Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis

Hospital-acquired pneumonia; Prevention; Quality improvement interventionNeumonía adquirida en el hospital; Prevención; Intervención de mejora de la calidadPneumònia adquirida a l'hospital; Prevenció; Intervenció de millorar de la qualitatBackground Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. Methods A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. Results Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=−0.59, 95% CI: −1.03, −0.15) and hospital length of stay (MD=−1.24, 95% CI: −2.30, −0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive. Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.This work was supported by CIBERES, Instituto de Salud Carlos III, Madrid, Spain (grant number: Fondos FEDER: CB06-06-036)

Seroepidemiology of infection with Toxoplasma gondii in healthy blood donors of Durango, Mexico

<p>Abstract</p> <p>Background</p> <p><it>Toxoplasma gondii </it>(<it>T. gondii</it>) infection in blood donors could represent a risk for transmission in blood recipients. There is scarce information about the epidemiology of <it>T. gondii </it>infection in blood donors in Mexico. Therefore, we sought to determine the prevalence of <it>T. gondii </it>infection and associated socio-demographic and behavioral characteristics in a population of healthy blood donors of Durango City, Mexico.</p> <p>Methods</p> <p>Four hundred and thirty two blood donors in two public blood banks of Durango City, Mexico were examined for <it>T. gondii </it>infection between August to September 2006. Blood donors were tested for anti-<it>T. gondii </it>IgG and IgM antibodies by using enzyme-linked immunoassays (Diagnostic Automation Inc., Calabasas, CA, USA). Socio-demographic and behavioral characteristics from each participant were also obtained.</p> <p>Results</p> <p>Thirty two (7.4%) of 432 blood donors had IgG anti-<it>T. gondii </it>antibodies. Eight (1.9%) of them had also IgM anti-<it>T. gondii </it>antibodies. Multivariate analysis using logic regression showed that <it>T. gondii </it>infection was associated with the presence of cats at home (adjusted OR = 3.81; 95% CI: 1.45–10.01). The age group of 45–60 years showed a significantly higher frequency of <it>T. gondii </it>infection than the group of 25–34 years (p = 0.02). Blood donors without education had a significantly higher frequency of infection (15.8%) than those with 13–19 years of education (4.5%) (p = 0.04). Other characteristics of blood donors including male gender, consumption of undercooked meat or blood transfusion did not show an association with infection.</p> <p>Conclusion</p> <p>The prevalence of <it>T. gondii </it>infection in healthy blood donors of Durango City, Mexico is lower than those reported in blood donors of south and central Mexico, and is one of the lowest reported in blood donors worldwide. <it>T. gondii </it>infection in our blood donors was most likely acquired by contact with cats. Prevalence of infection increased with age and decreased with educational level.</p

Homens violentados por suas parceiras: uma primeira abordagem à experiência de estudantes mexicanos de Durango

The experience of men as victims of intimate partner violence has been explored to a lesser degree. Little is known about the characteristics and circumstances in which they experience this phenomenon. This study aimed at estimating the presence (at least once) and recurrence (twice or more) of psychological, physical, sexual, and economic violence against men. In addition, it includes comparisons in terms of some sociodemographic variables. We addressed this subject by ausing random, stratified, and cluster sampling. We designed a survey and applied it to 232 men who studied at a public university in Durango, Mexico. Of these men, 95% had suffered intimate partner violence at least once, and 69% in a recurrent pattern. Some of them (6.7%) were fathers, which was related to economic violence (presence: prevalence ratio, PR=2.30 [1.35-3.94]; recurrence PR=3.31 [1.8-5.55]) and sexual violence (presence PR= 2.60 [1.60-4.21]; recurrence PR=3.53 [1.90-5.92]). The proportion of harmed men reported in this work is higher than in other studies. The results support the idea of the need for awareness, prevention, and attention programs focused on abused men.La violencia de pareja ha sido explorada en menor medida desde la perspectiva de los hombres como víctimas. Poco se conoce sobre las características y las circunstancias en que los varones experimentan este fenómeno. El presente estudio tuvo como propósito estimar la presencia y recurrencia de violencia emocional, física, sexual y económica en el papel de receptor, en varones estudiantes universitarios duranguenses, así como su comparación respecto a algunas variables sociodemográficas. Para ello, se aplicó un cuestionario a 232 hombres estudiantes de una universidad pública en Durango, México, a través de un muestreo aleatorio, estratificado y por conglomerados. El 95 % de los varones reportó haber sido víctima de algún tipo de violencia de pareja al menos una vez y el 69 %, de forma recurrente. El 6.7% de los estudiantes reportó tener hijos, condición que se encontró relacionada con la presencia de violencia económica (razón de prevalencia, RP= 2.30 [1.35-3.94] y su recurrencia RP= 3.31 [1.8-5.55]); asimismo, presencia de violencia sexual (RP= 2.60 [1.60-4.21] y su recurrencia RP= 3.53 [1.90-5.92]). La proporción de hombres víctimas de violencia es alta en comparación con otros estudios. Para finalizar, los datos permiten respaldar la necesidad de contar con programas de sensibilización, prevención y atención a los varones víctimas de violencia.A violência por parceiro íntimo tem sido menos explorada na perspectiva dos homens como vítimas. Pouco se sabe sobre as características e circunstâncias em que os homens vivenciam esse fenômeno. O objetivo deste estudo foi estimar a presença e recorrência de violência emocional, física, sexual e econômica, no papel de receptor, em universitários do sexo masculino de Durango; bem como sua comparação com algumas variáveis sociodemográficas. Um questionário foi aplicado a 232 estudantes do sexo masculino de uma universidade pública de Durango, no México; por amostragem aleatória, estratificada e por conglomerados. 95 % dos homens relataram ter sido vítimas de algum tipo de violência conjugal pelo menos uma vez e 69% recorrentemente. 6.7% dos alunos relataram ter filhos; e essa condição mostrou-se relacionada à presença de violência econômica (razão de prevalência, RP=2.30 [1.35-3.94] e sua recorrência RP=3.31 [1.8-5.55]), bem como à presença de violência sexual (RP= 2.60 [1.60-4.21]); e sua recorrência RP=3.53 [1.90-5.92]). A proporção de homens que sofreram violência é alta em comparação com outros estudos. Os dados corroboram a necessidade de programas de conscientização, prevenção e atendimento a homens vítimas de violência

Fungal spores in four catholic churches in the metropolitan area of Monterrey, Nuevo León State, Mexico – First study

Introduction. About 500,000 species of fungi have been described to-date, although an estimated between 1 – 1.5 million species may occur. They have a wide distribution in nature, contributing to the decomposition of organic matter and playing a part in the biogeochemical cycles of major nutrients. A small number are considered pathogens of animals and plants. There is ample historical evidence that certain types of allergies are associated with fungi; exposure to fungal allergens occurs in both outdoor and indoor spaces. Many indoor allergens are the same as those found outside buildings, entering through windows and doors, ventilation systems, or through cracks or other fissures in the walls. Objective. To determine the diversity and abundance of fungal spores inside four churches in the metropolitan area of Monterrey city in Mexico. Materials and methods. The study was carried out from July 2009 – January 2010 using a Hirst type volumetric collector (Burkard Manufacturing Co Ltd). Results. A total of 31,629 spores from 54 taxa were registered in the four churches. The building that showed the highest amount of spores was the Santa Catarina Mártir Church with 12,766 spores, followed by Cristo Rey with 7,155 and Nuestra Señora del Roble with 6,887. Regularly high concentrations of spores were recorded from 14:00 – 20:00 hours. The highest concentration value was observed at the church of Santa Catarina Mártir at 16:00 hours with 1153 spores/m3 air. Conclusions. The most abundant spores in the four churches studied corresponded to Cladosporium, the Aspergillus/Penicillium complex, Coprinus, Ganoderma, Curvularia and Ustilago

Blood Bacterial Profiles Associated With Human Immunodeficiency Virus Infection and Immune Recovery

[EN] Human immunodeficiency virus (HIV) infection impairs mucosal immunity and leads to bacterial translocation, fueling chronic inflammation and disease progression. While this is well established, questions remain about the compositional profile of the translocated bacteria, and to what extent it is influenced by antiretroviral therapy (ART). Using 16S ribosomal DNA targeted sequencing and shotgun proteomics, we showed that HIV increases bacterial translocation from the gut to the blood. HIV increased alpha diversity in the blood, which was dominated by aerobic bacteria belonging to Micrococcaceae (Actinobacteria) and Pseudomonadaceae (Proteobacteria) families, and the number of circulating bacterial proteins was also increased. Forty-eight weeks of ART attenuated this phenomenon. We found that enrichment with Lactobacillales order, and depletion of Actinobacteria class and Moraxellaceae and Corynebacteriacae families, were significantly associated with greater immune recovery and correlated with several inflammatory markers. Our findings suggest that the molecular cross talk between the host and the translocated bacterial products could influence ART-mediated immune recovery.This work was supported by the Instituto de Salud Carlos III (Plan Estatal de I+D+i 2013–2016, projects PI15/00345 and PI18/00154); the Fundación Asociación Española Contra el Cáncer within the European Research Era-NET aligning national/regional translational cancer research programs and activities program (grant AC17/00019) and cofinanced by the European Development Regional Fund; and Plan Estatal de I+D+i 2013–2016 (grant PT17/0019 to the Proteomics Facility of the Spanish National Center for BIotechnology)

Potential effects of delphinidin-3-O-sambubioside and cyanidin-3-O-sambubioside of Hibiscus sabdariffa L. on ruminant meat and milk quality

El articulo esta publicado en una revista de Open accessThe objective was to review the potential effects of adding anthocyanin delphinidin-3-O-sambubioside (DOS) and cyanidin-3-O-sambubioside (COS) of HS in animal diets. One hundred and four scientific articles published before 2021 in clinics, pharmacology, nutrition, and animal production were included. The grains/concentrate, metabolic exigency, and caloric stress contribute to increasing the reactive oxygen species (ROS). COS and DOS have antioxidant, antibacterial, antiviral, and anthelmintic activities. In the rumen, anthocyanin might obtain interactions and/or synergisms with substrates, microorganisms, and enzymes which could affect the fiber degradability and decrease potential methane (CH4) emissions; since anthocyanin interferes with ruminal fatty acids biohydrogenation (BH), they can increase the n-3 and n-6 polyunsaturated fatty acids (PUFA), linoleic acid (LA), and conjugated linoleic acid (CLA) in milk and meat, as well as improving their quality. Anthocyanins reduce plasma oxidation and can be deposited in milk and meat, increasing antioxidant activities. Therefore, the reduction of the oxidation of fats and proteins improves shelf-life. Although studies in ruminants are required, COS and DOS act as inhibitors of the angiotensin-converting enzyme (ACEi) and rennin expression, regulating the homeostatic control and possibly the milk yield and body weight. By-products of HS contain polyphenols as calyces with positive effects on the average daily gain and fat meat quality

Restless legs syndrome in end-stage renal disease patients undergoing hemodialysis

ABSTRACT Restless legs syndrome (RLS) is a frequent complication of hemodialysis that has been associated with poor quality of life and increased risk for complications. Nevertheless, few studies regarding this entity exist in resource-limited settings. Objectives: To determine the prevalence of RLS among Mexican patients on hemodialysis; and compare these patients with a control group of the same population. Methods: We recruited 105 hemodialysis patients. Restless legs syndrome was diagnosed according to the updated criteria set out by the International RLS Study Group. We selected patients who did not meet the criteria, as controls. Results: We found an RLS prevalence of 18%. The RLS patients had a significantly higher prevalence of iron deficiency anemia and uremic pruritus. None of the patients reported RLS symptoms prior to hemodialysis initiation. Conclusions: Restless legs syndrome is common among Mexican patients on hemodialysis. Larger studies are required to address the impact of RLS in hemodialysis patients. Keywords: Restless legs syndrome; renal dialysis; renal insufficiency. RESUMEN El síndrome de piernas inquietas (SPI) es una complicación de la hemodiálisis que se ha asociado con menor calidad de vida y riesgo aumentado de complicaciones. Sin embargo, existen pocos estudios acerca de esta entidad en escenarios de recursos limitados. Objetivos: Determinar la prevalencia de SPI en pacientes mexicanos en hemodiálisis, y comparar las características con un grupo control de la misma población. Métodos: Reclutamos 105 pacientes en hemodiálisis. El SPI se diagnosticó de acuerdo con los criterios actualizados del grupo de estudio internacional del síndrome de piernas inquietas. Seleccionamos a los pacientes que no cumplieron dichos criterios como controles. Resultados: Encontramos una prevalencia de SPI del 18%. Los pacientes con SPI tenían una prevalencia más alta de anemia ferropénica, y prurito urémico. Ninguno de los pacientes reportó síntomas de SPI previo a iniciar la hemodiálisis. Conclusiones: El SPI es frecuente en pacientes mexicanos en hemodiálisis; se requieren estudios más grandes para evaluar el impacto del síndrome en ésta población. Palabras-clave: Síndrome de piernas inquietas; diálisis renal; insuficiencia renal

Analysis of a Fundamental Procedure for Solving the Inverse Heat Conduction Problem Applied to Simple Systems

Heat transfer phenomena develop in various natural and artificially created processes. Fundamental laws of physics allow the transfer mechanisms to be classified; however, describing the phenomena is relatively complex, even if the analysis is limited to conduction. In particular, to determine the temperature distribution in a solid body, the definition of the boundary conditions that perturb it is required. Such conditions mathematically model a fluid’s hydrodynamic and thermodynamic behavior, and when the temperature differences are significantly high, the flow by radiation. It is then complex to define the functions of the thermal boundary conditions and solve the well-posed problem. Naturally, nonlinear system results and applying numerical methods are constant in the analysis. However, a unique solution for the thermal field in a solid does ensure. Alternatively, the scheme of the discretization of the system allows us to propose that through the knowledge of a fraction of the thermal field, the boundary condition is quantified independently of its nature. Such a procedure is called inverse analysis and has the characteristic of not satisfying the single solution criterion. However, some cases of interest can treat, and the estimate is guaranteed to be highly accurate

Smoking is associated with age at disease onset in Parkinson's disease

[Background] Previous studies linked disease-progression variables such as age at onset or survival to both genetic, and non-genetic factors in Parkinson's disease (PD) patients.[Objective] The aim of this study was to assess how genetic and non genetic factors act as modifiers of age at onset and survival and in a cohort of 753 PD patients, and to determine how these variables interact to define the overall risk.[Methods] We analyzed the effect of gender, tobacco, alcohol, type of PD (genetic, gPD or idiopathic, iPD) and three genetic variants rs5848- GRN, rs1042522- TP53 and APOE. We studied two cohorts (PPMI and IPDGC) to replicate positive results.[Results] Regarding age at onset, male smokers PD had a significantly lower mean age compared to non-smoker (p = 0.001). APOE-Ɛ4 carriers had a younger onset-age compared to non-carriers (p = 0.03) in the Spanish cohort, but these results were not replicated in the other cohorts. Concerning survival, PD patients with an early onset (below 50 years) had an increased survival rate (p < 0.001).[Conclusions] Our study showed how several genetic and non-genetic risk factors influenced the age at onset and survival in PD.Irene Rosas was supported by a grant from Fundación Jose Luis Castaño-SEQC. Sergio Pérez-Oliveira is supported by Fundación Parkinson Asturias-Obra Social Cajastur. This study was supported by grant PI 15/00878 (Fondos Feder) to VA.Peer reviewe

Seroepidemiology of Toxoplasma gondii infection in psychiatric inpatients in a northern Mexican city

BACKGROUND: Patients with psychiatric disorders were found to show a high seroprevalence of Toxoplasma gondii infection. There is scarce information about the epidemiology of T. gondii infection in psychiatric patients in Mexico. Therefore, we sought to determine the prevalence of T. gondii infection and associated socio-demographic, clinical and behavioural characteristics in a population of psychiatric patients in Durango City, Mexico. Seroprevalence in patients was compared with that obtained in a control population. METHODS: One hundred and thirty seven inpatients of a public psychiatric hospital and 180 controls were examined for the presence of IgG and IgM antibodies against T. gondii by enzyme-linked immunoassay (Diagnostic Automation Inc., Calabasas, CA, USA). The control population consisted of blood donors of a public blood bank and elderly persons attending a senior center in the same city. Age in controls (42 years +/- 20.2) was comparable with that of the psychiatric patients (43.7 years +/-13.8) (p = 0.42). Socio-demographic, clinical and behavioral characteristics from the patients were also obtained. RESULTS: Anti-T. gondii IgG antibodies indicating latent infection with T. gondii was found in 25 (18.2%) of 137 psychiatric inpatients and 16 (8.9%) of 180 controls (p = 0.02). Ten (26.3%) of 38 schizophrenic patients had latent infection and this prevalence was also significantly higher than that observed in controls (p = 0.005). Prevalence of anti-T. gondii IgM antibodies was comparable among patients and controls (4.4% vs 2.2%, respectively, p = 0.22). Multivariate analysis showed that T. gondii infection in inpatients was positively associated with sexual promiscuity (adjusted OR = 15.8; 95% CI: 3.8–64.8), unwashed raw fruit consumption (adjusted OR = 5.19; 95% CI: 2.3–11.3), and a history of surgery (adjusted OR = 6.5; 95% CI: 2.6–16), and negatively associated with lamb meat consumption (adjusted OR = 0.26; 95% CI: 0.10–0.63). CONCLUSION: In the present study, psychiatric inpatients in Durango, Mexico, in general and schizophrenia inpatients in particular had a significantly higher prevalence of T. gondii infection than the control group. Results suggest that unwashed raw fruit consumption might be the most important route of T. gondii transmission in our psychiatric inpatients while lamb meat consumption the less important. Additional studies will have to elucidate the causative relation between infection with T. gondii and psychiatric disorders