Multimorbidity patterns in COVID-19 patients and their relationship with infection severity : MRisk-COVID study

Several chronic conditions have been identified as risk factors for severe COVID-19 infection, yet the implications of multimorbidity need to be explored. The objective of this study was to establish multimorbidity clusters from a cohort of COVID-19 patients and assess their relationship with infection severity/mortality. The MRisk-COVID Big Data study included 14 286 COVID-19 patients of the first wave in a Spanish region. The cohort was stratified by age and sex. Multimorbid individuals were subjected to a fuzzy c-means cluster analysis in order to identify multimorbidity clusters within each stratum. Bivariate analyses were performed to assess the relationship between severity/mortality and age, sex, and multimorbidity clusters. Severe infection was reported in 9.5% (95% CI: 9.0-9.9) of the patients, and death occurred in 3.9% (95% CI: 3.6-4.2). We identified multimorbidity clusters related to severity/mortality in most age groups from 21 to 65 years. In males, the cluster with highest percentage of severity/mortality was Heart-liver-gastrointestinal (81-90 years, 34.1% severity, 29.5% mortality). In females, the clusters with the highest percentage of severity/mortality were Diabetes-cardiovascular (81-95 years, 22.5% severity) and Psychogeriatric (81-95 years, 16.0% mortality). This study characterized several multimorbidity clusters in COVID-19 patients based on sex and age, some of which were found to be associated with higher rates of infection severity/mortality, particularly in younger individuals. Further research is encouraged to ascertain the role of specific multimorbidity patterns on infection prognosis and identify the most vulnerable morbidity profiles in the community. Registered 4 August 2021 (retrospectively registered)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

5-ht5B Receptor mRNA in the Raphe Nuclei: Coexpression with Serotonin Transporter

We used double-label in situ hybridization to examine the cellular localization of 5-ht5B receptor mRNA in relation to serotonin transporter mRNA in the rat dorsal raphe (DR) and central superior nucleus (CS, median raphe nucleus). 5-ht5B receptor mRNA hybridization signal was often found on serotonin transporter mRNA-positive neuron profiles. The degree of cellular colocalization of these mRNAs notably varied among the different regions of the raphe nuclei. In the DR, cell bodies showing 5-ht5B receptor mRNA expression were abundant in the medial portions of the nucleus, all of them being also labeled for serotonin transporter mRNA. In contrast, in the ventrolateral regions (lateral wings) of the DR, we observed serotonin transporter mRNA-positive cells, but they were devoid of 5-ht5B receptor mRNA signal. In the CS, the level of coexpression of 5-ht5B receptor mRNA with serotonin transporter mRNA was high in the intermediate portions of the nucleus; however, we were unable to detect specific 5-ht 5B receptor mRNA hybridization signal in its caudal extent. Our results support the presence of 5-ht5B receptor in serotonergic neurons in the DR and CS, suggesting an autoreceptor role for this receptor subtype. © 2003 Wiley-Liss, Inc.Contract grant sponsor: >Ministerio de Ciencia y Tecnología> (MCYT); Contract grant numbers: SAF97-0117, SAF2000-0212; Contract grant sponsor: DURSI - >Generalitat de Catalunya> to the Department of Neurochemistry of IIBB-CSIC (IDIBAPS) as a >Grup de Recerca Consolidat> (5092-CSIC-01); Contract grant number: 2001-SGR-00355; Contract grant sponsors: >Institut d'Investigacions Biomèdiques August Pi i Synyer> (IDIBAPS) (fellowship >Beca de Formació de Personal Investigador> to JS), CIRIT (>Generalitt de Catalunya>) (fellowship to AR), the Ministerio de Ciencia y Tecnología (>Ramón y Cajal> contract to MTV)Peer Reviewe

Interacción de la glucosa con espesantes utilizados en el control de la disfagia orofaríngea

La disfagia se define como un trastorno de la deglución caracterizado por una dificultad en la preparación oral del bolo alimenticio o en el desplazamiento del alimento desde la boca hasta al estómago. Se asocia con la cuarta causa de muerte más frecuente en adultos mayores y se identifica como un agente contribuyente a la malnutrición. Los alimentos destinados a las personas que padecen disfagia son preparados con productos que modifican la viscosidad de forma que al ser ingeridos puedan ser más seguros. En el presente trabajo se pretende establecer la interacción entre la glucosa y tres espesantes comerciales de origen vegetal (dos a base de almidón y un tercero constituido por una mezcla de maltdextrina, goma xantana y goma guar) a efectos de identificar el más adecuado para uso en dietas de pacientes con disfagia orofaríngea, en las condiciones ensayadas. Para ello se determina el grado de estabilidad que presentan en función del tiempo de reposo (0, 24 horas) y su comportamiento en el intervalo de temperatura comprendido entre 25 y 50 °C. Se han estudiado concentraciones de espesante hasta el máximo del 6% en combinación con 5 concentraciones de glucosa hasta un máximo de 27%. Se constata la interacción conjunta de la goma xantana, la goma guar y la maltodextrina con la glucosa. Estos espesantes, potencialmente aptos para regular el grado de consistencia de productos alimentarios destinados a la alimentación de pacientes con disfagia orofaríngea, presentan un proceso de hidratación lento que, además, se ve agravado por la interacción de la glucosa

Viscosidad en la dieta de pacientes diagnosticados de disfagia orofaríngea

La disfagia orofaríngea está presente en una gran parte de la población y se describe como un síntoma que puede afectar a la formación y manejo del propio bolo alimenticio al transferirlo al estómago. Es un síntoma muy prevalente que puede presentarse en cualquier momento de la vida, si bien es en la tercera edad cuando este síntoma es más común. Con el fin de prevenir las consecuencias que puede ocasionar esta alteración fisiológica, los alimentos destinados a las personas que la padecen son preparados con productos que modifican la viscosidad de manera que al ser deglutidos puedan seguir el curso normal de la deglución y posterior digestión. Este estudio tiene como objetivo comprobar si determinados productos recomendados para ser utilizados en dietas destinadas a personas afectadas por disfagia cumplen adecuadamente las funciones para las que han estado diseñados y elaborados, independientemente de si son productos farmacéuticos o, simplemente, aditivos alimentarios. Los resultados indican que el almidón de maíz presenta un comportamiento distinto al de patata, siendo muy importante el tipo de agua utilizada. Se han detectado diferencias significativas relacionadas con el tiempo de reposo de la muestra y el porcentaje de espesante aplicado para conseguir las consistencias sanitarias: líquido fino, néctar, miel y pudding. Oropharyngeal dysphagia is present in a large part of the population and described as a symptom that may affect the formation and handling of the patient’s own bolus food when transferred into the stomach. Although it is a very prevalent symptom that can occur at any time of life, it is at senior age when this symptom is more common. In order to prevent the consequences that can result in this physiological alteration, food for people who suffer from this disorder is prepared with products that modify their viscosity, so that it follows the normal course of swallowing and later digestion. This study aims at verifying whether certain products recommended for use with people affected by dysphagia diets properly meet the functions for which they have been designed and produced, regardless of whether they are pharmaceutical products or, simply, food additives. The results indicate that corn starch presents a different behaviour from potato, the type of water used being very important. Significant differences related to the dwell time of rest from the sample and the percentage of thickener applied to achieve the valued health consistencies of thin liquid, nectar, honey and pudding were detected. A disfagia orofaríngea está presente em grande parte da população e é descrita como um sintoma que pode afetar a formação e a digestão do próprio bolo alimentar ao transferi-lo ao estômago. É um sintoma muito prevalente, podendo ocorrer a qualquer momento da vida, embora seja na terceira idade quando este sintoma se torna mais comum. Para evitar as consequências que podem resultar nessa alteração fisiológica, os alimentos destinados às pessoas que a padecem são preparados com produtos que modificam a viscosidade de maneira que, ao serem deglutidos, possam continuar o curso normal de deglutição e posterior digestão. Este estudo tem como objetivo comprovar se determinados produtos recomendados para uso em dietas destinadas a pessoas afetadas por disfagia cumprem adequadamente as funções para as quais foram concebidos e elaborados, independentemente de se são produtos farmacêuticos ou, simplesmente, aditivos alimentares. Os resultados indicam que o amido de milho apresenta um comportamento diferente da batata, sendo muito importante o tipo de água utilizada. Foram encontradas diferenças significativas relacionadas com o tempo de repouso da amostra e o percentual de espessante aplicado para conseguir as consistências sanitárias: líquido fino, néctar, mel e pudimPostprint (author's final draft

Viscosidad en la dieta de pacientes diagnosticados de disfagia orofaríngea

La disfagia orofaríngea está presente en una gran parte de la población y se describe como un síntoma que puede afectar a la formación y manejo del propio bolo alimenticio al transferirlo al estómago. Es un síntoma muy prevalente que puede presentarse en cualquier momento de la vida, si bien es en la tercera edad cuando este síntoma es más común. Con el fin de prevenir las consecuencias que puede ocasionar esta alteración fisiológica, los alimentos destinados a las personas que la padecen son preparados con productos que modifican la viscosidad de manera que al ser deglutidos puedan seguir el curso normal de la deglución y posterior digestión. Este estudio tiene como objetivo comprobar si determinados productos recomendados para ser utilizados en dietas destinadas a personas afectadas por disfagia cumplen adecuadamente las funciones para las que han estado diseñados y elaborados, independientemente de si son productos farmacéuticos o, simplemente, aditivos alimentarios. Los resultados indican que el almidón de maíz presenta un comportamiento distinto al de patata, siendo muy importante el tipo de agua utilizada. Se han detectado diferencias significativas relacionadas con el tiempo de reposo de la muestra y el porcentaje de espesante aplicado para conseguir las consistencias sanitarias: líquido fino, néctar, miel y pudding. Oropharyngeal dysphagia is present in a large part of the population and described as a symptom that may affect the formation and handling of the patient’s own bolus food when transferred into the stomach. Although it is a very prevalent symptom that can occur at any time of life, it is at senior age when this symptom is more common. In order to prevent the consequences that can result in this physiological alteration, food for people who suffer from this disorder is prepared with products that modify their viscosity, so that it follows the normal course of swallowing and later digestion. This study aims at verifying whether certain products recommended for use with people affected by dysphagia diets properly meet the functions for which they have been designed and produced, regardless of whether they are pharmaceutical products or, simply, food additives. The results indicate that corn starch presents a different behaviour from potato, the type of water used being very important. Significant differences related to the dwell time of rest from the sample and the percentage of thickener applied to achieve the valued health consistencies of thin liquid, nectar, honey and pudding were detected. A disfagia orofaríngea está presente em grande parte da população e é descrita como um sintoma que pode afetar a formação e a digestão do próprio bolo alimentar ao transferi-lo ao estômago. É um sintoma muito prevalente, podendo ocorrer a qualquer momento da vida, embora seja na terceira idade quando este sintoma se torna mais comum. Para evitar as consequências que podem resultar nessa alteração fisiológica, os alimentos destinados às pessoas que a padecem são preparados com produtos que modificam a viscosidade de maneira que, ao serem deglutidos, possam continuar o curso normal de deglutição e posterior digestão. Este estudo tem como objetivo comprovar se determinados produtos recomendados para uso em dietas destinadas a pessoas afetadas por disfagia cumprem adequadamente as funções para as quais foram concebidos e elaborados, independentemente de se são produtos farmacêuticos ou, simplesmente, aditivos alimentares. Os resultados indicam que o amido de milho apresenta um comportamento diferente da batata, sendo muito importante o tipo de água utilizada. Foram encontradas diferenças significativas relacionadas com o tempo de repouso da amostra e o percentual de espessante aplicado para conseguir as consistências sanitárias: líquido fino, néctar, mel e pudi

Interacción de la glucosa con espesantes utilizados en el control de la disfagia orofaríngea

La disfagia se define como un trastorno de la deglución caracterizado por una dificultad en la preparación oral del bolo alimenticio o en el desplazamiento del alimento desde la boca hasta al estómago. Se asocia con la cuarta causa de muerte más frecuente en adultos mayores y se identifica como un agente contribuyente a la malnutrición. Los alimentos destinados a las personas que padecen disfagia son preparados con productos que modifican la viscosidad de forma que al ser ingeridos puedan ser más seguros. En el presente trabajo se pretende establecer la interacción entre la glucosa y tres espesantes comerciales de origen vegetal (dos a base de almidón y un tercero constituido por una mezcla de maltdextrina, goma xantana y goma guar) a efectos de identificar el más adecuado para uso en dietas de pacientes con disfagia orofaríngea, en las condiciones ensayadas. Para ello se determina el grado de estabilidad que presentan en función del tiempo de reposo (0, 24 horas) y su comportamiento en el intervalo de temperatura comprendido entre 25 y 50 °C. Se han estudiado concentraciones de espesante hasta el máximo del 6% en combinación con 5 concentraciones de glucosa hasta un máximo de 27%. Se constata la interacción conjunta de la goma xantana, la goma guar y la maltodextrina con la glucosa. Estos espesantes, potencialmente aptos para regular el grado de consistencia de productos alimentarios destinados a la alimentación de pacientes con disfagia orofaríngea, presentan un proceso de hidratación lento que, además, se ve agravado por la interacción de la glucosa

Chemical neuroanatomy of 5-HT receptor subtypes in the mammalian brain

Capítulo en: Bryan L. Roth (ed.). The Serotonin Receptors : From Molecular Pharmacology to Human Therapeutics. Totowa; NJ: Humana Press, 2006, p.319-364. ISBN 978-1-59745-080-5. ISBN 978-1-58829-568-2. ISBN 978-1-61737-647-4. DOI 10.1007/978-1-59745-080-5Peer Reviewe