COVID-19: Is there a weaker sex? Gómez-Ochoa, Sergio Alejandro; Van Poll, Nina; Franco, Oscar H.
Case reports in women's health,
10/2020, Letnik:
28
Journal Article
Antimicrobial resistance of bacterial pathogens is an increasing clinical problem and alternative approaches to antibiotic chemotherapy are needed. One of these approaches is the use of lytic ...bacterial viruses known as phage therapy. We aimed to assess the efficacy of phage therapy in preclinical animal models of bacterial infection.
In this systematic review and meta-analysis, MEDLINE/Ovid, Embase/Ovid, CINAHL/EbscoHOST, Web of Science/Wiley, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar were searched from inception to Sept 30, 2021. Studies assessing phage efficacy in animal models were included. Only studies that assessed the efficacy of phage therapy in treating established bacterial infections in terms of survival and bacterial abundance or density were included. Studies reporting only in-vitro or ex-vivo results and those with incomplete information were excluded. Risk-of-bias assessment was performed using the Systematic Review Centre for Laboratory Animal Experimentation tool. The main endpoints were animal survival and tissue bacterial burden, which were reported using pooled odds ratios (ORs) and mean differences with random-effects models. The I2 measure and its 95% CI were also calculated. This study is registered with PROSPERO, CRD42022311309.
Of the 5084 references screened, 124 studies fulfilled the selection criteria. Risk of bias was high for 70 (56%) of the 124 included studies; therefore, only studies classified as having a low-to-moderate risk of bias were considered for quantitative data synthesis (n=32). Phage therapy was associated with significantly improved survival at 24 h in systemic infection models (OR 0·08 95% CI 0·03 to 0·20; I2=55% 95% CI 8 to 77), skin infection (OR 0·08 0·04 to 0·19; I2 = 0% 0 to 79), and pneumonia models (OR 0·13 0·06 to 0·31; I2=0% 0 to 68) when compared with placebo. Animals with skin infections (mean difference –2·66 95% CI –3·17 to –2·16; I2 = 95% 90 to 96) and those with pneumonia (mean difference –3·35 –6·00 to –0·69; I2 = 99% 98 to 99) treated with phage therapy had significantly lower tissue bacterial loads at 5 ± 2 days of follow-up compared with placebo.
Phage therapy significantly improved animal survival and reduced organ bacterial loads compared with placebo in preclinical animal models. However, high heterogeneity was observed in some comparisons. More evidence is needed to identify the factors influencing phage therapy performance to improve future clinical application.
Swiss National Foundation and Swiss Heart Foundation.
Introducción. El trauma es una de las principales causas de mortalidad a nivel mundial y representa un problema de salud pública. En Latinoamérica y particularmente en Colombia, son escasos los ...registros de trauma que se han desarrollado satisfactoriamente. El objetivo del presente estudio fue describir la epidemiología del trauma en el Hospital Universitario de Santander, en el primer año de implementación del registro de trauma institucional.
Métodos. Personal del Departamento de Cirugía General de la Universidad Industrial de Santander y el Hospital Universitario de Santander, iniciaron el diseño del registro de trauma en el año 2020. Se incluyeron todos los pacientes que ingresaron al hospital, incluso los que fallecieron en el servicio de urgencias. La implementación del registro se inició el 1 de agosto de 2020, previa realización de una prueba piloto. Los informes se recogieron automáticamente y se exportaron a una base de datos electrónica no identificada.
Resultados. Se evaluaron 3114 pacientes, el 78,1 % de ellos hombres, con una mediana de edad de 31 años. La mediana de tiempo prehospitalario fue de tres horas y lo más frecuente fue el ingreso por propios medios (51,2 %). El mecanismo de trauma más frecuente fue el penetrante (41,8 %), siendo la mayoría de heridas por arma cortopunzante (24,9 %). El trauma cerrado se presentó en el 41,7 % de los pacientes evaluados y el 14,4 % de la población se encontraba bajo el efecto de sustancias psicoactivas. El servicio de Cirugía general fue el más interconsultado (26,9 %), seguido del servicio de cirugía plástica (21,8 %). La mediana de estancia hospitalaria fue de dos días (Q1:0; Q3:4) y 75 pacientes (2,4 %) fallecieron durante su hospitalización.
Conclusión. El registro de trauma de nuestra institución se presenta como una plataforma propicia para el análisis de la atención prehospitalaria e institucional del trauma, y el desarrollo de planes de mejora en este contexto. Este registro constituye una herramienta sólida para la ejecución de nuevos de proyectos de investigación en esta área.
Introducción. Los tumores neuroendocrinos apendiculares (TNE-A) corresponden a la neoplasia apendicular más común. Aunque habitualmente tienen un comportamiento benigno, su potencial de extensión ...regional y metástasis, hacen necesario determinar de manera precisa el pronóstico de cada paciente. El objetivo del presente estudio fue diseñar y validar un nomograma pronóstico para predecir la supervivencia de los pacientes con TNE-A.
Métodos. Estudio de cohorte retrospectiva, de acuerdo a la información de la base de datos de vigilancia, epidemiología y desenlaces del Instituto Nacional de Cáncer de los Estados Unidos de América. Se incluyeron los pacientes con diagnóstico de TNE-A entre 1978 y 2016. El análisis de supervivencia se realizó mediante un modelo de regresión de Cox. Con estos resultados se construyeron los nomogramas para la supervivencia general y específica de cáncer a uno, dos, tres y cinco años. Los análisis fueron realizados en el software estadístico R (v. 3.5.3).
Resultados. Se incluyeron 3585 pacientes con diagnóstico de TNE-A, el 55,8 % fueron mujeres, y la mediana de edad fue de 49 años. El subtipo histológico más frecuente fue el Tumor de Histología Mixta (THM). La edad, el subtipo histológico, el tamaño y la extensión tumoral, fueron las únicas variables asociadas independientemente con la supervivencia después del análisis multivariado. El nomograma validado presentó una capacidad de discriminación sobresaliente para predecir tanto supervivencia general 0,81 (IC95%: 0,76-0,86), como específica a cáncer 0,88 (IC95%: 0,83 a 0,92).
Discusión. El presente estudio propone un nomograma pronóstico de supervivencia para pacientes con TNE-A, teniendo en cuenta el subtipo histológico, y alcanza una capacidad de discriminación sobresaliente para la predicción de estos desenlaces. Destacamos el peor pronóstico de los pacientes con THM, además de la supervivencia similar entre los pacientes llevados a hemicolectomía y aquellos sometidos a apendicectomía o resección del ciego, luego del análisis multivariado. Se requiere evaluar el rol de modalidades terapéuticas adyuvantes en la supervivencia de estos pacientes.
To analyze the prognostic value of left ventricular global longitudinal strain (LV-GLS) and other echocardiographic parameters to predict adverse outcomes in chronic Chagas cardiomyopathy (CCM). ...Prospective cohort study conducted in 177 consecutive patients with different CCM stages. Transthoracic echocardiography measurements were obtained following the American Society of Echocardiography recommendations. By speckle-tracking echocardiography, LV-GLS was obtained from the apical three-chamber, apical two-chamber, and apical four-chamber views. The primary composite outcome (CO) was all-cause mortality, cardiac transplantation, and a left ventricular assist device implantation. After a median follow-up of 42.3 months (Q1 = 38.6; Q3 = 52.1), the CO incidence was 22.6% (95% CI 16.7–29.5%, n = 40). The median LV-GLS value was − 13.6% (Q1 = − 18.6%; Q3 = − 8.5%). LVEF, LV-GLS, and E/e′ ratio with cut-off points of 40%, − 9, and 8.1, respectively, were the best independent CO predictors. We combined these three echocardiographic markers and evaluated the risk of CO according to the number of altered parameters, finding a significant increase in the risk across the groups. While in the group of patients in which all these three parameters were normal, only 3.2% had the CO; those with all three abnormal parameters had an incidence of 60%. We observed a potential incremental prognostic value of LV-GLS in the multivariate model of LVEF and E/e′ ratio, as the AUC increased slightly from 0.76 to 0.79, nevertheless, this difference was not statistically significant (p = 0.066). LV-GLS is an important predictor of adverse cardiovascular events in CCM, providing a potential incremental prognostic value to LVEF and E/e′ ratio when analyzed using optimal cut-off points, highlighting the potential utility of multimodal echocardiographic tools for predicting adverse outcomes in CCM.
Benznidazole (BZL) and Nifurtimox (NFX) are the pharmacological treatment for acute phase Chagas Disease (CD); however, therapy resistance and residual mortality development remain important ...unresolved issues. Posaconazole (POS) has shown a trypanocidal effect in vivo and in vitro. Thus, this study aimed at comparing the T. Cruzi parasitic load-reducing effect of the combination of BZL+POS against that of monotherapy with either, during acute phase CD, in an experimental murine model.
Nineteen Wistar rats were randomly allocated to four groups and inoculated with the trypomastigotes of T. cruzi strain´s JChVcl1. The rats were administered anti-parasites from day 20-29 post-infection. The Pizzi and Brener method was used for parasitemia measurement. Longitudinal data analysis for the continuous outcome of repeated measures was performed using parasitemia as the outcome measured at days 20, 22, 24, 27, and 29 post-infection.
All four groups had similar parasitic loads (p=0.143) prior to therapy initiation. Among the three treatment groups, the BZL+POS (n=5) group showed the highest mean parasitic load reduction (p=0.000) compared with the control group. Likewise, the BZL+POS group rats showed an earlier therapeutic effect and were the only ones without parasites in their myocardial samples.
Treatment of acute phase CD with BZL+POS was more efficacious at parasitemia and myocardial injury reduction, compared with monotherapy with either.
Hyperglycemia-associated chorea-ballism (HCB) is an infrequent neurological syndrome occurring predominantly in elderly females and in the setting of non-ketotic hyperglycemia (NKH). A systematic ...review was conducted in accordance with the PRISMA statement. Studies published between 1980 and 2018 that reported demographic, clinical, laboratory and imaging features from patients with HCB were screened. 136 studies describing 286 patients were included in the analysis. The patients included had a median age of 72 years; those with ketotic hyperglycemia (KH) were older (p<0.001). Women and NKH patients were the most frequently affected (63% and 92%, respectively). The median glucose level at admission was 420 mg/dL (IQR 328-535), and was significantly higher in KH (p=0.009). Moreover, the absence of a clear lesion on imaging studies and the finding of bilateral imaging evidence of lesions were each more frequent in the KH group (p=0.036 and p=0.008, respectively). 48 cases (19.4%) presented with bilateral CT/MRI lesions, having higher values of plasma osmolarity compared with the patients with unilateral lesions (p=0.011). Every patient received hypoglycemic treatment, but only 174 (60.84%) were prescribed neuroleptics. 213 patients (84.86%) showed a total recovery, after a median of 14 days (IQR 3-31). Bilateral chorea-ballism was supported by bilateral imaging evidence of involvement in only 60% of the cases (positive predictive value). Patients not prescribed neuroleptics, with negative lentiform nucleus involvement, and age within the third tertile (≥ 78 years) had an odds ratio of 6.6 (CI 95% 1.18-141.10) for a complete clinical recovery. Significant differences were identified between types of hyperglycemia and regarding the clinical and imaging laterality features. Furthermore, the predictor variables evaluated showed potential utility for assessing the prognosis of HCB patients.
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