Use of an airway bundle to reduce unplanned extubations in a neonatal intensive care unit.

BACKGROUND: Following the opening of an infant cardiac neonatal intensive care unit, our aim was to determine a baseline UE rate and implement initiatives to target a goal less than 0.5 UEs/100 ventilator days. METHODS: We utilized the Model for Improvement. Key stakeholders included neonatal providers, nurses, and respiratory therapists. We focused on the creation of an airway bundle that addressed securement methods, communication and education. RESULTS: From October 2017 to January 2018, our baseline UE rate was 0.92 UEs/100 ventilator days. Subsequent to the implementation of an airway bundle with high compliance, we observed a significant change in the centerline (0.45 to 0.02 UEs/100 ventilator days) during the spring of 2021, followed by a period of 480 days with no UEs. CONCLUSION: In a unit where UEs were infrequent events, high compliance with an airway bundle led to a significantly sustained decrease in our UE rates.

Care of the COVID-19 exposed complex newborn infant.

As we confront COVID-19, the global public health emergency of our times, new knowledge is emerging that, combined with information from prior epidemics, can provide insights on how to manage this threat in specific patient populations. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), both caused by coronaviruses, caused serious respiratory illness in pregnant women that resulted in adverse perinatal outcomes. Thus far, COVID-19 appears to follow a mild course in the vast majority of pregnant women. A significant proportion of pregnant women appear to be asymptomatic carriers of SARS-CoV-2. However, there is limited information on how COVID-19 impacts the fetus and whether vertical transmission occurs. While these knowledge gaps are addressed, it is important to recognize the highly efficient transmission characteristics of SARS-C0V-2 and its potential for causing serious disease in vulnerable individuals, including health care workers. This review provides perspectives from a single center in New York City, the epicenter of the pandemic within the United States. It offers an overview of the preparations required for deliveries of newborns of mothers with COVID-19 and the management of neonates with particular emphasis on those born with complex issues.

[Clinical experience with omalizumab in patients with severe asthma. Real-world data]. / Experiencia clínica con omalizumab en pacientes con asma severa. Datos del mundo real.

BACKGROUND: Omalizumab is a monoclonal antibody that is prescribed in a stepwise addition regimen for the treatment of severe asthma. OBJECTIVE: To report the experience of patients with severe asthma who were given omalizumab in accordance with international guides, in a context of real-world data. METHODS: Open, analytical, cross-sectional, retrospective, observational clinical study with real-world data. GINA 2006 Asthma Control Scheme was used to evaluate patients, and a questionnaire was used to evaluate patient characteristics, effectiveness, safety, and tolerance to omalizumab. RESULTS: 48 patients were studied, 34 women and 14 men with an average age of 39 years. The average disease duration was 26 years. Average serum IgE was 522 IU. At the beginning of treatment, all patients had uncontrolled asthma; at the end, 69% asthma control was obtained, 19% was partially controlled and 12% unchanged. The changes were observed at seven months on average. CONCLUSION: Omalizumab is effective and safe for treating severe asthma when applied in accordance with international guidelines for the management of bronchial asthma.

Antecedentes: El omalizumab es un anticuerpo monoclonal que se prescribe en esquema de adición por pasos para el tratamiento del asma severa. Objetivos: Informar la experiencia en pacientes con asma severa a quienes se aplicó omalizumab conforme a las guías internaciones, en un contexto de datos de mundo real. Métodos: Estudio retrospectivo, clínico, observacional, abierto, analítico y transversal a partir de datos de la vida real. Se utilizó el esquema de Control del Asma de GINA 2006 para evaluar a los pacientes y con un cuestionario se calificaron las características del paciente, efectividad, seguridad y tolerancia al omalizumab. Resultados: Se estudiaron 48 pacientes, 34 mujeres y 14 hombres, con edad promedio de 39 años. La duración promedio de la enfermedad fue de 26 años. La concentración sérica promedio de la IgE fue de 522 UI. Al inicio del tratamiento, todos los pacientes estaban sin control del asma; al final, en 69% se obtuvo control del asma, 19% estaba parcialmente controlado y 12% sin modificaciones. Los cambios se observaron en promedio a los siete meses. Conclusión: El omalizumab es efectivo y seguro para tratar el asma severa cuando se aplica conforme las guías internacionales para el manejo del asma bronquial.

Antibodies blocking adhesion and matrix binding domains of laminin-332 inhibit tumor growth and metastasis in vivo.

Laminin-332 (LN-332), which is essential for epithelial cell adhesion and migration, is up-regulated in most invasive carcinomas. Association between LN-332 and carcinoma cell integrins and stroma collagen is thought to be important for tumor growth and metastasis. Here, we show that function blocking LN-332 antibodies interfering with cellular adhesion and migration in vitro evoke apoptotic pathways. The antibodies also target epithelial tumors in vivo. Antibodies against the cell binding domain of the alpha3 chain of LN-332 inhibited tumor growth by up to 68%, and antibodies against the matrix binding domains of the beta3 and gamma2 chains significantly decreased lung metastases. The LN-332 antibodies appear to induce tumor cell anoikis and subsequent programmed cell death and reduce migration by interfering with tumor cell matrix interactions.

Transposition of three amino acids transforms the human metabotropic glutamate receptor (mGluR)-3-positive allosteric modulation site to mGluR2, and additional characterization of the mGluR2-positive allosteric modulation site.

Glutamate is a major neurotransmitter in the central nervous system, and abnormal glutamate neurotransmission has been implicated in many neurological disorders, including schizophrenia, Alzheimer's disease, Parkinson's disease, addiction, anxiety, depression, epilepsy, and pain. Metabotropic glutamate receptors (mGluRs) activate intracellular signaling cascades in a G protein-dependent manner, which offer the opportunity for developing drugs that regulate glutamate neurotransmission in a functionally selective manner. In the present study, we further characterize the human mGluR2 (hmGluR2) potentiator binding site by showing that the substitution of the three amino acids found to be required for hmGluR2 potentiation, specifically Ser(688), Gly(689), and Asn(735), with the homologous hmGluR3 amino acids, inactivates the positive allosteric modulator activity of several structurally unique mGluR2 potentiators. Based on the characterization of the hmGluR2 potentiator binding site, we developed a novel scintillation proximity assay that was able to discriminate between compounds that were hmGluR2-specific potentiators, and those that were active on both hmGluR2 and hmGluR3. In addition, we substituted Ser(688), Gly(689), and Asn(735) into hmGluR3 and created an active hmGluR2 allosteric modulation site on the hmGluR3 receptor.

Pharmacological characterization and identification of amino acids involved in the positive modulation of metabotropic glutamate receptor subtype 2.

In the present study, we describe the characterization of a positive allosteric modulator at metabotropic glutamate subtype 2 receptors (mGluR2). N-(4-(2-Methoxyphenoxy)-phenyl-N-(2,2,2-trifluoroethylsulfonyl)-pyrid-3-ylmethylamine (LY487379) is a selective positive allosteric modulator at human mGluR2 and is without activity at human mGluR3. Furthermore, LY487379 has no intrinsic agonist or antagonist activity at hmGluR2, as determined by functional guanosine 5'(gamma-[35S]thio)triphosphate ([35S]GTPgammaS) binding, single-cell Ca2+ imaging, and electrophysiological studies. However, LY487379 markedly potentiated glutamate-stimulated [35S]GTPgammaS binding in a concentration-dependent manner at hmGluR2, shifting the glutamate dose-response curve leftward by 3-fold and increasing the maximum levels of [35S]GTPgammaS stimulation. This effect of LY487479 was also observed to a greater extent on the concentration-response curves to selective hmGluR2/3 agonists. In radioligand binding studies to rat cortical membranes, LY487379 increased the affinity of the radiolabeled agonist, [3H]DCG-IV, without affecting the binding affinity of the radiolabeled antagonist, [3H]LY341495. In rat hippocampal slices, coapplication of LY487379 potentiated synaptically evoked mGluR2 responses. Finally, to elucidate the site of action, we systematically exchanged segments and single amino acids between hmGluR2 and hmGluR3. Substitution of Ser688 and/or Gly689 in transmembrane IV along with Asn735 located in transmembrane segment V, with the homologous amino acids of hmGluR3, completely eliminated LY487379 allosteric modulation of hmGluR2. We propose that this allosteric binding site defines a pocket that is different from the orthosteric site located in the amino terminal domain.

[Pidotimod in recurring respiratory infection in children with allergic rhinitis, asthma, or both conditions]. / Pidotimod en infección respiratoria recurrente en el niño con rinitis alérgica, asma o ambos padecimientos.

OBJECTIVE: To demonstrate a decrease in the number of recurrent breathing infections in patients with allergic rhinitis and asthma, by means of the use of Pidotimod (a immunomodulator). MATERIAL AND METHODS: Patients of both sexes, 2 to 16 years old, that had at least four episodes of acute respiratory infection, during the previous six months, administering a dose of 400 mg of pidotimod later, twice a day. RESULTS: It was identified a correlation between the number of cases of asthma and those of acute respiratory infection of r = 0.60 with a r2 = 40. A total of 73 patients of both sexes that presented allergic rhinitis and bronchial asthma, had developed at least four acute respiratory infection episodes. Form these patients, 33 were male, a rate that corresponded to 45%, and 40 were female, that corresponded to 55% of population. The average age was 6 years old, with a range from 2 to 16 years. The number of infectious events before using Pidotimod, was 422, with an average of 5.7 for patient, and later to its use, it was 295, that corresponded to 4.04 for each patient, in 6 months. The difference among the means was significant (p < 0.005). The number of days affected by each infectious event was of 446, with an average of 6.10 for patient, and later to administration of the product it was of 308 affected days, that corresponded to an average of 4.21 days for each patient, with a statistical significant of p < 0.001.

Evaluación clínica del cromoglicato de sodio en solución nasal al 2 por ciento en el tratamiento de la rinitis alérgica / Clinic evaluation of the 2 per cent cromoglycate sodium chomoglycate nasal solution in the allergic rhinitis

Resultados de un estudio doble ciego donde 30 pacientes con síntomas de rinitis alérgica y edades de 6 a 50 años fueron asignados aleatoriamente para recibir solución activa con CGS al 2 por ciento, un disparo en cada narina cada seis horas o solución con placebo. Todos los individuos recibieron astemizol 10 mg en ayunas diariamente e hiposensibilización durante un periodo de seis meses a dos años. Se revisaron los diarios en donde se anotaban los síntomas de los pacientes cada dos semanas durante siete visitas y se les efectuó exploración física. Ambos grupos tuvieron promedio de agudización de síntomas de rinitis comparable al inicio del estudio. Después de 45 días de tratamiento y en el seguimiento a tres meses, los promedios de síntomas indicaron superioridad del CGS en solución nasal para reducir la gravedad de la rinorrea, obstrucción nasal y estornudos; así como disminución de la secreción nasal y edema de cornetes (p<0.001). Los pacientes con CGS mejoraron significativamente según la valoración global hecha por el investigador (p<0.05). No hubo efectos secundarios en ninguno de los grupos

Hipersensibilidad a aeroalergenos y relación con residencia: estudio de hipersensibilidad cutánea, intradérmica a extractos alergénicos y residencia / Hipersensitivity air allergens and ralation to residency: study of hypersensitivity intradermic allergic extracts and residency

Revisión retrospectiva de 308 expedientes clínicos de pacientes que acuden al servicio de alergia e inmunología clínica del Centro Médico 20 de Noviembre del ISSSTE por cursar con padecimientos alérgicos, realizada para determinar la frecuencia de sensibilización a aeroalergenos (mediante intradermorreacciones) y su relación con la zona en que habitaban. Los pacientes fueron más sensibles al polvo y dermatofagoides (75 y 40 por ciento respectivamente). Otros aeroalergenos que causaron sensibilización en los pacientes fueron Capriola dactylon (37.6 por ciento), Ambrosia elatior (33 por ciento), Cándida (21.4 por ciento), Penicillium (18.1 por ciento), Mucor y Rizopus (17.8 por ciento cada uno)

Estudio de hipersensibilidad cutánea: intradérmica a extractos alergénicos y su relación con el lugar de residencia / Cotaneous hipersensitivity study: allergenic extracts intradermical and its relation with the living area

Revisión retrospectiva de 308 expedientes clínicos de pacientes que acuden al servicio de alergia e inmunología clínica del Centro Médico 20 de Noviembre del ISSSTE por cursar con padecimientos alérgicos, realizada para determinar la frecuencia de sensibilización a aeroalergenos (mediante intradermorreacciones) y su relación con la zona en que habitaban. Los pacientes fueron más sensibles al polvo y dermatofagoides (75 y 40 por ciento respectivamente). Otros aeroalergenos que causaron sensibilización en los pacientes fueron Capriola dactylon (37.6 por ciento), Amaranthus palmieri (35.5 por ciento), fracxinus (34.6 por ciento), Ambrosia elatior (33 por ciento), Cándida (21.4 por ciento), penicillium (18.1 por ciento), Mucor y Rizipus (17.8 por ciento cada uno).

Efectividad del cromoglicato de sodio en la reducción de las dosis de broncodilatadores en pacientes asmáticos / Effectivity of the sodium chromoglycate in the decrease in the use of bronchial dilators in asthmatic patients

Se estudiaron 30 asmáticos con límite de edad entre seis y 72 años, a quienes se hizo una evaluación clínica con duración de 14 semanas en las que se investigó gravedad de disnea, tos, expectoración y sibilancias. El cromoglicato de sodio (CGS) se administró en forma de aerosol inhalado a partir de la segunda semana y el esquema de reducción de broncodilatadores se puso en práctica a partir de la semana cuatro, reduciendo 25 porciento de la dosis total establecida inicialmente, cada dos semanas. En el estudio, el CGS demostró ser útil para disminuir los síntomas provocados por la hiperreactividad bronquial y en 70 porciento la necesidad de uso de broncodilatadores en los asmáticos en quienes se desencadenaron síntomas con un solo factor de riesgo (frío, el más frecuente).