ecuadorian Andes, being one of the first studies of an Amaryllidaceae from Ecuador, where 33 Amaryllidaceae species have been described. The plant S. aurantiacum was collected in March 2013 from Cuicococha (Imbabura). The purified alkaloid extracts, of the different organs, were analyzed by gas chromatography coupled to mass spectrometry (GC-MS). In total, 22 different Amaryllidaceae alkaloids were identified, with haemanthamine as the most abundant, found in concentrations above 15 % of the Total Ion Current (TIC) in all the organs, but higher in leaves. The next major alkaloids were tazettine in leaves, stem and flowers; and lycorine in bulb. This is an important finding, as previous, in vitro studies have shown that haemanthamine, lycorine and tazetine have antineoplastic and antiparasitic properties. We consider S. aurantiacum extracts could be useful in medical studies as these compounds may be effective treating tropical diseases such as Chagas or Malaria, as well as world-wide diseases such as cancer.Fil: Acosta, K.. Escuela Superior Politécnica del Chimborazo; EcuadorFil: Pigni, Natalia Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Ciencia y Tecnología de Alimentos Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Ciencia y Tecnología de Alimentos Córdoba; Argentina. Universidad de Barcelona; EspañaFil: Oleas, N.. Universidad Tecnológica Indoamérica. Quito; EcuadorFil: Bastida, J.. Universidad de Barcelona; Españ