Thrombosis and infections associated with PICC in onco-hematological patients, what is their relevance?

PURPOSE: Peripherally inserted central venous catheters (PICC) in the onco-hematological patients may be associated with thrombosis or infections that may have short- to medium-term repercussions. MATERIAL AND METHODS: Single-centre retrospective analysis of a prospectively collected cohort. Primary objective was to establish the PICC-thrombosis and infections incidence. Secondary objectives were to analyze profile of patients suffering from these complications and variables associated with an increased likelihood of developing these events. RESULTS: 549 patients were recruited. 58.5% (n = 321) were oncology patients and 41.5% (n = 228) hematology patients. The incidence of PICC-associated thrombosis was 3.5% (n = 19). Thrombosis was associated with progression of the underlying malignant pathology in 10.6% (n = 2) of cases. No association was found between clinical variables analysed and development of thrombosis. Incidence of PICC-associated infections was 7.65% (n = 42). In the 30 days prior to PICC infection, 57.1% (n = 24) had a febrile syndrome of another focus, 73.8% (n = 11) had been hospitalized, 49.5% (n = 25) had a neutrophil count of 0-500 cells/mm3 and 47.6% (n = 20) had an episode of neutropenic fever. Variables significantly associated with the development of infection were hematological patients, high-flow PICC, 3-lm PICC or PICC insertion because of administration of vesicant therapy. CONCLUSIONS: Incidence of PICC-associated thrombosis is low and apparently less prognostically aggressive than other forms of thrombosis associated with cancer, without identify predictive factors. Infection was more prevalent and the identification of risk factors in our series could facilitate its prevention.

Effect of halophyte-based management in physiological and biochemical responses of tomato plants under moderately saline greenhouse conditions.

Salinity, both in irrigation water and in soils, is one of the major abiotic constraints for agriculture activity worldwide. Phytodesalinization is a low-cost plant-based bioremediation strategy that can effectively amend salt-affected soils by cultivating salt tolerant plants. However, very few studies have evaluated the use of halophyte plants in crop management systems. In this work, we apply two different tomato crop management strategies involving the halophyte Arthrocaulon macrostachyum L. in a moderately saline soil: intercropping (mixed cultivation) and sequential cropping (cultivation of tomato where halophytes were previously grown). We investigated the effect of the different crop managements in some physiological and biochemical variables in tomato plants, including mineral nutrients content, photosynthesis, chlorophyll and flavonol contents, antioxidant metabolism and fruit production and quality. At soil level, both intercropping and sequential cropping decreased chloride content, sodium adsorption ratio and electrical conductivity, leading to reduced soil salinity. In tomato plants, halophyte-dependent management improved nutrient homeostasis and triggered a mild oxidative stress, whereas photosynthesis performance was enhanced by intercropping. In tomato fruits, the sequential cropping led to a 27% production increase and a slight decrease in the soluble sugar contents. We suggest the use of A. macrostachyum, and hence of halophyte plants, as an environmentally friendly phytoremediation strategy to improve plant performance while improving crop production, leading to a more sustainable agriculture and enhancing biodiversity.

The effect of a live music therapy intervention on critically ill paediatric patients in the intensive care unit: A quasi-experimental pretest-posttest study.

BACKGROUND: Music therapy as a nonpharmacological means of managing patient pain, anxiety, and discomfort is a recognised technique, although it is not widely used in the paediatric intensive care unit (PICU). AIM: The aim of this study was to assess the clinical effect of a live music therapy intervention on vital signs and levels of discomfort and pain for paediatric patients in the PICU. METHODS: This was a quasi-experimental pretest-posttest study. The music therapy intervention was carried out by two music therapists who were specifically trained, each possessing a master's degree in the field of hospital music therapy. Ten minutes before the start of the music therapy session, the investigators recorded the vital signs of the patients and assessed their levels of discomfort and pain. The procedure was repeated at the start of the intervention; at 2, 5, and 10 min during the intervention; and at 10 min following the conclusion of the intervention. RESULTS: Two hundred fifty-nine patients were included; 55.2% were male, with a median age of 1 year (0-21). A total of 96 (37.1%) patients suffered a chronic illness. The main reason for PICU admission was respiratory illness, at 50.2% (n = 130). Significantly lower values were observed for heart rate (p = 0.002), breathing rate (p < 0.001), and degree of discomfort (p < 0.001) during the music therapy session. CONCLUSIONS: Live music therapy results in reduced heart rates, breathing rates, and paediatric patient discomfort levels. Although music therapy is not widely used in the PICU, our results suggest that using interventions such as that used in this study could help reduce patient discomfort.

MAB-MIG: registry of the spanish neurological society of erenumab for migraine prevention.

BACKGROUND: Erenumab was approved in Europe for migraine prevention in patients with ≥ 4 monthly migraine days (MMDs). In Spain, Novartis started a personalized managed access program, which allowed free access to erenumab before official reimbursement. The Spanish Neurological Society started a prospective registry to evaluate real-world effectiveness and tolerability, and all Spanish headache experts were invited to participate. We present their first results. METHODS: Patients fulfilled the ICHD-3 criteria for migraine and had ≥ 4 MMDs. Sociodemographic and clinical data were registered as well as MMDs, monthly headache days, MHDs, prior and concomitant preventive treatment, medication overuse headache (MOH), migraine evolution, adverse events, and patient-reported outcomes (PROs): headache impact test (HIT-6), migraine disability assessment questionnaire (MIDAS), and patient global improvement change (PGIC). A > 50% reduction of MMDs after 12 weeks was considered as a response. RESULTS: We included 210 patients (female 86.7%, mean age 46.4 years old) from 22 Spanish hospitals from February 2019 to June 2020. Most patients (89.5%) suffered from chronic migraine with a mean evolution of 8.6 years. MOH was present in 70% of patients, and 17.1% had migraine with aura. Patients had failed a mean of 7.8 preventive treatments at baseline (botulinum toxin type A-BoNT/A-had been used by 95.2% of patients). Most patients (67.6%) started with erenumab 70 mg. Sixty-one percent of patients were also simultaneously taking oral preventive drugs and 27.6% were getting simultaneous BoNT/A. Responder rate was 37.1% and the mean reduction of MMDs and MHDs was -6.28 and -8.6, respectively. Changes in PROs were: MIDAS: -35 points, HIT-6: -11.6 points, PIGC: 4.7 points. Predictors of good response were prior HIT-6 score < 80 points (p = 0.01), ≤ 5 prior preventive treatment failures (p = 0.026), absence of MOH (p = 0.039), and simultaneous BoNT/A treatment (p < 0.001). Twenty percent of patients had an adverse event, but only two of them were severe (0.9%), which led to treatment discontinuation. Mild constipation was the most frequent adverse event (8.1%). CONCLUSIONS: In real-life, in a personalized managed access program, erenumab shows a good effectiveness profile and an excellent tolerability in migraine prevention in our cohort of refractory patients.

Modelling affected regions by the Iberian Quercus disease with proximity diagrams.

In this work, we propose a mathematical model to determine the potential propagation areas of the Mediterranean Quercus disease commonly referred to as "seca" (Tuser and Sánchez 2004) in specific areas of Extremadura. Although it is a syndrome of complex etiology caused by the action of the different biotic (insects and fungi) and abiotic factors (temperature, orography, soil, etc.), numerous studies suggest that the soil-borne pathogen cinnamomi represents the main responsible for the decay of the holm and cork oak. However, very little is known about the Phytophthora epidemic distribution patterns and its geographical dependence on other factors that favor its spread. With the aim to clarify this question, in this paper, we will use optimal computational geometry algorithms based on proximity diagrams that allow us to design a pathogen transmission map and to determine its correlation with different causing agents, specially with the presence of standing water or drainage lines water.

Stability of Cocaine Compounds in Biological Fluids During Post-Analytical Sample Storage.

The objective of this study is to evaluate in vitro stability of cocaine compounds, cocaine (COC), benzoylecgonine (BE), ecgonine methyl ester (EME) and benzoylecgonine ethyl ester (EBE), in blood and urine, during post-analysis custody. Stability was evaluated by measuring percent recovery. Parameters evaluated were time of custody (1 year), storage temperature (-20°C and 4°C), influence of preservative (only for blood samples) and pH (only for urine samples). The impact of the temperature is very important in blood samples. At -20°C all compounds demonstrated to be stable, with recoveries higher than 80% after 1 year. In contrast, degradation was observed in the concentration for all four compounds when the samples were maintained at 4°C. In these same conditions, the influence of the preservative was also noticeable and a higher stability was found in samples preserved with NaF. COC and EBE had similar profiles, and both compounds disappeared after 30 days in samples without NaF and after 150 days in samples with NaF added. EME disappeared after 185 days and after 215 days in samples without and with preservative, respectively. BE recoveries, after 365 days of storage, were 68.5% (in samples with NaF) and 3.7% (in samples without NaF). In urine samples, the four compounds were stable in all the studied conditions except when samples were at pH 8 and stored at 4°C where the compounds disappeared (COC and EBE after 75 days of storage and EME after 15 days). The exception was BE, with a recovery of 23% after 1 year of storage. Of the temperatures evaluated, -20°C seems to be optimal for storage to maintain the stability of cocaine and metabolites in biological samples. This can be further enhanced by maintaining a pH of 4 in urine samples and adding a NaF preservative to blood.

Hydrophilic interaction liquid chromatography-tandem mass spectrometry (HILIC-MS/MS) determination of cocaine and its metabolites benzoylecgonine, ecgonine methyl ester, and cocaethylene in hair samples.

This study reports the development and validation of a method using hydrophilic interaction liquid chromatography-tandem mass spectrometry (HILIC-MS/MS) for the analysis of cocaine and its metabolites benzoylecgonine (BE), ecgonine methyl ester (EME), and cocaethylene (CE) in hair samples. Decontamination was performed as follows: Firstly, the aliquot of hair was briefly rinsed with 2 mL dichloromethane, then was washed three times with 10 mL 0.01 M phosphate buffer, pH 6, for 15 min, followed by 2 mL 2-propanol for less than 2 min, and, finally, a last rinse with 2 mL dichloromethane was again done. Cocaine compounds were extracted from 10 mg of hair by incubation with 2 mL 0.1 M HCl at 50 °C for 12 h and purified by solid phase extraction with Oasis MCX cartridges. Analysis was performed by LC-MS/MS using an Atlantis HILIC silica chromatographic column. The method was fully validated. Linearity was established over the concentration range 0.020-10.0 ng/mg for cocaine (COC), 0.010-10.0 ng/mg for BE and CE, and 0.005-2.0 ng/mg for EME, and the correlation coefficients were all >0.99. Extraction efficiency was >70% for all analytes. Limits of detection were 0.0005 ng/mg for CE and 0.001 ng/mg for the other analytes (COC, BE, and EME). Lower limits of quantification were the lowest points of the calibration curves with acceptable accuracy and precision (coefficient of variation ≤20%). Intra- and inter-day imprecision ranged between 1.5% and 9.5% and 0.7% and 12.6%, respectively. Intra- and inter-day inaccuracy ranged from 0.5% to 12.3% and from 0.7% to 7.1%, respectively. With regard to matrix effects, suppression was <27.5% in all cases. The method was applied to the analysis of several samples derived from forensic cases.

Cocaine-related sudden death: a prospective investigation in south-west Spain.

AIMS: With an estimated 12 million consumers in Europe, cocaine (COC) is the illicit drug leading to the most emergency department visits. The aim of this study was to examine a consecutive series of sudden deaths (SDs) to focus on the prevalence, the toxicological characteristics, and the causes of death in COC-related fatalities. METHODS AND RESULTS: Prospective case-control study of forensic autopsies was carried out in the time interval November 2003 to June 2006 at the Institute of Legal Medicine, Seville, south-west Spain, with a reference population of 1 875 462 inhabitants. Toxicology included blood ethanol analysis and blood and urine investigation for drugs of abuse and medical drugs. Autopsy was performed according to the European standardized protocol. Ten age- and sex-matched patients who died of violent causes with no antecedents of COC consumption and negative toxicology served as controls. During the study period, 2477 forensic autopsies were performed, including 1114 natural deaths. Among the latter, 668 fulfilled the criteria of SD and 21 (all males, mean age 34.6 +/- 7.3 years) resulted to be COC-related (3.1%). Cocaine was detected in 67.1% of the blood (median 0.17 mg/L, interquartile range 0.08-0.42) and in 83.0% of the urine samples (median 1.15 mg/L, interquartile range 0.37-17.34). A concomitant use of ethanol was found in 76.0% and cigarette smoking in 81.0%. Causes of SD were cardiovascular in 62.0%, cerebrovascular in 14.0%, excited delirium in 14.0%, respiratory and metabolic in 5.0% each. Left ventricular hypertrophy was observed in 57.0%, small vessels disease in 42.9%, severe atherosclerotic coronary artery disease in 28.6%, and coronary thrombosis in 14.3%. CONCLUSION: Systematic toxicology investigation indicates that 3.1% of SDs are COC-related and are mainly due to cardio-cerebrovascular causes. Left ventricular hypertrophy, small vessel disease, and premature coronary artery atherosclerosis, with or without lumen thrombosis, are frequent findings that may account for myocardial ischaemia at risk of cardiac arrest in COC addicts.

Proficiency test for the analysis of hair for drugs of abuse, organized by the Society of Hair Testing.

Eighteen laboratories interested in the analysis of human hair for drugs of abuse participated in a proficiency test (PT) organized by the Society of Hair Testing (SoHT) in 2001. Samples sent to the participants included one drug-free hair sample and two samples from drug users, sent in the form of short segments previously checked for homogeneity by three reference laboratories. Participants were requested to analyze the samples following the standard procedure used routinely in their laboratories.The compounds present in the samples included opiates, cocaine and metabolite, cannabinoids and amphetamines. All the laboratories analyzed opiates, cocaine and benzoylecgonine (BE); only 10 analyzed amphetamines, and 9 cannabinoids. Various methods were used to extract drugs from the hair-enzyme treatment, acidic, basic and methanol extractions. All the laboratories employed GC-MS, with the exception of two which used GC-MS/MS and LC-MS/MS, respectively. Six laboratories performed initial screening tests by RIA, ELISA or EMIT. Results show that the laboratories performed well qualitatively, since they successfully identified all the analytes that they tested, with the exception of eight false results. However, the scatter of quantitative results was high.

Respuesta a la administración intracavernosa de tres fármacos diferentes en el mismo grupo de pacientes con disfunción eréctil / Response to intracavernosal administration of three different drugs in the same group of patiens with erectil dysfuntion

OBJETIVO: Comparar la rigidez medida de forma subjetiva y objetiva de la erección peneana en el mismo grupo de pacientes tras la administración de diferentes drogas vasoactivas intracavernosas (IIC).MÉTODOS: Se asignó al azar a noventa y un pacientes diagnosticados de impotencia en 3 grupos de IIC: A: Prostaglandina E1 (PGE1) 20 mcg; B:30 mg de clorhidrato de papaverina más 1 mg de fentolamina (bimix); C: 10 mcg de PGE1 más 15 mg de clorhidrato de papaverina más 0,5 mg de fentolamina (trimix). Cada paciente fue programado para recibir las tres combinaciones de IIC de forma randomizada y aleatoria con descansos de 7 a 10 días entre cada uno de ellas. Se consideró como positiva una rigidez igual o mayor del 60 por ciento . La rigidez peneana se evaluó subjetiva y objetivamente por el mismo observador con el uso de un calliper. RESULTADOS: Ochenta y dos pacientes completaron el estudio. Se retiraron a nueve pacientes tras haber presentado erecciones prolongadas después de una de las IIC. La rigidez después del tratamiento C (66ñ 15 por ciento) fue significativamente superior a la obtenida en el grupo B (59ñ 15 por ciento, p=0,0001) y a las del grupo A (60ñ 13 por ciento, p=0,0115). No se observaron diferencias entre los grupos Ay B (p=0,4644). Analizando únicamente las respuestas positivas, se observaron diferencias significativas entre A y C pero no entre C y B (p=0,3323). No se observaron diferencias entre las respuestas de PGE1 (A) y la combinación bimix (B) (p=0,1275). El orden de la aplicación del fármaco (p=0,026) no influyó sobre la respuesta. CONCLUSIONES: El mayor porcentaje de respuestas positivas en pacientes afectos de disfunción eréctil se obtuvo con el trimix. La elección de regímenes de IIC más potentes pueden mejorar la eficacia diagnóstica y/o terapéutica en hombres que no reaccionan a la PGE1 sola (AU)