Effects of sulfamethazine and tetracycline at molecular, cellular and tissue levels in Eisenia fetida earthworms

Soil contamination by antibiotics is a global issue of great concern that contributes to the rise of bacterial antibiotic resistance and can have toxic effects on non-target organisms. This study evaluated the variations of molecular, cellular, and histological parameters in Eisenia fetida earthworms exposed to sulfamethazine (SMZ) and tetracycline (TC), two antibiotics commonly found in agricultural soils. The earthworms were exposed for 14 days to a series of concentrations (0, 10, 100, and 1000 mg/kg) of both antibiotics. SMZ and TC did not affect the survival of E. fetida, however, other effects at different levels of biological complexity were detected. The two highest concentrations of SMZ reduced the viability of coelomocytes. At the highest TC concentration, there was a noticeable decline in cell viability, acetylcholinesterase activity (neurotoxicity), and the relative presence of mucopolysaccharides in the epidermis (mucous production). Glutathione S-transferase activity decreased in all TC treatments and at the highest SMZ concentration. However, levels of malondialdehyde and protein carbonyls did not change, suggesting an absence of oxidative stress. Tetracycline was neurotoxic to E. fetida and changed the integrity of the epidermis. Both antibiotics altered the intestinal microbiota of E. fetida, leading to a reduction in the relative abundance of bacteria from the phyla Proteobacteria and Bacteroidetes, while causing an increase in the phylum Actinobacteroidota. All observed changes indicate that both SMZ and TC can disrupt the earthworms' immune system and gut microbiome, while fostering the growth of bacteria that harbour antibiotic resistance genes. Finally, both antibiotics exerted additional metabolic and physiological effects that increased the vulnerability of E. fetida to pathogens.Partially funded by the Basque Government (KONTRAE, KK2020-00007; Consolidate groups, IT1446-22, IT1743-22), Joint Research Laboratory on Environmental Antibiotic Resistance (Euskampus), “Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES” (001), and “Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq” (313503/2021-4). Also grateful to the University of the Basque Country (UPV/EHU) for the pre-doctoraI fellowship of I. Vergara-Luis. We extend our deepest gratitude to Ainhoa Ugarte and Ane Arrizabalaga for the micrographs

In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome

Observational study[Abstract] Background: Infection is a major cause of morbidity and mortality after heart transplantation (HT). Little information about its importance in the immediate post-operative period is available. The aim of this study was to analyze the characteristics, incidence, and outcomes of in-hospital post-operative infections after HT. Methods: We conducted an observational, single-center study based on 677 adults who underwent HT from 1991 to 2015 and who survived the surgical intervention. In-hospital post-operative infections were identified retrospectively according to the medical finding in the clinical records. Results: Over a mean hospital stay of 24.5 days, 239 patients (35.3%) developed 348 episodes of infection (2 episodes per 100 patient-days). The most common sources of infection were those related to invasive procedures (respiratory infections, 115 [33%]; urinary tract infections, 47 [13.5%]; bacteremia, 42 [12.1%]; surgical site infections, 25 [7.2%]), in addition to abdominal focus (33, 9.5%). Enterobacteriaceae (76, 21.8%) and gram-positive cocci (58, 16.7%) were the predominant germs, although opportunistic infections were not infrequent (69, 19.8%). Ninety-five septic episodes were detected with a mean Sequential Organ Failure Assessment Score of 9.5 ± 5.3 points, with hemodynamic failure being the most severe organ dysfunction and renal dysfunction the most frequent one. Management included broad-spectrum antibiotics in 48.8% of episodes and surgical management in 13.8%. The overall antimicrobial success rate was 96.3%. Higher in-hospital mortality was observed among infected patients (15.1% vs. 10.3%), but this difference was not statistically significant (p = 0.067). The one-year survival and events were not different between patients suffering from a post-operative infection and those who did not. Conclusions: In-hospital infections were frequent in the post-operative period after HT and were associated with a poor short-term outcome. Patients who survived sepsis had a similar one-year morbidity and mortality compared with patients who did not develop an infection

Valor pronóstico del índice de riesgo nutricional en receptores de trasplante cardiaco

[Abstract] Introduction and objectives. To study the prognostic impact of preoperative nutritional status, as assessed through the nutritional risk index (NRI), on postoperative outcomes after heart transplantation (HT). Methods. We conducted a retrospective, single-center study of 574 patients who underwent HT from 1991 to 2014. Preoperative NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (body weight [kg] / ideal body weight [kg]). The association between preoperative NRI and postoperative outcomes was analyzed by means of multivariable logistic regression and multivariable Cox regression. Results. Mean NRI before HT was 100.9 ± 9.9. According to this parameter, the prevalence of severe nutritional risk (NRI < 83.5), moderate nutritional risk (83.5 ≤ NRI < 97.5), and mild nutritional risk (97.5 ≤ NRI < 100) was 5%, 22%, and 10%, respectively. One year post-transplant mortality rates in these 4 categories were 18.2%, 25.3%, 7.9% and 10.2% (P < .001), respectively. The NRI was independently associated with a lower risk of postoperative infection (adjusted OR, 0.97; 95%CI, 0.95-1.00; P = .027) and prolonged postoperative ventilator support (adjusted OR, 0.96; 95%CI, 0.94-0.98; P = .001). Patients at moderate or severe nutritional risk had significantly higher 1-year post-HT mortality (adjusted HR, 1.55; 95%CI, 1.22-1.97; P < .001). Conclusions. Malnourished patients have a higher risk of postoperative complications and mortality after HT. Preoperative NRI determination may help to identify HT candidates who might benefit from nutritional intervention.[Resumen] Introducción y objetivos. Analizar el impacto del estado nutricional preoperatorio, evaluado mediante el índice de riesgo nutricional (IRN), en el pronóstico tras el trasplante cardiaco (TxC). Métodos. Se realizó un estudio retrospectivo de 574 pacientes que recibieron un TxC entre 1991 y 2014 en un centro. El IRN preoperatorio se calculó como 1,519 × albúmina (g/l) + 41,7 × (peso real [kg] / peso ideal [kg]). La asociación entre IRN preoperatorio y eventos clínicos posoperatorios se analizó mediante modelos multivariables de regresión logística y regresión de Cox. Resultados. El IRN preoperatorio medio de la población del estudio era de 100,9 ± 9,9. Según este parámetro, las prevalencias de riesgo nutricional grave (IRN < 83,5), moderado (83,5 ≤ IRN < 97,5) y leve (97,5 ≤ IRN < 100) antes del TxC eran el 5, el 22 y el 10% respectivamente. Las tasas de mortalidad a 1 año tras el TxC en estas 4 categorías fueron del 18,2, el 25,3, el 7,9 y el 10,2% (p < 0,001) respectivamente. El IRN preoperatorio resultó predictor independiente de menor riesgo de infección posoperatoria (odds ratio ajustada [ORa] = 0,97; intervalo de confianza del 95% [IC95%], 0,95-1,00; p = 0,027) y ventilación mecánica prolongada posoperatoria (ORa = 0,96; IC95%, 0,94-0,98; p = 0,001). Los pacientes con riesgo nutricional moderado a grave mostraron mayor mortalidad a 1 año tras el TxC (hazard ratio ajustada = 1,55; IC95%, 1,22-1,97; p < 0,001). Conclusiones. Los pacientes desnutridos tienen mayor riesgo de complicaciones posoperatorias y muerte tras el TxC. La determinación del IRN podría facilitar la identificación de candidatos a TxC que se beneficien de intervenciones nutricionales en espera del órgano

Estrategias metodológicas enfocadas a la mejora del aprendizaje en estudiantes con diversidad

Diseño y desarrollo de estrategias metodológicas que faciliten el aprendizaje de los estudiantes en general y que permitan a los estudiantes con diversidad funcional la integración y participación en el proceso de aprendizaje, que refuercen su inclusión y que favorezcan la adquisición de competencias

Factores clínicos y electrocardiográficos como predictores de mortalidad en pacientes en fase aguda de un primer evento cerebrovascular Clinical and electrocardiographic factors as mortality predictors in patients in the acute phase of a first cerebrovasc

RESUMENIntroducción: El accidente cerebrovascular (ACV) es la segunda causa de muerte y tercera causa dediscapacidad en el mundo.Objetivo:Evaluar la asociación entre variables clínicas, electrocardiográficas,escalas neurológicas en pacientes con ACV como predictoras de mortalidad a 3 meses posteriores al egreso hospitalario. Materiales y métodos: Estudio de cohorte prospectivo con muestreo no probabilístico, en pacientes mayores de 18 años con primer ACV. Se evaluaron variables demográficos,clínicas, escalas neurológicas del Instituto Nacional de Salud (NIHSS) y canadiense (CNS), variabilidad de la frecuencia cardiaca (VFC) y del QT (QTV), dispersión del QT. Se determinó la mortalidad a los tres meses de seguimiento. Se realizó análisis bivariado y de regresión logística múltiple cuyo desenlacefue mortalidad a tres meses post egreso hospitalario, incluyendo variables con baja correlación (r&lt; 0.4) y significancia estadística (p&lt;0.05).Resultados: Se incluyeron 92 pacientes, 13 de los cuales fallecieron en la fase de tratamiento intrahospitalario. Se realizó seguimiento durante tres meses después del egreso hospitalario en 81 pacientes. La mortalidad total en tres meses de seguimiento fue del 21.7%(n=20).Se identificaron cinco variables predictoras de mortalidad en el modelo final: puntaje de escala NIHSS,frecuencia cardiaca media, VLF QT ≥36.311, LF/HF ≤1.019, valores extremos r-MSD (≥7.985o≤2.363) de VFC. La capacidad discriminatoria del modelo mediante el análisis del área bajo la curva fue de 0.95, con valores de sensibilidad y especificidad del 60% y 93% respectivamente.Conclusión:Altos puntajes de escala NIHSS, VLF-QT, frecuencia cardiaca media, así como valores bajos LF/HF y valores extremosr-MSD, fueron factores de riesgo independientes para mortalidad a los 90 días después de un primer ACV.Palabras Clave: Accidente cerebrovascular, Electrocardiografia, Frecuencia cardiaca, Mortalidad, Predicción.ABSTRACTIntroduction:Stroke is the second cause of death and third cause of disability worldwide.Objective: To assess association between clinical and electrocardiographic variables, neurological scales in stroke patients like predictorsof mortality at three months after hospital discharge.Subjects and methods:Prospective cohort with nonprobabilistic sampling, in patients over 18 years with first stroke. Demographic and clinical variables, neurological scales (NIHSS, Canadian), heart rate (HRV) and QT variability (QTV), QT dispersion were evaluated. Mortality was determined during the 3 months follow up. Bivariate and multiple logistic regression analysis were performed with mortality at three months after discharge as outcome. Variables were included in the model if they have low correlation (r&lt;0.4) and significant statistically p values (P&lt; 0.05).Results: 92 patients were included in the study,13 patients died during the intra-hospital stay, 81 were followed at 3 months after their hospital discharge. Totalmortality in patients included at three months follow-up was 21.7 % (n=20). We identified five predictors of mortality in the final model: NIHSS score, mean heart rate, VLF QT ≥36,311, LF/HF ≤ 1,019, extreme values of r-MSD (≥ 7,985 or ≤ 2,363) of HRV. The area under the curve (AUC) of the model was 0,95 with sensitivity of 60% and specificity of 93%. Conclusions: High NIHSS scores, VLF-QT, mean heart rate, low values of LF/HF and high extreme values of r-MSD were independent risk factors for mortality at 90 days after a first stroke.Keywords: Stroke, Electrocardiography, Heart Rate, Mortality Prediction. Forma de citar: Rueda Ochoa OL, Torres Mantilla HA, Fernández Dulcey CA, Villa Acuña MM, Velasco Gómez ST, Niño Niño CA, Sierra Bueno DA. Factores clínicos y electrocardiográficos como predictores de mortalidad en pacientes en fase aguda de un primer evento cerebrovascular. rev.univ.ind.santander.salud 2014; 46(2): 147-158

Factores clínicos y electrocardiográficos como predictores de mortalidad en pacientes en fase aguda de un primer evento cerebrovascular Clinical and electrocardiographic factors as mortality predictors in patients in the acute phase of a first cerebrovasc

RESUMENIntroducción: El accidente cerebrovascular (ACV) es la segunda causa de muerte y tercera causa dediscapacidad en el mundo.Objetivo:Evaluar la asociación entre variables clínicas, electrocardiográficas,escalas neurológicas en pacientes con ACV como predictoras de mortalidad a 3 meses posteriores al egreso hospitalario. Materiales y métodos: Estudio de cohorte prospectivo con muestreo no probabilístico, en pacientes mayores de 18 años con primer ACV. Se evaluaron variables demográficos,clínicas, escalas neurológicas del Instituto Nacional de Salud (NIHSS) y canadiense (CNS), variabilidad de la frecuencia cardiaca (VFC) y del QT (QTV), dispersión del QT. Se determinó la mortalidad a los tres meses de seguimiento. Se realizó análisis bivariado y de regresión logística múltiple cuyo desenlacefue mortalidad a tres meses post egreso hospitalario, incluyendo variables con baja correlación (r&lt; 0.4) y significancia estadística (p&lt;0.05).Resultados: Se incluyeron 92 pacientes, 13 de los cuales fallecieron en la fase de tratamiento intrahospitalario. Se realizó seguimiento durante tres meses después del egreso hospitalario en 81 pacientes. La mortalidad total en tres meses de seguimiento fue del 21.7%(n=20).Se identificaron cinco variables predictoras de mortalidad en el modelo final: puntaje de escala NIHSS,frecuencia cardiaca media, VLF QT ≥36.311, LF/HF ≤1.019, valores extremos r-MSD (≥7.985o≤2.363) de VFC. La capacidad discriminatoria del modelo mediante el análisis del área bajo la curva fue de 0.95, con valores de sensibilidad y especificidad del 60% y 93% respectivamente.Conclusión:Altos puntajes de escala NIHSS, VLF-QT, frecuencia cardiaca media, así como valores bajos LF/HF y valores extremosr-MSD, fueron factores de riesgo independientes para mortalidad a los 90 días después de un primer ACV.Palabras Clave: Accidente cerebrovascular, Electrocardiografia, Frecuencia cardiaca, Mortalidad, Predicción.ABSTRACTIntroduction:Stroke is the second cause of death and third cause of disability worldwide.Objective: To assess association between clinical and electrocardiographic variables, neurological scales in stroke patients like predictorsof mortality at three months after hospital discharge.Subjects and methods:Prospective cohort with nonprobabilistic sampling, in patients over 18 years with first stroke. Demographic and clinical variables, neurological scales (NIHSS, Canadian), heart rate (HRV) and QT variability (QTV), QT dispersion were evaluated. Mortality was determined during the 3 months follow up. Bivariate and multiple logistic regression analysis were performed with mortality at three months after discharge as outcome. Variables were included in the model if they have low correlation (r&lt;0.4) and significant statistically p values (P&lt; 0.05).Results: 92 patients were included in the study,13 patients died during the intra-hospital stay, 81 were followed at 3 months after their hospital discharge. Totalmortality in patients included at three months follow-up was 21.7 % (n=20). We identified five predictors of mortality in the final model: NIHSS score, mean heart rate, VLF QT ≥36,311, LF/HF ≤ 1,019, extreme values of r-MSD (≥ 7,985 or ≤ 2,363) of HRV. The area under the curve (AUC) of the model was 0,95 with sensitivity of 60% and specificity of 93%. Conclusions: High NIHSS scores, VLF-QT, mean heart rate, low values of LF/HF and high extreme values of r-MSD were independent risk factors for mortality at 90 days after a first stroke.Keywords: Stroke, Electrocardiography, Heart Rate, Mortality Prediction. Forma de citar: Rueda Ochoa OL, Torres Mantilla HA, Fernández Dulcey CA, Villa Acuña MM, Velasco Gómez ST, Niño Niño CA, Sierra Bueno DA. Factores clínicos y electrocardiográficos como predictores de mortalidad en pacientes en fase aguda de un primer evento cerebrovascular. rev.univ.ind.santander.salud 2014; 46(2): 147-158

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES) doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidencebased guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.Funding: J.M. Miró was a recipient of a personal 80:20 research grant from IDIBAPS during the period 2017–2021

A primary healthcare information intervention for communicating cardiovascular risk to patients with poorly controlled hypertension: The Education and Coronary Risk Evaluation (Educore) study-A pragmatic, cluster-randomized trial

PURPOSE: Uncertainty exists regarding the best way to communicate cardiovascular risk (CVR) to patients, and it is unclear whether the comprehension and perception of CVR varies according to the format used. The aim of the present work was to determine whether a strategy designed for communicating CVR information to patients with poorly controlled high blood pressure (HBP), but with no background of cardiovascular disease, was more effective than usual care in the control of blood pressure (BP) over the course of a year. METHODS: A pragmatic, two-arm, cluster-randomized controlled trial was performed. Consecutive patients aged 40-65 years, all diagnosed with HBP in the last 12 months, and all of whom showed poor control of their condition (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg), were recruited at 22 primary healthcare centres. Eleven centres were randomly assigned to the usual care arm, and 11 to the informative intervention arm (Educore arm). At the start of the study, the Educore arm subjects were shown the "low risk SCORE table", along with impacting images and information pamphlets encouraging the maintenance of good cardiovascular health. The main outcome variable measured was the control of HBP; the secondary outcome variables were SCORE table score, total plasma cholesterol concentration, use of tobacco, adherence to prescribed treatment, and quality of life. RESULTS: The study participants were 411 patients (185 in the Educore arm and 226 in the usual care arm). Multilevel logistic regression showed that, at 12 months, the Educore intervention achieved better control of HBP (OR = 1.57; 1.02 to 2.41). No statistically significant differences were seen between the two arms at 12 months with respect to the secondary outcomes. CONCLUSIONS: Compared to usual care, the Educore intervention was associated with better control of HBP after adjusting for age, baseline SBP and plasma cholesterol, at 12 months.This study was funded by the Spanish Ministry of Science and Innovation via the Instituto de Salud Carlos III, Subprograma de Proyectos de Investigación en Evaluación de Tecnologías Sanitarias y Servicios de Salud (PI 09/90354), and the Fundación de Investigación e Innovación Biomédica en Atención Primaria (FIIBAP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptS

Cardiac Extracellular Matrix Hydrogel Enriched with Polyethylene Glycol Presents Improved Gelation Time and Increased On-Target Site Retention of Extracellular Vesicles

Stem-cell-derived extracellular vesicles (EVs) have demonstrated multiple beneficial effects in preclinical models of cardiac diseases. However, poor retention at the target site may limit their therapeutic efficacy. Cardiac extracellular matrix hydrogels (cECMH) seem promising as drug-delivery materials and could improve the retention of EVs, but may be limited by their long gelation time and soft mechanical properties. Our objective was to develop and characterize an optimized product combining cECMH, polyethylene glycol (PEG), and EVs (EVs–PEG–cECMH) in an attempt to overcome their individual limitations: long gelation time of the cECMH and poor retention of the EVs. The new combined product presented improved physicochemical properties (60% reduction in half gelation time, p < 0.001, and threefold increase in storage modulus, p < 0.01, vs. cECMH alone), while preserving injectability and biodegradability. It also maintained in vitro bioactivity of its individual components (55% reduction in cellular senescence vs. serum-free medium, p < 0.001, similar to EVs and cECMH alone) and increased on-site retention in vivo (fourfold increase vs. EVs alone, p < 0.05). In conclusion, the combination of EVs–PEG–cECMH is a potential multipronged product with improved gelation time and mechanical properties, increased on-site retention, and maintained bioactivity that, all together, may translate into boosted therapeutic efficacy

Metodologías alternativas y colaborativas en el uso de la fotografía analógica en períodos de crisis II

Depto. de Ciencias de la Comunicación AplicadaFac. de Ciencias de la InformaciónFALSEsubmitte