Efecto de un equipo multidisciplinar (código TEP) en el pronóstico de los pacientes con tromboembolia de pulmón aguda sintomática / Impact of a pulmonary embolism response team (PERT) in the prognosis of patients with acute symptomatic pulmonary embolism

Antecedentes No se han aclarado suficientemente los beneficios del manejo multidisciplinar (código TEP) de los pacientes con tromboembolia de pulmón (TEP) aguda sintomática. El objetivo de este estudio fue evaluar el efecto sobre la mortalidad a corto plazo del código TEP comparado con la atención habitual. Métodos Realizamos un estudio retrospectivo que incluyó a todos los pacientes con diagnóstico de TEP aguda sintomática ingresados en un hospital terciario universitario entre los años 2007 y 2022. Mediante un análisis de emparejamiento exacto 1:1, los pacientes atendidos por un equipo multidisciplinar para el manejo de la TEP (código TEP) fueron emparejados con otros que recibieron la atención habitual (es decir, no multidisciplinar) para la TEP. El evento primario de eficacia fue la mortalidad por cualquier causa durante los 30 primeros días después del diagnóstico. El evento secundario de eficacia fue la mortalidad por la propia TEP durante el mismo período de tiempo. Resultados De los 2.902 pacientes con diagnóstico de TEP aguda sintomática incluidos en este estudio, 223 (7,7%; intervalo de confianza [IC] del 95%: 6,7-8,7%) fueron manejados por el código TEP. Se emparejaron 207 pacientes manejados por el código TEP con 207 pacientes manejados de forma habitual. En la cohorte emparejada, la atención multidisciplinar a los pacientes con TEP aguda sintomática no se asoció a una reducción significativa de la mortalidad por cualquier causa (odds ratio [OR]: 1,09; IC del 95%: 0,63-1,89) o por la propia TEP (OR: 1,30; IC del 95%: 0,47-3,62) en el mes posterior al diagnóstico de la TEP. Conclusiones La atención multidisciplinar a los pacientes con TEP aguda sintomática no se asoció a una reducción significativa de la mortalidad precoz. (AU)

Background The effect of a pulmonary embolism response team (PERT) in the short-term prognosis of patients with acute symptomatic pulmonary embolism (PE) lacks clarity. We therefore aimed at evaluating the effect of a PERT team on short-term mortality among patients with acute PE. Methods We retrospectively reviewed consecutive patients with acute symptomatic PE enrolled in a single-center registry between 2007 and 2022. We used propensity score matching to compare treatment effects for patients with similar predicted probabilities of receiving management by the PERT team. The primary outcome was all-cause mortality within 30 days following the diagnosis of PE. The secondary outcome was 30-day PE-related mortality. Results Of the 2,902 eligible patients who had acute symptomatic PE, 223 (7.7%; 95% confidence interval [CI], 6.7%-8.7%) were managed by the PERT team. Two hundred and seven patients who were treated by the PERT were matched with 207 patients who were not. Matched pairs did not show a statistically significant lower all-cause (odds ratio [OR], 1.09; 95% CI, 0.63-1.89) or PE-related death (OR, 1.30; 95% CI, 0.47-3.62) for PERT management compared with no PERT management through 30 days after diagnosis of PE. Conclusions Our results suggest that multidisciplinary care of patients with acute symptomatic PE by a PERT team is not associated with a significant reduction in short-term all-cause or PE-related mortality. (AU)

Impact of a pulmonary embolism response team (PERT) in the prognosis of patients with acute symptomatic pulmonary embolism.

BACKGROUND: The effect of a pulmonary embolism response team (PERT) in the short-term prognosis of patients with acute symptomatic pulmonary embolism (PE) lacks clarity. We therefore aimed at evaluating the effect of a PERT team on short-term mortality among patients with acute PE. METHODS: We retrospectively reviewed consecutive patients with acute symptomatic PE enrolled in a single-center registry between 2007 and 2022. We used propensity score matching to compare treatment effects for patients with similar predicted probabilities of receiving management by the PERT team. The primary outcome was all-cause mortality within 30 days following the diagnosis of PE. The secondary outcome was 30-day PE-related mortality. RESULTS: Of the 2,902 eligible patients who had acute symptomatic PE, 223 (7.7%; 95% confidence interval [CI], 6.7%-8.7%) were managed by the PERT team. Two hundred and seven patients who were treated by the PERT were matched with 207 patients who were not. Matched pairs did not show a statistically significant lower all-cause (odds ratio [OR], 1.09; 95% CI, 0.63-1.89) or PE-related death (OR, 1.30; 95% CI, 0.47-3.62) for PERT management compared with no PERT management through 30 days after diagnosis of PE. CONCLUSIONS: Our results suggest that multidisciplinary care of patients with acute symptomatic PE by a PERT team is not associated with a significant reduction in short-term all-cause or PE-related mortality.

Performance metrics based on signal intensity for ion mobility spectrometry--based explosive trace detectors using inkjet printed materials.

Commercial off-the-shelf (COTS) explosive trace detectors (ETDs) have become an integral part of security practices aimed at protecting the public, transportation, and facilities. Despite their widespread deployment, quality control procedures that can evaluate day-to-day instrument performance or differences among units of the same manufacture are in need for development. In this work, we describe the preparation of test materials (TMs) using inkjet printing that have fixed dosing levels of two explosives; 1,3,5-trinitroperhydro-1,3,5-triazine (RDX) and pentaerythritol tetranitrate (PETN). The uncertainty in the mass of dispensed solute is 0.8% (nominal 1 ng RDX and 5 ng or 20 ng PETN depending on ETD). TMs are stable under storage for at least 20 days at temperatures consistent with indoor and outdoor environments, and can be used by field personnel at deployed locations. Inkjet printing is shown to provide the necessary control over the spatial distribution of analyte on the substrate, thus limiting the variability in the signal response due to the sample. Measurements of signal intensities for two COTS ETDs were obtained from TMs over multi-year time spans and for multiple units of each ETD. Reproducibility in the signal response is shown to be between 6% and 15% RSD, or approximately double the within-day variability. The large datasets allow for the first time modeling of signal intensities with respect to normal distributions, which support the use of standard 3-sigma control practices.

Effect of different terpene-containing essential oils on permeation of estradiol through hairless mouse skin.

Purpose of the present investigation was to evaluate six terpene-containing essential oils for their capacity to promote permeation of estradiol (ES) through hairless mouse skin in vitro. Tests on cajuput, cardamom, melissa, myrtle, niaouli and orange oil, all used at the 10% w/w concentration in propylene glycol (PG), evidenced niaouli oil (NIA) as the best permeation promoter for ES. Tests on the main terpene components of NIA (1,8 cineole, alpha-pinene, alpha-terpineol and D-limonene), evaluated neat (10% w/w in PG) or in admixture, confirmed the better promoting activity of whole NIA. The present data point to the validity of complex terpene mixtures, such as that composing NIA, as transdermal penetration enhancers for moderately lipophilic drugs like ES.

Increased corneal hydration induced by potential ocular penetration enhancers: assessment by differential scanning calorimetry (DSC) and by desiccation.

The corneal toxicity of some surfactants of possible use as ocular penetration enhancers was investigated by measuring their effect on hydration of rabbit corneas 'in vitro'. The tested substances were benzalkonium chloride (BAC), cetylpyridinium chloride (CPC), ethylenediaminetetraacetic acid disodium salt (EDTA), polyoxyethylene-20-stearyl ether (Brij 78, PSE), polyethoxylated castor oil (Cremophor EL, PCO) and sodium deoxycholate (DC). Freshly excised corneas, mounted in perfusion cells, were kept in contact for 1 h with solutions of these agents; corneal hydration was then evaluated by measuring: (a) their total (free+bound) water content by desiccation (gravimetric analysis); and (b) their free water content by differential scanning calorimetry (DSC). The DSC measurements also provided a rough quantitative estimate of corneal solutes. All tested agents significantly influenced corneal hydration, evidently as a consequence of alteration of the corneal epithelium. Although a brief contact with the precorneal tissues 'in vivo' may not prove harmful, the use of these compounds as potential ocular permeation enhancers or otherwise as ingredients of topical ocular formulations for long-term use should be considered with caution.