OBJECTIVEThe condition of critically ill patients in the emergency department (ED) varies from moment to moment. The aims of this study are to quantify sequential organ failure assessment (SOFA) and ...changes in SOFA scores over time and determine its prognostic impact.
PATIENTS AND METHODSThis is a prospective observational cohort study. We included 269 patients consecutively admitted to the ICU from the ED over 18 months. The SOFA scores at ED admission (ED-SOFA) and ICU admission (ICU-SOFA) were obtained. Relative changes in SOFA scores were calculated as followsΔ-SOFA=ICU-SOFA−ED-SOFA. Patients were divided into two groups depending on the Δ-SOFA score(a) Δ-SOFA=0–1; and (b) Δ-SOFA more than or equal to 2.
RESULTSThe median ED-SOFA score was two points (interquartile range1–4.5) and the Δ-SOFA score was 2 points (interquartile range0–3). The Δ-SOFA score was more powerful (area under the curve0.81) than the ED-SOFA score (area under the curve0.75) in predicting hospital mortality. Sixteen (6%) patients had a Δ-SOFA score less than 0, 116 (43%) patients had a Δ-SOFA=0–1, and 137 (51%) patients had a Δ-SOFA of at least 2 points. The probability of being alive at hospital discharge was 51 and 86.5% in Δ-SOFA of at least 2 and Δ-SOFA=0–1 groups, respectively (P<0.001). Risk factors for an increase of two or more SOFA points were age, cirrhosis, a diagnosis of sepsis, and a prolonged ED stay.
CONCLUSIONSOFA and changes in the SOFA score over time are potentially useful tools for risk stratification when applied to critically ill patients admitted to ICUs from the ED.
Abstract
Objectives
NDM carbapenemases have spread worldwide. However, little information exists about the impact of NDM-producing Enterobacteriaceae in Spain. By WGS, we sought to elucidate the ...population structure of NDM-like-producing Klebsiella pneumoniae and Escherichia coli in Spain and to determine the plasmids harbouring blaNDM-like genes.
Methods
High-resolution SNP typing, core-genome MLST and plasmid reconstruction (PlasmidID) were performed on 59 NDM-like-producing K. pneumoniae and 8 NDM-like-producing E. coli isolated over an 8 year period in Spain.
Results
Five major epidemic clones of NDM-producing K. pneumoniae caused five important nationwide outbreaks: ST437/NDM-7, ST437/NDM-1, ST147/NDM-1, ST11/NDM-1 and ST101/NDM-1; in contrast, the spread of NDM-producing E. coli was polyclonal. Three blaNDM types were identified: blaNDM-1, 61.2%; blaNDM-7, 32.8%; and blaNDM-5, 6%. Five K. pneumoniae isolates co-produced other carbapenemases (three blaOXA-48 and two blaVIM-1). The average number of acquired resistance genes was higher in K. pneumoniae than in E. coli. The plasmids encoding blaNDM-like genes belonged to IncFII, IncFIB, IncX3, IncR, IncN and IncC types, of which IncF, IncR and IncC were associated with MDR. The genetic surroundings of blaNDM-like genes showed a highly variable region upstream of ISAba125.
Conclusions
In recent years NDM-producing K. pneumoniae and E. coli have emerged in Spain; the spread of a few high-risk K. pneumoniae clones such as ST437/NDM-7, ST437/NDM-1, ST147/NDM-1, ST11/NDM-1 and ST101/NDM-1 have caused several interregional outbreaks. In contrast, the spread of NDM-producing E. coli has been polyclonal. Plasmid types IncFII, IncFIB, IncX3, IncR, IncN and IncC carried blaNDM, and the same IncX3 plasmid was detected in K. pneumoniae and E. coli.
To analyze the association between sitting time and biomarkers of insulin resistance and inflammation in a sample of healthy male workers.
Cross-sectional study carried out in a sample of 929 ...volunteers belonging to the Aragon Workers’ Health Study cohort. Sociodemographic, anthropometric, pharmacological and laboratory data were collected: lipids—total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoproteins A-1 and B-100, lipoprotein (a)—, insulin resistance—glucose, glycated hemoglobin, homeostasis model assessment of insulin resistance, insulin, and triglyceride/high-density lipoprotein cholesterol ratio—, and inflammatory profile—C-reactive protein and leukocytes. Information on sitting time and physical activity was assessed using a questionnaire. Sedentary behavior was analyzed in terms of prevalences and medians, according to tertiles, using a multivariate model (crude and adjusted linear regression) with biomarkers of inflammation and insulin resistance.
The most sedentary individuals had higher body mass index, greater waist circumference, and higher systolic blood pressure, with a significant upward trend in each tertile. Likewise, they had a worse lipid profile with a higher C-reactive protein level, homeostasis model assessment of insulin resistance index, triglyceride/high-density lipoprotein cholesterol ratio, and insulin concentration. In the multivariate analysis, we observed a significant association between the latter parameters and sitting time in hours (log C-reactive protein β = 0.07, log homeostasis model assessment of insulin resistance index β = 0.05, triglyceride/high-density lipoprotein cholesterol ratio β = 0.23, and insulin β = 0.44), which remained after adjustment for metabolic equivalents-h/week.
Workers who spend more time sitting show a worse inflammatory and insulin resistance profile independently of the physical activity performed.
Analizar la asociación entre tiempo sentado y biomarcadores de resistencia a la insulina e inflamación en una población de trabajadores varones.
Estudio transversal realizado sobre 929 voluntarios, pertenecientes a la cohorte del Aragon Workers’ Health Study. Se obtuvieron datos sociodemográficos, antropométricos, farmacológicos y bioquímicos: lipídicos —colesterol total, colesterol unido a lipoproteínas de alta y baja densidad, triglicéridos, apolipoproteínas A1 y B100 y lipoproteína (a)—, glucídicos —glucosa, glucohemoglobina, homeostasis model assessment of insulin resistance, insulina y cociente triglicéridos/colesterol unido a lipoproteínas de alta densidad— e inflamatorios —proteína C reactiva y leucocitos—. El tiempo sentado y la actividad física realizada se obtuvieron mediante cuestionarios. Se realizó un análisis de prevalencias y medianas según terciles de sedentarismo y multivariable (regresión lineal bruta y ajustada) con los biomarcadores de inflamación y de resistencia a la insulina.
Los trabajadores más sedentarios presentan unas medianas de índice de masa corporal, perímetro de cintura y presión arterial sistólica mayores, con una tendencia significativa de aumento en cada tercil, peor perfil lipídico, valores más elevados de proteína C reactiva, homeostasis model assessment of insulin resistance, cociente triglicéridos/colesterol unido a lipoproteínas de alta densidad e insulina. En el modelo de regresión lineal bruta y ajustada, encontramos una asociación significativa de estas últimas variables con el tiempo de sedestación medido en horas (β = 0,07 log proteína C reactiva; β = 0,05 log homeostasis model assessment of insulin resistance; β = 0,23 triglicéridos/colesterol unido a lipoproteínas de alta densidad, y β = 0,44 insulina) que no se modifican tras ajustar por los equivalentes metabólicos-h/semana.
Los trabajadores más sedentarios presentan parámetros inflamatorios y de resistencia a la insulina más altos de manera independiente de la actividad física realizada.
Small rural communities around the world have worse or null access to telecommunication services than populated urban areas. This is due to the disadvantageous relationship between the potential ...revenues for the operators and the cost of required infrastructures. Nowadays there are interesting low-cost solutions based on small cells for providing 3G access to small communities. However, the backhaul infrastructure to rural areas that are far away from cities can be very expensive. This barrier represents an opportunity for rural communities that already own and manage a multi-hop wireless infrastructure that interconnects them to neighboring communities, the Internet, and/or the PSTN. In this paper we propose the opportunity for 3G operators to share community-deployed wireless infrastructures for their 3G backhauling needs. Infrastructure sharing is a win–win solution because it helps rural communities to achieve financial sustainability for their community networks, while allowing operators to extend their coverage to regions where it would not be economically sustainable otherwise. This paper studies the techno-economic feasibility of the proposed solution through a CAPEX/OPEX analysis. It also identifies the negotiation margin that exists for the community networks that provide backhauling services to mobile network operators. In addition, it provides a general architecture for rural broadband community networks, derived from several particular experiences and from the Quality of Service requirements of 3G traffic. Three techniques are considered to ensure the quality of the backhaul while 3G traffic is transported together with non-3G traffic: DiffServ, plain MPLS and MPLS-TE. Experiments on a laboratory test-bed have allowed us to compare the performance of these three techniques in regards to the advantages and drawbacks of each.
Abstract Myoelectric activity and range of motion during ULNT1 were recorded in 62 breast cancer (BC) survivors who had axillary lymph node dissection (n = 30) or sentinel lymph node biopsy (n = 32) ...within the previous 18 months, and 63 age-matched healthy women. BC survivors' symptoms were reproduced by ULNT1 and exhibited greater myoelectric activity in the biceps brachii than healthy women (MD (95% CI): 21,26 (10,83-31,70)). No differences between the axillary lymph node dissection and sentinel lymph node biopsy groups (MD (95% CI): 8,47 (−7,84-24,79)) were found. Myoelectric activity in the triceps brachii was greater in the sentinel lymph node biopsy group (MD (95% CI): 2,70 (−2,06–7,60)). BC survivors exhibited less shoulder and elbow range of motion during ULNT1 than healthy women. Increased upper limb nerve mechanosensitivity in BC survivors was associated with a greater protective muscle response during ULNT1.
Ovarian cancer is the third most frequent gynaecological malignancy worldwide and in Mexico, with a high mortality rate, due to that in many cases its diagnosis is made in advanced stages. Prognosis ...is important for determining the subtype and the degree of evolution. During lasts years, the management of ovarian cancer has undergone an important evolution with the incorporation of new therapeutic options, which in turn represent an increase in the survival of these patients. We present recommendations for the management of ovarian cancer developed by an expert panel Mexican based on available evidence so far and the characteristics of health care in the country.
Resumen Introducción y objetivos Analizar la asociación entre tiempo sentado y biomarcadores de resistencia a la insulina e inflamación en una población de trabajadores varones. Métodos Estudio ...transversal realizado sobre 929 voluntarios, pertenecientes a la cohorte del Aragon Workers’ Health Study. Se obtuvieron datos sociodemográficos, antropométricos, farmacológicos y bioquímicos: lipídicos —colesterol total, colesterol unido a lipoproteínas de alta y baja densidad, triglicéridos, apolipoproteínas A1 y B100 y lipoproteína (a)—, glucídicos —glucosa, glucohemoglobina, homeostasis model assessment of insulin resistance , insulina y cociente triglicéridos/colesterol unido a lipoproteínas de alta densidad— e inflamatorios —proteína C reactiva y leucocitos—. El tiempo sentado y la actividad física realizada se obtuvieron mediante cuestionarios. Se realizó un análisis de prevalencias y medianas según terciles de sedentarismo y multivariable (regresión lineal bruta y ajustada) con los biomarcadores de inflamación y de resistencia a la insulina. Resultados Los trabajadores más sedentarios presentan unas medianas de índice de masa corporal, perímetro de cintura y presión arterial sistólica mayores, con una tendencia significativa de aumento en cada tercil, peor perfil lipídico, valores más elevados de proteína C reactiva, homeostasis model assessment of insulin resistance , cociente triglicéridos/colesterol unido a lipoproteínas de alta densidad e insulina. En el modelo de regresión lineal bruta y ajustada, encontramos una asociación significativa de estas últimas variables con el tiempo de posición de sentado medido en horas (β = 0,07 log proteína C reactiva; β = 0,05 log homeostasis model assessment of insulin resistance ; β = 0,23 triglicéridos/colesterol unido a lipoproteínas de alta densidad, y β = 0,44 insulina) que no se modifican tras ajustar por los equivalentes metabólicos-h/semana. Conclusiones Los trabajadores más sedentarios presentan parámetros inflamatorios y de resistencia a la insulina más altos de manera independiente de la actividad física realizada.
Abstract Methods We studied patients requiring mechanical ventilation for more than 48 hours who died in the intensive care unit and whose bodies were autopsied. We evaluated 3 clinical definitions ...of ventilator-associated pneumonia: loose definition, defined as chest radiograph infiltrates and 2 of 3 clinical criteria (leukocytosis, fever, purulent respiratory secretions); rigorous definition, defined as chest radiograph infiltrates and all of the clinical criteria; and a clinical pulmonary infection score higher than 6 points. Sensitivity, specificity, and likelihood ratios were calculated by using pathology pattern as criterion standard. Results One hundred forty-two (56%) of the 253 patients included had histological criteria of pneumonia. Patients who met the clinical criteria of ventilator-associated pneumonia were 163 (64%) for the loose definition, 32 (13%) for the rigorous definition, and 109 (43%) for the clinical pulmonary infection score. The operative indexes (sensitivity and specificity) of each definition were as follows: loose definition, 64.8% and 36%; rigorous definition, 91% and 15.5%; and clinical pulmonary infection score higher than 6, 45.8% and 60.4%. The addition of microbiological data to the clinical definitions increased the specificity and decreased the sensitivity but not significantly. Conclusions Accuracy of 3 commonly used clinical definitions of ventilator-associated pneumonia was poor taking the autopsy findings as reference standard.
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