Gas-Phase Kinetic Investigation of the OH-Initiated Oxidation of a Series of Methyl-Butenols under Simulated Atmospheric Conditions.

Five biogenic unsaturated alcohols have been investigated under simulated atmospheric conditions regarding their gas-phase OH reactivity. The gas-phase rate coefficients of OH radicals with 2-methyl-3-buten-2-ol (k1), 3-methyl-2-buten-1-ol (k2), 3-methyl-3-buten-1-ol (k3), 2-methyl-3-buten-1-ol (k4), and 3-methyl-3-buten-2-ol (k5) at 298 ± 2 K and 1000 ± 10 mbar total pressure of synthetic air were determined under low- and high-NOx conditions using the relative kinetic technique. The present work provides for the first time the rate coefficients of gas-phase reactions of hydroxyl radicals with 2-methyl-3-buten-1-ol and 3-methyl-3-buten-2-ol. The following rate constants were measured (in 10-11 cm3 molecule-1 s-1): k1 = 6.32 ± 0.49, k2 = 14.55 ± 0.93, k3 = 10.04 ± 0.78, k4 = 5.31 ± 0.37, and k5 = 11.71 ± 1.29. No significant differences in the measured rate coefficients were obtained when either 365 nm photolysis of CH3ONO in the presence of NO or 254 nm photolysis of H2O2 was used as a source of OH radicals. Reactivity toward other classes of related compounds such as alkenes and saturated alcohols is discussed. A comparison of the structure-activity relationship (SAR) estimates derived from the available accepted methodologies with experimental data available for unsaturated alcohols is provided. Atmospheric lifetimes for the investigated series of alkenols with respect to the main atmospheric oxidants are given and discussed.

Evaluation of the Environmental Fate of a Semivolatile Transformation Product of Ibuprofen Based on a Simple Two-Media Fate Model.

Partitioning between surface waters and the atmosphere is an important process, influencing the fate and transport of semi-volatile contaminants. In this work, a simple methodology that combines experimental data and modeling was used to investigate the degradation of a semi-volatile pollutant in a two-phase system (surface water + atmosphere). 4-Isobutylacetophenone (IBAP) was chosen as a model contaminant; IBAP is a toxic transformation product of the non-steroidal, anti-inflammatory drug ibuprofen. Here, we show that the atmospheric behavior of IBAP would mainly be characterized by reaction with •OH radicals, while degradation initiated by •NO3 or direct photolysis would be negligible. The present study underlines that the gas-phase reactivity of IBAP with •OH is faster, compared to the likely kinetics of volatilization from aqueous systems. Therefore, it might prove very difficult to detect gas-phase IBAP. Nevertheless, up to 60% of IBAP occurring in a deep and dissolved organic carbon-rich water body might be eliminated via volatilization and subsequent reaction with gas-phase •OH. The present study suggests that the gas-phase chemistry of semi-volatile organic compounds which, like IBAP, initially occur in natural water bodies in contact with the atmosphere is potentially very important in some environmental conditions.

Gas-Phase Ozone Reaction Kinetics of C5-C8 Unsaturated Alcohols of Biogenic Interest.

Unsaturated alcohols are volatile organic compounds (VOCs) that characterize the emissions of plants. Changes in climate together with related increases of biotic and abiotic stresses are expected to increase these emissions in the future. Ozonolysis is one of the oxidation pathways that control the fate of unsaturated alcohols in the atmosphere. The rate coefficients of the gas-phase O3 reaction with seven C5-C8 unsaturated alcohols were determined at 296 K using both absolute and relative kinetic methods. The following rate coefficients (cm3 molecule-1 s-1) were obtained using the absolute method: (1.1 ± 0.2) × 10-16 for cis-2-penten-1-ol, (1.2 ± 0.2) × 10-16 for trans-2-hexen-1-ol, (6.4 ± 1.0) × 10-17 for trans-3-hexen-1-ol, (5.8 ± 0.9) × 10-17 for cis-3-hexen-1-ol, (2.0 ± 0.3) × 10-17 for 1-octen-3-ol, and (8.4 ± 1.3) × 10-17 for trans-2-octen-1-ol. The following rate coefficients (cm3 molecule-1 s-1) were obtained using the relative method: (1.27 ± 0.11) × 10-16 for trans-2-hexen-1-ol, (5.01 ± 0.30) × 10-17 for trans-3-hexen-1-ol, (4.13 ± 0.34) × 10-17 for cis-3-hexen-1-ol, and (1.40 ± 0.12) × 10-16 for trans-4-hexen-1-ol. Alkenols display high reactivities with ozone with lifetimes in the hour range. Rate coefficients show a strong and complex dependence on the structure of the alkenol, particularly the relative position of the OH group toward the C═C double bond. The results are discussed and compared to both the available literature data and four structure-activity relationship (SAR) methods.

Doublet Ground State in a Vanadium(II) Complex: Redox and Coordinative Noninnocence of Tripodal Ligand Architecture.

We report on the geometric and electronic structures of a series of V2+/3+ tren-bridged iminopyridine complexes [tren = tris(2-aminoethyl)amine] that enable the observation of an unexpected doublet ground state for a nominally 3d3 species. Tren undergoes condensation reactions with picolinaldehyde or methyl-6-formylnictonate to form the respective tripodal ligand sets of (py)3tren and (5-CO2Mepy)3tren. The (py)3tren ligand is coordinated to V2+ and V3+ metal centers to form complex salts [1-H](OTf)2 and [1-H](OTf)3, respectively (OTf- = CF3SO3-). For [1-H]2+, strong metal-ligand π-covalency with respect to the V2+ (3d3) and iminopyridine ligands weakens its interelectronic repulsion. For [1-H]3+, the bridgehead nitrogen of the tren scaffold forms a seventh coordinate covalent bond with a V3+ (3d2) metal center. The coordination of (5-CO2Mepy)3tren to a V2+ metal center results in the redox noninnocent and heptacoordinate compound [1-CO2Me](OTf)2 with a doublet (S = 1/2) ground state that we support with magnetic susceptibility and spectroscopy measurements. The complexes are uniformly characterized experimentally with single-crystal X-ray diffraction, electronic absorbance, and electrochemistry, and electronic structures are corroborated by computational techniques. We present a new computational procedure that we term the spin-optimized approximate pair (SOAP) method that enables the visualization and quantification of electron-electron interactions.

Electronic Structures of Cr(III) and V(II) Polypyridyl Systems: Undertones in an Isoelectronic Analogy.

A recently reported description of the photophysical properties of V2+ polypyridyl systems has highlighted several distinctions between isoelectronic, d3, Cr3+, and V2+ tris-homoleptic polypyridyl complexes of 2,2'-bipyridine (bpy) and 1,10-phenanthroline (phen). Here, we combine theory and experimental data to elucidate the differences in electronic structures. We provide the first crystallographic structures of the V2+ complexes [V(bpy)3](BPh4)2 (V-1B) and [V(phen)3](OTf)2 (V2) and observe pronounced trigonal distortion relative to analogous Cr3+ complexes. We use electronic absorption spectroscopy in tandem with TD-DFT computations to assign metal-ligand charge transfer (MLCT) properties of V-1B and V2 that are unique from the intraligand transitions, 4(3IL), solely observed in Cr3+ analogues. Our newly developed natural transition spin density (NTρα,ß) plots characterize both the Cr3+ and V2+ absorbance properties. A multideterminant approach to DFT assigns the energy of the 2E state of V-1B as stabilized through electron delocalization. We find that the profound differences in excited state lifetimes for Cr3+ and V2+ polypyridyls arise from differences in the characters of their lowest doublet states and pathways for intersystem crossing, both of which stem from trigonal structural distortion and metal-ligand π-covalency.

Long-Lived Mixed 2MLCT/MC States in Antiferromagnetically Coupled d3 Vanadium(II) Bipyridine and Phenanthroline Complexes.

Exploration of [V(bpy)3]2+ and [V(phen)3]2+ (bpy = 2,2'-bipyridine; phen = 1,10-phenanthroline) using electronic spectroscopy reveals an ultrafast excited-state decay process and implicates a pair of low-lying doublets with mixed metal-to-ligand charge-transfer (MLCT) and metal-centered (MC) character. Transient absorption (TA) studies of the vanadium(II) species probing in the visible and near-IR, in combination with spectroelectrochemical techniques and computational chemistry, lead to the conclusion that after excitation into the intense and broad visible 4MLCT ← 4GS (ground-state) absorption band (ε400-700 nm = 900-8000 M-1 cm-1), the 4MLCT state rapidly (τisc < 200 fs) relaxes to the upper of two doublet states with mixed MLCT/MC character. Electronic interconversion (τ ∼ 2.5-3 ps) to the long-lived excited state follows, which we attribute to formation of the lower mixed state. Following these initial dynamics, GS recovery ensues with τ = 430 ps and 1.6 ns for [V(bpy)3]2+ and [V(phen)3]2+, respectively. This stands in stark contrast with isoelectronic [Cr(bpy)3]3+, which rapidly forms a long-lived doublet metal-centered (2MC) state following photoexcitation and lacks strong visible GS absorption character. 2MLCT character in the long-lived states of the vanadium(II) species produces geometric distortion and energetic stabilization, both of which accelerate nonradiative decay to the GS compared to [Cr(bpy)3]3+, where the GS and 2MC are well nested. These conclusions are significant because (i) long-lived states with MLCT character are rare in first-row transition-metal complexes and (ii) the presence of a 2MLCT state at lower energy than the 4MLCT state has not been previously considered. The spin assignment of charge-transfer states in open-shell transition-metal complexes is not trivial; when metal-ligand interaction is strong, low-spin states must be carefully considered when assessing reactivity and decay from electronic excited states.

Epidemiology of maxillofacial trauma in the elderly: A European multicenter study.

INTRODUCTION: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more). MATERIALS AND METHODS: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS). RESULTS: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (P<.005). Concomitant injuries were observed in 27.3% of patients. Falls were associated with the absence of concomitant injuries. The ninth decade (P<.05) and a high FISS score (P<.005) were associated with concomitant body injuries too. CONCLUSIONS: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.

Management of mandibular condylar fractures in patients with atrophic edentulous mandibles.

INTRODUCTION: Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. METHODS: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. RESULTS: A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. CONCLUSIONS: The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.

Función visual y deficiencia visual cerebral (cerebral visual impairment) en niños. La importancia de entenderla y atenderla / Visual function and CVI in children (cerebral visual impairment): The importance of understanding and treating it

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Lithospheric folding by flexural slip in subduction zones as source for reverse fault intraslab earthquakes.

Subduction requires the permanent generation of a bend fold in the subducting slab which mechanics is not well understood. Lithospheric bending of subducting slabs was traditionally considered to be accommodated by orthogonal flexure, generating extensional outer rise earthquakes responsible of the external arc elongation during folding. Here we explore the possibility of lithospheric flexure being accommodated through simple shear deformation parallel to the slab (folding by flexural slip) and evaluate this process as source of earthquakes. The seismicity predicted by flexural slip dominated slab bending explains a significant amount of intermediate earthquakes observed in subduction zones with different degrees of coupling. This mechanism predicts the generation of intraslab thrust earthquakes with fault planes subparallel to the slab top. Being the orientations of the fault planes the same for the interface thrust earthquakes and the flexural-slip intraslab earthquakes, the amount of seismic moment liberated by the interface could be significantly lower than considered before. This proposed seismic source should be taken into account in models and hazard studies of subduction zones. Determining the seismic generating processes in subduction zones and their characteristics is a fundamental issue for the correct assessment of the associated seismic and tsunami risk.

The Role of PDGFs and PDGFRs in Colorectal Cancer.

Introduction. Colorectal cancer (CRC) is an important cause of morbidity and mortality worldwide. Angiogenesis was reported as one important mechanism activated in colorectal carcinogenesis. Tumor microenvironment associated angiogenesis involves a large spectrum of signaling molecules and deciphering their role in colorectal carcinogenesis still represents a major challenge. The aim of our study is to point out the diagnosis and prediction role of PDGF family and their receptors in colorectal carcinogenesis. Material and Methods. A systematic search in Medline and PubMed for studies reporting the role of platelet-derived growth factors (PDGFs) and their receptors (PDGFRs) in tumor biology related to CRC was made. Results. PDGFs are important growth factors for normal tissue growth and division, with an important role in blood vessel formation. PDGFs/PDGFRs signaling pathway has been demonstrated to be involved in angiogenesis mainly by targeting pericytes and vascular smooth muscle cells. High levels of PDGF-BB were reported in CRC patients compared to those with adenomas, while elevated levels of PDGFR α/ß in the stroma of CRC patients were correlated with invasion and metastasis. Moreover, PDGF-AB and PDGF-C were correlated with early diagnosis, cancer grading, and metastatic disease. Conclusions. Both PDGFs and PDGFRs families play an important role in colorectal carcinogenesis and could be considered to be investigated as useful biomarkers both for diagnosis and treatment of CRC.

Is there a correlation between peripheral blood expression of angiogenic transcriptional factors/receptors and colorectal cancer?

PURPOSE: The aim of this study was to evaluate whether there is a correlation between peripheral blood expression of angiogenic transcriptional factors/receptors and colorectal cancer (CRC). METHODS: Eighty six blood samples collected from patients with CRC (N=42), adenomas and/or hyperplastic polyps(AP, N=30) and individuals without colon pathology (control group/CTR, N=14) were used for this study. Twelve transcription factors and receptors were assessed by qRT-PCR in a case-control study. The molecules with a minimum of 30% differences in gene expression for CRC and AP compared to CTR were then analyzed separately for each sample. Gene expression was evaluated relatively to the CTR after normalization to the large ribosomal protein PO (RPLPO) housekeeping gene, and the differential expression between studied groups was assessed by ANOVA. RESULTS: Seven out of 12 genes presented differences in expression between 10-29% in CRC and/or AP compared to CTR. Considering the selection criteria, we further individually evaluated the levels of expression of 5 genes that had a minimum of 30% expression in the case-control study. Our data showed a significant up-regulation of platelet derived growth factor (PDGF) C in the blood of the patients with CRC compared to CTR (p=0.007). Likewise, clusterin (CLU) was significantly up-regulated both in CRC and AP groups compared to healthy subjects (p=0.01). For VEGFR1, PDGFRA and TGFB1 we didn't find significantly differential expression between any of the studied groups, even if increased levels were observed in both CRC and AP vs CTR. CONCLUSIONS: The results of our study indicated that increased blood level of PDGFC mRNA was associated with the presence of CRC (p=0.007). Additionally, high levels of circulating CLU mRNA were observed in both malignant and benign colorectal pathologies.

Can we change our microbiome to prevent colorectal cancer development?

BACKGROUND: Colorectal cancer represents an important disease as one of the major causes of death worldwide. Although a lot of genetic and epigenetic research has been conducted, all the pieces of the puzzle of colorectal cancer carcinogenesis have not yet been identified. New recent data has highlighted that gut microbiota could have an influence on colorectal carcinogenesis. Gut microbiota represents the microbe population living in the human intestine and contains tens of trillions of microorganisms. MATERIAL AND METHODS: A systematic search in Medline and PubMed for studies reporting the influence of gut microbiota and inflammation on patients with colorectal cancer was made. RESULTS: In this review we discuss many of the specific bacteria, as well as their metabolites which may have an important role in development of colorectal cancer. Furthermore, we emphasize the molecular mechanisms modulated by gut microbiota, which promote inflammation, toxic metabolites, DNA damaging and pro-carcinogenic compounds, as support for colorectal carcinogenesis. The interrelation between microbiota and inflammation is complex because bacteria and inflammation could mutually impact upon each other. In this context, both endogenous and exogenous miRNAs may have an important role to modulate tumor-related inflammation in colorectal cancer. CONCLUSIONS: Better understanding of the role of gut microbiota in colorectal carcinogenesis could provide promising new directions to improve both prevention and treatment of colorectal cancer. Moreover, the discovery of novel biomarkers in the gut microbiome in order to detect colorectal cancer in an early stage or even in a precancerous stage is of outmost importance.

The mechanism of pyrolysis of benzyl azide: spectroscopic evidence for benzenemethanimine formation.

We study the gas-phase pyrolysis of benzyl azide (BA, C6H5CH2N3) using ultraviolet photoelectron spectroscopy (UVPES) and matrix-isolation infrared (IR) spectroscopy, together with electronic structure calculations and Rice-Ramsperger-Kassel-Marcus (RRKM) calculations. It is found that BA decomposes via N2 elimination at ca. 615 K, primarily yielding benzenemethaninime. Other end products include HCN and C6H6. N-Methyleneaniline is not detected, although its formation at higher temperature is foreseen by RRKM calculations.

Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes / Urinary Infection in Patients With Neurogenic Bladder: Patterns of Resistance to the Most Frequent Uropathogens

Objetivos: Analizar la etiología y resistencias de los uropatógenos más frecuentes en una población con vejiga neurógena. Material y métodos: Se incluyeron 284 pacientes a los que se practicaron un total de 284 urocultivos. De estos, 106 procedían de pacientes con lesión neurológica, 28 de grupo control no neurógeno, 75 de pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) y 75 de pacientes que acudieron a Urgencias por sintomatología de infección aguda del tracto urinario. Se realizó urocultivo cuantitativo en medio cromogénico, así como identificación y estudio de resistencias de todos los urocultivos positivos para uno o dos microorganismos. Resultados: El 67% de los pacientes neurológicos presentaron urocultivos positivos, frente al25% de los pacientes control. Los urocultivos de pacientes ingresados en UCI y los del grupo Urgencias fueron positivos al 100%, ya que se seleccionaron los primeros 75 urocultivos positivos. E. coli fue el microorganismo más frecuentemente aislado en el grupo de neurológicos, al igual que en enfermos procedentes de Urgencias y del grupo control. En UCI fue Enterococcus spp. (19,4%), seguido de P. aeruginosa (16,5%). En el estudio de resistencias E. coli presentó altas tasas de resistencia a ampicilina y cotrimoxazol y, aunque en menor grado, a ciprofloxacino. Conclusiones: E. coli es el microorganismo más frecuentemente aislado entre todos los grupos, excepto en UCI, en el que es superado por Enterococcus spp. y P. aeruginosa. Las resistencias entre los 4 grupos de población estudiada tienen características diferentes, mostrando globalmente un bajo índice de resistencias a nitrofurantoína y especialmente a fosfomicina, observado en pacientes que provienen de Urgencias o ingresados en UCI y neurológicos (AU)

Purpose: To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder. Material and methods: A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied. Results: A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcusspp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin. Conclusions: E. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients (AU)

[Urinary infection in patients with neurogenic bladder: patterns of resistance to the most frequent uropathogens]. / Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes.

PURPOSE: To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder. MATERIAL AND METHODS: A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied. RESULTS: A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcus spp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin. CONCLUSIONS: E. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients.

[Adherence to antihypertensive and lipid-lowering medications: a problem of public health, not yet resolved]. / Aderenza alla terapia con farmaci antipertensivi e ipolipemizzanti: un problema di sanità pubblica ancora irrisolto.

Assessment of compliance in patients with relevant comorbidity condition, above all those at high cardiovascular risk, is especially relevant because their clinical condition can be considerably mitigated by treatment with concomitant antihypertensive (AH) and lipid-lowering (LL) medications. The aim of the study was to evaluate patterns and predictors of adherence and persistence with concomitant AH and LL therapy. This retrospective cohort study included 363 enrolled from database of 3 physicians who initiated treatment with AH and LL therapy between January 2007 and January 2010. Adherence was measured as the proportion of days covered in 3-month intervals and patients were considered adherent if they had filled prescriptions for at least 80% of the period. Persistence was measured as absence of discontinuation define as > 30 days between a filled prescription and the subsequent claim. A multivariate analysis with a Cox regression model was performed to evaluate potential predictors of adherence and persistence. Finally, patients outcome was evaluated to assess potential association with adherence and persistence with AH and LL therapy. The mean percentage of patients adherent with both AH and LL medications was 39%, declining from 47% to 31%. The mean percentage of persistence was 43%. After adjustment for variables of interest, major predictors of adherence and persistence were the number of concomitant prescriptions, age of patients, gender time between start of AH and LL therapy, and gravity of coronary disease. Finally, adherent and persistent patients had significant lower blood pressure compared to other subjects. Adherence and persistence with concomitant AH and LL therapy was poor and declined over time. Interventions to improve these attitudes and to contain costs affecting a limited health budget are needed.

[Characteristics of urinary tract infections in different patient subpopulations and depending on the bladder emptying system]. / Características de las infecciones urinarias en pacientes con vejiga neurógena según el sistema de vaciado vesical utilizado en comparación con pacientes sin vejiga neurógena.

INTRODUCTION: To analyze the prevalence and etiology of urinary tract infection in patients with neurogenic bladder depending on the bladder emptying system used as compared to a population with no neurological impairment. To assess perception of urinary tract infection by patients with neurogenic bladder. MATERIALS AND METHODS: An epidemiological and prospective study was conducted on 283 patients, in whom a total of 283 urethral cultures were performed. Of these, 106 came from patients with neurological damage, 28 from a control group with no neurological impairment, 74 from patients admitted to the intensive care unit (ICU) of our hospital, and 75 from patients who attended the emergency room for symptoms of acute urinary tract infection. The sensitivity and specificity of patient perception as indicative of urinary tract infection was analyzed using ROC curves. RESULTS: Positive urethral cultures were found in 66% of patients with neurological damage and 25% of control patients. Within the neurological group, patients with the highest rates of positive urethral cultures were those with myelomeningocele (MMC) (81.5%) and spinal cord injuries (71.7%), with a statistically significant difference (p=0.01). The microorganism most commonly found in all subgroups was Escherichia coli, followed by Enterococcus faecalis and Pseudomonas aeruginosa in the neurological subgroup, Enterococcus faecalis and Proteus mirabilis in the control subgroup, and Klebsiella pneumoniae and Staphylococcus agalactiae in the emergency room subgroup. In the ICU subgroup, the most commonly found microorganism was Enterococcus faecalis, followed by Escherichia coli and Pseudomonas aeruginosa. Sensitivity for perception by neurological patients as an indication of the presence of urinary tract infection was 97.2%, as compared to 80% in the control group. Specificity was low in both groups. CONCLUSIONS: E. coli was the microorganism found in positive urethral cultures from all subgroups, except in the ICU group. The groups with the highest urinary tract infection rates were patients with MMC and spinal cord injuries. Sensitivity and specificity (as measured using ROC curves) for perception by neurological patients as an indication of the presence of urinary tract infection was higher in neurological patients than in the non-neurological control group (p=0.0004, area: 0.643).