Tuberculosis-Related Deaths within a Well-Functioning DOTS Control Program

To describe the molecular epidemiology of tuberculosis (TB)-related deaths in a well-managed program in a low-HIV area, we analyzed data from a cohort of 454 pulmonary TB patients recruited between March 1995 and October 2000 in southern Mexico. Patients who were sputum acid-fast bacillus smear positive underwent clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) and received treatment from the local directly observed treatment strategy (DOTS) program. After an average of 2.3 years of follow-up, death was higher for clustered cases (28.6 vs. 7%, p=0.01). Cox analysis revealed that TB-related mortality hazard ratios included treatment default (8.9), multidrug resistance (5.7), recently transmitted TB (4.1), weight loss (3.9), and having less than 6 years of formal education (2). In this community, TB is associated with high mortality rates

Influence of synthesis conditions in the catalytic performance of Nb-P catalysts

Glycerol is a natural byproduct of the manufacture of soaps from the hydrolysis of animal fats and vegetable oils. Due to the incessant increment of the worldwide production of biodiesel, the production of glycerol, a by-product of the biodiesel industry, has notably increased causing as consequence a drop in its price. In this way, glycerol has been turned into an interesting starting raw material for others chemical products, where the double dehydration of glycerol to acrolein is one of proposed routes for glycerol valorisation. Because of the crude glycerine is found diluted in water, the catalysts must be active and resistance to the presence of water avoiding a separation step of the glycerine from the water and therefore reducing the price of production of acrolein. Various solid acid catalysts have been tested in the dehydration of glycerol, including nio-bium oxide [1-3], phosphoric acid [4, 5] and zirconium niobium mixed oxides [6]. These catalysts reach the full conversion of glycerol and acrolein selectivities as high as 75mol% [3]. However, the main drawback of these cata-lysts is the deactivation with time on stream due to mainly to adsorption of high boiling point compounds. The characteristic features of the catalysts affecting to the catalytic activity are related to the amount of acid centers and the type of acid sites. The catalytic activity is related to Nb – OH groups and polymeric structures exposing Nb=O species [3, 6]. The main goal of this work is to evaluated how the preparation of the catalysts affect to the catalytic activity of supported niobia-phosporous on a mesoporous silica SBA-15 doped with zirconium. Doping with zirconium improves the acidity of the support and the stability of the catalysts as it has been shown previously [7]. 2 Experimental For the synthesis of mesoporous silica SBA-15 doped with zirconium (Si/Zr molar ratio of 5), 8 g of EO20-PO70-EO20 (Pluronic 123 from Aldrich) polymer was dissolved in 288 mL of a 1.7 M HCl aqueous solution and stirred at 313 K for 1 day. Then, 14.6 mL of tetraethoxysilane and 5.8 mL of zirconium n-propoxide were added, under vigorous stirring. The resulting solution was aged at room temperature for 3 days. The final product was fil-tered, washed with water and dried at 333 K. The solid was calcined at 823 K for 6 h. The support was labelled as SiZr This solid was impregnated with niobium oxalate to achieve a 8wt% of Nb2O5 by using the incipient wetness impregnation. The catalyst was dried and calcined at 673 K during 4h (heating rate 2 K/min) and labelled SiZr_8Nb2O5. The niobium-phosphorous catalysts were prepared following to two different strategies. In the first one, the support was impregnated with a solution of niobium oxalate (8wt%Nb2O5) and then dried over night at 333 K. Following, the phosphorous was added by using H3PO4 (85wt%) wiith Nb/P molar ratio of 0.2. Finally, the catalyst was dried and calcined at different temperatures (523, 673 and 973 K) during 4 hours. The catalysts were labelled 0.2NbP-x where x is the temperature of calcination. In the second strategy, the support was impregnated with a solution containing niobium oxale and phosphoric acid with the Nb/P molar ratio of 0.2. This catalyst was calcined at 673 K for 4 hours and labelled 0.2NbP-400-I. The support and catalysts were characterized by means of nitrogen adsorption, elemental analysis, XDR, XPS, TPD-NH3 and adsorption of pyridine coupled to FTIR. The dehydration of glycerol was performed, at atmospheric pressure, in a fixed-bed continuous-flow stainless steel reactor (9.1mm in diameter, and 230mm in length), operated in the down-flow mode Catalysts were pre-treated in situ at atmospheric pressure under a nitrogen flow of 30 mLmin−1 at 598 K for 30 min. The glycerol solu-tion (10 wt.% in water) was supplied by means of HPLC pump at 0.05 mLmin−1 feed rate in a N2 flow (30mLmin−1). The evolution of catalytic tests was studied by collecting liquid samples after 2, 5 and 8 h in a vial cooled in an isopropanol–liquid N2 trap. These vials were sealed for posterior analysis by gas chromatography. The products measured were acrolein, acetaldehyde, hydroxyacetone and allyl alcohol. 3 Results and discussion The support and catalysts were studied by XRD to confirm the presence of the mesoporous structure which was mantained after the impregnation and calcination of the active phases. Moreove, it was not detected neither niobium phase nor phosphate phaser at higher 2.The SiZr catalyst show a high glycerol conversion even higher than the SiZr_8Nb2O5 within the 8 hours of time on stream (TOS) although the selectivity of the SiZr_8Nb2O5 to-wards acrolein is higher (Table 1). This issue is related to higher Brönsted acid sites present in the SiZr_8Nb2O5 since the SiZr support only shows Lewis acid sites. When phosphorus is added to the SiZr_8Nb2O5 catalyst (Table 1), the catalytic performance is improved both in terms of glycerol conversion and acrolein selectivity. It is observed an increase of Brönsted acid sites, probably the presence of P – OH speccies and a decrease of Lewis acid sites compared to the SiZr_8Nb2O5 catalyst. This improvement is only shows when the catalyst is calcined at 673 K (Figure 1) higher and lower calcination temperatures had not beneficial effect on the catalytic activity. It was also compared the catalytic activity when the impregnation with phosphorous and niobium was carried out in one step (Figure 2). In this case, the catalytic performance is drastically improved since the acrolein yield is increased in a 20mol%. This fact point out the presence of an active phase, no detected by XRD analysis, formed by interaction of niobium and phosphorous. 4 Conclusions The catalytic performance of a Nb-P catalyst supported on a mesoporous silica SBA-15 doped with zirconium is ameliorated when the impregnation of the two active phases is carried out in one step reaching an acrolein yield of 46mol% and a glycerol conversion of 85mol%Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. Spanish Ministry of Economy and Competitiveness CTQ2012-38204-C03-02 project), Junta de Andalucía RNM-1565) and FEDER funds

NB2O5 soportado en SBA-15 para la deshidratación de glicerol a acroleína

En este trabajo se evalúa la actividad catalítica del óxido de niobio soportado sobre sílice mesoporosa con estructura SBA-15 en la deshidratación de glicerol para la obtención de acroleínaLa producción industrial de la acroleína se basa en la oxidación selectiva del propeno, de origen fósil, en presencia de catalizadores complejos de BiMoOx . Debido a la disminución de los recursos petroquímicos, los recursos renovables se están haciendo más competitivos. Entre ellos destaca el glicerol, subproducto de la industria de producción de biodiésel. El glicerol tiene más de 1500 aplicaciones directas en las industrias farmacéuticas, alimentarias o cosmética. Entre las posibles reacciones que se están explorando destaca la deshidratación del glicerol a acroleína; debido a que la glicerina cruda se encuentra diluida en agua, es necesaria la búsqueda de catalizadores sólidos ácidos que sean activos y resistentes a la presencia de agua, evitando así el paso de separación y disminuyendo el coste de producción de acroleína. Con este fin, se han ensayado diferentes catalizadores sólidos ácidos, entre los que se encuentra el Nb2O5.Ministerio de Ciencia e Innovación (Proyecto ENE2009-12743-C04-03), Fondos FEDER y a la Junta de Andalucía (P09-FQM-5070) RMT al Ministerio de Ciencia e Innovación por la financiación dentro del Programa Ramón y Cajal (RYC-2008-03387

Influence of the Incorporation of Basic or Amphoteric Oxides on the Performance of Cu-Based Catalysts Supported on Sepiolite in Furfural Hydrogenation

Cu-based catalysts supported on sepiolite have been tested in vapor-phase hydrogenation of furfural. The incorporation of basic or amphoteric metal oxides (magnesium oxide, zinc oxide, or cerium oxide) improves the catalytic behavior, reaching a maximum furfural conversion above 80% after 5 h of reaction at 210 ºC. In all cases, the main product is furfuryl alcohol, obtaining 2-methylfuran in lower proportions. The incorporation of these metal oxide species ameliorates the dispersion of metallic Cu nanoparticles, increasing the number of available Cu(0)-sites, which enhances the catalytic performance. The presence of acid sites favors the hydrogenolysis of furfuryl alcohol towards 2-methylfuran, although it also causes an increase of carbon species on its surface, which is associated with the catalytic deactivation of the catalyst along the time-on-stream.This research was funded by the Ministry of Economy and Competitiveness (Spain), grant numbers (CTQ2015-64226-C3-3-R, IEDI-2016-00743), Junta de Andalucía (Spain) (P12-RNM-1565), and FEDER (European Union) funds

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

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

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