Adaptation and Validation of the ICU Mobility Scale in Spain

Objetivo: adaptar la ICU Mobility Scale (IMS) al ámbito de las unidades de cuidados intensivos (UCI) de España y evaluar las propiedades métricas de la IMS versión española (IMS-Es). Método: estudio descriptivo de carácter métrico desarrollado en dos fases. Fase 1: adaptación al español de la IMS mediante equipo de enfermeras y fisioterapeutas (traducción, piloto, retrotraducción y acuerdo). Fase 2: análisis de propiedades métricas (validez convergente, divergente y predictiva, fiabilidad interobservador, sensibilidad y diferencia mínima importante) de la IMS-Es. Se registraron características de los pacientes (Barthel, Charlson, IMC, sexo), nivel de sedación/agitación (RASS), estancias en UCI y hospital, supervivencia, calidad de vida (SF-12), debilidad muscular (MRC-SS) y movilidad (IMS-Es) en los pacientes del estudio multicéntrico nacional MOviPre. Resultados: tras obtener la IMS-Es, se implementó en 645 pacientes de 80UCI españolas entre abril y junio de 2017. Validez convergente: moderada correlación entre IMS-Es y MRC-SS (r=0,389; p<0,001) y comparación significativa entre grupos con y sin debilidad adquirida en la UCI (p<0,001). Validez divergente: no correlación entre IMS-Es e IMC (r [IC95%]: −0,112 [−0,232 a 0,011]), peso (r [IC95%]: −0,098 [−0,219 a 0,026]), Charlson (r [IC95%]: −0,122 [−0,242 a 0,001]) y Barthel (r [IC95%]: −0,037 [−0,160 a 0,087]) y sin diferencias entre sexos (p=0,587) ni categorías de IMC (p=0,412). Validez predictiva: moderadas y significativas correlaciones con estancia en hospital post-UCI (r [IC95%]: −0,442 [−0,502 a −0,377]) y componente físico del SF-12 (PCS) (r [IC95%]: 0,318 [0,063 a 0,534]); pacientes sin movilización activa en UCI mayor riesgo de mortalidad hospitalaria (OR [IC95%]: 3,769 [1,428 a 9,947]). Fiabilidad interobservador: muy buena concordancia entre enfermeras (CCI [IC95%]: 0,987 [0,983 a 0,990]) y entre enfermera-fisioterapeuta (CCI [IC95%]: 0,963 [0,948 a 0,974]). Sensibilidad al cambio: efecto pequeño al alta de UCI (d=0,273) y moderado a los 3meses del alta hospitalaria (d=0,709). Diferencia mínima importante: punto de corte de la diferencia de 2puntos, sensibilidad del 91,1% y especificidad del 100,0%. Conclusiones: la IMS-Es es útil, válida y fiable para ser implementada por enfermeras de UCI y por fisioterapeutas al valorar la movilidad de los pacientes críticos

Revisiting the usefulness of the short acute octreotide test to predict treatment outcomes in acromegaly

Introduction: We previously described that a short version of the acute octreotide test (sAOT) can predict the response to first-generation somatostatin receptor ligands (SRLs) in patients with acromegaly. We have prospectively reassessed the sAOT in patients from the ACROFAST study using current ultra-sensitive GH assays. We also studied the correlation of sAOT with tumor expression of E-cadherin and somatostatin receptor 2 (SSTR2) .Methods: A total of 47 patients treated with SRLs for 6 months were evaluated with the sAOT at diagnosis and correlated with SRLs' response. Those patients whose IGF1 decreased to = 3SDS, were considered non-responders. The 2 hours GH value (GH2h) after s.c. administration of 100 mcg of octreotide was used to define predictive cutoffs. E-cadherin and SSTR2 immunostaining in somatotropinoma tissue were investigated in 24/47 and 18/47 patients, respectively.Results: In all, 30 patients were responders and 17 were non-responders. GH(2h) was 0.68 (0.25-1.98) ng/mL in responders vs 2.35 (1.59-9.37) ng/mL in non-responders (p<0.001). GH(2h) = 1.4ng/mL showed the highest ability to identify responders (accuracy of 81%, sensitivity of 73.3%, and specificity of 94.1%). GH(2h) = 4.3ng/mL was the best cutoff for non-response prediction (accuracy of 74%, sensitivity of 35.3%, and specificity of 96.7%). Patients with E-cadherin-positive tumors showed a lower GH(2h) than those with E-cadherin-negative tumors [0.9 (0.3-2.1) vs 3.3 (1.5-12.1) ng/mL; p<0.01], and patients with positive E-cadherin presented a higher score of SSTR2 (7.5 +/- 4.2 vs 3.3 +/- 2.1; p=0.01).Conclusion: The sAOT is a good predictor tool for assessing response to SRLs and correlates with tumor E-cadherin and SSTR2 expression. Thus, it can be useful in clinical practice for therapeutic decision-making in patients with acromegaly

Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry

Objectives. This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods. RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results. Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion. Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies

COVID-19 outbreaks in a transmission control scenario: challenges posed by social and leisure activities, and for workers in vulnerable conditions, Spain, early summer 2020

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends’ gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied

Revisiting the usefulness of the short acute octreotide test to predict treatment outcomes in acromegaly

IntroductionWe previously described that a short version of the acute octreotide test (sAOT) can predict the response to first-generation somatostatin receptor ligands (SRLs) in patients with acromegaly. We have prospectively reassessed the sAOT in patients from the ACROFAST study using current ultra-sensitive GH assays. We also studied the correlation of sAOT with tumor expression of E-cadherin and somatostatin receptor 2 (SSTR2) .MethodsA total of 47 patients treated with SRLs for 6 months were evaluated with the sAOT at diagnosis and correlated with SRLs’ response. Those patients whose IGF1 decreased to &lt;3SDS from normal value were considered responders and those whose IGF1 was ≥3SDS, were considered non-responders. The 2 hours GH value (GH2h) after s.c. administration of 100 mcg of octreotide was used to define predictive cutoffs. E-cadherin and SSTR2 immunostaining in somatotropinoma tissue were investigated in 24/47 and 18/47 patients, respectively.ResultsIn all, 30 patients were responders and 17 were non-responders. GH2h was 0.68 (0.25-1.98) ng/mL in responders vs 2.35 (1.59-9.37) ng/mL in non-responders (p&lt;0.001). GH2h = 1.4ng/mL showed the highest ability to identify responders (accuracy of 81%, sensitivity of 73.3%, and specificity of 94.1%). GH2h = 4.3ng/mL was the best cutoff for non-response prediction (accuracy of 74%, sensitivity of 35.3%, and specificity of 96.7%). Patients with E-cadherin-positive tumors showed a lower GH2h than those with E-cadherin-negative tumors [0.9 (0.3-2.1) vs 3.3 (1.5-12.1) ng/mL; p&lt;0.01], and patients with positive E-cadherin presented a higher score of SSTR2 (7.5 ± 4.2 vs 3.3 ± 2.1; p=0.01).ConclusionThe sAOT is a good predictor tool for assessing response to SRLs and correlates with tumor E-cadherin and SSTR2 expression. Thus, it can be useful in clinical practice for therapeutic decision-making in patients with acromegaly

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Embryo Reduction: An Open Window to Decreasing the Twinning Rate in High-Producing Dairy Cattle

Les gestacions de bessons tenen un impacte negatiu sobre l’economia de les explotacions lleteres per l’elevat risc d’avortament i els efectes negatius del part de bessons sobre l’eficiència reproductiva postpart de les vaques. La reducció embrionària ofereix l’oportunitat de transformar una gestació múltiple en una simple i es presenta con una eina per a disminuir la creixent taxa de bessons i els seus efectes negatius. El principal objectiu d’aquesta tesi ha estat desenvolupar i avaluar els beneficis i riscs potencials de la reducció embrionària en vaques d’alta producció. També es van estudiar els factors de maneig que poden afectar la incidència de gestacions de bessons i els efectes del part de bessons sobre la vida productiva de la vaca. Els quatre estudis que s’inclouen en aquesta tesi han estat publicats o estan sotmesos a revisió per a la seva publicació en revistes científiques. En el primer estudi es van analitzar l’efecte dels factors de maneig i especialment els diferents protocols de sincronització de cel emprats sobre la incidència de gestacions de bessons. La taxa de gestació de bessons sobre un total de 2015 gestacions va ser del 17.9% i la incidència es va veure significativament afectada per factors individuals (lactació i bessons en el part anterior), factors ambientals (fotoperíode y estació) i pel protocol de sincronització aplicat abans de la inseminació. El segon estudi recull els historials reproductius complets de 4861 vaques lleteres d’alta producció amb un total de 12587 parts amb l’objectiu de determinar els efectes del part de bessons sobre l’eficiència reproductiva postpart i la vida productiva de les vaques. La taxa de parts de bessons durant el 11 anys d’estudi va ser del 5.6% y el 9.8% de las vaques van tenir bessons al menys en una ocasió al llarg de la seva vida. Les vaques amb part de bessons van presentar una menor taxa de concepció i un major risc d’eliminació en la lactació següent, major risc d’avortament i menor la vida productiva que les vaques amb un únic vedell al part. En el tercer estudi es va avaluar l’efecte de la reducció embrionària per la ruptura manual de l’amnios d’un dels embrions en gestacions de bessons unilaterals i bilaterals sobre el manteniment de la gestació. El risc de pèrdua de la gestació va ser similar en el grup de vaques amb gestacions de bessons unilaterals tractades i control. Tanmateix, la reducció embrionària va incrementar el risc de pèrdua en les vaques amb gestacions de bessons bilaterals. A l’últim estudi es van comparar les taxes de manteniment de la gestació en gestacions múltiples reduïdes mitjançant la ruptura manual de l’amnios o mitjançant aspiració transvaginal del fluid fetal guiada per ecografia. El risc de pèrdua de la gestació va ser similar per ambdós mètodes de reducció.Las gestaciones gemelares tienen un impacto negativo sobre la economía de las explotaciones de vacuno lechero por su elevado riesgo de aborto y el efecto del parto gemelar sobre la eficiencia reproductiva postparto de la vaca. La reducción embrionaria brinda la oportunidad de transformar una gestación múltiple en una simple y se presenta como una herramienta para disminuir la creciente tasa de partos gestaciones y sus efectos negativos. El principal objetivo de esta tesis fue desarrollar y evaluar los beneficios y riesgos potenciales de la reducción embrionaria en vacas de alta producción. Se estudiaron además los factores que afectan a la incidencia de gestaciones gemelares y los efectos de los partos de gemelos sobre la vida productiva de la vaca. Los cuatro estudios experimentales y epidemiológicos incluidos en esta tesis han sido publicados o están sometidos a revisión para su publicación en revistas científicas. En el primer estudio se analizaron los factores de manejo y especialmente de los diferentes protocolos de sincronización de celo empleados sobre la incidencia de gestaciones gemelares. La tasa de gestaciones gemelares sobre un total de 2015 gestaciones fue del 17.9% y la incidencia se vio significativamente afectada por factores individuales (número de lactación y gemelos en el parto previo), factores ambientales (fotoperiodo y estación) y por el protocolo de sincronización aplicado antes de la inseminación. En el secundo estudio se recogieron los historiales reproductivos completos de 4861 vacas lecheras de alta producción con un total de 12587 partos con el objetivo de determinar los efectos del parto gemelar sobre la eficiencia reproductiva postparto y la vida productiva de las vacas. La tasa de partos gemelares durante los 11 años de estudio fue del 5.6% y el 9.8% de las vacas parieron gemelos al menos en una ocasión a lo largo de sus vidas. Las vacas con partos gemelares presentaron, además de una menor tasa de concepción y un mayor riesgo de ser eliminadas durante la siguiente lactación, un mayor riesgo de aborto y una menor vida productiva que las vacas con un único ternero al parto. El tercer estudio evaluó el efecto de la reducción embrionaria mediante la ruptura manual del amnios de uno de los embriones en gestaciones gemelares unilaterales y bilaterales sobre el mantenimiento de la gestación. El riesgo de pérdida de la gestación fue similar para el grupo de vacas con gestación unilateral tratadas y control mientras que la reducción embrionaria incrementó el riesgo de pierda de la gestación en las vacas con gestaciones bilaterales. En el último estudio se compararon las tasas de mantenimiento de la gestación tras reducir gestaciones múltiples mediante la ruptura manual del amnios o mediante aspiración transvaginal del fluido fetal guiado por ecografía. El riesgo de pérdida de la gestación fue similar para ambos métodos de reducción.Twin pregnancy is an increasing and current topic of the high-producing dairy herds due to the economic losses caused by their great risk of pregnancy failure and the detrimental effects of twinning on the postpartum reproductive efficiency. Transforming a multiple pregnancy into a singleton pregnancy by inducing embryo reduction may circumvent those problems. Therefore, the main aim of this thesis was to develop and evaluate the potential risks and benefits of embryo reduction in dairy cattle as a therapeutic strategy addressed to prevent cows from delivering twins and to reduce the twinning rate in high-producing dairy herds. In order to offer a holistic perspective on the problem of twins and to determine its magnitude, we also studied the factors that affect the incidence of twin pregnancies and the effects of twinning on the productive lifespan of the cows. Research included in this thesis was divided in four studies published or submitted for publication in peer-reviewed journals. The first study addressed potential management risk factors affecting the incidence of twin pregnancies in high-producing dairy cows. Special attention was paid to the estrus synchronization protocol used before the AI resulting in pregnancy. Twin pregnancy was recorded in the 17.9% of the 2015 pregnancy diagnoses, and the incidence was affected by cow factors (lactation number and previous twining), environmental factors (photoperiod and season) and management related to synchronization protocols. The second study analyzed data from complete reproductive records for 4861 high milk-producing dairy cows including 12587 calving events to determine the effects of twinning on the subsequent reproductive performance and productive lifespan of the cows. The twinning rate was 5.6%, and 9.8% of the cows delivered twins at least once during their life. Cows delivering twins, besides being less likely to conceive and more likely to be culled in the subsequent lactation, also carry a higher risk of abortion on the subsequent lactation and show a reduced mean productive lifespan. In the third study we evaluated the effect on pregnancy maintenance of embryo reduction by manual amnion rupture in unilateral and bilateral twin pregnant cows. Embryo reduction by manual amnion rupture did not carry an additional risk of pregnancy loss for unilateral twin pregnancies, whereas the treatment increased the risk of pregnancy failure in bilateral twin pregnancies. The last study compared the effect on pregnancy maintenance of two embryo reduction techniques, Manual Rupture (MR) and Transvaginal Ultrasound Guided Aspiration (TUGA) of allanto-amniotic fluid in dairy cows with multiple pregnancies. No effect was detected on pregnancy maintenance of the technique used

Determination of tetracycline residues in soil by pressurized liquid extraction and liquid chromatography tandem mass spectrometry

11 páginas, 5 figuras, 4 tablas.An optimized extraction and cleanup method for the analysis of chlortetracycline (CTC), doxycycline (DC), oxytetracycline(OTC) and tetracycline (TC) in soil is presented. Soil extraction in a pressurized liquid extraction system, followed by extract clean up using solid-phase extraction (SPE) and tetracycline determination by liquid chromatography tandem mass spectrometry (LC-MS/MS)provided appropriate efficiency and reproducibility. Different dispersing agents and solvents for soil extraction and several SPE cartridges for cleanup were compared. The best extraction results were obtained using ethylenediamine tetraacetic acid-treated sand as dispersing agent, and water at 70 A degrees C. The most effective cleanup was obtained using Strata-X-TM sorbent in combination with a strong anion exchange cartridge. Recoveries ranged from 71% to 96% and precision, as indicated by the relative standard deviations, was within the range of 8-15%. The limits of quantification (LOQs) by using LC-MS/MS, based on signal-to-noise ratio (S/N) of 10, ranged from 1 mu g kg(-1) for TC to 5 mu g kg(-1) for CTC. These results pointed out that this technique is appropriate to determine tetracyclines in soils. Analysis of 100 samples taken in the Valencian Community revealed that, in soil, up to 5 mu g kg(-1) CTC, 15 mu g kg(-1) OTC, 18 mu g kg(-1) TC, and 12 mu g kg(-1) DC could be detected. Detection of the analytes in several samples, which typify great part of the Spanish agricultural soils, should be outlined as most important result of this study.The authors thank the Spanish Ministry of Science and Innovation together with the European Regional Development Funds (ERDF) (projects GCL2007-66687-C02-01/BOS, CGL2007-66687-C02-02 and CGL2008-01693/BTE) and the Conselleria de Sanitat of the Generalitat Valenciana (EVES2008-011) for financial support. P.V.R thanks the Spanish Ministry of Science and Innovation for the FPU grant.Peer reviewe

Efecto del estrés térmico en vacas secas y su repercusión en los parámetros productivos

Sin financiaciónNo data 2019UE

Assessment of Pesticide Contamination in Soil and Water Samples from Natural Park of L'Albufera using Liquid Chromatography Tandem Mass Spectrometry

Ponencia presentada en el 28th International Symposium on Chromatography celebrado en Valencia del 12 al 16 de septiembre de 2010Pesticides are an important group of agrochemicals used for food crop protection. Unfortunately, these compounds are easily accumulable in soils becoming a real environmental pollution risk and can contaminate surface water directly as spray drift or run-off, and also via drainage through the soils of treated farmland [1, 2]. For these reasons, there is increasing need for the development of well validated, accurate, time-saving, low cost, modern, multicomponents methods. In the light of the aforementioned, the aim of this study was to validate a sensitive multi-residue method for the target analysis of sixteen pesticides in soils and waters.The selected pesticides were: alachlor, atrazine, buprofezin, chlorfenvinphos, chlorpyriphos, diazinon, diuron, fenitrothion, fenthion, hexythiazox, imazalil, isoproturon, malathion, prochloraz, tolclophos-methyl and trifluralin. Pesticides from soil were extracted by pressurized liquid extraction (PLE), using an ASE 200 system from Dionex. Soil samples (10 g) were introduced into 11 mL cell and heated to 100 ºC for 7 min and extracted by ethyl acetate with a flush volume of 100 % in one cycle. Water was extracted by solid-phase extraction (SPE). Water samples (500 mL) were acidified and then extracted using Oasis HLB cartridges previously conditioned with methanol and water. Analytes were eluted with 4 mL. The residue analyses were performed by liquid chromatography-tandem quadrupole mass spectrometry (LC-MS/MS) multi-residue method. Separation was made with a Luna 3μm C18 (Phenomenex®) analytical column. The mobile phase was MeOH and H2O 5 mM ammonium formate gradient composition, used in conjunction with positive mode electrospray ionization tandem mass spectrometry. Performance characteristics of the proposed method were established. Selectivity, linearity, precision, recoveries and limits of detection (LODs) and quantification (LOQs) were studied. The method allowed LOQ from 0.03 μg/kg to 0.05 μg/kg. Recoveries ranged from 75 to 95% with relative standard desviation < 18%. The results of the validation procedure confirmed that the method is suitable for the planned purpose. This method has been applied successfully to the analysis of incurred water and soil samples from Natural Park of L ́ Albufera. The results revealed the presence of some pesticides at several concentration levels both in the soil and water samples. Nevertheless, they exist in a range of residual levelsThis work has been supported by the Spanish Ministry of Science and Innovation through the project Consolider-Ingenio 2010 CSD2009-00065, as well as by this Ministry and the European Regional Development Funds (ERDF) (project GCL2007-66687-C02 01/BOS).Peer Reviewe