Intra-hospital transport of neonatal intensive care patients: risk factors for complications

OBJECTIVE: Evaluate factors associated with hypothermia and increased need of oxygen and/or ventilatory support during intra-hospital transport of neonatal intensive care patients. METHODS: Prospective study of infants admitted to a single neonatal unit in need of at least one intra-hospital transport during weekdays, from 8:00AM to 05:00PM, from January 1997 to December 2000. Factors associated with hypothermia and increased need of oxygen and/or need of ventilatory support during and up to two hours after transport were studied by regression analyses. RESULTS: During the study period, 502 transports were analyzed. At the time of transport, the neonates had a mean weight and gestational age of, respectively, 2,000g and 35 weeks, and they were 22 days old. The main reasons for transport were: surgery and image exams. Hypothermia occurred in 17% of the transported infants and increased need of oxygen and/or ventilatory support in 7%. Factors associated with hypothermia were: duration of transportation >3h (OR=2.1; 95%CI=1.2-3.6), neurologic malformation (OR=1.7; 95%CI=1.1-2.5), transport performed in 1997 (OR=1.7; 95%CI=1.1-2.6) and weight at time of transport >3,500g (OR=0.3; 95%CI=0.16-0.68). Factors associated with increased need of oxygen and/or ventilation support were: gestational age at birth in weeks (OR=0.9; 95%CI=0.8-0.9), age in days at transportation (OR=1.0; 95%CI=1.0-1.1) and presence of gastrointestinal and genitourinary malformation (OR=3.1; 95%CI=1.6-6.2). CONCLUSIONS: Complications related to neonatal intra-hospital transports are frequent and associated with the patients characteristics and transport conditions.OBJETIVO: Estudar os fatores associados à hipotermia e ao aumento da necessidade de oxigênio e/ou suporte ventilatório durante o transporte intra-hospitalar de pacientes internados em Unidade de Terapia Intensiva neonatal. MÉTODOS: Estudo prospectivo de todos os pacientes internados na unidade neonatal que necessitaram de transporte intra-hospitalar de janeiro de 1997 a dezembro de 2000, entre segundas-feiras e sextas-feiras, das 8h às 17h. Fatores associados à hipotermia e ao aumento da necessidade de oxigênio e/ou de suporte ventilatório durante e até duas horas após o transporte foram estudados por meio de regressão logística. RESULTADOS: Foram realizados 502 transportes no período. Os pacientes tinham em média 2.000g, 35 semanas de idade gestacional ao nascer e 22 dias de vida. As principais indicações do transporte foram: cirurgia e realização de exames de imagem. A hipotermia ocorreu em 17% dos transportes e o aumento da necessidade de oxigênio e/ou de suporte ventilatório em 7%. Fatores associados à hipotermia foram: duração do transporte >3h (OR=2,1; IC95%=1,2-3,6), presença de malformações neurológicas (OR=1,7; IC95%=1,1-2,5), transporte realizado em 1997 (OR=1,7; IC95%=1,1-2,6) e peso no transporte >3.500g (OR=0,3; IC95%=0,16-0,68). Fatores de risco para o aumento da necessidade de oxigênio e/ou de suporte ventilatório foram: idade gestacional ao nascimento em semanas (OR=0,9; IC95%=0,8-0,9), idade em dias no transporte (OR=1,0; IC95%=1,0-1,1) e presença de malformações gastrintestinais e geniturinárias (OR=3,1; IC95%=1,6-6,2). CONCLUSÕES: As intercorrências relativas ao transporte intra-hospitalar são freqüentes nos neonatos em UTI e estão associadas às condições dos pacientes e dos transportes.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP-EPM Departamento de PediatriaUNIFESP-EPM Departamento de Medicina PreventivaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM Depto. de PediatriaUNIFESP, EPM Depto. de Medicina PreventivaSciEL

Development of Gene Expression Markers of Acute Heat-Light Stress in Reef-Building Corals of the Genus Porites

Coral reefs are declining worldwide due to increased incidence of climate-induced coral bleaching, which will have widespread biodiversity and economic impacts. A simple method to measure the sub-bleaching level of heat-light stress experienced by corals would greatly inform reef management practices by making it possible to assess the distribution of bleaching risks among individual reef sites. Gene expression analysis based on quantitative PCR (qPCR) can be used as a diagnostic tool to determine coral condition in situ. We evaluated the expression of 13 candidate genes during heat-light stress in a common Caribbean coral Porites astreoides, and observed strong and consistent changes in gene expression in two independent experiments. Furthermore, we found that the apparent return to baseline expression levels during a recovery phase was rapid, despite visible signs of colony bleaching. We show that the response to acute heat-light stress in P. astreoides can be monitored by measuring the difference in expression of only two genes: Hsp16 and actin. We demonstrate that this assay discriminates between corals sampled from two field sites experiencing different temperatures. We also show that the assay is applicable to an Indo-Pacific congener, P. lobata, and therefore could potentially be used to diagnose acute heat-light stress on coral reefs worldwide

Antibiotic Resistance Genes in the Bacteriophage DNA Fraction of Environmental Samples

Antibiotic resistance is an increasing global problem resulting from the pressure of antibiotic usage, greater mobility of the population, and industrialization. Many antibiotic resistance genes are believed to have originated in microorganisms in the environment, and to have been transferred to other bacteria through mobile genetic elements. Among others, β-lactam antibiotics show clinical efficacy and low toxicity, and they are thus widely used as antimicrobials. Resistance to β-lactam antibiotics is conferred by β-lactamase genes and penicillin-binding proteins, which are chromosomal- or plasmid-encoded, although there is little information available on the contribution of other mobile genetic elements, such as phages. This study is focused on three genes that confer resistance to β-lactam antibiotics, namely two β-lactamase genes (blaTEM and blaCTX-M9) and one encoding a penicillin-binding protein (mecA) in bacteriophage DNA isolated from environmental water samples. The three genes were quantified in the DNA isolated from bacteriophages collected from 30 urban sewage and river water samples, using quantitative PCR amplification. All three genes were detected in the DNA of phages from all the samples tested, in some cases reaching 104 gene copies (GC) of blaTEM or 102 GC of blaCTX-M and mecA. These values are consistent with the amount of fecal pollution in the sample, except for mecA, which showed a higher number of copies in river water samples than in urban sewage. The bla genes from phage DNA were transferred by electroporation to sensitive host bacteria, which became resistant to ampicillin. blaTEM and blaCTX were detected in the DNA of the resistant clones after transfection. This study indicates that phages are reservoirs of resistance genes in the environment

Total and corrected antioxidant capacity in hemodialyzed patients

BACKGROUND: Oxidative stress may play a critical role in the vascular disease of end stage renal failure and hemodialysis patients. Studies, analyzing either discrete analytes and antioxidant substances, or the integrated total antioxidant activity of human plasma during hemodialysis, give contradictory results. METHODS: Recently, we have introduced a new automated method for the determination of Total Antioxidant Capacity (TAC) of human plasma. We have serially measured TAC and corrected TAC (cTAC: after subtraction of the interactions due to endogenous uric acid, bilirubin and albumin) in 10 patients before the onset of the dialysis session, 10 min, 30 min, 1 h, 2 h and 3 h into the procedure and after completion of the session. RESULTS: Our results indicate that TAC decreases, reaching minimum levels at 2 h. However, corrected TAC increases with t(1/2 )of about 30 min. We then repeated the measurements in 65 patients undergoing dialysis with different filters (36 patients with ethylene vinyl alcohol copolymer resin filter -Eval-, 23 patients with two polysulfone filters -10 with F6 and 13 with PSN140-, and 6 patients with hemophan filters). Three specimens were collected (0, 30, 240 min). The results of this second group confirm our initial results, while no significant difference was observed using either filter. CONCLUSIONS: Our results are discussed under the point of view of possible mechanisms of modification of endogenous antioxidants, and the interaction of lipid- and water-soluble antioxidants

The Role of the Proteinase Inhibitor Ovorubin in Apple Snail Eggs Resembles Plant Embryo Defense against Predation

BACKGROUND: Fieldwork has thoroughly established that most eggs are intensely predated. Among the few exceptions are the aerial egg clutches from the aquatic snail Pomacea canaliculata which have virtually no predators. Its defenses are advertised by the pigmented ovorubin perivitellin providing a conspicuous reddish coloration. The nature of the defense however, was not clear, except for a screening for defenses that identified a neurotoxic perivitellin with lethal effect on rodents. Ovorubin is a proteinase inhibitor (PI) whose role to protect against pathogens was taken for granted, according to the prevailing assumption. Through biochemical, biophysical and feeding experiments we studied the proteinase inhibitor function of ovorubin in egg defenses. METHODOLOGY/PRINCIPAL FINDINGS: Mass spectrometry sequencing indicated ovorubin belongs to the Kunitz-type serine proteinase inhibitor family. It specifically binds trypsin as determined by small angle X-ray scattering (SAXS) and cross-linking studies but, in contrast to the classical assumption, it does not prevent bacterial growth. Ovorubin was found extremely resistant to in vitro gastrointestinal proteolysis. Moreover feeding studies showed that ovorubin ingestion diminishes growth rate in rats indicating that this highly stable PI is capable of surviving passage through the gastrointestinal tract in a biologically active form. CONCLUSIONS: To our knowledge, this is the first direct evidence of the interaction of an egg PI with a digestive protease of potential predators, limiting predator's ability to digest egg nutrients. This role has not been reported in the animal kingdom but it is similar to plant defenses against herbivory. Further, this would be the only defense model with no trade-offs between conspicuousness and noxiousness by encoding into the same molecule both the aposematic warning signal and an antinutritive/antidigestive defense. These defenses, combined with a neurotoxin and probably unpalatable factors would explain the near absence of predators, opening new perspectives in the study of the evolution and ecology of egg defensive strategies