Traqueotomía Percutánea (II) con seguridad para el paciente crítico: Checklist, ecografía y fibrobroncoscopio

En 1.998 apareció un set para Traqueotomía Percutánea por Dilatación (TPD) conocido como Ciaglia Blue Rhino®, que esencialmente consiste en una modificación del método de Ciaglia original, y que se caracteriza por presentar un único dilatador curvo con un recubrimiento hidrofílico que reduce el coeficiente de fricción y que permite crear el traqueostoma en un único paso. En una entrada anterior hemos hablado ya de la historia, los distintos métodos y sets para realizar una TPD, las indicaciones, contraindicaciones y complicaciones de la técnica. En esta entrada: - Presentaremos el Checklist que hemos confeccionado en nuestro centro y que revisamos antes a la realización de una Traqueotomía Percutánea por Dilatación (TPD) en la Unidad de Reanimación, válido para cualquiera de los modelos existentes en el mercado. - Describiremos la técnica que seguimos en nuestro centro usando el dispositivo Blue Rhino®

Traqueotomía Percutánea en Reanimación (I): Historia, indicaciones, complicaciones

Un número importante de los pacientes de las Unidades de Cuidados Críticos y Reanimación precisan de asistencia respiratoria con ventilación mecánica (VM) durante períodos prolongados de tiempo, y cada vez es más frecuente que en estos pacientes se plantee la realización de traqueotomías para proteger las estructuras laríngeas y favorecer el destete. La incidencia de traqueostomías en pacientes con ventilación mecánicas prolongada es creciente (en Carolina del Norte (EEUU), Cox y cols. describen un incremento del 200% entre los años 1.993 y 2.002, y en Ontario (Canadá) prevén un aumento del 80% en la necesidad de VM para el 2.026). La Traqueotomía Percutánea por Dilatación (TPD) se ha convertido en la técnica de primera elección sobre la traqueotomía quirúrgica convencional en muchos países calculándose que se realiza en más del 15% de los pacientes críticos. En España la TPD realizada a pie de cama en Reanimación es una técnica bien establecida, considerándose de primera elección en pacientes críticos, puesto que evita el traslado del paciente al quirófano, además de ser una técnica rápida, sencilla, segura y coste-efectiva aunque no exenta de riesgos

Análisis Socioeconómico de los Pequeños Productores de Cacao en Honduras. Caso APROSACAO

The production of cocoa in Honduras is a very important productive activity that generates income for small farmers and their families. In this activity, small producers represent 55% of total nationwide, this group cultivates in an area smaller than 0.7 ha. On the other hand, medium producers cultivate an area between 0.7 to 3.4 ha and generate 41% of the nationwide production. Socioeconomic characteristics and perception of the environmental sustainability of the Association of Producers with Agroforestry Systems of Organic Cocoa in Olancho (APROSACAO) were studied. These aspects are useful for evaluating rural development projects. The study was carried out in the municipality of Catacamas, Department of Olancho, in the northeastern region of Honduras. The population under study was APROSACAO, located in the same municipality. The association has 332 affiliates, most of them are small farmers. The information was analyzed through multivariate and regression analysis. We found that most of farmers were men (78%), with ages above 35 years (74.58%) and basic schooling. The average association production and productivity are below the national average. The association's production is explained in 48% by the number of hectares of cocoa that producers grow and production costs in addition to technical assistance. The relationship between different variables that contribute to making producers farms sustainability was determined were studied as part of the producer’s environmental perception.El cultivo de cacao en Honduras tiene gran importancia por ser una actividad productiva que genera ingresos para los pequeños productores y sus familias. En esta actividad, a nivel nacional, los pequeños productores, quienes siembran en un área menor a 0.7 ha, representan el 55%; los medianos, que cultivan en un área de 0.7 a 3.4 ha, generan el 41% de la producción. En la presente investigación se estudiaron los indicadores socioeconómicos y de percepción de la sostenibilidad ambiental de la Asociación de Productores con Sistemas Agroforestales de Cacao Orgánico en Olancho (APROSACAO), los cuales son útiles para evaluar proyectos de desarrollo rural. El estudio se realizó en el municipio de Catacamas, Departamento de Olancho, en la región nororiental de Honduras. La población objeto de estudio fueron miembros de la mencionada asociación, la cual cuenta con 332 afiliados, en su gran mayoría pequeños productores. El análisis de la información fue llevado a cabo a través de análisis multivariado y de regresión lineal. La mayoría de los productores son hombres (78%), con edades arriba de los 35 años (74.58%) y escolaridad básica. La producción promedio está por abajo del promedio nacional. La producción de la asociación está explicada en un 48% por la cantidad de hectáreas de cacao que cultiva y los costos de producción, así como asistencia técnica. Como parte de la percepción ambiental se determinó la relación entre diferentes variables que contribuyen a hacer sustentables las fincas de los productores

Genetics of adult attachment: An updated review of the literature

Attachment style, which has been theorized to be rooted in childhood bonding experiences, influences adult cognitive, emotional and interpersonal functioning. Despite its relationship with early experiences, research indicates that the continuity of attachment style across childhood and adulthood is only partial, being a malleable tendency that is shaped throughout development, with an increasing influence of genetics, as it occurs in other cognitive and behavioral phenotypes. Genetic research indicates that up to 45% of the variability in anxious and 39% in avoidant adult attachment style could be explained by genetic causes, but the precise mechanisms remain unclear. A narrative review is conducted analyzing the existing literature regarding the implication of candidate genes related to oxytocin, dopaminergic pathways, serotonergic pathways and brain-derived neurotrophic factor in adult attachment, with both vulnerability and differential susceptibility approaches, yielding mixed results. We highlight the lack of genome-wide studies and the scarcity of epigenetic investigation. Based on the existing data, we conclude that the genetics of adult attachment is an area that requires further research to clarify its etiological role and that it should be preferably approached as an interaction between nature and nurture

Molecular characterization of rpoB gene mutations in isolates from tuberculosis patients in Cubal, Republic of Angola

Angola; Rifampicina; Mutaciones rpoBAngola; Rifampicina; Mutacions rpoBAngola; Rifampicin; rpoB mutationsBackground The importance of Mycobacterium tuberculosis strains with disputed rpoB mutations remains to be defined. This study aimed to assess the frequency and types of rpoB mutations in M. tuberculosis isolates from Cubal, Angola, a country with a high incidence of tuberculosis. Methods All isolates included (n = 308) were analyzed using phenotypic drug susceptibility testing and GenoType MTBDRplus assay. DNA sequencing of the rpoB gene and determination of rifampicin MIC by macrodilution method were additionally performed on isolates yielding discordant results (n = 12) and those in which the mutation detected was not characterized (n = 8). Results In total, 85.1% (74/87) of rifampicin-resistant strains had undisputed rpoB mutations -S450L (49), D435V (15), H445D (3), H445Y (2), Q432ins (1), L449M plus S450F (1), S450F (1), S450W (1) and S450Y (1)-; 10.3% (9/87) had disputed rpoB mutations—L430P plus S493L (1), N437del (1), H445L (3), D435Y (2), L452P (2)-, 2.3% (2.3%) showed no rpoB mutations and 2.3% (2/87) showed heteroresistance—D435Y plus L452P and L430P plus S493L-. Conclusion Disputed rpoB mutations were common, occurring in 10.3% of rifampicin resistant isolates. Current phenotyping techniques may be unable to detect this resistance pattern. To increase their sensitivity, a lower concentration of RIF could be used in these tests or alternatively, rpoB mutations could be screened and characterized in all M. tuberculosis strains.This work was supported by Probitas Foundation. Thanks to the financial support received from Probitas Foundation it was possible not only purchase the equipment and reagents to launch the study but to strengthen the capacity of the laboratory and local staff

Molecular characterization of rpoB gene mutations in isolates from tuberculosis patients in Cubal, Republic of Angola

Background: The importance of Mycobacterium tuberculosis strains with disputed rpoB mutations remains to be defined. This study aimed to assess the frequency and types of rpoB mutations in M. tuberculosis isolates from Cubal, Angola, a country with a high incidence of tuberculosis. Methods: All isolates included (n = 308) were analyzed using phenotypic drug susceptibility testing and GenoType MTBDRplus assay. DNA sequencing of the rpoB gene and determination of rifampicin MIC by macrodilution method were additionally performed on isolates yielding discordant results (n = 12) and those in which the mutation detected was not characterized (n = 8). Results: In total, 85.1% (74/87) of rifampicin-resistant strains had undisputed rpoB mutations -S450L (49), D435V (15), H445D (3), H445Y (2), Q432ins (1), L449M plus S450F (1), S450F (1), S450W (1) and S450Y (1)-; 10.3% (9/87) had disputed rpoB mutations-L430P plus S493L (1), N437del (1), H445L (3), D435Y (2), L452P (2)-, 2.3% (2.3%) showed no rpoB mutations and 2.3% (2/87) showed heteroresistance-D435Y plus L452P and L430P plus S493L-. Conclusion: Disputed rpoB mutations were common, occurring in 10.3% of rifampicin resistant isolates. Current phenotyping techniques may be unable to detect this resistance pattern. To increase their sensitivity, a lower concentration of RIF could be used in these tests or alternatively, rpoB mutations could be screened and characterized in all M. tuberculosis strains

Influence of the LILRA3 Deletion on Multiple Sclerosis Risk: Original Data and Meta-Analysis.

BACKGROUND: Multiple sclerosis (MS) is a neurodegenerative, autoimmune disease of the central nervous system. Genome-wide association studies (GWAS) have identified over hundred polymorphisms with modest individual effects in MS susceptibility and they have confirmed the main individual effect of the Major Histocompatibility Complex. Additional risk loci with immunologically relevant genes were found significantly overrepresented. Nonetheless, it is accepted that most of the genetic architecture underlying susceptibility to the disease remains to be defined. Candidate association studies of the leukocyte immunoglobulin-like receptor LILRA3 gene in MS have been repeatedly reported with inconsistent results. OBJECTIVES: In an attempt to shed some light on these controversial findings, a combined analysis was performed including the previously published datasets and three newly genotyped cohorts. Both wild-type and deleted LILRA3 alleles were discriminated in a single-tube PCR amplification and the resulting products were visualized by their different electrophoretic mobilities. RESULTS AND CONCLUSION: Overall, this meta-analysis involved 3200 MS patients and 3069 matched healthy controls and it did not evidence significant association of the LILRA3 deletion [carriers of LILRA3 deletion: p = 0.25, OR (95% CI) = 1.07 (0.95-1.19)], even after stratification by gender and the HLA-DRB1*15:01 risk allele.Financial support for the study was provided by: Fondo de Investigación Sanitaria (FIS)- Instituto de Salud Carlos III (ISCIII)-Fondos Europeos de Desarrollo Regional (FEDER) (grant numbers PI12/00555 to FM; PI13/01527 to AA; PI13/01466 to GI; PI13/0879 to EU and RETICS-REEM RD12/0032/ ) and Junta de Andalucía (JA)- Fondos Europeos de Desarrollo Regional (FEDER) (grant number CTS2704 to FM

Limited survival and impaired hepatic fasting metabolism in mice with constitutive Rag GTPase signaling

The mechanistic target of rapamycin complex 1 (mTORC1) integrates nutrient and hormonal signals to control metabolism. Here the authors investigate the effects of constitutive nutrient signaling through genetic activation of RagA in adult mice and show that constitutive nutrient signaling regulates the response to feeding-fasting cycles and does not drive liver cancer

Browning inhibition and microbial control in fresh-cut persimmon (Diospyros kaki Thunb. cv. Rojo Brillante) by apple pectin-based edible coatings

The aim of this study was to develop new edible coatings based on apple pectin with a combination of antioxidants and antimicrobial agents to control enzymatic browning and microbial growth of fresh-cut ‘Rojo Brillante’ persimmon. The survival of important food-borne human pathogens artificially inoculated on fresh-cut fruit was also assessed. Potassium sorbate (PS) at 2 or 4 g kg−1, sodium benzoate (SB) at 4 g kg−1, or nisin (NI) at 500 IU mL−1, were added to apple pectin coatings containing 10 g kg−1 citric acid and 10 g kg−1 calcium chloride as antioxidants. Persimmon slices were dipped in the coatings, the aqueous antioxidant solution (citric acid and calcium chloride) or water (control), packed in an ambient atmosphere and stored at 5 °C for up to 9 days. Microbial growth, colour, firmness, polyphenol oxidase (PPO) activity, visual quality and overall sensory flavour were measured during storage. Coated samples and those dipped in the antioxidant aqueous solution presented lower a* values than control samples, which indicated effective browning inhibition. Persimmon slices treated with coatings containing PS and SB reached the limit of marketability after 7 days of storage. At the end of storage, the overall fruit flavour was ranked above the limit of acceptability. Antimicrobial coatings inhibited growth of mesophilic aerobic bacteria, and those containing SB and NI were the most effective. No growth of moulds, yeasts and psychrophilic aerobic bacteria was detected during storage. All the treatments effectively reduced the populations of Escherichia coli and Salmonella enteritidis, NI-coating being the most effective. For Listeria monocytogenes, only the NI-coating effectively reduced the bacterial population