Review and evaluation of cardiopulmonary resuscitation in an emergency department

Introducción: La baja incidencia de parada cardiorrespiratoria (PCR) en niños ha motivado la creación de registros de datos que permiten valorar las medidas implantadas para poder compararlas y extraer conclusiones. El objetivo de este trabajo era conocer la experiencia del personal de un servicio de urgencias pediátricas (SUP) en la atención de las PCR, describir las medidas de reanimación cardiopulmonar (RCP) empleadas y su evaluación. Métodos: Estudio retrospectivo de las historias clínicas y del registro «tipo Utstein», durante 10 años (2001-2010), de los pacientes a quienes el personal del SUP realizó maniobras de RCP. Resultados: Se analizaron 49 episodios de RCP correspondientes a 46 pacientes (28 varones, con una mediana de edad de 2,1 años). Presentaban alguna enfermedad crónica 28 pacientes. La PCR y la etiología neurológica fueron el motivo de aviso y la causa más frecuente, respectivamente. Se encontraban en medio extrahospitalario 21 pacientes, y se iniciaron maniobras de RCP en 13. En 44 episodios se intubó al paciente, en 35 se realizó masaje cardiaco externo y en 33 se administraron fármacos. En 13 pacientes no se consiguió la recuperación de la circulación espontánea (RECE). La mediana de tiempo de RCP fue de 30 minutos, y resultó superior en los pacientes en quienes no se consiguió la RECE (45 frente a 15 min; p= 0,03). Otros 12 pacientes fallecieron durante el ingreso posterior a la PCR. El personal del SUP consideró mejorables las maniobras de RCP realizadas en 12 de los 43 episodios evaluados. Conclusiones: La realización de RCP por parte del personal del SUP es poco frecuente. La mayoría de los pacientes estaban en PCR en el momento de ser atendidos, por lo que requirieron la realización de RCP avanzada. El personal del SUP evaluó las maniobras de RCP realizadas en 43 casos, y las consideró correctas en 31, mejorables en 10 y deficientes en 2 episodios

Grapevine nursery propagation material as source of fungal trunk disease pathogens in Uruguay

Grapevine fungal trunk diseases (GTDs) have become a serious problem for grapevines worldwide. Nursery vines infected during the propagation process are considered one of the main ways of dissemination of GTD pathogens. In this study, we examined the status of GTDs in grapevine planting material, from rootstocks and scion mother cuttings to grafted rooted vines ready to plant, according to the local nursery propagation process. During 2018-2019, internal symptoms of GTDs were examined in 2400 propagation materials and fungal isolations were carried out from a subsample of 1026 selected materials. Our results revealed that nursery grapevine plants produced in Uruguay have a high incidence of GTDs, regardless of the scion/rootstock combination. Typical brown to black streaks and sectorial wood necrosis were observed in materials on all propagation stages, with a markedly increasing incidence throughout the nursery process, reaching almost 100% in grafted rooted vines ready to plant. Botryosphaeria dieback, Petri disease and black-foot disease were the main GTDs found. The results showed that Botryosphaeria dieback and Petri disease pathogens infect materials from the early stages of the process, with a marked increase towards the end of the plant production process, whereas black-foot disease pathogens were found exclusively in vines ready to plant. Diaporthe dieback pathogens were also detected in materials in all stages but in a low proportion (less than 10% of infected material). Based on single locus analysis, the 180 isolates selected were placed into eight genera and 89% identified within 22 fungal species associated with GTDs, with Phaeoacremonium oleae and Diaporthe terebinthifolii as new records on grapevine worldwide. Our results have concluded that locally produced vines are one of the main ways of dissemination of GTD pathogens and showed that a nursery sanitation programme is required to reduce the incidence of these diseases

Recomendaciones de manipulación doméstica de frutas y hortalizas para preservar su valor nutritivo

The health benefits of daily consumption of at least 5 portions of a variety of fruit and vegetables are well documented. The World Health Organization (WHO) public health goal, established in 600 grams per person/day, is not achieved in Spain, so it is important to improve access to these foods, maintain their potential nutritive value and overcome barriers for their consumption. The objectives of this paper are: facilitate responsible decision-making regarding health; maximize the nutritional value of fruit and vegetables, help overcome barriers for fruit and vegetables consumption and report on how their storage at home, their handling and cooking affect to nutritional value of fruit and vegetables.In order to minimize nutrients loss and improve their bioavailability during fruit and vegetables handling, the Association for the promotion of fruit and vegetables “5 a day” (Spain) recommends: avoid prolonged storage of fruit and vegetables in the fridge; use layers and outer leaves; peel and/or cut them just before consumption; wash the whole pieces and then chop them; controlling the soaking time of cut pieces; prefer cooking techniques that do not require direct contact with water; a shorter cooking time, less loss of nutrients; the correct frying retains nutrients very well, although it is a technique of which should not be abused; add a few drops of vinegar or lemon juice to the cooking water if it does not change the taste and dish acceptance; use the water of cooking to elaborate other foods (e.g. sauces, soups, purees, etc.) except those coming from chard, spinach or beets. The “5 a day” Association (Spain) recommends increasing consumption of fruit and vegetables, and state that theloss of nutrients during their home handling should not be understood as a barrier for their consumption.El beneficio para la salud del consumo diario de al menos 5 raciones entre frutas y hortalizas está bien documentado. En España no se alcanzan los 600 gramos por persona y día que recomienda la Organización Mundial de la Salud (OMS) en sus objetivos de salud pública, por lo que es importante mejorar el acceso a estos alimentos, aprovechar su potencial nutritivo y salvar las barreras para su consumo. Los objetivos de este documento son: facilitar la toma de decisiones responsables con la salud; aprovechar al máximo el valor nutritivo de frutas y hortalizas; ayudar a salvar las barreras para su consumo e informar sobre cómo afecta la conservación, manipulación y cocinado domésticos a su valor nutritivo.Para minimizar la pérdida de nutrientes y mejorar su biodisponibilidad durante la manipulación de frutas y hortalizas, la Asociación para la promoción del consumo de frutas y hortalizas “5 al día” (España) recomienda: evitar almacenamientos prolongados en el refrigerador; aprovechar las capas y hojas exteriores; pelar y/o cortar el alimento justo antes de consumirlo; lavar las piezas enteras y trocearlas posteriormente; controlar el tiempo de remojo de las piezas cortadas; preferir técnicas de cocinado que no requieran contacto directo con el agua; a menor tiempo de cocción, menor pérdida de nutrientes; la fritura correcta conserva muy bien los nutrientes, aunque no debe abusarse de esta técnica; añadir un chorrito de vinagre o de zumo de limón al agua de cocción; aprovechar el agua de los vegetales cocidos para elaborar otros alimentos (ej.: salsas, sopas, purés, etc.), excepto la de acelgas, espinacas o remolacha. La Asociación “5 al día” recomienda aumentar el consumo de frutas y hortalizas, y considera que la pérdida de nutrientes durante su manipulación doméstica no debe entenderse como una barrera para su consumo

Genome-scale sequencing and analysis of human, wolf, and bison DNA from 25,000-year-old sediment

Cave sediments have been shown to preserve ancient DNA but so far have not yielded the genome-scale information of skeletal remains. We retrieved and analyzed human and mammalian nuclear and mitochondrial environmental "shotgun" genomes from a single 25,000-year-old Upper Paleolithic sediment sample from Satsurblia cave, western Georgia:first, a human environmental genome with substantial basal Eurasian ancestry, which was an ancestral component of the majority of post-Ice Age people in the Near East, North Africa, and parts of Europe; second, a wolf environmental genome that is basal to extant Eurasian wolves and dogs and represents a previously unknown, likely extinct, Caucasian lineage; and third, a European bison environmental genome that is basal to present-day populations, suggesting that population structure has been substantially reshaped since the Last Glacial Maximum. Our results provide new insights into the Late Pleistocene genetic histories of these three species and demonstrate that direct shotgun sequencing of sediment DNA, without target enrichment methods, can yield genome-wide data informative of ancestry and phylogenetic relationships

Recomendaciones de manipulación doméstica de frutas y hortalizas para preservar su valor nutritivo

El beneficio para la salud del consumo diario de al menos 5 raciones entre frutas y hortalizas está bien documentado. En España no se alcanzan los 600 gramos por persona y día que recomienda la Organización Mundial de la Salud (OMS) en sus objetivos de salud pública, por lo que es importante mejorar el acceso a estos alimentos, aprovechar su potencial nutritivo y salvar las barreras para su consumo. Los objetivos de este documento son: facilitar la toma de decisiones responsables con la salud; aprovechar al máximo el valor nutritivo de frutas y hortalizas; ayudar a salvar las barreras para su consumo e informar sobre cómo afecta la conservación, manipulación y cocinado domésticos a su valor nutritivo. Para minimizar la pérdida de nutrientes y mejorar su biodisponibilidad durante la manipulación de frutas y hortalizas, la Asociación para la promoción del consumo de frutas y hortalizas"5 al día" (España) recomienda: evitar almacenamientos prolongados en el refrigerador; aprovechar las capas y hojas exteriores; pelar y/o cortar el alimento justo antes de consumirlo; lavar las piezas enteras y trocearlas posteriormente; controlar el tiempo de remojo de las piezas cortadas; preferir técnicas de cocinado que no requieran contacto directo con el agua; a menor tiempo de cocción, menor pérdida de nutrientes; la fritura correcta conserva muy bien los nutrientes, aunque no debe abusarse de esta técnica; añadir un chorrito de vinagre o de zumo de limón al agua de cocción; aprovechar el agua de los vegetales cocidos para elaborar otros alimentos (ej.: salsas, sopas, purés, etc.), excepto la de acelgas, espinacas o remolacha. La Asociación"5 al día" recomienda aumentar el consumo de frutas y hortalizas, y considera que la pérdida de nutrientes durante su manipulación doméstica no debe entenderse como una barrera para su consumo

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Stable population structure in Europe since the Iron Age, despite high mobility

Ancient DNA research in the past decade has revealed that European population structure changed dramatically in the prehistoric period (14,000–3000 years before present, YBP), reflecting the widespread introduction of Neolithic farmer and Bronze Age Steppe ancestries. However, little is known about how population structure changed from the historical period onward (3000 YBP - present). To address this, we collected whole genomes from 204 individuals from Europe and the Mediterranean, many of which are the first historical period genomes from their region (e.g. Armenia and France). We found that most regions show remarkable inter-individual heterogeneity. At least 7% of historical individuals carry ancestry uncommon in the region where they were sampled, some indicating cross-Mediterranean contacts. Despite this high level of mobility, overall population structure across western Eurasia is relatively stable through the historical period up to the present, mirroring geography. We show that, under standard population genetics models with local panmixia, the observed level of dispersal would lead to a collapse of population structure. Persistent population structure thus suggests a lower effective migration rate than indicated by the observed dispersal. We hypothesize that this phenomenon can be explained by extensive transient dispersal arising from drastically improved transportation networks and the Roman Empire’s mobilization of people for trade, labor, and military. This work highlights the utility of ancient DNA in elucidating finer scale human population dynamics in recent history

Carbon monoxide proficiency testing scheme with metrological traceability

This paper details the activities carried out by the Chemical Metrology Department of LATU in the development of a national proficiency testing (PT) scheme aimed at assessing the competence of laboratories in air quality parameters analysis. In this PT scheme, environmental monitoring laboratories were required to determine the concentration of elements in quartz-grade microfiber filters and impinger solutions, as well as to determine the amount fraction of a carbon monoxide in nitrogen gas mixture, within the range of (800 to 1700) mu mol/mol. The focus of the present paper is mainly devoted to the second phase of the test, which addresses the preparation of the gas cylinder distributed to each participant for measurement. A detailed description of this stage is provided, along with the evaluation of the results reported by participating laboratories. This test provided an effective tool for participating laboratories to assess their national technical competence, using their preferred analysis methods