Toxicidad de extractos vegetales para el control de Trialeurodes vaporariorum W.(Homoptera: Aleyrodidae) en laboratorio y en cultivo de tomate en invernadero.

The constant search for natural insecticides in the form of extracts from many plants has received attention, and many of these extracts have been evaluated for their effectiveness as insecticides. To determine the toxic effect of six plant species Arundo donax L. (Poaceae), Brassica campestris L. (Brassicaceae), Cynodon dactylon L. (Poaceae), Hura polyandra Baill. (Euphorbiaceae), Phytollacca icosandra L. (Phytolaccaceae) and Sida acuta Burn. (Malvaceae) on Trialeurodes vaporariorum W. (Homoptera: Aleyrodidae) (adult whitefly), we evaluated the mortality rate and the lethal concentration (LC50) of the methanolic and aqueous extracts under laboratory and greenhouse conditions in a culture of Lycopersicum esculentum Mill. (Solanaceae). Analysis of Variance ANOVA and a test of comparison of means (Tukey, a = 0.05) showed a tendency of the methanolic extract in the six species towards a higher mortality rate and LC50 compared to that of the aqueous extract, both under greenhouse and laboratory conditions. The methanolic and aqueous extracts of A. donax and P. icosandra showed a higher toxicity under laboratory conditions (39.5 y 40.5%, respectively) than under greenhouse conditions (23.3 and 26.3%, respectively). The Treatments did not interfere with the tomato yield; so we are able to confirm the effectiveness of A. donax and P. icosandra extracts in the control of T. vaporariorum, which represents an ecological alternative for pest control in open field crops.La investigación de insecticidas naturales en forma de extractos de plantas ha recibido constante atención y varios de estos extractos han sido evaluados por su efectividad como insecticidas. Para determinar el efecto tóxico de seis especies de plantas Arundo donax L. (Poaceae), Brassica campestris L. (Brassicaceae), Cynodon dactylon L. (Poaceae), Hura polyandra Baill. (Euphorbiaceae), Phytolacca icosandra L. (Phytolaccaceae) y Sida acuta Burn. (Malvaceae) sobre Trialeurodes vaporariorum W. (Homoptera: Aleyrodidae) (mosca blanca en estadio adulto), evaluamos el grado de mortalidad y la dosis letal (CL50) de los extractos metanólico y acuoso en un experimento bajo condiciones de laboratorio e invernadero en un cultivo de Lycopersicum esculentum Mili. (Solanaceae). El análisis de varianza y la prueba de comparación de medias (Tukey, a = 0.05) mostraron una tendencia del extracto metanólico de seis especies hacia un mayor grado de mortalidad y de CL50 comparado con esos parámetros en el extracto acuoso bajo condiciones de laboratorio e Invernadero. Los extractos metanólico y acuoso de A. donax y P. icosandra mostraron la más alta toxicidad bajo condiciones de laboratorio (39.5 y 40.5%, respectivamente) e invernadero (23.3 y 26.3%, respectivamente). Los tratamientos no interfirieron con la producción de tomate, por lo que se puede confirmar la eficacia del uso de los extractos A. donax y P. icosandra para el control de T. vaporariorum como una alternativa para el control de la plaga en un cultivo a campo abierto sin contaminar el medio ambiente

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols