Identification of Predictive Markers of Response to Immunomodulators in the Treatment of COVID-19 Patients.

BACKGROUND: Proper identification of patients at risk of developing serious disease in the context of SARS-CoV-2 infection, as well as the initiation of early treatment, is one of the fundamental elements for successful management of COVID-19. The main objective of this study was to evaluate the usefulness of serum biomarkers (neutrophils, lymphocytes, C-reactive protein, lactate dehydrogenase, D-dimer, ferritin, and interleukin-6) to predict the early response to immunosuppressant therapy in COVID-19 patients. METHODS: This is a case-control study nested in a retrospective cohort, which included hospitalized patients with interstitial pneumonia and with elevation of some proinflammatory parameters. Each of the individuals who died during the 28-day follow-up was defined as a case. For each case, 4 controls were selected, matched by age, gender, and comorbidities. RESULTS: The initial cohort included 856 patients. The incidence of therapeutic failure in the cohort was 14%, thus we identified a total of 120 cases. After the application of a Cox regression model, high serum concentrations of LDH (> 451 IU/L), ferritin (> 1,014 ng/mL) and D-Dimer (> 1,300 ng/mL) were identified as predictors of poor response to treatment. Highly-specific cut-off points could not be established for any of these biomarkers. CONCLUSIONS: Some inflammatory biomarkers, such as LDH, ferritin, and D-dimer, may be helpful in identifying patients for whom an early immunomodulatory therapeutic intervention should be considered in the treatment of COVID-19 patients with pneumonia.

Carbofuran degraded by iron-doped anatase: Weakening the cholinesterase inhibitory activity in the photoproducts mixture.

Carbofuran is a toxic carbamate pesticide, and its use has increased in recent years. While marketing information indicates stability in different chemical media, carbofuran exhibits relative photolability. The aim of this research was to decompose carbofuran and to identify the photoproducts achieved when two different doped titania photocatalysts were employed under UV irradiation. The iron-doped TiO2 materials were obtained (a) via a hydrothermal method and (b) by an ultrasound-assisted sol-gel method. The precursors were TiOSO4⋅xH2O and Fe3(NO3)·9H2O. X-ray studies confirmed that the anatase phase of the iron-doped TiO2 resulted from the two preparation methods. The photocatalytic performance of the prepared materials was monitored by LC/ESI-QTOF-MS, enabling the identification of photoproducts: oxo-carbamates, hydroxylated benzofuranes, a carboxamide, and one amine. By using the iron-doped TiO2 materials, 2,2-dimethyl-2,3-dihydrobenzofuran-3,7-diol was the most abundant photoproduct, and N,2,2-trimethyl-2,3-dihydrobenzofuran-7-amine was the only compound that had not been previously reported in the photolysis and photocatalysis of carbofuran. The product 3-hydroxy carbofuran, a cholinesterase inhibitor, was quantified and was found to be transformed into compounds that lack this inhibitive property.

TiO2 immobilized on Manihot carbon: optimal preparation and evaluation of its activity in the decomposition of indigo carmine.

Applications of carbon-TiO2 materials have attracted attention in nanotechnology due to their synergic effects. We report the immobilization of TiO2 on carbon prepared from residues of the plant Manihot, commercial TiO2 and glycerol. The objective was to obtain a moderate loading of the anatase phase by preserving the carbonaceous external surface and micropores of the composite. Two preparation methods were compared, including mixing dry precursors and immobilization using a glycerol slurry. The evaluation of the micropore blocking was performed using nitrogen adsorption isotherms. The results indicated that it was possible to use Manihot residues and glycerol to prepare an anatase-containing material with a basic surface and a significant SBET value. The activities of the prepared materials were tested in a decomposition assay of indigo carmine. The TiO2/carbon eliminated nearly 100% of the dye under UV irradiation using the optimal conditions found by a Taguchi L4 orthogonal array considering the specific surface, temperature and initial concentration. The reaction was monitored by UV-Vis spectrophotometry and LC-ESI-(Qq)-TOF-MS, enabling the identification of some intermediates. No isatin-5-sulfonic acid was detected after a 60 min photocatalytic reaction, and three sulfonated aromatic amines, including 4-amino-3-hydroxybenzenesulfonic acid, 2-(2-amino-5-sulfophenyl)-2-oxoacetic acid and 2-amino-5-sulfobenzoic acid, were present in the reaction mixture.

Photoproducts of carminic acid formed by a composite from Manihot dulcis waste.

Carbon-TiO2 composites were obtained from carbonised Manihot dulcis waste and TiO2 using glycerol as an additive and thermally treating the composites at 800 °C. Furthermore, carbon was obtained from manihot to study the adsorption, desorption and photocatalysis of carminic acid on these materials. Carminic acid, a natural dye extracted from cochineal insects, is a pollutant produced by the food industry and handicrafts. Its photocatalysis was observed under different atmospheres, and kinetic curves were measured by both UV-Vis and HPLC for comparison, yielding interesting differences. The composite was capable of decomposing approximately 50% of the carminic acid under various conditions. The reaction was monitored by UV-Vis spectroscopy and LC-ESI-(Qq)-TOF-MS-DAD, enabling the identification of some intermediate species. The deleterious compound anthracene-9,10-dione was detected both in N2 and air atmospheres.

[Neurological examination in patients undergoing sedation with propofol: a descriptive study]. / Exploracion neurologica en pacientes sometidos a sedacion con propofol: estudio descriptivo.

INTRODUCTION: The neurological examination is a resource used in evaluating patients who are in coma. Anaesthesia can be a factor that exerts an influence on the findings. We evaluated the examination of the comatose patient in the case of patients anaesthetised with propofol in order to define its clinical value. PATIENTS AND METHODS: A prospective study was conducted among those who had undergone heart surgery in the intensive care unit of a tertiary hospital during the months of April and May 2011. Aspects that were analysed were the examination of the anaesthetic coma, pharmacological or medical factors that can have an influence and a full neurological examination following recovery. Patients with previous neurological symptoms were excluded. RESULTS: Thirty patients were selected (16 males and 14 females); mean age: 72 ± 10 years. All the patients were sedated with propofol. During sedation, 17 (46.7%) presented unreactive pupils. No spontaneous eye movements were observed in 100% of the sample. Ocular alterations in primary position were observed in 23.3% of them. Oculocephalic reflexes were absent in 93.3% and oculovestibular reflexes, in 100%; the corneal reflex, was absent in 70% (with asymmetry), as was the ciliospinal reflex, in 83.3%. The algesic motor response was absent in 93.3%, as were the cutaneous plantar extensor reflexes, in 20%; and 66.7% were indifferent. Following anaesthesia, the neurological examination was normal in 80%, there were slight orientation impairments in 16.7% and a hemispheric syndrome was found in one patient. CONCLUSIONS: Anaesthesia with propofol alters the reversible cutaneous-plantar, pupillary, trunk and motor response reflexes on withdrawing sedation. The alterations may be asymmetrical. Neurological examinations should not be used in the case of patients sedated with propofol in order to make clinical decisions.

TITLE: Exploracion neurologica en pacientes sometidos a sedacion con propofol: estudio descriptivo.Introduccion. La exploracion neurologica es un recurso en la evaluacion de los pacientes en coma. La anestesia puede ser un factor influyente en los hallazgos. Evaluamos la exploracion del paciente en coma en pacientes anestesiados con propofol para definir su valor clinico. Pacientes y metodos. Estudio prospectivo en sometidos a cirugia cardiaca en los cuidados intensivos de un hospital terciario durante los meses de abril y mayo de 2011. Se analiza la exploracion del coma anestesico, factores farmacologicos o medicos que pueden influir y exploracion neurologica completa tras la recuperacion. Se excluyeron pacientes con sintomas neurologicos previos. Resultados. Se seleccionan 30 pacientes (16 hombres y 14 mujeres); edad media: 72 ± 10 años. Todos los pacientes estaban sedados con propofol. Durante la sedacion, 17 (46,7%) presentaban pupilas arreactivas. En el 100% no se observaron movimientos espontaneos de los ojos. El 23,3% presentaba alteracion ocular en posicion primaria. Los reflejos oculocefalicos estaban ausentes en el 93,3%, y los oculovestibulares, en el 100%; el reflejo corneal, en el 70% (con asimetria); el espinociliar, en el 83,3%. La respuesta motora algesica estaba ausente en el 93,3%; en un 20%, los reflejos cutaneoplantares extensores; e indiferentes, en el 66,7%. Tras la anestesia, la exploracion neurologica fue normal en el 80%, hubo leves alteraciones de orientacion en un 16,7% y se encontro un sindrome hemisferico en un paciente. Conclusiones. La anestesia con propofol altera los reflejos pupilares, del tronco, respuestas motoras y reflejo cutaneoplantar reversibles al retirar la sedacion. Las alteraciones pueden ser asimetricas. No se deberia utilizar la exploracion neurologica en el paciente sedado con propofol para la toma de decisiones clinicas.

Exploración neurológica en pacientes sometidos a sedación con propofol: estudio descriptivo / eurological examination in patients undergoing sedation with propofol: a descriptive study

Introducción. La exploración neurológica es un recurso en la evaluación de los pacientes en coma. La anestesia puede ser un factor influyente en los hallazgos. Evaluamos la exploración del paciente en coma en pacientes anestesiados con propofol para definir su valor clínico. Pacientes y métodos. Estudio prospectivo en sometidos a cirugía cardíaca en los cuidados intensivos de un hospital terciario durante los meses de abril y mayo de 2011. Se analiza la exploración del coma anestésico, factores farmacológicos o médicos que pueden influir y exploración neurológica completa tras la recuperación. Se excluyeron pacientes con síntomas neurológicos previos. Resultados. Se seleccionan 30 pacientes (16 hombres y 14 mujeres); edad media: 72 ± 10 años. Todos los pacientes estaban sedados con propofol. Durante la sedación, 17 (46,7%) presentaban pupilas arreactivas. En el 100% no se observaron movimientos espontáneos de los ojos. El 23,3% presentaba alteración ocular en posición primaria. Los reflejos oculocefálicos estaban ausentes en el 93,3%, y los oculovestibulares, en el 100%; el reflejo corneal, en el 70% (con asimetría); el espinociliar, en el 83,3%. La respuesta motora algésica estaba ausente en el 93,3%; en un 20%, los reflejos cutaneoplantares extensores; e indiferentes, en el 66,7%. Tras la anestesia, la exploración neurológica fue normal en el 80%, hubo leves alteraciones de orientación en un 16,7% y se encontró un síndrome hemisférico en un paciente. Conclusiones. La anestesia con propofol altera los reflejos pupilares, del tronco, respuestas motoras y reflejo cutaneoplantar reversibles al retirar la sedación. Las alteraciones pueden ser asimétricas. No se debería utilizar la exploración neurológica en el paciente sedado con propofol para la toma de decisiones clínicas (AU)

Introduction. The neurological examination is a resource used in evaluating patients who are in coma. Anaesthesia can be a factor that exerts an influence on the findings. We evaluated the examination of the comatose patient in the case of patients anaesthetised with propofol in order to define its clinical value. Patients and methods. A prospective study was conducted among those who had undergone heart surgery in the intensive care unit of a tertiary hospital during the months of April and May 2011. Aspects that were analysed were the examination of the anaesthetic coma, pharmacological or medical factors that can have an influence and a full neurological examination following recovery. Patients with previous neurological symptoms were excluded. Results. Thirty patients were selected (16 males and 14 females); mean age: 72 ± 10 years. All the patients were sedated with propofol. During sedation, 17 (46.7%) presented unreactive pupils. No spontaneous eye movements were observed in 100% of the sample. Ocular alterations in primary position were observed in 23.3% of them. Oculocephalic reflexes were absent in 93.3% and oculovestibular reflexes, in 100%; the corneal reflex, was absent in 70% (with asymmetry), as was the ciliospinal reflex, in 83.3%. The algesic motor response was absent in 93.3%, as were the cutaneous plantar extensor reflexes, in 20%; and 66.7% were indifferent. Following anaesthesia, the neurological examination was normal in 80%, there were slight orientation impairments in 16.7% and a hemispheric syndrome was found in one patient. Conclusions. Anaesthesia with propofol alters the reversible cutaneous-plantar, pupillary, trunk and motor response reflexes on withdrawing sedation. The alterations may be asymmetrical. Neurological examinations should not be used in the case of patients sedated with propofol in order to make clinical decisions (AU)

Formation of sulfonyl aromatic alcohols by electrolysis of a bisazo reactive dye.

Five sulfonyl aromatic alcohols, namely 4-((2-hydroxyethyl)sulfonyl)phenol, 4-((2-(2-((4-hydroxyphenyl)sulfonyl)ethoxy)vinyl)sulfonyl)phenol, 4-(ethylsulfonyl)phenol, 4-(vinylsulfonyl)phenol and 5-((4-aminophenyl)sulfonyl)-2-penten-1-ol were identified by LC-ESI-Qq-TOF-MS as products formed by electrolysis of the bisazo reactive dye Reactive Black 5 (RB5). Since electrolyses were performed in an undivided cell equipped with Ni electrodes in alkaline medium, amines like 4-(2-methoxyethylsulfonyl)benzene-amine (MEBA) with m/z 216 were also suspected to be formed due to the plausible chemical reaction in the bulk or the cathodic reduction of RB5 and its oxidation by-products. Aiming to check this hypothesis, a method was used for the preparation of MEBA with 98% purity, via chemical reduction also of the dye RB5. The logP of the synthesized sulfonyl aromatic compounds was calculated and their logkw values were determined chromatographically. These data were discussed in regard to the relationship between hydrophobicity/lipophilicity and toxicity.

Performance of mango seed adsorbents in the adsorption of anthraquinone and azo acid dyes in single and binary aqueous solutions.

In this study the husk of mango seed and two carbonaceous adsorbents prepared from it were used to study the adsorption behavior of eight acid dyes. The adsorbed amount in mmol m(-2) decayed asymptotically as the molecular volume and area increased. The interaction between the studied dyes and the mesoporous carbon was governed by the ionic species in solution and the acidic/basic groups on the surface. Less than 50% of the external surface of the microporous carbon became covered with the dyes molecules, though monolayer formation demonstrating specific interactions only with active sites on the surface and the adsorption magnitudes correlated with the shape parameter of the molecule within a particular dye group. The adsorption behavior in mixtures was determined by the molecular volume of the constituents; the greater the molecular volume difference, the greater the effect on the adsorbed amount. We also demonstrated that the raw husk of the mango seed can be used to remove up to 50% from model 50 mg l(-1) solutions of the studied acid dyes.

[Prolonged sedation in Intensive Care Units]. / Sedación prolongada en Unidades de Cuidados Intensivos.

Sedation and analgesia constitute one of the cornerstones in the management of the critically ill patients. Most patients admitted to an Intensive Care Unit require prolonged sedation and analgesia. It has been demonstrated that adequate sedo- analgesia lessens stress-related events in the critically ill patients, facilitating their management and improving their outcomes. However, the use of sedatives and analgesics, especially when administered in continuous intravenous infusion, may have its complications derived from its infra or over utilization with proved impact on the outcome of critically ill patients. A proper monitoring and the implementation of sedation and analgesia protocols warrant the adequate management of existing sedatives aiding to avoid tolerance and dependency events. Strategies such as "sequential sedation", "dynamic sedation" or "daily sedation interruption" have been proposed as efficacious tools for the avoidance of complications related to prolonged sedation. In the present chapter, concepts related to prolonged sedation (meaning sedation for more than 72 hours) are reviewed; available agents are evaluated and strategies aimed to assure quality in its application are described.

Sedación prolongada en Unidades de Cuidados Intensivos / Prolonged sedation in intensive care units

La sedoanalgesia es uno de los pilares básicos del manejo del paciente crítico. La mayoría de los pacientes ingresados en una Unidad de Cuidados Intensivos requiere sedoanalgesia de forma prolongada. Una adecuada sedoanalgesia disminuye el grado de estrés del paciente crítico, facilitando su manejo y tratamiento y mejorando su pronóstico. Sin embargo, la sedoanalgesia, sobre todo en perfusión continua, es una práctica que no está exenta de complicaciones derivadas tanto de su infra-como de su sobre-utilización, que pueden empeorar el pronóstico de los pacientes críticos. Una adecuada monitorización y la aplicación de protocolos consensuados en sedoanalgesia garantizan la utilización adecuada de los sedantes evitando fenómenos de tolerancia y dependencia. Estrategias como la sedación secuencial, la sedación dinámica o la interrupción diaria de la sedación se han propuesto como herramientas útiles para evitar complicaciones asociadas a la sedación prolongada. En el presente capítulo se revisan conceptos relacionados con la sedación prolongada, entendida ésta como aquélla cuya duración es mayor de 72 horas; se evalúan los agentes disponibles y se proponen estrategias para garantizar la calidad de su aplicación (AU)

Sedation and analgesia constitute one of the cornerstones in the management of the critically ill patients. Most patients admitted to an Intensive Care Unit require prolonged sedation and analgesia. It has been demonstrated that adequate sedo-analgesia lessens stress-related events in the critically ill patients, facilitating their management and improving their outcomes. However, the use of sedatives and analgesics, especially when administered in continuous intravenous infusion, may have its complications derived from its infra or over utilization with proved impact on the outcome of critically ill patients. A proper monitoring and the implementation of sedation and analgesia protocols warrant the adequate management of existing sedatives aiding to avoid tolerance and dependency events. Strategies such as “sequential sedation”, “dynamic sedation” or “daily sedation interruption” have been proposed as efficacious tools for the avoidance of complications related to prolonged sedation. In the present chapter, concepts related to prolonged sedation (meaning sedation for more than 72 hours) are reviewed; available agents are evaluated and strategies aimed to assure quality in its application are described (AU)

Efectos del ayuno del Ramadán sobre la secreción de gastrina en jóvenes musulmanes en edad escolar / No disponible

Fundamento: Los cambios de hábitos durante el Ramadán, obligan a importantes reajustes fisiológicos, para mantener la homeostasis. El objetivo del presente trabajo ha sido analizar el perfil secretor de gastrina durante el ayuno de Ramadán en un grupo de musulmanes voluntarios, en edad escolar (13 a 15 años).Método: La muestra estuvo constituida por17 varones sanos, sin problemas gastrointestinales previos, seleccionados al azar entre todos los alumnos voluntarios de centros de enseñanza secundaria de Ceuta que practican el ayuno del Ramadán. Los niveles hormonales de gastrina se determinaron mediante radioinmunoanálisis. Resultados: Nuestros resultados muestran una disminución significativa de los niveles de gastrina al avanzar el período de ayuno, alcanzando el día 21, cifras de 23,89 pmol/L en comparación con los 28,49 de la semana previa(p=0,006) y de los 28,13 de la primera semana de ayuno (p=0,015). Estos cambios pueden interpretarse como una respuesta homeostática de adaptación a las nuevas pautas de alimentación. Finalizado el tiempo de Ramadán, observamos un incremento en los niveles de gastrina que devuelve los niveles hormonales a 30,15pmol/L, similares a los encontrados las semanas previa y primera del ayuno. Conclusión: Estos resultados sugieren un perfil de secreción para la hormona dependiente de la ingesta, que requiere un tiempo de adaptación a la nueva situación (AU)

Background: The changes in habits during Ramadan result in significant physiological readjustments, in order to maintain homeostasis. The main objective of the present study was to analyze the gastrin secretion during Ramdan Fast in a young muslim group during the school period between 13 - 15 years old. Method: Sample size was integrated by 17healthy men, without digestive personal history, selected by a randomized program between all the muslim students of the High Schools from Ceuta that practise Ramadan fast. Gastrin levels were determined by radioimmuno analysis(RIA).Results: Gastrin levels tend to go down during the fast period and at the 21st the media is23,89 pmol/L comparing with 28,49 pmol/L of the previous week (p=0,006) and the levels of the 1st week (28,13 pmol/L; p=0,015). These changes can be interpreted like an homeostatic answer of adaptation to the new guidelines of feeding. When Ramadan Fast concludes, gastrin levels come up again to basal levels (30,15pmol/L).Conclusion: These results suggest a secretion profile for the dependent hormone of the ingestion, that requires a time from adaptation to the new situation (AU)

Bloqueo auriculoventricular completo tras infusión intravenosa de metoclopramida / Complete atrio-ventricular block after intravenous infusion of metoclopramide

No disponible

Coma en el postoperatorio de cirugía cardíaca: masa en la silla turca / Coma following cardiac surgery. Mass in the sella turcica

Las causas de bajo nivel de conciencia tras el postoperatorio de cirugía cardíaca son numerosas. Una de ellas muy poco frecuente es el infarto o hemorragia de un adenoma hipofisario que, en general, no había sido diagnosticado previamente. Describimos el caso de una paciente que, durante el postoperatorio de cirugía cardíaca, presentó una evolución tórpida con múltiples complicaciones, entre ellas bajo nivel de conciencia, siendo diagnosticada de macroadenoma hipofisario e hipopituitarismo, y con un curso evolutivo favorable mediante tratamiento hormonal sustitutivo (AU)