Many essential oils (EOs) of different plant species possess interesting antimicrobial effects on buccal bacteria and antioxidant properties. Eugenia klotzschiana Berg (pêra-do-cerrado, in ...Portuguese) is a species of Myrtaceae with restricted distribution in the Cerrado. The essential oils were extracted through the hydrodistillation technique using a modified Clevenger apparatus (2 hours) and chemically characterized by GC-MS. The major compounds were α-copaene (10.6 %) found in oil from leaves in natura, β-bisabolene (17.4 %) in the essential oil from dry leaves and α-(E)-bergamotene (29.9 %) in oil from flowers. The antioxidant activity of essential oils showed similarities in both methods under analysis (DPPH and ABTS˙+) and the results suggested moderate to high antioxidant activity. The antibacterial activity was evaluated by determining minimum inhibitory concentrations (MICs), using the microdilution method. MIC values below 400 µg/mL were obtained against Streptococcus salivarius (200 µg/mL), S. mutans (50 µg/mL), S. mitis (200 µg/mL) and Prevotella nigrescens (50 µg/mL). This is the first report of the chemical composition and antibacterial and antioxidant activities of the essential oils of E. klotzschiana. These results suggest that E. klotzschiana, a Brazilian plant, provide initial evidence of a new and alternative source of substances with medicinal interest.
Purpose Hereditary progressive arthro‐ophthalmopathy, also called Stickler syndrome, is an autosomal dominant genetic disease affecting connective tissue collagen. It is considered the leading cause ...of inherited retinal detachment in all ages and produces multisystem manifestations such as premature arthritis, micrognathia or eye disorder.
Methods A 31‐year‐old man reports hereditary progressive arthro‐ophthalmopathy. He presented degenerative myopia, congenital cataract and bilateral recurrent retinal detachments during childhood. At birth, he presented craniofacial anomalies, hearing loss and flat feet. When he was 6 years old, he suffered a retinal detachment associated with giant tear, which was treated with 20G pars plana vitrectomy and injection of silicone oil. At 22 years, the right eye presented another retinal detachment that was treated with silicone band placement, cryotherapy and C3F8 gas intravitreal injection. Two months later the retinal detachment recurred in right eye, needing 23 G pars plana vitrectomy and intravitreal silicone oil implantation.
Results The patient presented several ophthalmic complications such as post‐surgical ocular hypertension and retinal tears requiring selective photocoagulation with argon laser in the right eye. Recently, genetic diagnosis was confirmed by COL11A1 gene mutation.
Conclusion Development, prevention and therapeutic management of ophthalmic complications during 26 years follow‐up are presented. The importance of early diagnosis and follow‐up by a vitreoretinal surgeon are also emphasized.
INTRODUCTION
Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm‐FINGERS) is the first non‐pharmacological multicenter randomized clinical trial (RCT) to prevent ...cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization.
METHODS
This 1‐year RCT (working on a 1‐year extension) investigates the feasibility of a multi‐domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries.
RESULTS
Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome).
DISCUSSION
LatAm‐FINGERS overcame a significant challenge to combine the region's diversity into a multi‐domain risk reduction intervention feasible across LA while preserving the original FINGER design.
The surface represents the two main thematic axes of the article. The left section portrays the harmonization processes among the members of LatAm FINGERS, and with other relevant initiatives, while the right section depicts the trial design, featuring two intervention branches (i.e., Systematic and Flexible) surrounded by their respective components. Additionally, the right column showcases the most relevant results, including the number of participants randomized per country, the percentage of individuals affected by metabolic syndrome, and the ethnic distribution of the sample.
The issue of pulse pile-up is frequently encountered in nuclear experiments involving high counting rates, which will distort the pulse shapes and the energy spectra. A digital method of off-line ...processing of pile-up pulses is presented. The pile-up pulses were firstly identified by detecting the downward-going zero-crossings in the first-order derivative of the original signal, and then the constituent pulses were reconstructed based on comparing the pile-up pulse with four models that are generated by combining pairs of neutron and γ standard pulses together with a controllable time interval. The accuracy of this method in resolving the pile-up events was investigated as a function of the time interval between two pulses constituting a pile-up event. The obtained results show that the method is capable of disentangling two pulses with a time interval among them down to 20 ns, as well as classifying them as neutrons or γ rays. Furthermore, the error of reconstructing pile-up pulses could be kept below 6% when successive peaks were separated by more than 50 ns. By applying the method in a high counting rate of pile-up events measurement of the NEutron Detector Array (NEDA), it was empirically found that this method can reconstruct the pile-up pulses and perform neutron-γ discrimination quite accurately. It can also significantly correct the distorted pulse height spectrum due to pile-up events.
Abstract
Background and Hypothesis
There is limited evidence to guide the approaches to clozapine treatment. Accordingly, an international initiative was undertaken with the aim of developing ...consensus recommendations for the optimization of clozapine monotherapy.
Study Design
We conducted an online Delphi survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group comprising experts from twenty-nine countries. The threshold criterion for a consensus recommendation was ≥ 75% agreement (“agree” and “strongly agree” responses) on a question. Agreement of ≥ 50% but < 75% in a second or third Delphi round was deemed to provide guidance.
Study Results
Forty-nine (first round), 32 (second round), and 48 (third round) of the 91 current TRRIP members participated. Expert recommendations at ≥ 75% comprised second-line treatment with clozapine in cases of persistent positive symptoms with co-occurring extrapyramidal symptoms, tardive dyskinesia, or suicidality/aggression. There was considerable disagreement on myocarditis screening parameters. The management of somatic and neuropsychiatric adverse drug reactions warrants further research for more evidence-based recommendations. Rechallenge with clozapine was recommended for eosinophilia, sinus tachycardia and fever and guidance (agreement ≥ 50%) was reached for pneumonia and thrombocytopenia.
Conclusions
Given the limited evidence available, this consensus-based series of recommendations and guidance statements supports clinical decision-making to optimize clozapine monotherapy and provides guidance for future research in treatment-resistant schizophrenia.
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health ...Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine SEMICYUC, Spanish Society of Pulmonologists SEPAR, Spanish Society of Emergency SEMES, Spanish Society of Anesthesiology, Reanimation, and Pain SEDAR) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.
BackgroundTranexamic acid reduced haematoma expansion and early death, but did not improve functional outcome in the tranexamic acid for hyperacute spontaneous intracerebral haemorrhage-2 (TICH-2) ...trial. In a predefined subgroup, there was a statistically significant interaction between prerandomisation baseline systolic blood pressure (SBP) and the effect of tranexamic acid on functional outcome (p=0.019).MethodsTICH-2 was an international prospective double-blind placebo-controlled randomised trial evaluating intravenous tranexamic acid in patients with acute spontaneous intracerebral haemorrhage (ICH). Prerandomisation baseline SBP was split into predefined ≤170 and >170 mm Hg groups. The primary outcome at day 90 was the modified Rankin Scale (mRS), a measure of dependency, analysed using ordinal logistic regression. Haematoma expansion was defined as an increase in haematoma volume of >33% or >6 mL from baseline to 24 hours. Data are OR or common OR (cOR) with 95% CIs, with significance at p<0.05.ResultsOf 2325 participants in TICH-2, 1152 had baseline SBP≤170 mm Hg and were older, had larger lobar haematomas and were randomised later than 1173 with baseline SBP>170 mm Hg. Tranexamic acid was associated with a favourable shift in mRS at day 90 in those with baseline SBP≤170 mm Hg (cOR 0.73, 95% CI 0.59 to 0.91, p=0.005), but not in those with baseline SBP>170 mm Hg (cOR 1.05, 95% CI 0.85 to 1.30, p=0.63). In those with baseline SBP≤170 mm Hg, tranexamic acid reduced haematoma expansion (OR 0.62, 95% CI 0.47 to 0.82, p=0.001), but not in those with baseline SBP>170 mm Hg (OR 1.02, 95% CI 0.77 to 1.35, p=0.90).ConclusionsTranexamic acid was associated with improved clinical and radiological outcomes in ICH patients with baseline SBP≤170 mm Hg. Further research is needed to establish whether certain subgroups may benefit from tranexamic acid in acute ICH.Trial registration numberISRCTN93732214.
Introduction
Advancements in and accessibility to effective antiretroviral therapy has improved the life expectancy of people living with HIV, increasing the proportion of people living with HIV ...reaching older age (≥60 years), making this population's health‐related quality of life (HRQoL) more relevant. Our aim was to identify the determinants of poor HRQoL in people living with HIV aged ≥60 years and compare them with those of their younger counterparts.
Methods
We used data from the ‘Vive+’ study, a cross‐sectional survey conducted between October 2019 and March 2020, nested within the PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands, Spain. We used the 12‐item short‐form survey (SF‐12), divided into a physical component summary (PCS) and a mental component summary (MCS), to evaluate HRQoL. We used the least absolute shrinkage and selection operator for variable selection and used multivariable regression models to identify predictors.
Results
Of the 1060 people living with HIV (78.6% males) who participated in the study, 209 (19.7%) were aged ≥60 years. When comparing older people living with HIV (≥60 years) and their younger counterparts, older people exhibited a worse PCS (median 51.3 interquartile range {IQR} 46.0–58.1 vs. 46.43 IQR 42.5–52.7, p < 0.001) but a similar MCS (median 56.0 IQR 49.34–64.7 vs. 57.0 IQR 48.9–66.3, p = 0.476). In the multivariable analysis, cognitive function correlated with a PCS (β correlation factor β −0.18, p = 0.014), and depressive symptoms and satisfaction with social role correlated with an MCS (β 0.61 and β −0.97, respectively, p < 0.001) in people living with HIV aged ≥60 years.
Conclusion
Depressive symptoms, poor cognitive function, and lower satisfaction with social roles predict poorer HRQoL in older people living with HIV. These factors need to be considered when designing targeted interventions.
Methicillin-resistant
Staphylococcus aureus
(MRSA) is a pathogen of public health importance. In Chile, the Cordobes/Chilean clone was the predominant healthcare-associated MRSA (HA-MRSA) clone in ...1998. Since then, the molecular epidemiological surveillance of MRSA has not been performed in Southern Chile. We aimed to investigate the molecular epidemiology of HA-MRSA infections in Southern Chile to identify the MRSA clones involved, and their evolutionary relationships with epidemic international MRSA lineages. A total of 303 single inpatient isolates of
S. aureus
were collected in the Valdivia County Hospital (2007–2008), revealing 33 % (100 MRSA/303) prevalence for HA-MRSA infections. The SCC
mec
types I and IV were identified in 97 % and 3 % of HA-MRSA, respectively. All isolates lacked the
pvl
genes. A random sample (
n
= 29) of all MRSA was studied by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), SCC
mec
subtyping,
agr
and
spa
typing, and virulence genes profiling. PFGE analysis revealed the predominance (89 %, 26/29) of pulsotype A and three additional pulsotypes, designated H1, I33, and G1. Pulsotype A (ST5-SCC
mec
I-
spa
-t149) is clonally related to the Cordobes/Chilean clone. Pulsotype H1 (ST5-SCC
mec
IVNT-
spa
-t002) is genetically related to the Pediatric clone (ST5-SCC
mec
IV). Pulsotype I33 (ST5-SCC
mec
IVc-
spa
-t002) is clonally related by PFGE to the community-associated MRSA (CA-MRSA) clone spread in Argentina, I-ST5-IVa-PVL
+
. The G1 pulsotype (ST8-SCC
mec
IVc-
spa
-t024) is clonally related to the epidemic USA300 CA-MRSA. Here, we demonstrate the stability of the Cordobes/Chilean clone over time as the major HA-MRSA clone in Southern Chile. The identification of two CA-MRSA clones might suggest that these clones have entered into the healthcare setting from the community. These results emphasize the importance of the local surveillance of MRSA infections in the community and hospital settings.
Dissolved organic carbon (DOC) plays an essential role in the global marine carbon cycle, with coastal vegetated communities as important DOC producers. However, the ultimate fate of this DOC remains ...still largely unknown due to the lack of knowledge about its chemical composition and lability. Furthermore, global change could alter both DOC fluxes and its bioavailability, affecting the carbon sequestration capacity of coastal vegetated communities. This study explores, in two contrasting seasons (winter and summer), the effects of an in situ simulated marine heatwave on carbon metabolism and DOC fluxes produced by seagrass (Cymodocea nodosa) and macroalgae (Caulerpa prolifera) communities. In addition, the fluorescent characteristics and biodegradability of the dissolved organic matter released directly by the communities under such conditions are evaluated. Under marine heatwave conditions, a significant increase in net community production (NCP) in C. nodosa and a shift to negative DOC fluxes in C. prolifera were observed. In control treatments, the seagrass‐dominated community produced a substantial amount of labile (between 44% and 58%) and recalcitrant DOC (between 42% and 56%), while C. prolifera community produced mainly recalcitrant DOC (between 64% and 87%). Therefore, this research revealed that temperature is an important factor determining the NCP in benthic communities and the chemical structure and bioavailability of DOC produced by these communities, since both communities tended to produce more humic‐like and less bioavailable DOC with increasing temperature.
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