Immunonutrition as a potential strategy to prevent and cope with coronavirus disease (COVID-19)

In this article, a brief review of immunonutrition as a feasible alternative to modulating the immune system in defence of the SARS-CoV-2 that causes COVID-19 was presented. Immunonutrition is the nutritional practice that includes the necessary nutrients to modulate the activity of the immune system in health and disease. To date, studies are encouraging because they indicate that a good diet restores or improves the immune system's response to pathogens such as SARS-CoV-2. In addition, applying immunonutrition helps people recover with fewer sequelae after going through a serious infection in hospitalization and/or intensive care unit. Finally, it is suggested that immunonutrition be applied in conjunction with other good lifestyles and strictly following current health recommendations.Revisión por pare

Do emergency department patients receive a pathological diagnosis? A nationally-representative sample.

Introduction Understanding the cause of patients’ symptoms often requires identifying a pathological diagnosis. A single-center study found that many patients discharged from the emergency department (ED) do not receive a pathological diagnosis. We analyzed 17 years of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to identify the proportion of patients who received a pathological diagnosis at ED discharge. We hypothesized that many patients do not receive a pathological diagnosis, and that the proportion of pathological diagnoses increased between 1993 and 2009. Methods Using the NHAMCS data from 1993–2009, we analyzed visits of patients age ≥18 years, discharged from the ED, who had presented with the three most common chief complaints: chest pain, abdominal pain, and headache. Discharge diagnoses were coded as symptomatic versus pathological based on a pre-defined coding system. We compared weighted annual proportions of pathological discharge diagnoses with 95% CIs and used logistic regression to test for trend. Results Among 299,919 sampled visits, 44,742 met inclusion criteria, allowing us to estimate that there were 164 million adult ED visits presenting with the three chief complaints and then discharged home. Among these visits, the proportions with pathological discharge diagnosis were 55%, 71%, and 70% for chest pain, abdominal pain, and headache, respectively. The total proportion of those with a pathological discharge diagnosis decreased between 1993 and 2009, from 72% (95% CI, 69–75%) to 63% (95% CI, 59–66%). In the multivariable logistic regression model, those more likely to receive pathological diagnoses were females, African-American as compared to Caucasian, and self-pay patients. Those more likely to receive a symptomatic diagnosis were patients aged 30–79 years, with visits to EDs in the South or West regions, and seen by a physician in the ED. Conclusion In this analysis of a nationally-representative database of ED visits, many patients were discharged from the ED without a pathological diagnosis that explained the likely cause of their symptoms. Despite advances in diagnostic testing, the proportion of pathological discharge diagnoses decreased. Future studies should investigate reasons for not providing a pathological diagnosis and how this may affect clinical outcomes

Importance of Glutamate Dehydrogenase (GDH) in Clostridium difficile Colonization In Vivo

Citation: Girinathan, B. P., Braun, S., Sirigireddy, A. R., Lopez, J. E., & Govind, R. (2016). Importance of Glutamate Dehydrogenase (GDH) in Clostridium difficile Colonization In Vivo. Plos One, 11(7), 18. doi:10.1371/journal.pone.0160107Clostridium difficile is the principal cause of antibiotic-associated diarrhea. Major metabolic requirements for colonization and expansion of C. difficile after microbiota disturbance have not been fully determined. In this study, we show that glutamate utilization is important for C. difficile to establish itself in the animal gut. When the gluD gene, which codes for glutamate dehydrogenase (GDH), was disrupted, the mutant C. difficile was unable to colonize and cause disease in a hamster model. Further, from the complementation experiment it appears that extracellular GDH may be playing a role in promoting C. difficile colonization and disease progression. Quantification of free amino acids in the hamster gut during C. difficile infection showed that glutamate is among preferred amino acids utilized by C. difficile during its expansion. This study provides evidence of the importance of glutamate metabolism for C. difficile pathogenesis

Understanding atrioventricular septal defect: Anatomoechocardiographic correlation

<p>Abstract</p> <p>Objective</p> <p>Correlate the anatomic features of atrioventricular septal defect with echocardiographic images.</p> <p>Materials and methods</p> <p>Sixty specimen hearts were studied by sequential segmental analysis. Echocardiograms were performed on 34 patients. Specimen hearts with findings equivalent to those of echocardiographic images were selected in order to establish an anatomo-echocardiographic correlation.</p> <p>Results</p> <p>Thirty-three specimen hearts were in situs solitus, 19 showed dextroisomerism, 6 were in situs inversus and 2 levoisomerism. Fifty-eight had a common atrioventricular valve and 2 had two atrioventricular valves. Rastelli types were determined in 21 hearts. Nine were type A, 2 intermediate between A and B, 1 mixed between A and B, 4 type B and 5 type C. Associated anomalies included pulmonary stenosis, pulmonary atresia atrial septal defect, patent ductus arteriosus and anomalous connection of pulmonary veins. Echocardiograms revealed dextroisomerism in 12 patients, situs solitus in 11, levoisomerism in 7 and situs inversus in 4. Thirty-one patients had common atrioventricular valves and three two atrioventricular valves. Rastelli types were established in all cases with common atrioventricular valves; 17 had type A canal defects, 10 type B, 3 intermediate between A and B, 1 mixed between A and B and 3 type C. Associated anomalies included regurgitation of the atrioventricular valve, pulmonary stenosis, anomalous connection of pulmonary veins, pulmonary hypertension and pulmonary atresia.</p> <p>Conclusion</p> <p>Anatomo-echocardiographic correlation demonstrated a high degree of diagnostic precision with echocardiography.</p

Variable Access to Immediate Bedside Ultrasound in the Emergency Department

Objective: Use of bedside emergency department (ED) ultrasound has become increasingly important for the clinical practice of emergency medicine (EM). We sought to evaluate differences in the availability of immediate bedside ultrasound based on basic ED characteristics and physician staffing.Methods: We surveyed ED directors in all 351 EDs in Colorado, Georgia, Massachusetts, and Oregon between January and April 2009. We assessed access to bedside ED ultrasound by the question: “Is bedside ultrasound available immediately in the ED?” ED characteristics included location, visit volume, admission rate, percent uninsured, total emergency physician full-time equivalents and proportion of EM board-certified (BC) or EM board-eligible (BE) physicians. Data analysis used chi-square tests and multivariable logistical regression to compare differences in access to bedside ED ultrasound by ED characteristics and staffing.Results: We received complete responses from 298 (85%) EDs. Immediate access to bedside ultrasound was available in 175 (59%) EDs. ED characteristics associated with access to bedside ultrasound were: location (39% for rural vs. 71% for urban, P20%] rates, P<0.001); and EM BC/BE physicians (26% for EDs with a low percentage [0-20%] vs.74% for EDs with a high percentage [≥80%], P<0.001).Conclusion: U.S. EDs differ significantly in their access to immediate bedside ultrasound. Smaller, rural EDs and those staffed by fewer EM BC/BE physicians more frequently lacked access to immediate bedside ultrasound in the ED. [West J Emerg Med. 2011;12(1):96-99.

Mid-infrared optical parametric amplifier using silicon nanophotonic waveguides

All-optical signal processing is envisioned as an approach to dramatically decrease power consumption and speed up performance of next-generation optical telecommunications networks. Nonlinear optical effects, such as four-wave mixing (FWM) and parametric gain, have long been explored to realize all-optical functions in glass fibers. An alternative approach is to employ nanoscale engineering of silicon waveguides to enhance the optical nonlinearities by up to five orders of magnitude, enabling integrated chip-scale all-optical signal processing. Previously, strong two-photon absorption (TPA) of the telecom-band pump has been a fundamental and unavoidable obstacle, limiting parametric gain to values on the order of a few dB. Here we demonstrate a silicon nanophotonic optical parametric amplifier exhibiting gain as large as 25.4 dB, by operating the pump in the mid-IR near one-half the band-gap energy (E~0.55eV, lambda~2200nm), at which parasitic TPA-related absorption vanishes. This gain is high enough to compensate all insertion losses, resulting in 13 dB net off-chip amplification. Furthermore, dispersion engineering dramatically increases the gain bandwidth to more than 220 nm, all realized using an ultra-compact 4 mm silicon chip. Beyond its significant relevance to all-optical signal processing, the broadband parametric gain also facilitates the simultaneous generation of multiple on-chip mid-IR sources through cascaded FWM, covering a 500 nm spectral range. Together, these results provide a foundation for the construction of silicon-based room-temperature mid-IR light sources including tunable chip-scale parametric oscillators, optical frequency combs, and supercontinuum generators

Modelling of photonic wire Bragg Gratings

Some important properties of photonic wire Bragg grating structures have been investigate. The design, obtained as a generalisation of the full-width gap grating, has been modelled using 3D finite-difference time-domain simulations. Different types of stop-band have been observed. The impact of the grating geometry on the lowest order (longest wavelength) stop-band has been investigated - and has identified deeply indented configurations where reduction of the stop-bandwidth and of the reflectivity occurred. Our computational results have been substantially validated by an experimental demonstration of the fundamental stop-band of photonic wire Bragg gratings fabricated on silicon-on-insulator material. The accuracy of two distinct 2D computational models based on the effective index method has also been studied - because of their inherently much greater rapidity and consequent utility for approximate initial designs. A 2D plan-view model has been found to reproduce a large part of the essential features of the spectral response of full 3D models

Detección inmunohistoquímica del virus de Epstein-Barr en pacientes con linfoma

El virus de Epstein-Barr es un gammaherpes virus que infecta principalmente a linfocitos B permaneciendo en un estado de latencia en el interior del mismo, pudiendo también infectar a linfocitos T y células epiteliales. La persistencia de la infección viral inmortaliza a los linfocitos y favorece el desarrollo de procesos linfoproliferativos malignos como linfomas. Si bien se conoce que la relación entre la infección crónica del virus y el desarrollo de linfoma, varía de acuerdo al tipo histológico, se incrementa en pacientes inmunocomprometidos y de edad avanzada, la evidencia científica indica no sólo la importancia de este virus como agente infeccioso asociado con la etiología de esta neoplasia, sino también como un marcador asociado a respuesta refractaria y peor supervivencia. El objetivo de este estudio observacional descriptivo, fue detectar la presencia del Epstein-Barr virus por técnicas de inmunohistoquímica empleando anticuerpos monoclonales anti antígeno viral proteína latente de membrana en 86 pacientes con linfoma. La positividad para proteína en el total de pacientes con linfoma fue del 44%, correspondiendo el 20% a pacientes con linfoma de Hodgkin y el 24% a pacientes con linfoma no Hodgkin. La detección del virus en estas enfermedades, contribuye al manejo clínico de las mismas ya que el virus no sólo tiene un rol etiológico, sino además es un marcador pronóstico importante, incluso de interés terapéutico

Perfil de resistencia de Staphylococcus spp aislados de hemocultivos en el Hospital Central del Instituto de Previsión Social

Las infecciones nosocomiales por Staphylococcus spp constituyen uno de los problemas de mayor preocupación en salud pública en todo el mundo. Debido a que existen diferencias según centro hospitalario, paciente, área y tiempo de internación es esencial conocer el perfil de resistencia a los antibióticos más utilizados de las cepas de Staphylococcus involucradas en estas infecciones. El objetivo del presente estudio fue determinar el perfil de resistencia de los aislados de Staphylococcus aureus (Sau) y Estafilococo coagulasa negativo (ECN) de muestras de hemocultivos de pacientes adultos, pediátricos y recién nacidos internados entre el 1 de junio de 2005 al 30 de junio de2006, en varios servicios del Hospital Central del Instituto de Previsión Social (IPS.).Se realizó un análisis retrospectivo de los resultados de antibiograma realizados en el Servicio de Microbiología del IPS. Los antibióticos evaluados fueron oxacilina (OXA),penicilina (PEN), eritromicina (ERY), clindamicina (CLI), ciprofloxacina (CIP), gentamicina (GEN), trimetoprim-sulfametoxazol (TMS), tetraciclina (TET) y vancomicina (VAN). De 5698 hemocultivos realizados en este periodo, 1706 (30%) fueron positivos. De estos, en755 (44%) se aisló Staphylococcus spp; correspondiendo 327 (43,3%) a Sau y 428 (56,7%) a ECN. El perfil de resistencia para Sau y ECN fue respectivamente como sigue: OXA 64% y 87%, PEN 96% y 95%, ERY 48% y 52%, CIP 42% y 40%, GEN 48% y 48% yno presentaron R a VAN. El 58% de los Sau y el 56% de los ECN fueron resistentes a más de 4 antibióticos. La alta frecuencia de resistencia a la meticilina y la poliresistencia hallada en este trabajo deben ser tenidos en cuenta a la hora de indicar esquemas deantibióticos empíricos y para realizar ajustes oportunos de los ya iniciados. No se encontró ninguna cepa resistente a la vancomicina, que es considerada el mejor antimicrobiano disponible para el tratamiento de infecciones por estafilococos resistentesa las penicilinas que no son inhibidas por las penicilinasas