The COVID-19 epidemic generated major changes in general surgical management protocols. The literature has reported high mortality rates for hip fracture surgery in patients with COVID-19. This study ...describes the morbidity and mortality in patients undergoing surgery due to hip fractures in 12 Colombian institutions between March and September 2020.
This was a retrospective observational descriptive study. Medical records of 12 hospitals were reviewed. Consecutive patients who underwent hip fracture surgery from March 6 to September 6, 2020, were included. Data collected were sociodemographic profile, type of fracture, surgical treatment, complications, and early (1 month) or mid-term (1-6 months) mortality associated or not with COVID-19.
Five hundred twenty patients with hip fractures requiring surgery in the 12 institutions were included. 364 (70%) were women; mean age was 77.7 years (SD: 13.8), mean BMI was 25.1, 91.73% of patients had at least one comorbidity, 60.38% were classified as ASA II and 25.77% as ASA III. There were 267 (51.34%) pertrochanteric fractures, 227 (43.65%) femoral neck fractures, and 26 (5.0%) subtrochanteric fractures. 274 (52.69%) patients were treated with osteosynthesis, 244 (46.92%) with arthroplasty, and 2 (0.38%) with girdlestone. Surgery was performed less than 24 h after the fracture for 115 (22.11%) patients, between 24 and 72 h for 208 (40.0%) patients, and more than 72 h for 197 (37.88%) patients. One hundred six patients in total suffered a medical or surgical complication throughout the different follow-up stages, amongst the most frequent were respiratory failure, coronary events, surgical site infection, cutting-out and peri‑implant fracture. 25 (4.8%) patients required attention in the Intensive Care Unit (ICU). 13 patients had COVID-19 throughout the follow-up period. 27 patients died due to any cause, and 3 of them had reported a positive COVID-19 test any time during follow-up period, of which one died during the first month, and two died between 1 and 6 months. Statistically significant associations were found between age older than 75 years old, ASA classification, ICU requirement, and death.
520 patients received surgical treatment for hip fracture during the first six months of the COVID-19 pandemic in 12 medical centers in Colombia. 21.10% suffered a complication during the early stage (30 days) and 4.77% during the midterm stage (1-6 months). 4.8% were admitted in the ICU during the early stage. All-cause death was 27 patients, early death was 11 (40.74%) and midterm death was 16 (59.25%). 13 patients were positive for COVID-19, 3 died, one (1/5=20%) on the first 30 days and the other two (2/8=25%) from month 1 to 6.
The SARS-CoV-2 pandemic has affected 771 million people and caused 6.9 million confirmed deaths as of November 2023. Beyond the adversity, a crucial and less-explored chapter unfolds: adaptive ...sequelae. These have altered social, mental, and emotional conditions, leaving an imprint on biological systems. While some cases fully resolve the pathological process post-acute infection, others persist with symptoms, posing a challenge that underscores the need to comprehend pathophysiology from innovative perspectives. The article delves into “Long COVID” or Post-Acute COVID-19 Syndrome (PACS), where symptoms persist for ≥4 weeks irrespective of initial severity. Risk factors include a history of severe illness, in-hospital management, and intensive care. This article also explores theories, derived from various experimental models, that have demonstrated the involvement of the nervous system in coordination with the psychoneuroimmunoendocrine axes in the expression of inflammation. It is posited that PACS involves processes of peripheral and central sensitization (corticalization), facilitating dishomeostasis and the chronicity of the inflammatory process. In this context, various therapeutic strategies grounded in modulating the inflammatory reflex are reviewed, primarily through the infiltration of local anesthetics via linear and non-linear approaches. Neural therapeutic use is considered to stimulate the regulatory inflammatory circuits coordinated by the neuroimmune-endocrine system.
•Active case finding of individuals with history of transfusion events before 1996 in three cities in Colombia.•Characterization of HCV genetic diversity in samples obtained from individuals with ...history of blood transfusion, PWID and patients with end-stage liver disease.•First characterization of HCV genotypes 4a and 4d and first detection of RAS in samples obtained from Colombian individuals.
Hepatitis C virus (HCV) infection is one of the leading risk factors for end-stage liver disease development worldwide. This RNA virus displays high genetic diversity with 8 genotypes and 96 subgenotypes with heterogeneous geographical distribution around the world. In this study, we carried out an active case finding of individuals with a history of transfusion events before 1996 in three cities in Colombia. Then, the characterization of the HCV genotypes, subgenotypes, and resistance associate substitutions (RAS) was performed in samples positives for antibodies anti-HCV + from this study population. In addition, samples from PWID and patients with end-stage liver disease submitted to liver transplantation were included in the phylogenetic and RAS analysis. The 5′UTR, NS5A, and NS5B regions of the HCV genome were amplified in serum or liver explants samples. After the edition, assembly, and alignment of the sequences, genotyping through phylogenetic analysis was performed using IQTREE V2.0.5 based on the maximum likelihood approach. The identification of RAS was carried out by alignments based on the reference sequence (GenBank NC_004102). Two hundred sixty individuals with blood transfusion events before 1996 were recruited. The seroprevalence of antibodies anti-HCV was 2.69% in this population. The HCV genotypes 1, 2, and 4 and subgenotypes 1a, 1b, 2a, 4a and 4d were characterized in samples of the study populations. Three RAS (Q30R, C316N, and Y93H) were identified in samples obtained from 2 individuals who received blood transfusion before 1996 and without previous antiviral treatment and 6 samples obtained from patients with end-stage liver disease. Among the 20 samples analyzed, the HCV genotype 1, subgenotype 1b, was the most frequent (60%). We report the first characterization of HCV subgenotypes 4a and 4d and the first RAS identification in patients in Colombia.
The World Health Organization (WHO) has established a target to eliminate mother‐to‐child‐transmission (EMTCT) of hepatitis B virus (HBV), defined as a prevalence of hepatitis B surface antigen ...(HBsAg) of ≤0.1% among children, by 2030. Using nationally representative serosurveys to verify achievement of this target requires large sample sizes and significant resources. We assessed the feasibility of a potentially more efficient two‐phase method to verify EMTCT of HBV in Colombia. In the first phase, we conducted a risk assessment to identify municipalities at the highest risk of ongoing HBV transmission. We ranked the 1122 municipalities of Colombia based on the reports of HBV infection in pregnant women per 1000 population. Municipalities with ≥0.3 reports per 1000 persons (equating to the top quartile) were further assessed based on health facility birth rates, coverage with three doses of hepatitis B vaccine (HepB3) and seroprevalence data. Hepatitis B risk was considered to be further increased for municipalities with HepB3 coverage or health facility birth rate <90%. In the second phase, we conducted a multistage household serosurvey of children aged 5–10 years in 36 municipalities with the highest assessed HBV risk. HBsAg was not detected in any of 3203 children tested, yielding a 90% upper confidence bound of <0.1% prevalence. Coverage with HepB3 and hepatitis B birth dose was high at 97.5% and 95.6%, respectively. These results support the conclusion that Colombia has likely achieved EMTCT of HBV.
The Magdalena River has the greatest length (1612km) and drainage area (257400km2) of any river system in Colombia, and its watershed occupies 24% of the Colombian territory. The river originates in ...the Andean Cordillera at an elevation of 3685m and flows to its mouth in the Caribbean Sea (Bocas de Cenizas). For this study, information on daily flow discharge (Q), suspended sediment transport (Qs) and mean suspended sediment concentration (Cs) from 1990–2010 for the Magdalena River, based on measurements at the Calamar gauging station (the closest station to the mouth), was provided by the Institute of Hydrology, Meteorology and Environmental Studies of Colombia (IDEAM in Spanish). The mean annual suspended sediment load was 169±73×106tyr−1 for the period from 1990–1999 and 145±47×106tyr−1 for the period from 2000–2010, amounting to a 14% reduction in the suspended sediment transport rate between the two periods. The sediment rating curve (Qs=aQb) was also evaluated for these two periods (1990–1999 and 2000–2010). An analysis of the regression coefficients (a, b) for the two periods showed a decrease in b and an increase in a after 1999, which coincides with a decrease in suspended sediment transport. This change might be attributed to natural factors, including the accumulation of sediment in the Depresion Momposina and variation in hydro-climatological patterns in the Caribbean region. Decreases in effective transport were confirmed using three methods (Log-Normal and Normal distribution, and magnitude-frequency histogram) for the study period.
Restrepo, J.C.; Schrottke, K.; Traini, C.; Ortiz, J.C.; Orejarena, A.; Otero, L.; Higgins, A., and Marriaga, L., 2016. Sediment transport and geomorphological change in a high-discharge tropical ...delta (Magdalena River, Colombia): Insights from a period of intense change and human intervention (1990–2010). There is strong indication that environmental changes and human interventions have affected freshwater discharge and sediment flux in the Magdalena River (northwestern South America) within the period from 1990 to 2010. Thus, stream flow, suspended sediment load (SSL), and riverbed dynamics were analysed in this study for estimating changes in the suspended sediment transport regime as well as of erosional/depositional patterns in different zones of the delta. It can be shown that stream flow increased at a higher rate than suspended sediment transport, promoting changes in the sediment transport regime. Erosion appeared at the mouth/frontal bar and the outlet zones and modified the sedimentary balance within the prodelta in the early 2000s. There is indication that cycles of erosion and accretion were controlled by the magnitude of fluvial discharge and riverbed scouring in the river outlet, whereas effluent diffusion and sediment dispersion were dominant in the delta front. High freshwater discharge, as buoyancy inputs, promoted the transfer of sediments from the river channel to the outer prodelta through the upper layers of the water column. Total sediment accumulation in the delta corresponded to <5% of the annual mean SSL of the Magdalena River. Overall, delta morphology remained relatively stable, experiencing a slow progradational state with highest sedimentation rates (≤1430 mm y−1) in the deepest zones.
Studies have shown that more than 50% of the antibiotics used in hospitals are unnecessary or inappropriate and, that antimicrobial resistance may cost up to 20 billion USD in excess medical costs ...each year. On the other hand, Antimicrobial Stewardship Programs (ASP) significantly reduce inappropriate antimicrobial use, emergence of antimicrobial resistance, healthcare associated infections, and costs in hospital settings.
To evaluate the development of ASP and antibiotic savings in 7 Latin American hospitals using standardized quantitative indicators in all the participating health care institutions.
An interventional study was conducted, where pre- and post- evaluations were performed using a standardized score tool adapted from the Joint Commission International accreditation standards and, the Colombian Institute of Technical Standards and Certification. We evaluated ASP from 7 Latin American hospitals between 2019 and 2020. A pre-intervention evaluation was done in each hospital to quantify the degree of development of the ASP (ASP Development score). Based on these results, tailored on-site training was implemented in each hospital, followed by a post-intervention evaluation to quantify improvement of ASP-development indicators. In addition, monetary savings in antimicrobials derived from the ASP intervention were estimated.
In the pre-intervention evaluation, the average ASP development score for the 7 institutions was 65.8% (40-94.3%). The items with the lowest development score were those related to monitoring and communicating the ASP progress and success. For the post-intervention evaluation, 2 institutions couldn't participate due to the pressure imposed by the COVID-19 pandemic. For the remaining 5/7 hospitals, the average ASP development score was 82.3% with an increase of 12.0% when compared to the pre-intervention measurement of the same institutions (average pre-intervention score 70.3% (48.2%-94.3%) The items with a significant increase were key performance indicators, AMS education and training of the prescribers. Three of the seven (3/7) hospitals reported antibiotic monetary savings associated to the ASP intervention.
The use of the tool described shown to be useful to evaluate specific areas of ASP-development that were lacking and tailor interventions for the participating hospitals, consequently, it helped improve ASP-development in the institutions that underwent pre- intervention and post-intervention analysis. In addition, the strategies showed monetary savings on antimicrobial costs when measured.
Background
Verbal fluency tests (VFT) are highly sensitive to cognitive deficits. Usually, the score on VFT is based on the number of correct words produced, yet it alone gives little information ...regarding underlying test performance. The implementation of different strategies (cluster and switching) to perform efficiently during the tasks provide more valuable information. However, normative data for clustering and switching strategies are scarce. Moreover, scoring criteria adapted to Colombian Spanish are missing.
Aims
(1) To describe the Colombian adaptation of the scoring system guidelines for clustering and switching strategies in VFT; (2) to determine its reliability; and (3) to provide normative data for Colombian children and adolescents aged 6–17 years.
Methods & Procedures
A total of 691 children and adolescents from Colombia completed phonological (/f/, /a/, /s/, /m/, /r/ and /p/) and semantic (animals and fruits) VFT, and five scores were calculated: total score (TS), number of clusters (NC), cluster size (CS), mean cluster size (MCS) and number of switches (NS). The intraclass correlation coefficient was used for interrater reliability. Hierarchical multiple regressions were conducted to investigate which strategies were associated with VFT TS. Multiple regressions were conducted for each strategy, including as predictors age, age2, sex, mean parents’ education (MPE), MPE2 and type of school, to generate normative data.
Outcomes & Results
Reliability indexes were excellent. Age was associated with VFT TS, but weakly compared with strategies. For both VFT TS, NS was the strongest variable, followed by CS and NC. Regarding norms, age was the strongest predictor for all measures, while age2 was relevant for NC (/f/ phoneme) and NS (/m/ phoneme). Participants with higher MPE obtained more NC, and NS, and larger CS in several phonemes and categories. Children and adolescents from private school generated more NC, NS and larger CS in /s/ phoneme.
Conclusions & Implications
This study provides new scoring guidelines and normative data for clustering and switching strategies for Colombian children and adolescents between 6 and 17 years old. Clinical neuropsychologists should include these measures as part of their everyday practice.
WHAT THIS PAPER ADDS
What is already known on the subject
VFT are widely used within the paediatric population due to its sensitivity to brain injury. Its score is based on the number of correct words produced; however, TS alone gives little information regarding underlying test performance. Several normative data for VFT TS in the paediatric population exist, but normative data for clustering and switching strategies are scarce.
What this paper adds to existing knowledge
The present study is the first to describe the Colombian adaptation of the scoring guidelines for clustering and switching strategies, and provided normative data for these strategies for children and adolescents between 6 and 17 years old.
What are the potential or actual clinical implications of this work?
Knowing VFT's performance, including strategy development and use in healthy children and adolescents, may be useful for clinical settings. We encourage clinicians to include not only TS, but also a careful analysis of strategies that may be more informative of the underlying cognitive processes failure than TS.
Hepatitis B virus (HBV) occult infection (OBI) is a risk factor to be taken into account in transfusion, hemodialysis and organ transplantation. The aim of this study was to identify and characterize ...at the molecular level OBI cases in patients with end-stage liver disease.
Sixty-six liver samples were obtained from patients with diagnosis of end-stage liver disease submitted to liver transplantation in Medellin (North West, Colombia). Samples obtained from patients who were negative for the surface antigen of HBV (n = 50) were tested for viral DNA detection by nested PCR for ORFs S, C, and X and confirmed by Southern-Blot. OBI cases were analyzed by sequencing the viral genome to determine the genotype and mutations; additionally, viral genome integration events were examined by the Alu-PCR technique.
In five cases out of 50 patients (10%) the criteria for OBI was confirmed. HBV genotype F (subgenotypes F1 and F3), genotype A and genotype D were characterized in liver samples. Three integration events in chromosomes 5q14.1, 16p13 and 20q12 affecting Receptor-type tyrosine-protein phosphatase T, Ras Protein Specific Guanine Nucleotide Releasing Factor 2, and the zinc finger 263 genes were identified in two OBI cases. Sequence analysis of the viral genome of the 5 OBI cases showed several punctual missense and nonsense mutations affecting ORFs S, P, Core and X.
This is the first characterization of OBI in patients with end-stage liver disease in Colombia. The OBI cases were identified in patients with HCV infection or cryptogenic cirrhosis. The integration events (5q14.1, 16p13 and 20q12) described in this study have not been previously reported. Further studies are required to validate the role of mutations and integration events in OBI pathogenesis.
Biosurfactants are surface active molecules produced by microorganisms which have the ability to disrupt the plasma membrane. Biosurfactant properties are important in the food, pharmaceutical and ...oil industries. Lactic acid bacteria can produce cell-bound and excreted biosurfactants.
The biosurfactant-producing ability of three Lactobacillus strains was analyzed, and the effects of carbon and nitrogen sources and aeration conditions were studied. The three species of lactobacillus evaluated were able to produce biosurfactants in anaerobic conditions, which was measured as the capacity of one extract to reduce the surface tension compared to a control. The decreasing order of biosurfactant production was L. plantarum>Lactobacillus sp.>L. acidophilus. Lactose was a better carbon source than glucose, achieving a 23.8% reduction in surface tension versus 12.9% for glucose. Two complex nitrogen sources are required for growth and biosurfactant production. The maximum production was reached at 48 h under stationary conditions. However, the highest level of production occurred in the exponential phase. Biosurfactant exhibits a critical micelle concentration of 0.359 ± 0.001 g/L and a low toxicity against E. coli. Fourier transform infrared spectroscopy indicated a glycoprotein structure. Additionally, the kinetics of fermentation were modeled using a logistic model for the biomass and the product, achieving a good fit (R2 > 0.9).
L. plantarum derived biosurfactant production was enhanced using adequate carbon and nitrogen sources, the biosurfactant is complex in structure and because of its low toxicity could be applied to enhance cell permeability in E. coli.
How to cite: Montoya Vallejo C, Florez Restrepo MA, Guzmán Duque FL, et al. Production, characterization and kinetic model of biosurfactant produced by lactic acid bacteria. Electron J Biotechnol 2021;53. https://doi.org/10.1016/j.ejbt.2021.06.001
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