Septic shock in pediatrics I. Current approach in diagnosis and therapeutics

Indexación: Web of Science; Scielo.El shock séptico es una de las principales causas de mortalidad infantil a nivel mundial y representa una compleja y progresiva vía inflamatoria secundaria a una enfermedad infecciosa, la cual origina disfunción cardiovascular aguda, no necesariamente hipotensión arterial, condicionando disoxia tisular y eventualmente falla celular y orgánica. Los paquetes de medidas de resucitación propuestos enfatizan el reconocimiento clínico y un tratamiento precoz. Estas intervenciones se basan en la pronta y agresiva resucitación con fluidos intravenosos para una adecuada perfusión tisular, administración de antibióticos, remoción del foco infeccioso y el uso de drogas vasoactivas en caso de ser necesario. La terapia debe evaluarse permanentemente según la normalización de metas clínicas y de laboratorio. En la presente publicación se actualiza el conocimiento de las características epidemiológicas y fisiopatológicas de la sepsis, una puesta al día en definiciones operacionales, campañas internacionales y referentes a las iniciativas propuestas para disminuir su morbimortalidad. Se aborda el enfoque terapéutico inicial en el servicio de urgencia. El objetivo de este artículo es dar a conocer el estado actual del conocimiento en el diagnóstico y tratamiento del paciente con shock séptico especialmente en su fase inicial previo al ingreso a UCI.Septic shock is a major cause of infant mortality worldwide and represents the progressive underlying inflammatory pathway secondary to an infectious disease, which causes acute cardiovascular dysfunction, not necessarily hypotension, tissue dysoxia and eventually cellular and organ failure. Standard resuscitative measures emphasize clinical recognition and early treatment. These interventions are based on early and aggressive resuscitation with intravenous fluids to optimize tissue perfusion, antibiotics, removal of the source of infection and the use of vasoactive drugs if necessary. Therapy should be permanently evaluated according to the standardized laboratory and clinical targets. This publication is an update on the epidemiology and pathophysiology of sepsis, operational definitions, current international campaigns and initiatives concerning proposals to decrease the morbidity and mortality of this condition. It also addresses initial therapeutic approaches in the emergency room. The aim of this study is to present the current state of knowledge in the diagnosis and treatment of patients with septic shock especially in the initial phase before admissions to intensive care units.http://ref.scielo.org/sbjrb

Septic shock in pediatrics II. Current concepts in diagnosis and treatment

Indexación: Web of Science; Scielo.Aunque los principios básicos para el diagnóstico y los pilares terapéuticos del niño con shock séptico se mantienen en el tiempo, es innegable que en las últimas décadas se han incorporado nuevos y trascendentes conceptos, siendo importante que el médico tratante en el Servicio de Urgencia tenga conocimiento a cabalidad de ellos. En la segunda parte de esta actualización se discuten las similitudes y diferencias entre la población infantil y adulta, la utilidad de las metas de reanimación metabólicas, como también el enfoque terapéutico inicial en el paciente séptico. Los conceptos más importantes revisados se refieren a las diferencias entre el niño y adulto con shock séptico, especialmente en la fisiopatología, clínica y tratamiento. Se recalca la importancia de expansión de la volemia y el uso de drogas vasoactivas si no hay respuesta a fluidos de reanimación. El manejo terapéutico debe estar orientado a la búsqueda de la normalización de metas macrohemodinámicas y de perfusión sistémica. Se deben evitar los errores más frecuentes de observar en el tratamiento inicial del paciente séptico. Esta entidad presenta una elevada incidencia y mortalidad, por lo cual el manejo precoz y agresivo es de máxima importancia en pediatría.Although the basic concepts of diagnosis and therapy of the child with septic shock have remained similar over time, it is undeniable that in recent decades, new and important concepts have been added, and any treating physician either at the Emergency Department or Intensive Care Unit should be fully aware of them. This second part discusses the similarities and differences between pediatric and adult populations, the utility of metabolic resuscitation goals, as well as the initial therapeutic approach in septic patients. The most important concepts of this work make reference to the differences between children and adults with septic shock, specifically regarding to pathophysiology, clinical presentation and treatment. Volume expansion and vasoactive drugs are crucial if there is no response to fluid resuscitation. The therapeutic management should focus on finding the normalization of macrohemodynamic and systemic perfusion targets. Common observation mistakes in the initial treatment of septic patients should be avoided. This condition has a high incidence and mortality rate; therefore an early and aggressive treatment is essential.http://ref.scielo.org/cc6t3

Septic shock in ICU: Advanced therapeutics, immunoparalysis and genomics. State of the art

Indexación: Web of Science; Scielo.En las últimas décadas, se han incorporado nuevos y trascendentes conceptos para el tratamiento avanzado del paciente en shock séptico. Se debe considerar el uso de terapia inmune en grupos seleccionados de pacientes. Las terapias de sustitución renal de carácter continuo sonbien toleradas y su empleo precoz evita sobrecargas de fluidos. El uso de hemofiltración de alto volumen puede jugar un papel en el paciente séptico hiperdinámico. La plasmaféresis es útil en el paciente con disfunción multiorgánica. El empleo de soporte extracorpóreo se debe considerar en quienes presentan shock séptico refractario. La inmunoparálisis se ha asociado con infecciones nosocomiales y mortalidad tardía. La información obtenida de los marcadores genéticos puede permitir la búsqueda de una medicina basada en la genómica.New and important concepts have emerged for the advanced management of the child with septic shock in the recent decades. Attending physicians in the Pediatric intensive care unit must be fully aware of them to improve patient care in the critical care unit. It should be considered the use of immune therapy only in selected groups of patients. Continuous renal replacement therapies are well tolerated and their early use prevents deleterious fluid overload. Removal of inflammatory mediators by using high volume hemofiltration may play a role in hyperdynamic septic patients. The use of plasmapheresis is recommended in patients with thrombocytopenia-associated multiple organ failure. Extracorporeal support use should be considered in those with refractory septic shock despite goals directed therapy. The immunoparalysis has been associated with nosocomial infections and late mortality. The information from genetic markers may allow early intervention and preventive genomics-based medicine.http://ref.scielo.org/g8m9m

Septic shock in intensive care units. Current focus on treatment

Indexación: Web of Science; Scielo.Los pilares terapéuticos del niño con shock séptico se mantienen en el tiempo, sin embargo, se han incorporado nuevos conceptos, siendo importante que el pediatra y el intensivista tengan conocimiento a cabalidad de ellos. La reanimación con fluidos es una intervención fundamental, no obstante, aún no se ha establecido un tipo de fluido ideal, presentando cada uno limitaciones específicas, no existiendo evidencia sobre la superioridad de un tipo de fluido. Si a pesar de una adecuada resucitación con fluidos persiste el shock, el inicio de inótropos y/o vasopresores está indicado. En caso de refractariedad al uso de vasopresores, nuevos fármacos vasoactivos pueden ser empleados y el uso de hidrocortisona debe considerarse en niños con sospecha de insuficiencia suprarrenal. Existe controversia respecto a la transfusión de glóbulos rojos o el nivel óptimo de glucemia, no existiendo consenso en el valor umbral para el uso de estos hemocomponentes o el inicio de insulina, respectivamente. Asimismo, la utilización de la hemofiltración de alto volumen (HFAV)aún permanece controversial, requiriendo mayores estudios para su recomendación en forma rutinaria en el curso de un shock séptico refractario. El soporte nutricional es primordial, ya que la desnutrición es una grave complicación que debe ser prevenida y tratada adecuadamente. El objetivo de la presente revisión es entregar una actualización en los más recientes avances en tratamiento del shock séptico en la población pediátrica.Essential therapeutic principles in children with septic shock persist over time, although some new concepts have been recently incorporated, and fully awareness of pediatricians and intensivists is essential. Fluid resuscitation is a fundamental intervention, but the kind of ideal fluid has not been established yet, as each of these interventions has specific limitations and there is no evidence supportive of the superiority of one type of fluid. Should septic shock persists despite adequate fluid resuscitation, the use of inotropic medication and/or vasopressors is indicated. New vasoactive drugs can be used in refractory septic shock caused by vasopressors, and the use of hydrocortisone should be considered in children with suspected adrenal insufficiency, as it reduces the need for vasopressors. The indications for red blood cells transfusion or the optimal level of glycemia are still controversial, with no consensus on the threshold value for the use of these blood products or the initiation of insulin administration, respectively. Likewise, the use of high-volume hemofiltration is a controversial issue and further study is needed on the routine recommendation in the course of septic shock. Nutritional support is crucial, as malnutrition is a serious complication that should be properly prevented and treated. The aim of this paper is to provide update on the most recent advances as concerns the treatment of septic shock in the pediatric population.http://ref.scielo.org/79wr6

Biomasa y stock de carbono en la Reserva de Campo Alegre, la caldera, provincia de Salta

En un bosque secundario de la Reserva Privada Campo Alegre, provincia de Salta, en zona de transición entre dos regiones naturales: Yungas y Chaco, se estimó la biomasa leñosa aérea, subterránea y stock de carbono. Se zonificó la Reserva en bosque de galería, bosque de filo, zona incendiada y zona no incendiada, y se realizó un muestreo al azar estratificado (n: 36). Interesó comparar el stock de carbono de los distintos sitios y su contribución al conjunto de la Reserva. Se emplearon distintos modelos alométricos construidos en ecosistemas similares al área de estudio. Se realizó un ANOVA y test de Tukey; encontrándose diferencias significativas en algunos sitios con respecto a otros. El stock total de carbono de la biomasa (aérea y subterránea) de la Reserva fue de 63,25 tn C/ha. Esta información contribuirá al determinar el potencial de mitigación de estos bosques frente al Cambio Climático Global (CCG).Fil: Ontiveros, Silvina Noemí. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Salta. Instituto de Investigaciones En Energía No Convencional; Argentina. Universidad Nacional de Salta; ArgentinaFil: Manrique, Silvina Magdalena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Salta. Instituto de Investigaciones En Energía No Convencional; Argentina. Universidad Nacional de Salta; ArgentinaFil: Franco, J.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Salta. Instituto de Investigaciones En Energía No Convencional; Argentina. Universidad Nacional de Salta; ArgentinaFil: Díaz, R.. Universidad Nacional de Salta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Salta. Instituto de Investigaciones en Energía no Convencional; ArgentinaFil: Barranco, N.. Universidad Nacional de Salta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Salta. Instituto de Investigaciones en Energía no Convencional; Argentin

Closing the Light Gluino Window in Supersymmetric Grand Unified Models

We study the light gluino scenario giving special attention to constraints from the masses of the light CP-even neutral Higgs $m_h$, the lightest chargino $m_{\chi^{\pm}_1}$, and the second lightest neutralino $m_{\chi^0_2}$, and from the $b\rightarrow s\gamma$ decay. We find that minimal $N=1$ supergravity, with a radiatively broken electroweak symmetry group and universality of scalar and gaugino masses at the unification scale, is incompatible with the existence of a light gluino.Comment: 12 pages (plain tex), 1 figure not included, VAND-TH-94-7-R. An error is corrected. Modifications to the text and the figure are mad

Phosphomannosylation and the functional analysis of the extended Candida albicans MNN4-like gene family

We thank Luz A. López-Ramírez (Universidad de Guanajuato) for technical assistance. This work was supported by Consejo Nacional de Ciencia y Tecnología (ref. CB2011/166860; PDCPN2014-247109, and FC 2015-02-834), Universidad de Guanajuato (ref. 000025/11; 0087/13; ref. 1025/2016; Convocatoria Institucional para Fortalecer la Excelencia Académica 2015; CIFOREA 89/2016), Programa de Mejoramiento de Profesorado (ref. UGTO-PTC-261), and Red Temática Glicociencia en Salud (CONACYT-México). NG acknowledges the Wellcome Trust (086827, 075470, 101873, and 200208) and MRC Centre for Medical Mycology for funding (N006364/1). KJ was supported by a research visitor grant to Aberdeen from China Scholarship Council (CSC No. 201406055024). The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmicb.2017.02156/full#supplementary-materialPeer reviewedPublisher PD

Novel Procedure for Laboratory Scale Production of Composite Functional Filaments for Additive Manufacturing

Successful 3D printing by material extrusion of functional parts for new devices requires high quality filaments. Uniform homogeneity and good dispersion of particles embedded in filaments typically takes several cycles of extrusion or well-prepared feedstock by injection molding, industrial kneaders or twin-screw compounding. These methods need specific production devices that are not available in many laboratories non-specialized in polymer research, such as those working on different material science and technology topics that try to connect with additive manufacturing. Therefore, laboratory studies are usually limited to compositions and filler concentrations provided by commercial companies. Here, we present an original laboratory scale methodology to custom-prepare the feedstock for extruding magnetic composite filaments for fused filament fabrication (FFF), which is attainable by a desktop single-screw extruder. It consists in encapsulating the fillers in custom made capsules that are used as feedstock and reach the melting area of the extruder maintaining the same concentration of fillers. Results have shown that our approach can create smooth and continuous composite filaments with good homogeneity and printability with fine level of dimensional control. We further show the good dispersion of the particles in the composite filament using X-Ray Tomography, which enabled a 3D reconstruction of the spacial distribution of the embedded magnetic particles. The major advantage of this new way of preparing the composite feedstock is that it avoids the hassle of multiple extrusion runs and industrial machinery, yet providing uniform filaments of well controlled filler concentration, which is predictable and reproducible. The proposed methodology is suitable for different polymer matrices and applicable to other functional particle types, not just limited to magnetic ones. This opens an avenue for further laboratory scale development of novel functional composite filaments, useful for any community. This democratization of complex filament preparation, including consumers preparing their own desired uniform novel filaments, will facilitate to unify efforts nearing 3D printing of new functional devices.Fondo Europeo de Desarrollo Regional MAT-201677265-RJunta de Andalucía US-1260179, P18-RT-74

Biomasa y stock de carbono en la reserva de Campo Alegre, La Caldera, provincia de Salta

En un bosque secundario de la Reserva Privada Campo Alegre, provincia de Salta, en zona de transición entre dos regiones naturales: Yungas y Chaco, se estimó la biomasa aérea leñosa, subterránea y stock de carbono. Se zonifícó la Reserva en bosque de galería, bosque de filo, zona incendiada y zona no incendiada, y se realizó un muestreo al azar estratificado (n: 36). Interesó comparar el stock de carbono de los distintos sitios y su contribución al conjunto de la Reserva. Se emplearon distintos modelos alométricos construidos en ecosistemas similares al área de estudio. Se realizó un ANOVA y test de Tukey; encontrándose diferencias significativas en algunos sitios con respecto a otros. El stock total de carbono de la biomasa (aérea y subterránea) del ecosistema estudiado fue de 63,25 t C/ha. Esta información contribuirá al determinar el potencial de mitigación de estos bosques secundarios frente al Cambio Climático Global (CCG).The above and underground biomass, and carbon stock was estimated in a secondary forest from a Private Reserve "Campo Alegre", in Salta province. It is a transition zone between two natural regions: Chaco and Yungas, The forest reserve was zoned in gallery forest, forest edge, area burned and not burned area. A stratified random sample (n = 36) was performed. A comparison of the carbon stock and their contribution to the whole reserve of the different sites was made. Different allometric models built in similar ecosystems to the study area were used. ANOVA and Tukey test was performed and finding significant differences in some sites over others. The total carbon stock of biomass (above and below ground) ecosystem was 63.25 tons C / ha. This information will help in determining the mitigation potential of these secondary forests against Global Climate Change (GCC).Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Detection of metabolites in Flor de Mayo common beans (Phaseolus vulgaris L.) and their response to inoculation with Trichoderma harzianum

Seed germination involves complex processes where plant growth-promoting substances are released into the growth medium, mainly involving pathways that start in tryptophan (TRP) and end in the formation of indole-3-acetic acid (IAA). Among them, four are known as TRP-dependent and a fifth as TRP-independent. Some compounds were observed during germination of bean seeds that involved at least three IAA synthesis pathways and that kynurenine (KYN) is the first detected metabolite which is found in greater concentration. It was followed by tryptamine (TAM), TRP and IAA. The results of Trichoderma harzianum inoculation in greenhouse tests showed variability in Flor de Mayo beans seedlings in response to physiological level and production parameters. The effect of Trichoderma in Flor de Mayo common bean showed that strain 802 had a significant effect on the development of the height of bean seedlings, and that the 812 strain showed significant effect on the development of root bean seedlings. Increased growth of stem and root caused by Trichoderma strains in Flor de Mayo beans involves beneficial effects of inoculation on plant growth and development parameters and can be taken as they were a measure of survival and development of seedlings.Key words: Biofertilizers, indole-3-acetamide, tryptophan,indole-3- acetic acid, kynurenine