Advanced interpenetrating polymer networks for innovative gastroretentive formulations targeting Helicobacter pylori gastric colonization.

The escalating challenges of Helicobacter pylori-induced gastric complications, driven by rising antibiotic resistance and persistent cancer risks, underscore the demand for innovative therapeutic strategies. This study addresses this urgency through the development of tailored semi-interpenetrating polymer networks (semi-IPN) serving as gastroretentive matrices for amoxicillin (AMOX). They are biodegradable, absorb significant volume of simulated gastric fluid (swelling index > 360 %) and exhibit superporous microstructures, remarkable mucoadhesion, and buoyancy. The investigation includes assessment at pH 1.2 for comparative analysis with prior studies and, notably, at pH 5.0, reflecting the acidic environment in H. pylori-infected stomachs. The semi-IPN demonstrated gel-like structures, maintaining integrity throughout the 24-hour controlled release study, and disintegrating upon completing their intended function. Evaluated in gastroretentive drug delivery system performance, AMOX release at pH 1.2 and pH 5.0 over 24 h (10 %-100 %) employed experimental design methodology, elucidating dominant release mechanisms. Their mucoadhesive, buoyant, three-dimensional scaffold stability, and gastric biodegradability make them ideal for accommodating substantial AMOX quantities. Furthermore, exploring the inclusion of the potassium-competitive acid blocker (P-CAB) vonoprazan (VONO) in AMOX-loaded formulations shows promise for precise and effective drug delivery. This innovative approach has the potential to combat H. pylori infections, thereby preventing the gastric cancer induced by this pathogen.

Simultaneous Formation of Polyhydroxyurethanes and Multicomponent Semi-IPN Hydrogels.

This study introduces an efficient strategy for synthesizing polyhydroxyurethane-based multicomponent hydrogels with enhanced rheological properties. In a single-step process, 3D materials composed of Polymer 1 (PHU) and Polymer 2 (PVA or gelatin) were produced. Polymer 1, a crosslinked polyhydroxyurethane (PHU), grew within a colloidal solution of Polymer 2, forming an interconnected network. The synthesis of Polymer 1 utilized a Non-Isocyanate Polyurethane (NIPU) methodology based on the aminolysis of bis(cyclic carbonate) (bisCC) monomers derived from 1-thioglycerol and 1,2-dithioglycerol (monomers A and E, respectively). This method, applied for the first time in Semi-Interpenetrating Network (SIPN) formation, demonstrated exceptional orthogonality since the functional groups in Polymer 2 do not interfere with Polymer 1 formation. Optimizing PHU formation involved a 20-trial methodology, identifying influential variables such as polymer concentration, temperature, solvent (an aprotic and a protic solvent), and the organo-catalyst used [a thiourea derivative (TU) and 1,8-diazabicyclo [5.4.0]undec-7-ene (DBU)]. The highest molecular weights were achieved under near-bulk polymerization conditions using TU-protic and DBU-aprotic as catalyst-solvent combinations. Monomer E-based PHU exhibited higher Mw¯ than monomer A-based PHU (34.1 kDa and 16.4 kDa, respectively). Applying the enhanced methodology to prepare 10 multicomponent hydrogels using PVA or gelatin as the polymer scaffold revealed superior rheological properties in PVA-based hydrogels, exhibiting solid-like gel behavior. Incorporating monomer E enhanced mechanical properties and elasticity (with loss tangent values of 0.09 and 0.14). SEM images unveiled distinct microstructures, including a sponge-like pattern in certain PVA-based hydrogels when monomer A was chosen, indicating the formation of highly superporous interpenetrated materials. In summary, this innovative approach presents a versatile methodology for obtaining advanced hydrogel-based systems with potential applications in various biomedical fields.

Sudden hearing loss secondary to syphilis.

BACKGROUND: Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum, whose incidence has increased significantly in recent years. Some patients may develop sudden hearing loss (SHL) against the background of otosyphilis. OBJECTIVES: The objective of our study was to determine whether routine lues serology is useful in patients presenting with sudden hearing loss. METHODS: For this purpose, all cases of SHL treated in our hospital during a period of 6 years were propectively collected. The frequency of positivity for syphilis in these patients, the treatment received, and their evolution were determined. RESULTS: Of the total number of patients evaluated during that period, 71 underwent serological screening for syphilis, of whom 2 (2.8 %) presented positive screening antibodies. In one of them, the RPR was normal and had been treated with lues a few years before. After treatment there was no improvement. The other patient, diagnosed with otosyphilis with unconfirmed suspected neurological disease, showed normalization of hearing after specific treatment. CONCLUSIONS: Since it is a potentially curable disease, despite the low overall frequency of syphilis in patients with SHL it is advisable to perform serological screening for syphilis in high risk patients (e.g., incarceration, multiple recent sexual partners, men who have sex with men) or atypical clinical presentation (e.g., concurrent neuropathies).

Experiences of Spanish out-of-hospital emergency workers with high levels of depression during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The COVID-19 pandemic had a major psychological impact on health care workers (HCWs). This study was embedded in a larger quantitative study on the mental health care of out-of-hospital HCWs in Spain. To better understand this, a qualitative study was conducted to explore the experiences, coping strategies, and influencing factors of out-of-hospital HCWs who scored high (> 25 points) on the Depression Anxiety Stress Scale (DASS-21) in a previous quantitative mental health study. METHODS: A qualitative study was conducted using six in-depth interviews with individuals who scored high on the depression scale and agreed to be contacted by email between May and June 2021, using the phenomenological approach. The data were analysed using Brawn and Clare's method. RESULTS: The main results findings related to four themes. The emotional impact of assuming a professional role with high self-demands and responsibilities; Factors influencing the development of negative emotions such as the cruelty of the pandemic, the helplessness in relation to health management and policy, the changing role of the professional and the relationship with society; Personal protection through coping strategies to manage negative emotions such as support from colleagues and family; Good practices for the future looking for different management strategies that can influence individuals and their personal, professional, and social relationships. CONCLUSION: The strong impact of the circumstances experienced points to the need to develop psychological support programmes that can protect people's mental health from depression during a crisis and improve the relationship between workers and their managers.

RESUMEN: ANTECEDENTES: La pandemia de COVID-19 tuvo un gran impacto psicológico en el personal sanitario. Este estudio forma parte de un estudio cuantitativo más amplio sobre la atención a la salud mental de los trabajadores sanitarios extrahospitalarios en España. Para comprenderlo mejor, se llevó a cabo un estudio cualitativo para explorar las experiencias, estrategias de afrontamiento y factores de influencia de los trabajadores extrahospitalarios que obtuvieron puntuaciones altas (> 25 puntos) en la Escala de Depresión, Ansiedad y Estrés (DASS-21) en un estudio cuantitativo previo sobre salud mental. MéTODOS: Se realizó un estudio cualitativo mediante seis entrevistas en profundidad con individuos que puntuaron alto en la escala de depresión y aceptaron ser contactados por correo electrónico entre mayo y junio de 2021, utilizando el enfoque fenomenológico. Los datos se analizaron utilizando el método de Brawn y Clare. RESULTADOS: Los principales hallazgos de los resultados se relacionaron con cuatro temas. El impacto emocional de asumir un rol profesional con altas autoexigencias y responsabilidades; Factores que influyen en el desarrollo de emociones negativas como la crueldad de la pandemia, la impotencia en relación con la gestión y la política sanitaria, el papel cambiante del profesional y la relación con la sociedad; Protección personal a través de estrategias de afrontamiento para gestionar las emociones negativas como el apoyo de los compañeros y la familia; Buenas prácticas para el futuro buscando diferentes estrategias de gestión que puedan influir en los individuos y en sus relaciones personales, profesionales y sociales. CONCLUSIóN: El fuerte impacto de las circunstancias vividas apunta a la necesidad de desarrollar programas de apoyo psicológico que puedan proteger la salud mental de las personas durante una crisis y mejorar la relación entre los trabajadores y sus jefes.

Does the COVID-19 pandemic condition the delusional content of patients with psychosis? An observational study.

INTRODUCTION: The primary objective is to analyse the impact of the COVID-19 pandemic on the triggers of psychopathology and on the delusional content of patients with psychotic symptoms treated during the first three months of the pandemic in a tertiary hospital in Madrid. METHODS: We conducted a cross-sectional, observational and retrospective study of all patients attending the psychiatric emergency room (ER) between 11th March and 11th June 2020. Sociodemographic and clinical variables were included. The chi-squared test or Fisher's exact test were performed to compare categorical variables. The level of statistical significance was set at P<.05. RESULTS: In the first month of the pandemic, COVID-19 conditioned the delirious content of 38.5% of the admitted patients and acted as a direct trigger for 46.2% of consultations. In the second week it affected 100.0% of the patients in both cases. Subsequently, a progressive and significant decrease was observed, with COVID-19 being the triggering factor for 17.6% and 11.5% of consultations in the second and third months of the pandemic respectively. Similarly, it was the main determinant of the delusional content in 13.7% and 3.8% of cases respectively. CONCLUSIONS: The current pandemic affects delirium's pathoplasty. The delusional content of patients admitted with psychotic symptoms is quickly conditioned, which may be related to the radical change in their life, without transition or prior preparation. The patient's environmental context and events have a huge impact on the dynamics and characteristics of mental disorders.

A novel biocompatible polymer derived from D-mannitol used as a vector in the field of genetic engineering of eukaryotic cells.

The design and preparation of new vectors to transport genetic material and increase the transfection efficiency continue being an important research line. Here, a novel biocompatible sugar-based polymer derived from D-mannitol has been synthesized to be used as a gene material nanocarrier in human (gene transfection) and microalga cells (transformation process). Its low toxicity allows its use in processes with both medical and industrial applications. A multidisciplinary study about the formation of polymer/p-DNA polyplexes has been carried out using techniques such as gel electrophoresis, zeta potential, dynamic light scattering, atomic force microscopy, and circular dichroism spectroscopy. The nucleic acids used were the eukaryotic expression plasmid pEGFP-C1 and the microalgal expression plasmid Phyco69, which showed different behaviors. The importance of DNA supercoiling in both transfection and transformation processes was demonstrated. Better results were obtained in microalga cells nuclear transformation than in human cells gene transfection. This was related to the plasmid's conformational changes, in particular to their superhelical structure. It is noteworthy that the same nanocarrier has been used with eukaryotic cells from both human and microalga.

Influence of Previous Mental State on Psychological Outcomes of Spanish Out-of-Hospital Professionals during the COVID-19 Pandemic.

This study aimed to describe factors relating to the psychological distress of healthcare workers (HCWs) in Spanish out-of-hospital emergency medical services (EMS), according to the previous or non-use of psychotropic drugs or psychotherapy. A multicentre, cross-sectional descriptive study was designed. The study population were all physicians, nurses, and emergency medical technicians (EMTs) working in any Spanish out-of-hospital EMS between February and April 2021. The main outcomes were the levels of stress, anxiety, depression, and self-efficacy, assessed by DASS-21 and G-SES. Differences in levels of stress, anxiety, depression, and self-efficacy, according to sex, age, previous use of psychotropic drug or psychotherapy, work experience, professional category, type of work, and modification of working conditions were measured using the Student's t-test for independent samples, one-way ANOVA, Pearson's correlation, or 2-factor analysis of covariance. A total of 1636 HCWs were included, of whom one in three had severe mental disorders because of the pandemic. The interaction of the previous or non-use of psychotropic drugs or psychotherapy with the rest of the factors considered did not modify the levels of stress, anxiety, depression, and self-efficacy. However, HCWs with a history of psychotropic drug or psychotherapy use had a more intense negative emotional response and lower self-efficacy, regardless of their sex, professional category, type of work, or change in the working conditions. These HCWs are considered particularly vulnerable to the development or recurrence of new disorders or other comorbidities; therefore, the implementation of monitoring and follow-up strategies should be a priority.

Biodegradable Guar-Gum-Based Super-Porous Matrices for Gastroretentive Controlled Drug Release in the Treatment of Helicobacter pylori: A Proof of Concept.

An increase in resistance to key antibiotics has made the need for novel treatments for the gastric colonization of Helicobacter pylori (H. pylori) a matter of the utmost urgency. Recent studies tackling this topic have focused either on the discovery of new compounds to ameliorate therapeutic regimes (such as vonoprazan) or the synthesis of gastroretentive drug delivery systems (GRDDSs) to improve the pharmacokinetics of oral formulations. The use of semi-interpenetrating polymer networks (semi-IPNs) that can act as super-porous hydrogels for this purpose is proposed in the present work, specifically those displaying low ecological footprint, easy synthesis, self-floating properties, high encapsulation efficiency for drugs such as amoxicillin (AMOX), great mucoadhesiveness, and optimal mechanical strength when exposed to stomach-like fluids. To achieve such systems, biodegradable synthetic copolymers containing acid-labile monomers were prepared and interpenetrated with guar gum (GG) in a one-pot polymerization process based on thiol-ene click reactions. The resulting matrices were characterized by SEM, GPC, TGA, NMR, and rheology studies, and the acidic hydrolysis of the acid-sensitive polymers was also studied. Results confirm that some of the obtained matrices are expected to perform optimally as GRDDSs for the sustained release of active pharmaceutical ingredients at the gastrointestinal level, being a priori facilitated by its disaggregation. Therefore, the optimal performance of these systems is assessed by varying the molar ratio of the labile monomer in the matrices.

Influence of the Cumulative Incidence of COVID-19 Cases on the Mental Health of the Spanish Out-of-Hospital Professionals.

This study aimed to analyze the psychological affectation of health professionals (HPs) of Spanish Emergency Medical Services (EMSs) according to the cumulative incidence (CI) of COVID-19 cases in the regions in which they worked. A cross-sectional descriptive study was designed, including all HPs working in any EMS of the Spanish geography between 1 February 2021 and 30 April 2021. Their level of stress, anxiety and depression (DASS-21) and the perception of self-efficacy (G-SES) were the study's main results. A 2-factor analysis of covariance was used to determine if the CI regions of COVID-19 cases determined the psychological impact on each of the studied variables. A total of 1710 HPs were included. A third presented psychological impairment classified as severe. The interaction of CI regions with the studied variables did not influence their levels of stress, anxiety, depression or self-efficacy. Women, younger HPs or those with less EMS work experience, emergency medical technicians (EMT), workers who had to modify their working conditions or those who lived with minors or dependents suffered a greater impact from the COVID-19 pandemic in certain regions. These HPs have shown high levels of stress, anxiety, depression and medium levels of self-efficacy, with similar data in the different geographical areas. Psychological support is essential to mitigate their suffering and teach them to react to adverse events.

Infección bacteriana/fúngica en pacientes con COVID-19 ingresados en un hospital de tercer nivel de Castilla y León, España / Bacterial/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y León, Spain

IntroducciónLa coinfección/sobreinfección bacteriana/fúngica contribuye al incremento de la morbimortalidad de las infecciones respiratorias (IRs) virales. El objetivo de este trabajo es conocer la incidencia de estas infecciones en los pacientes hospitalizados por COVID-19.MétodoEstudio retrospectivo observacional de todos los pacientes ingresados por COVID-19 e infección bacteriana/fúngica en el Hospital Clínico de Valladolid (1 marzo-31 mayo, 2020). Comparación de datos demográficos, clínicos y microbiológicos en función del ingreso en UCI e identificación de los factores predictores de mortalidad mediante regresión logística multivariante.ResultadosDe 712 pacientes con COVID-19, 113 (16%) presentaron coinfección/ sobreinfección bacteriana/fúngica. Mediana de edad 73 años (RIQ 57-89), 59% de ellos hombres. Perfil del paciente de UCI (44%): hombre con neumonía por SARS-CoV-2, leucocitosis, interleucina-6 elevada, con interferón β-1b y tocilizumab y sobreinfección (p < 0,05). El 5% (39/712) de los pacientes presentaron una coinfección. Streptococcus pneumoniae (6) y Staphylococcus aureus (6) fueron los principales patógenos de las coinfecciones respiratorias (18). El 11% (80/712) se sobreinfectaron. Las infecciones más frecuentes fueron las urinarias (53) e IRs (39). Acinetobacter baumannii multirresistente fue el principal agente de la IR y la bacteriemia. Un brote por A. baumannii contribuyó a este resultado. Tres pacientes se diagnosticaron como probable aspergilosis pulmonar. La mortalidad fue superior en los pacientes de UCI (50 vs. 29%; p = 0,028). Factores predictores de mortalidad: hombre con varias comorbilidades, neumonía por SARS-CoV-2, bacteriemia y sobreinfectado por A. baumannii.ConclusiónEl brote por A. baumannii fue determinante en la incidencia de la infección y en la morbimortalidad de los pacientes de UCI.

IntroductionBacterial/fungal coinfection and superinfections contribute to the increased morbi-mortality of viral respiratory infections (RIs). The main objective of this study was to determine the incidence of these infections in hospitalized patients with COVID-19.MethodRetrospective observational study of all patients admitted for COVID-19 and bacterial/fungal infections at the Hospital Clínico Universitario of Valladolid, Spain (March 1-May 31, 2020). Demographic, clinical and microbiological data were compared based on Intensive Care Unit (ICU) admission and predictors of mortality by were identified using multivariate logistic regression analyses.ResultsOf the 712 COVID-19 patients, 113 (16%) presented bacterial/fungal coinfections or superinfections. Their median age was 73 years (IQR 57-89) and 59% were men. The profiles of ICU patients (44%) included male, SARS-CoV-2 pneumonia, leukocytosis, elevated inteleukin-6, with interferon β-1b and tocilizumab and superinfection (p < 0.05). Coinfections were diagnosed in 5% (39/712) patients. Most common pathogens of respiratory coinfection (18) were Streptococcus pneumoniae (6) and Staphylococcus aureus (6). Superinfections were detected in 11% (80/712) patients. Urinary (53) and RIs (39) constituted the majority of superinfections Acinetobacter baumannii multidrug-resistant was the main agent of IR and bacteremia. An outbreak of A. baumannii contributed to this result. Three patients were considered to have probable pulmonary aspergillosis. Mortality was higher in UCI patients (50 vs. 29%; p = 0.028). The predictive factors of mortality included being a male with various comorbidities, SARS-CoV-2 pneumonia, bacteremia and superinfections from A. baumannii.ConclusionThe outbreak of A. baumannii was a determining factor in the increases of the incidence of infection and the morbi-mortality of ICU patients.

Bacterial/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y León, Spain.

INTRODUCTION: Bacterial/fungal coinfection and superinfections contribute to the increased morbi-mortality of viral respiratory infections (RIs). The main objective of this study was to determine the incidence of these infections in hospitalized patients with COVID-19. METHOD: Retrospective observational study of all patients admitted for COVID-19 and bacterial/fungal infections at the Hospital Clínico Universitario of Valladolid, Spain (March 1-May 31, 2020). Demographic, clinical and microbiological data were compared based on Intensive Care Unit (ICU) admission and predictors of mortality by were identified using multivariate logistic regression analyses. RESULTS: Of the 712 COVID-19 patients, 113 (16%) presented bacterial/fungal coinfections or superinfections. Their median age was 73 years (IQR 57-89) and 59% were men. The profiles of ICU patients (44%) included male, SARS-CoV-2 pneumonia, leukocytosis, elevated inteleukin-6, with interferon ß-1b and tocilizumab and superinfection (p < 0.05). Coinfections were diagnosed in 5% (39/712) patients. Most common pathogens of respiratory coinfection (18) were Streptococcus pneumoniae (6) and Staphylococcus aureus (6). Superinfections were detected in 11% (80/712) patients. Urinary (53) and RI (39) constituted the majority of superinfections Acinetobacter baumannii multidrug-resistant was the main agent of IR and bacteremia. An outbreak of A. baumannii contributed to this result. Three patients were considered to have probable pulmonary aspergillosis. Mortality was higher in UCI patients (50% vs. 29%, p = 0.028). The predictive factors of mortality included being a male with various comorbidities, SARS-CoV-2 pneumonia, bacteremia and superinfections from A. baumannii. CONCLUSION: The outbreak of A. baumannii was a determining factor in the increases of the incidence of infection and the morbi-mortality of ICU patients.

[Does the COVID-19 pandemic condition the delusional content of patients with psychosis? An observational study]. / ¿La pandemia de COVID-19 condiciona el contenido delirante de los pacientes con psicosis? Un estudio observacional.

Introduction: The primary objective is to analyse the impact of the COVID-19 pandemic on the triggers of psychopathology and on the delusional content of patients with psychotic symptoms treated during the first three months of the pandemic in a tertiary hospital in Madrid.Methods: We conducted a cross-sectional, observational and retrospective study of all patients attending the psychiatric emergency room (ER) between 11th March and 11th June 2020. Sociodemographic and clinical variables were included. The chi-squared test or Fisher's exact test were performed to compare categorical variables. The level of statistical significance was set at p<0.05.Results: In the first month of the pandemic, COVID-19 conditioned the delirious content of 38.5% of the admitted patients and acted as a direct trigger for 46.2% of consultations. In the second week it affected 100.0% of the patients in both cases. Subsequently, a progressive and significant decrease was observed, with COVID-19 being the triggering factor for 17.6% and 11.5% of consultations in the second and third months of the pandemic respectively. Similarly, it was the main determinant of the delusional content in 13.7% and 3.8% of cases respectively.Conclusions: The current pandemic affects delirium's pathoplasty. The delusional content of patients admitted with psychotic symptoms is quickly conditioned, which may be related to the radical change in their life, without transition or prior preparation. The patient's environmental context and events have a huge impact on the dynamics and characteristics of mental disorders.

Análisis de la demanda asistencial en la urgencia y unidad de hospitalización psiquiátrica en el contexto de pandemia por COVID-19 / Analysis of the demand for care in a psychiatric emergency room and an acute inpatient unit in the context of the COVID-19 pandemic

INTRODUCCIÓN: El objetivo consiste en analizar el impacto del COVID-19 en la demanda asistencial de las urgencias y en los ingresos psiquiátricos durante el primer mes de la pandemia. MÉTODOS: Realizamos un estudio transversal observacional retrospectivo en pacientes que acuden a urgencias psiquiátricas entre el 11 de marzo y el 11 de abril de 2019 y 2020 respectivamente. Se incluyeron variables sociodemográficas y clínicas en el estudio. Se realizaron las pruebas de Chi Cuadrado o Test exacto de Fisher para el contraste de hipótesis de variables categóricas y la prueba U Mann-Whitney para el contraste de variables cuantitativas. El nivel de significación estadística se estableció en p<0.05. Los análisis se realizaron con IBM SPSS Statistics. RESULTADOS: Se observa un descenso significativo de la media de pacientes atendidos al día en urgencias entre ambos periodos, siendo esta de 5,91 (±2,53) en 2019 y de 2,41 (±1,81) en 2020 (p<0.001). Se ha visto una disminución significativa de la ocupación media de camas en la UHB, ocupándose un 91,84% (±7,72) de camas en 2019 y un 58,85% (±13,81) en 2020 (p<0,001). En cuanto a la proporción de ingresos de los pacientes que acuden a urgencias, se ha visto un aumento significativo en el año 2020 respecto al año anterior. CONCLUSIONES: La demanda en la urgencia de pacientes psiquiátricos y la ocupación media de camas se ha reducido durante el primer mes tras la declaración de la pandemia. El miedo al contagio puede actuar como modulador de la demanda psiquiátrica.

INTRODUCTION: The aim is to analyze the impact of COVID-19 on the demand for emergency care and psychiatric admissions during the first month of the pandemic. METHODS: We conducted a retrospective, observational and cross-sectional study. We reviewed the clinical records of all patients attending the psychiatric emergency room (ER) between March 11th and April 11th, of both 2019 and 2020. Sociodemographic and clinical variables were included in the study. Chi-square test or Fisher's exact test were performed to compare categorical variables, while U Mann-Whitney U test was used for quantitative variables. The level of statistical significance was set at p<0.05. Analysis were conducted using IBM SPSS Statistics. RESULTS: The was a significant decrease in the number of patients attended in the ER. An average of 5.91 (±2.53) patients were treated per day in 2019 compared to 2.41 (±1.81) in 2020 (p<0.001). There was also a significant decrease in the occupancy rate at the inpatient psychiatric unit, with a 91.84% (±7.72) of beds occupied in 2019 and only 58.85% (±13.81) in 2020 (p<0.001). Regarding the percentage of patients admitted after assessment in the ER, there was a significant increase in 2020 compared to the previous year. CONCLUSIONS: The demand for care in the psychiatric emergency room and the average bed occupancy have decreased during the first month after the declaration of the pandemic. Fear of contagion may act as a modulator of psychiatric demand.

Infección bacteriana/fúngica en pacientes con COVID-19 ingresados en un hospital de tercer nivel de Castilla y León, España / Bacterial/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y León, Spain

INTRODUCCIÓN: La coinfección/sobreinfección bacteriana/fúngica contribuye al incremento de la morbimortalidad de las infecciones respiratorias (IRs) virales. El objetivo de este trabajo es conocer la incidencia de estas infecciones en los pacientes hospitalizados por COVID-19. MÉTODO: Estudio retrospectivo observacional de todos los pacientes ingresados por COVID-19 e infección bacteriana/fúngica en el Hospital Clínico de Valladolid (1 marzo-31 mayo, 2020). Comparación de datos demográficos, clínicos y microbiológicos en función del ingreso en UCI e identificación de los factores predictores de mortalidad mediante regresión logística multivariante. RESULTADOS: De 712 pacientes con COVID-19, 113 (16%) presentaron coinfección/ sobreinfección bacteriana/fúngica. Mediana de edad 73 años (RIQ 57-89), 59% de ellos hombres. Perfil del paciente de UCI (44%): hombre con neumonía por SARS-CoV-2, leucocitosis, interleucina-6 elevada, con interferón β-1b y tocilizumab y sobreinfección (p < 0,05). El 5% (39/712) de los pacientes presentaron una coinfección. Streptococcus pneumoniae (6) y Staphylococcus aureus (6) fueron los principales patógenos de las coinfecciones respiratorias (18). El 11% (80/712) se sobreinfectaron. Las infecciones más frecuentes fueron las urinarias (53) e IRs (39). Acinetobacter baumannii multirresistente fue el principal agente de la IR y la bacteriemia. Un brote por A. baumannii contribuyó a este resultado. Tres pacientes se diagnosticaron como probable aspergilosis pulmonar. La mortalidad fue superior en los pacientes de UCI (50 vs. 29%; p = 0,028). Factores predictores de mortalidad: hombre con varias comorbilidades, neumonía por SARS-CoV-2, bacteriemia y sobreinfectado por A. baumannii. CONCLUSIÓN: El brote por A. baumannii fue determinante en la incidencia de la infección y en la morbimortalidad de los pacientes de UCI

INTRODUCTION: Bacterial/fungal coinfection and superinfections contribute to the increased morbi-mortality of viral respiratory infections (RIs). The main objective of this study was to determine the incidence of these infections in hospitalized patients with COVID-19. METHOD: Retrospective observational study of all patients admitted for COVID-19 and bacterial/fungal infections at the Hospital Clínico Universitario of Valladolid, Spain (March 1-May 31, 2020). Demographic, clinical and microbiological data were compared based on Intensive Care Unit (ICU) admission and predictors of mortality by were identified using multivariate logistic regression analyses. RESULTS: Of the 712 COVID-19 patients, 113 (16%) presented bacterial/fungal coinfections or superinfections. Their median age was 73 years (IQR 57-89) and 59% were men. The profiles of ICU patients (44%) included male, SARS-CoV-2 pneumonia, leukocytosis, elevated inteleukin-6, with interferon beta-1b and tocilizumab and superinfection (p < 0.05). Coinfections were diagnosed in 5% (39/712) patients. Most common pathogens of respiratory coinfection (18) were Streptococcus pneumoniae (6) and Staphylococcus aureus (6). Superinfections were detected in 11% (80/712) patients. Urinary (53) and RIs (39) constituted the majority of superinfections Acinetobacter baumannii multidrug-resistant was the main agent of IR and bacteremia. An outbreak of A. baumannii contributed to this result. Three patients were considered to have probable pulmonary aspergillosis. Mortality was higher in UCI patients (50 vs. 29%; p = 0.028). The predictive factors of mortality included being a male with various comorbidities, SARS-CoV-2 pneumonia, bacteremia and superinfections from A. baumannii. CONCLUSION: The outbreak of A. baumannii was a determining factor in the increases of the incidence of infection and the morbi-mortality of ICU patients

Serum endocannabinoid levels in suicide attempters: A pilot study.

The search for a biomarker for suicide risk is a longstanding pursuit in clinical psychiatry. Literature addressing the role of endocannabinoids in suicide attempters (SA) is sparse. This cross-sectional study is aimed at comparing 8 AM serum concentrations of 4 endogenous cannabinoids (anandamide, AEA; 2-arachidonoylglycerol, 2-AG; N-palmitoiletanolamida, PEA; and oleoylethanolamide, OEA) in 30 suicide attempters (SA) and 12 psychiatric controls (PC). 8 AM AEA and PEA serum levels were higher in SA compared to PC without controlling for cannabis use (n = 42) (3.58 ± 5.77 vs. 1.62 ± 2.49, F = 3.04, P = 0.089; and 3.31 ± 4.82 vs. 1.21 ± 1.20, F = 6.22, p = 0.017, respectively). Serum ACTH was higher in PC compared to SA (32.11 ± 21.60 vs. 20.05 ± 9.96, F = 9.031, p = 0.0.005). After controlling for cannabis use in the urine test (n = 28), 8 AM AEA and PEA serum levels remained higher in SA compared to PC (4.57 ± 6.38 vs. 0.64 ± 1.11, F = 4.852, P = 0.037; and 4.35 ± 5.46 vs. 1.21 ± 1.25, F = 4.125, p = 0.053, respectively). The present study offers preliminary evidence about the role of AEA and PEA in suicidal behavior (SB). Furthermore, in the context of the mental pain model of SB, our findings suggest that some endocannabinoids may play a role in the pathophysiology of SB. Our pilot study deserves replication by other studies with bigger sample sizes.

Serum ß-endorphin levels are associated with addiction to suicidal behavior: A pilot study.

The literature provides partial support for the hypothesis that some suicide attempters develop a behavioral addiction to suicidal behavior (SB). We hypothesized that major suicide repeaters (MR) (≥5 lifetime suicide attempts) are addicted to suicide attempts as measured by modified DSM-IV criteria for substance dependence. In this cross-sectional study with 13 psychiatric controls (PC), 55 non-major suicide attempters (NMR), and 9 MR we found that MR are characterized by emotional abuse and neglect, as well as higher scores on the Personality and Life Event scale (short version). The levels of 8 AM serum ACTH, cortisol and ß-endorphin were elevated in all three groups. Serum ß-endorphin (pg/mL) was particularly high in PC diagnosed with schizophrenia 220.34 (±56.30). The level of 8 AM serum ß-endorphin rose with increased numbers of criteria met for addiction to SB from 130.31 (±88.16) (≥ 3 criteria met for addiction to SB) to 174.84 (±114.93) (≥ 6 criteria met for addiction to SB) whereas serum ACTH and cortisol did not change. SB addicts (≥ 6 criteria) displayed higher serum ß-endorphin concentrations than non-addicts (174.84 ± 114.93 vs. 116.93 ± 61.70, FET p = 0.09). The present study brings some support to the addictive hypothesis of SB. Our results delineate ß-endorphin as a promising biomarker of SB addiction, and offer a good basis for future studies that test whether buprenorphine can be used to prevent repetitive suicide attempts, non-suicidal-self-injury (NSSI), and the development of an addiction to SB.

In-Depth Study into Polymeric Materials in Low-Density Gastroretentive Formulations.

The extensive use of oral dosage forms for the treatment of diseases may be linked to deficient pharmacokinetic properties. In some cases the drug is barely soluble; in others, the rapid transit of the formulation through the gastrointestinal tract (GIT) makes it difficult to achieve therapeutic levels in the organism; moreover, some drugs must act locally due to a gastric pathology, but the time they remain in the stomach is short. The use of formulations capable of improving all these parameters, as well as increasing the resident time in the stomach, has been the target of numerous research works, with low-density systems being the most promising and widely explored, however, there is further scope to improve these systems. There are a vast variety of polymeric materials used in low-density gastroretentive systems and a number of methods to improve the bioavailability of the drugs. This works aims to expedite the development of breakthrough approaches by providing an in-depth understanding of the polymeric materials currently used, both natural and synthetic, their properties, advantages, and drawbacks.

Bacterial/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y León, Spain. / Infección bacteriana/fúngica en pacientes con COVID-19 ingresados en un hospital de tercer nivel de Castilla y León, España.

INTRODUCTION: Bacterial/fungal coinfection and superinfections contribute to the increased morbi-mortality of viral respiratory infections (RIs). The main objective of this study was to determine the incidence of these infections in hospitalized patients with COVID-19. METHOD: Retrospective observational study of all patients admitted for COVID-19 and bacterial/fungal infections at the Hospital Clínico Universitario of Valladolid, Spain (March 1-May 31, 2020). Demographic, clinical and microbiological data were compared based on Intensive Care Unit (ICU) admission and predictors of mortality by were identified using multivariate logistic regression analyses. RESULTS: Of the 712 COVID-19 patients, 113 (16%) presented bacterial/fungal coinfections or superinfections. Their median age was 73 years (IQR 57-89) and 59% were men. The profiles of ICU patients (44%) included male, SARS-CoV-2 pneumonia, leukocytosis, elevated inteleukin-6, with interferon ß-1b and tocilizumab and superinfection (p < 0.05). Coinfections were diagnosed in 5% (39/712) patients. Most common pathogens of respiratory coinfection (18) were Streptococcus pneumoniae (6) and Staphylococcus aureus (6). Superinfections were detected in 11% (80/712) patients. Urinary (53) and RIs (39) constituted the majority of superinfections Acinetobacter baumannii multidrug-resistant was the main agent of IR and bacteremia. An outbreak of A. baumannii contributed to this result. Three patients were considered to have probable pulmonary aspergillosis. Mortality was higher in UCI patients (50 vs. 29%; p = 0.028). The predictive factors of mortality included being a male with various comorbidities, SARS-CoV-2 pneumonia, bacteremia and superinfections from A. baumannii. CONCLUSION: The outbreak of A. baumannii was a determining factor in the increases of the incidence of infection and the morbi-mortality of ICU patients.

Nanostructured Chitosan-Based Biomaterials for Sustained and Colon-Specific Resveratrol Release.

In the present work, we demonstrate the preparation of chitosan-based composites as vehicles of the natural occurring multi-drug resveratrol (RES). Such systems are endowed with potential therapeutic effects on inflammatory bowel diseases (IBD), such as Crohn's disease (CD) and ulcerative colitis, through the sustained colonic release of RES from long-lasting mucoadhesive drug depots. The loading of RES into nanoparticles (NPs) was optimized regarding two independent variables: RES/polymer ratio, and temperature. Twenty experiments were carried out and a Box⁻Behnken experimental design was used to evaluate the significance of these independent variables related to encapsulation efficiency (EE). The enhanced RES EE values were achieved in 24 h at 39 °C and at RES/polymer ratio of 0.75:1 w/w. Sizes and polydispersities of the optimized NPs were studied by dynamic light scattering (DLS). Chitosan (CTS) dispersions containing the RES-loaded NPs were ionically gelled with tricarballylic acid to yield CTS-NPs composites. Macro- and microscopic features (morphology and porosity studied by SEM and spreadability), thermal stability (studied by TGA), and release kinetics of the RES-loaded CTS-NPs were investigated. Release patterns in simulated colon conditions for 48 h displayed significant differences between the NPs (final cumulative drug release: 79⁻81%), and the CTS-NPs composites (29⁻34%).

Cannabinoid Receptors, Mental Pain and Suicidal Behavior: a Systematic Review.

PURPOSE OF REVIEW: The current serotonin-based biological model of suicidal behavior (SB) may be too simplistic. There is emerging evidence that other biomarkers and biological systems may be involved in SB pathophysiology. The literature on the endocannabinoid (EC) systems and SB is limited. The objective of the present article is to review all available information on the relationship between cannabinoid receptors (CB1 and CB2 receptors), and SB and/or psychological pain. RECENT FINDINGS: Our review is limited by the small number and heterogeneity of studies identified: (1) an autopsy study describing elevated levels of CB1 receptor activity in the prefrontal cortex and suicide in both depression and alcoholism and (2) studies supporting the involvement of both CB1 and CB2 receptors in the regulation of neuropathic pain and stress-induced analgesia. We conclude that cannabinoid receptors, particularly CB1 receptors, may become promising targets for the development of novel therapeutic tools for the treatment of SB.