Guidelines for inhaled sedation in the ICU.

INTRODUCTION AND OBJECTIVES: Sedation is used in intensive care units (ICU) to improve comfort and tolerance during mechanical ventilation, invasive interventions, and nursing care. In recent years, the use of inhalation anaesthetics for this purpose has increased. Our objective was to obtain and summarise the best evidence on inhaled sedation in adult patients in the ICU, and use this to help physicians choose the most appropriate approach in terms of the impact of sedation on clinical outcomes and the risk-benefit of the chosen strategy. METHODOLOGY: Given the overall lack of literature and scientific evidence on various aspects of inhaled sedation in the ICU, we decided to use a Delphi method to achieve consensus among a group of 17 expert panellists. The processes was conducted over a 12-month period between 2022 and 2023, and followed the recommendations of the CREDES guidelines. RESULTS: The results of the Delphi survey form the basis of these 39 recommendations - 23 with a strong consensus and 15 with a weak consensus. CONCLUSION: The use of inhaled sedation in the ICU is a reliable and appropriate option in a wide variety of clinical scenarios. However, there are numerous aspects of the technique that require further study.

Synthesis and design of Ag-Fe bimetallic nanoparticles as antimicrobial synergistic combination therapies against clinically relevant pathogens.

The inappropriate use of antibiotics and the inadequate control of infections have led to the emergence of drug-resistant strains. In recent years, metallo-pharmaceutics and metallic nanoparticles have been proposed as potential alternative antimicrobials due to their broad-spectrum antimicrobial properties. Moreover, recent findings have shown that combinations of transition metal compounds can exhibit synergistic antimicrobial properties. Therefore, the synthesis and design of bimetallic nanoparticles is a field worth exploring to harness the interactions between groups of metals and organic complex structures found in different microbial targets, towards the development of more efficient combinatorial antimicrobials composed of synergistic metals. In this study, we present a green synthesis of Ag-Fe bimetallic nanoparticles using an aqueous extract from the leaves of Gardenia jasminoides. The characterization of the nanoparticles demonstrated that the synthesis methodology produces homogenously distributed core-shell Ag-Fe structures with spherical shapes and average diameter sizes of 13 nm (± 6.3 nm). The Ag-Fe bimetallic nanoparticles showed magnetic and antimicrobial properties; the latter were evaluated against six different, clinically relevant multi-drug-resistant microbial strains. The Ag-Fe bimetallic nanoparticles exhibited an antimicrobial (bactericidal) synergistic effect between the two metals composing the bimetallic nanoparticles compared to the effects of the mono-metallic nanoparticles against yeast and both Gram-positive and Gram-negative multidrug-resistant bacteria. Our results provide insight towards the design of bimetallic nanoparticles, synthesized through green chemistry methodologies, to develop synergistic combinatorial antimicrobials with possible applications in both industrial processes and the treatment of infections caused by clinically relevant drug-resistant strains.

Therapeutic Applications of Cannabinoids in Cardiomyopathy and Heart Failure.

A large number of cannabinoids have been discovered that could play a role in mitigating cardiac affections. However, none of them has been as widely studied as cannabidiol (CBD), most likely because, individually, the others offer only partial effects or can activate potential harmful pathways. In this regard, CBD has proven to be of great value as a cardioprotective agent since it is a potent antioxidant and anti-inflammatory molecule. Thus, we conducted a review to condensate the currently available knowledge on CBD as a therapy for different experimental models of cardiomyopathies and heart failure to detect the molecular pathways involved in cardiac protection. CBD therapy can greatly limit the production of oxygen/nitrogen reactive species, thereby limiting cellular damage, protecting mitochondria, avoiding caspase activation, and regulating ionic homeostasis. Hence, it can affect myocardial contraction by restricting the activation of inflammatory pathways and cytokine secretion, lowering tissular infiltration by immune cells, and reducing the area of infarct and fibrosis formation. These effects are mediated by the activation or inhibition of different receptors and target molecules of the endocannabinoid system. In the final part of this review, we explore the current state of CBD in clinical trials as a treatment for cardiovascular diseases and provide evidence of its potential benefits in humans.

In vivo antimicrobial activity of silver nanoparticles produced via a green chemistry synthesis using Acacia rigidula as a reducing and capping agent.

INTRODUCTION: One of the main issues in the medical field and clinical practice is the development of novel and effective treatments against infections caused by antibiotic-resistant bacteria. One avenue that has been approached to develop effective antimicrobials is the use of silver nanoparticles (Ag-NPs), since they have been found to exhibit an efficient and wide spectrum of antimicrobial properties. Among the main drawbacks of using Ag-NPs are their potential cytotoxicity against eukaryotic cells and the latent environmental toxicity of their synthesis methods. Therefore, diverse green synthesis methods, which involve the use of environmentally friendly plant extracts as reductive and capping agents, have become attractive to synthesize Ag-NPs that exhibit antimicrobial effects against resistant bacteria at concentrations below toxicity thresholds for eukaryotic cells. PURPOSE: In this study, we report a green one-pot synthesis method that uses Acacia rigidula extract as a reducing and capping agent, to produce Ag-NPs with applications as therapeutic agents to treat infections in vivo. MATERIALS AND METHODS: The Ag-NPs were characterized using transmission electron microscopy (TEM), high-resolution TEM, selected area electron diffraction, energy-dispersive spectroscopy, ultraviolet-visible, and Fourier transform infrared. RESULTS: We show that Ag-NPs are spherical with a narrow size distribution. The Ag-NPs show antimicrobial activities in vitro against Gram-negative (Escherichia coli, Pseudomonas aeruginosa, and a clinical multidrug-resistant strain of P. aeruginosa) and Gram-positive (Bacillus subtilis) bacteria. Moreover, antimicrobial effects of the Ag-NPs, against a resistant P. aeruginosa clinical strain, were tested in a murine skin infection model. The results demonstrate that the Ag-NPs reported in this work are capable of eradicating pathogenic resistant bacteria in an infection in vivo. In addition, skin, liver, and kidney damage profiles were monitored in the murine infection model, and the results demonstrate that Ag-NPs can be used safely as therapeutic agents in animal models. CONCLUSION: Together, these results suggest the potential use of Ag-NPs, synthesized by green chemistry methods, as therapeutic agents against infections caused by resistant and nonresistant strains.

Relationship between Serum Concentration of Uric Acid and Insulin Secretion among Adults with Type 2 Diabetes Mellitus.

To determine the relationship between serum concentrations of uric acid and insulin secretion with hyperglycaemic clamp technique among adults with type 2 diabetes mellitus (DM2) without hyperuricemia, we carried out a cross-sectional study on 45 patients of both gender. We observed correlation between uric acid with male gender r = 0.710 (P = 0.001). Also correlation between uric acid and total insulin secretion was positive r = 0.295 (P = 0.049). As well as a positive correlation adjusted for body mass index was demonstrated for the first, second, and total phases of insulin secretion, respectively, r = 0.438 (P = 0.022), r = 0.433 (P = 0.022), and r = 0.439 (P = 0.024). Serum concentration of uric acid showed a positive relationship with the total phase of insulin secretion; even in states prior to hyperuricemia, uric acid can play an important role in the function of the beta cell in patients with DM2.

Electrically tuned phase transition and band structure in a liquid-crystal-infilled photonic crystal.

We studied a nematic liquid crystal (LC) cylinder under the action of an axial electric field E(0). Elaborate modeling of the free energy leads to the conclusion that the configuration of the molecules is "escaped radial" for low E(0); a phase transition, however, occurs for a critical value E(c), the configuration becoming axial for E(0) >E(c). From these results, the position-dependent dielectric tensor is determined and the photonic band (PB) structure is calculated for a photonic crystal of LC cylinders. It is shown that by varying E(0) a PB gap can be fully tuned from open to closed. Also, switching to a supercritical field can give rise to interesting polarization and directional effects in the propagation of light.

Effect of a nutritional liquid supplement designed for the patient with diabetes mellitus (Glucerna SR) on the postprandial glucose state, insulin secretion and insulin sensitivity in healthy subjects.

AIM: To identify the effect of a nutritional liquid supplement designed for the patient with diabetes mellitus (Glucerna SR) in single administration on the postprandial glucose state, insulin secretion and insulin sensitivity in healthy subjects. METHODS: A randomized, single-blind, cross-over, clinical trial was carried out in 14 young, healthy, non-obese, volunteers. A basal metabolic profile, which included glucose level, insulin, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, creatinine, and uric acid, was measured. Subjects received a single administration of 300 kcal, gauged with water at 350 ml, of each of the following (at least 3 days apart): glucose 75 g, polymeric supplement (Ensure high calcium) 315 ml or Glucerna SR 323 ml. At the beginning of each administration and 30, 60, 90 and 120 min later, glucose and insulin concentrations were measured. Areas under the curve of glucose and insulin were calculated. First-phase and total insulin secretions and insulin sensitivity were also estimated. RESULTS: Glucose level at 120 min was significantly lower after receiving Ensure high calcium or Glucerna SR. Administration of Glucerna SR resulted in a significant reduction in the areas under the curve of glucose and insulin, as well as in total insulin secretion with a tendency to be lower in their first phase. Insulin sensitivity was increased. CONCLUSIONS: A single administration of Glucerna SR to healthy subjects decreased the postprandial glucose and insulin states, as well as the insulin secretion; insulin sensitivity increased.

Antibacterial properties of some plants used in Mexican traditional medicine for the treatment of gastrointestinal disorders.

Antibacterial properties of aqueous and methanolic extracts of 26 medicinal plants used in Mexico to treat gastrointestinal disorders were tested against eight different species of enteropathogens: two Escherichia coli species; two Shigella sonnei species; two Shigella flexneri species; and two Salmonella sp. species. The results showed that all crude extracts exhibited antibacterial activity, at least against one of the microorganisms tested, at concentrations of 8 mg/mL or lower. The extracts from Caesalpinia pulcherria, Chiranthodendron pentadactylon, Cocos nucifera, Geranium mexicanum (aerial parts and roots), Hippocratea excelsa, and Punica granatum possessed strong antibacterial activity against most of the pathogens tested. In general, methanolic extracts were more active than aqueous extracts. Their activity was higher than chloramphenicol but did not exceed that of trimethoprim. Shigella sonnei species showed the highest susceptibility to both extracts. This is the first evaluation of these plants against bacterial pathogen isolates, which cause diarrhea and dysentery in Mexican population.

The effects of surgically removing subcutaneous fat on the metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment.

The aim of this study was to identify the effects of surgically removing subcutaneous fat on the metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment. An open clinical trial with a non-intervention parallel group was carried out on 12 young, obese women. After randomization, six volunteers were selected to the surgical intervention consisting of large-volume liposuction; the other six women were considered as the non-intervention group. Metabolic profiles and insulin tolerance tests to assess insulin sensitivity were performed on all volunteers before intervention or non-intervention and 21 - 28 days afterwards. There were a significant decrease in glucose (4.9 +/- 0.4 vs. 4.6 +/- 0.2 mmol/l, p < 0.05) and uric acid (250.8 +/- 56.2 vs. 224.0 +/- 53.4 micromol/l, p < 0.05) levels after liposuction; insulin sensitivity improved after the surgical intervention (4.3 +/- 0.9 vs. 5.3 +/- 0.8 %/min, p = 0.046). In conclusion, surgical removal of subcutaneous fat by large-volume liposuction led to an improvement in insulin sensitivity and a decrease in glucose and uric acid concentrations.

Inhibition of cyclooxygenase-1 or -2 on insulin sensitivity in healthy subjects.

The aim of this study was to identify the effects of cyclooxygenase (COX)-1 and -2 inhibition each on insulin sensitivity in healthy subjects. A randomized, double-blind, controlled clinical trial was carried out in 21 young, healthy, non-obese male volunteers. Pharmacological COX-1 inhibition was performed with the prescription of acetylsalicylic acid (ASA) at a low dose, and COX-2 selective inhibition was performed with celecoxib. After randomization, all subjects received an oral morning dose of ASA 100 mg (n = 7), celecoxib 200 mg (n = 7), or placebo for the control group (n = 7) during a period of 15 days. Before and after of the study period, a metabolic profile was measured in all participants. An insulin tolerance test (ITT) was performed to assess insulin sensitivity, and the constant for the serum glucose disappearance rate (K ITT) was calculated. Clinical and metabolic characteristics were similar between groups. The K ITT calculated with the ITT was higher after celecoxib than at baseline (4.8 +/- 0.9 vs. 4.3 +/- 0.6%/min, p = 0.04), indicating improvement in insulin sensitivity. Neither ASA nor placebo administrations modified insulin sensitivity. In conclusion, COX-2-selective inhibitor at a celecoxib dose of 200 mg daily increased insulin sensitivity in healthy subjects.