Outbreak by serratia marcescens producing carbapenemases in an adult intensive care unit

Serratia marcescens (SM) es un bacilo Gram-negativo perteneciente a la familia Enterobacteriaceae, reconocido como patógeno oportunista asociado a brotes nosocomiales. Es naturalmente resistente a tetraciclina, amoxicilina, amoxicilina-clavulánico, cefalotina y colistin. En los últimos años existe preocupación por la gran dispersión de los bacilos gramnegativos resistentes a los carbapenémicos (KPC), también causantes de brotes nosocomiales; éstas aumentan la morbimortalidad, los costos hospitalarios y prolon-gan la internación. En nuestro hospital en la Unidad de Cuidados Intensivos (UCI) en el año 2012 tuvimos el primer caso de Infección por SM KPC, constituyéndose un gran desafío médico y de control de infecciones en cuanto al tratamiento, y medidas de control

Deep CO₂ in the end-Triassic Central Atlantic Magmatic Province

Large Igneous Province eruptions coincide with many major Phanerozoic mass extinctions, suggesting a cause-effect relationship where volcanic degassing triggers global climatic changes. In order to fully understand this relationship, it is necessary to constrain the quantity and type of degassed magmatic volatiles, and to determine the depth of their source and the timing of eruption. Here we present direct evidence of abundant CO2 in basaltic rocks from the end-Triassic Central Atlantic Magmatic Province (CAMP), through investigation of gas exsolution bubbles preserved by melt inclusions. Our results indicate abundance of CO2 and a mantle and/or lower-middle crustal origin for at least part of the degassed carbon. The presence of deep carbon is a key control on the emplacement mode of CAMP magmas, favouring rapid eruption pulses (a few centuries each). Our estimates suggest that the amount of CO2 that each CAMP magmatic pulse injected into the end-Triassic atmosphere is comparable to the amount of anthropogenic emissions projected for the 21st century. Such large volumes of volcanic CO2 likely contributed to end-Triassic global warming and ocean acidification

High-temperature oxidation of propanol isomers in the mixtures with N2O at high Ar dilution conditions

This work provides, for the first time, new information regarding the kinetics interaction between N2O and propyl alcohol isomers. To this end, the formation and consumption of atomic oxygen were measured behind the reflected shock waves using Atomic Resonance Absorption Spectroscopy (ARAS) technique for 1–10 ppm n- i-propanol + 10 ppm N2O + Ar mixtures, at 2–3 bar and over a wide temperature range of 1700–3200 K. The Konnov and POLIMI detailed combustion mechanisms were assessed against experimental data and also employed to study the main reactions influencing the oxidation dynamics of fuel mixtures under the investigated conditions. The study highlighted a certain difficulty by the models tested in predicting the formation of atomic oxygen at T < 2000 K. The rate of production and the sensitivity analysis was performed with the attempt to identify the most important reactions involved in the process oxidation for future kinetic model refinements

COMPASS criteria applied to a contemporary cohort of unselected patients with stable coronary artery diseases: insights from the START registry

Aims Recently, the cardiovascular outcomes for people using anticoagulation strategies (COMPASS) trial demonstrated that dual therapy reduced cardiovascular outcomes compared with aspirin alone in patients with stable atherosclerotic disease. Methods and We sought to assess the proportion of patients eligible for the COMPASS trial and to compare the epidemiology results and outcome of these patients with those without COMPASS inclusion or with any exclusion criteria in a contemporary, nationwide cohort of patients with stable coronary artery disease. Among the 4068 patients with detailed information allowing evaluation of eligibility, 1416 (34.8%) did not fulfil the inclusion criteria (COMPASS-Not-Included), 841 (20.7%) had exclusion criteria (COMPASS-Excluded), and the remaining 1811 (44.5%) were classified as COMPASS-Like. At 1 year, the incidence of major adverse cardiovascular event (MACE), a composite of cardiovascular death, myocardial infarction, and stroke, was 0.9% in the COMPASS-Not-Included and 2.0% in the COMPASS-Like (P = 0.01), and 5.0% in the COMPASS-Excluded group (P &lt; 0.0001 for all comparisons). Among the COMPASS-Like population, patients with multiple COMPASS enrichment criteria presented a significant increase in the risk of MACE (from 1.0% to 3.3% in those with 1 and &gt;_3 criteria, respectively; P = 0.012), and a modest absolute increase in major bleeding risk (from 0.2% to 0.4%, respectively; P = 0.46). Conclusion In a contemporary real-world cohort registry of stable coronary artery disease, most patients resulted as eligible for the COMPASS. These patients presented a considerable annual risk of MACE that consistently increases in the presence of multiple risk factors

Clinical outcomes, pharmacological treatment, and quality of life of patients with stable coronary artery diseases managed by cardiologists: 1-year results of the START study

Aims: We evaluated the 1-year clinical events, pharmacological management, and quality of life in a contemporary cohort of stable coronary artery disease (CAD) patients managed by cardiologists. Methods and results: START (STable Coronary Artery Diseases RegisTry) was a prospective, observational, nationwide study that enrolled 5070 stable CAD patients over 3 months in 183 cardiology centres in Italy. At 1 year, 4790 (94.5%) patients had data on vital status. Death occurred in 107 (2.2%) patients and the cause of death was cardiovascular in 41 (38.3%) of cases. Among the 4775 patients with follow-up data on clinical events available, a hospitalization due to cardiovascular and non-cardiovascular causes occurred in 523 (11.0%) and in 231 (4.8%) of cases, respectively. Over 60% of patients reported as 'no problems' in all domains (61.4-84.5%) of the EuroQoL quality of life 5D-5L questionnaire. Among the 3239 patients with clinical visit/telephone interview at follow-up, in whom optimal medical therapy (OMT; aspirin or thienopyridine, β-blocker, and statin) was prescribed at enrolment, 2971 (91.7%) were still receiving OMT at follow-up. At multivariable analysis, only increasing age (odds ratio 0.98; 95% confidence interval 0.97-0.99; P = 0.04) resulted as independent negative predictor of OMT persistence at 1 year from enrolment. Conclusion: In this large, contemporary registry, stable CAD patients managed by cardiologists presented a high rate of clinical events at 1 year. Nevertheless, the persistence to OMT and quality of life appeared reasonable