Background
Chronic inflammation and gastric carcinogenesis show a close association, so gene polymorphisms that modify the intensity of the inflammatory response may contribute to variations in ...gastric cancer risk.
Aims
The purpose of this study was to investigate the combined effect of the pro- and anti-inflammatory cytokines and toll-like receptors polymorphisms on the chronic gastritis and gastric cancer risk in a Brazilian population sample.
Methods
We evaluated 669 DNA samples (200 of gastric cancer GC, 229 of chronic gastritis CG, and 240 of healthy individuals C). Ten polymorphisms were genotyped:
IL
-
1RN
and
TLR2
-196 to -174
del
using the allele-specific PCR method and
TNF
-
A
(rs1800629; rs1799724),
TNF
-
B
(rs909253)
, IL
-
8
(rs4073; rs2227532)
, IL
-
10
(rs1800872) and
TLR4
(rs4986790; rs4986791) using PCR–RFLP.
Results
Polymorphisms
TNF
-
A
-
308G/A, IL
-
8
-
251A/T, TNF
-
B
+
252A/G
and
TLR4
+
1196C/T
were not associated with risk of any gastric lesion. However, an association with increased risk for GC was observed for polymorphisms
IL
-
1RNL/2
(
p
< 0.001),
TNF
-
A
-
857C/T
(
p
= 0.022),
IL
-
8
-
845T/C
(
p
< 0.001)
, IL
-
10
-
592C/A
(
p
< 0.001),
TLR2ins/del
(
p
< 0.001), and
TLR4
+
896A/G
(
p
= 0.033). In CG, an association was observed only with polymorphisms
IL
-
1RNL/2
and
IL
-
10
-
592A/C
(
p
< 0.001 for both). A combined analysis of these six polymorphisms associated with GC revealed a profile with two to four combined genotypes which confer a higher risk of gastric carcinogenesis, with an OR increased 2.95-fold to 50.4-fold, highlighting the combinations
IL
-
1RN2/TNF
-
A
-
857T/IL
-
8
-
845C, IL
-
1RN2/IL
-
8
-
845C/TLR2del, IL
-
1RN2/IL
-
10
-
592A/TLR4
+
896G, IL
-
10
-
592A/TLR2del/TLR4
+
896G,
and
IL
-
1RN2/TNFA
-
857T/IL8
-
845C/TLR2del.
Conclusions
Our findings evidenced that the combined effect of polymorphisms in genes involved in the inflammatory process may potentiate the risk of gastric cancer, thus emphasizing the importance of evaluating multiple polymorphisms together.
Our aim was to identify optimal cardiopulmonary exercise testing (CPET) threshold values that distinguish disease severity progression in patients with co-existing systolic heart failure (HF) and ...chronic obstructive pulmonary disease (COPD), and to evaluate the impact of the cut-off determined on the prognosis of hospitalizations. We evaluated 40 patients (30 men and 10 woman) with HF and COPD through pulmonary function testing, doppler echocardiography and maximal incremental CPET on a cycle ergometer. Several significant CPET threshold values were identified in detecting a forced expiratory volume in 1 second (FEV
) < 1.6 L: 1) oxygen uptake efficiency slope (OUES) < 1.3; and 2) circulatory power (CP) < 2383 mmHg.mlO
.kg
. CPET significant threshold values in identifying a left ventricular ejection fraction (LVEF) < 39% were: 1) OUES: < 1.3; 2) CP < 2116 mmHg.mlO
.kg
.min
and minute ventilation/carbon dioxide production (V̇
/V̇CO
) slope>38. The 15 (38%) patients hospitalized during follow-up (8 ± 2 months). In the hospitalizations analysis, LVEF < 39% and FEV
< 1.6, OUES < 1.3, CP < 2116 mmHg.mlO
.kg
.min
and V̇
/V̇CO
> 38 were a strong risk predictor for hospitalization (P ≤ 0.050). The CPET response effectively identified worsening disease severity in patients with a HF-COPD phenotype. LVEF, FEV
CP, OUES, and the V̇
/V̇CO
slope may be particularly useful in the clinical assessment and strong risk predictor for hospitalization.
Sepsis is associated with marked alterations in hemodynamic responses, autonomic dysfunction and impaired vascular function. However, to our knowledge, analysis of noninvasive markers to identify ...greater risk of death has not yet been investigated. Thus, our aim was to explore the prognostic utility of cardiac output (CO), stroke volume (SV), indices of vagal modulation (RMSSD and SD1), total heart rate variability (HRV) indices and FMD of brachial artery (%FMD), all measured noninvasively, in the first 24 hours of the diagnosis of sepsis.
60 patients were recruited at ICU between 2015 and 2017 and followed by 28 days. CO, SV, RR intervals were measurement. Doppler ultrasound was used to assess brachial artery FMD and the hyperemic response were obtained (%FMD). Patients were divided by survivors (SG) and nonsurvivors groups (NSG).
A total of 60 patients were analysed (SG = 21 and NSG = 39). Survivors were younger (41±15 years vs. 55±11 years) and used less vasoactive drugs. As expected, APACHE and SOFA scores were lower in NSG compared to SG. In addition, higher SD1, triangular index, % FMD, velocity baseline and hyperemia flow velocity as well as lower HR values were observed in the SG, compared to NSG (P<0.05). Interestingly, RMSSD and SD1 indices were independent predictors of %FMD, ΔFMD and FMDpeak. RMSSD threshold of 10.8ms and %FMD threshold of -1 were optimal at discriminatomg survivors and nonsurvivors.
Noninvasive measurements of autonomic and endotelial function may be important markers of sepsis mortality, which can be easily obtained in the early stages of sepsis at the bedside.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Detection of colonization by carbapenem-resistant Enterobacterales varies according to the method used.•KPC-producing Enterobacterales can be resistant to at least one carbapenem with ertapenem MIC ...lower (≤ 4 μg/ml) than imipenem and/or meropenem MIC (≥16 μg/ml) by the Vitek 2 system.•KPC-producing Enterobacterales can be susceptible to carbapenems using disk diffusion and/or gradient diffusion methods and resistant using Vitek 2 system.
KPC-producing K. pneumoniae is an endemic challenge. Seven KPC-producing Enterobacterales showed unusual carbapenems susceptibility profile. These strains were resistance at least one carbapenem and the ertapenem MIC was lower than imipenem and/or meropenem MICs using Vitek 2™ system (bioMerieux). When E-test™ and disk diffusion methods were performed the carbapenems showed susceptible results.
Over a period of 7 months, 151 consecutive methicillin-resistant Staphylococcus aureus blood isolates were evaluated. None was community acquired. Twenty (13%) were susceptible to four or more ...antimicrobials, and 95% of these isolates were identified as SCCmec type IV. Molecular typing demonstrated four patterns, with one predominant pattern. Although usually community acquired, SCCmec type IV in our setting is clearly nosocomial.
Background: Age-related changes in pulmonary function increase respiratory muscle work. In the face of this increased demand, poor muscle mass, frequently associated with age and multi-morbidity, can ...reduce endurance and strength of respiratory muscles. Furthermore, poor muscle mass may per se contribute to exercise intolerance and lower physical performance. The aim of the study was to evaluate if respiratory muscle strength has a significant impact on physical performance in an elderly population.
We included 68 patients (28 men and 40 women) aged over 65 years (mean 79 years, standard deviation SD 6) in stable condition at discharge from our acute care geriatric ward. We assessed the function of respiratory muscle by measuring maximal inspiratory and expiratory pressures (MIP, MEP) and physical function using the 6-Minute Walk Test (6MWT).
The mean age of our sample was 78.2 years (SD 6.1). There was a statistically significant correlation between MIP or MEP and 6MWT distance (MIP, r=0.43, p<0.001; MEP, r=0.41, p=0.001). The association between respiratory pressures and 6MWT was maintained after adjustment for forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), age, sex, fat-free mass index (FFMI), and leg strength. The multiple regression model showed a significant relation between 6-Minute Walk Test distance (6MWD) and both MIP and MEP after correction for sex, age, FEV1, and FVC. Furthermore, MEP can significant predict poorer performance at 6MWD in a multiple logistic regression model.
Reduced respiratory muscle strength is independently associated with worse physical performance in elderly patients.
Abstract
Background
Overcrowded emergency departments (EDs) may increase the risk of carbapenem-resistant Enterobacterales (CRE) transmission.
Methods
We conducted a quasi-experimental study divided ...into 2 phases (baseline and intervention) to investigate the impact of an intervention on the acquisition rate and identify risk factors for CRE colonization in an ED of a tertiary academic hospital in Brazil. In both phases, we did universal screening with rapid molecular test (blaKPC, blaNDM, blaOXA48, blaOXA23, and blaIMP) and culture. At baseline, both screening test results were not reported, and patients were put under contact precautions (CP) based on previous colonization or infection by multidrug-resistant organisms. During the intervention, all patients hospitalized in the ED were placed in empiric CP and the result of CRE screening was reported; if negative, patients were released from CP. Patients were rescreened if they stayed >7 days in the ED or were transferred to an intensive care unit.
Results
A total of 845 patients were included: 342 in baseline and 503 in intervention. Colonization at admission was 3.4% by culture and molecular test. Acquisition rates during ED stay dropped from 4.6% (11/241) to 1% (5/416) during intervention (P = .06). The aggregated antimicrobial use in the ED decreased from phase 1 to phase 2 (804 defined daily doses DDD/1000 patients to 394 DDD/1000 patients, respectively). Length of stay >2 days in the ED was a risk factor for CRE acquisition (adjusted odds ratio, 4.58 95% confidence interval, 1.44–14.58; P = .01).
Conclusions
Early empiric CP and rapid identification of CRE-colonized patients reduce cross-transmission in ED. Nevertheless, staying >2 days in ED compromised efforts.
This quasi-experimental study shows that early contact precautions and rapid identification of patients colonized with carbapenem-resistant Enterobacterales was associated with a nonsignificant reduction of cross-transmission in emergency departments.
Colistin resistance involving Gram-negative bacilli infections is a challenge for health institutions around of the world. Carbapenem-resistance among these isolates makes colistin the last ...therapeutic option for this treatment. Colistin resistance among Enterobacteriaceae, Acinetobacter spp., and Pseudomonas spp. was evaluated between 2010 and 2014 years, at Hospital das Clínicas, São Paulo, Brazil. Over five years 1346 (4.0%) colistin resistant Gram-negative bacilli were evaluated. Enterobacteriaceae was the most frequent (86.1%) pathogen isolated, followed by Acinetobacter spp. (7.6%), and Pseudomonas spp. (6.3%). By temporal analysis there was a trend for an increase of colistin resistance among Enterobacteriaceae, but not among non-fermentative isolates. Among 1346 colistin resistant isolates, carbapenem susceptibility was observed in 21.5%. Colistin resistance in our hospital has been alarmingly increased among Klebsiella pneumoniae isolates in both KPC positive and negative, thus becoming a therapeutic problem.
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