Decreased mortality among patients with catheter-related bloodstream infections at Catalan hospitals (2010-2019).

BACKGROUND: The incidence of catheter-related bloodstream infections (CRBSIs) has fallen over the last decade, especially in intensive care units (ICUs). AIM: To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality. METHODS: A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare-associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical, and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model. FINDINGS: Over the study period, 4795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (hazard ratio (HR): 0.95; 95% confidence interval (CI): 0.92-0.98). The multivariate analysis identified age (HR: 1.03; 95% CI: 1.02-1.04), femoral catheter (1.78; 1.33-2.38), medical ward acquisition (2.07; 1.62-2.65), ICU acquisition (3.45; 2.7-4.41), S. aureus (1.59; 1.27-1.99) and Candida sp. (2.19; 1.64-2.94) as risk factors for mortality, whereas the mortality rate associated with episodes originating in peripheral catheters was significantly lower (0.69; 0.54-0.88). CONCLUSION: Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programmes should focus especially on ICUs and medical wards, where incidence and mortality rates are highest.

Bezlotoxumab in the treatment of Clostridioides difficile infections: a real-life experience.

OBJECTIVE: Following the approval of bezlotoxumab in 2017, studies evaluating its effectiveness in prevention of Clostridioides difficile infection under "real-life" conditions are scarce. METHODS: We conducted a retrospective study developed in a large tertiary care hospital describing the use and outcomes of patients with Clostridioides difficile infection (CDI) treated with bezlotoxumab. RESULTS: A total of 16 patients were include, all of whom had an episode of CDI with high probability of recurrence and 14 of them had some kind of immunosuppression. Bezlotoxumab was effective in the prevention of CDI recurrence in 11 of the 14 cases in which follow up was possible, without significant side effects. CONCLUSIONS: Bezlotoxumab was well tolerated and the incidence of recurrent CDI in a high-risk population for recurrence was only 21.4%.

Western U.S. lake expansions during Heinrich stadials linked to Pacific Hadley circulation.

Lake and cave records show that winter precipitation in the southwestern United States increased substantially during millennial-scale periods of Northern Hemisphere winter cooling known as Heinrich stadials. However, previous work has not produced a clear picture of the atmospheric circulation changes driving these precipitation increases. Here, we combine data with model simulations to show that maximum winter precipitation anomalies were related to an intensified subtropical jet and a deepened, southeastward-shifted Aleutian Low, which together increased atmospheric river-like transport of subtropical moisture into the western United States. The jet and Aleutian Low changes are tied to the southward displacement of the intertropical convergence zone and the accompanying intensification of the Hadley circulation in the central Pacific. These results refine our understanding of atmospheric changes accompanying Heinrich stadials and highlight the need for accurate representations of tropical-extratropical teleconnections in simulations of past and future precipitation changes in the region.

Coupled photochemical-biological system to treat biorecalcitrant wastewater.

The aim of the present work is to study a coupled system to treat biorecalcitrant wastewaters. The combination consists of an advanced oxidation process (AOP) named photo-Fenton (Ph-F), which is a photochemical treatment and a sequencing batch biofilter reactor (SBBR). The synthetic wastewater used to optimise this process is a solution of 200 ppm of 4-chlorophenol (4-CP). The first part of the work is the study of the biodegradability enhancement achieved by the photochemical process, measured as the ratio between the biochemical oxygen demand (BOD5) and the chemical oxygen demand (COD). The second step is the start-up and optimisation of the biological process. The results showed that it is necessary to severely treat the toxic solution (with 500 ppm of [H2O2]0) in order to achieve more than 90% of TOC removal in the whole process. The photochemical and biological treatments lasted 50 minutes and 24 hours, respectively.

Determinación de parámetros cinéticos en las pruebas de equilibrio y marcha de pacientes con latigazo cervical / Measurement of kinetic parameters in the balance and gait of patients with whiplash

Introducción. La sintomatología referida como sensación de inestabilidad es muy habitual en pacientes que han sufrido un latigazo cervical. Se trata de un grupo de pacientes en el que habitualmente las pruebas de diagnóstico complementario no ofrecen hallazgos de interés. Pretendemos encontrar hallazgos comunes a la población con latigazo cervical que nos permitan diferenciarla de la sana. Material y métodos. Estudiamos una muestra de 30 pacientes que sufrieron un latigazo cervical en 2004 (7 hombres y 23 mujeres, con edades entre 20 y 72 años). Todos cumplimentaron dos escalas de valoración (Tinetti y Berg) y un estudio de posturografía con plataforma dinamométrica. Comparamos los datos obtenidos en la posturografía con población sana. Resultados. Se han encontrado diferencias significativas en la mayor parte de las pruebas analizadas, sobre todo en la valoración global (23,735). Las pruebas de Romberg con gomaespuma fueron las más sensibles para diferenciar ambas poblaciones (6,966 y 14,258). En las escalas de valoración utilizadas los datos fueron idénticos a la población sana. Los índices sensoriales también se vieron alterados, sobre todo el somatosensorial (21,075) y el vestibular (17,905). Los pacientes con latigazo cervical utilizaron de forma predominante la estrategia de cadera o medio-lateral (56,994) para compensar su inestabilidad. Conclusión. El análisis de los parámetros cinéticos de las pruebas de equilibrio y marcha, a diferencia de las escalas de valoración, permite diferenciar la población con latigazo cervical de la sana. Las pruebas más sensibles son las de Romberg con gomaespuma (ojos abiertos y cerrados)

Introduction. The symptomatology explained as sensation of instability is very usual in patients who have suffered a whiplash injury. In this type of patients the complementary tests of diagnosis do not usually offer findings of interest. With this work we aim to look for common findings to the population suffering whiplash injury so as to differentiate them from the healthy population. Methodology. A sample of 30 patients who suffered a whiplash injury in 2004 (7 men and 23 women, with ages between 20 and 72 years) was studied. All of them filled out the evaluation scales of Tinetti and Berg and performed a study based on gait and balance analysis with a dynamometric platform. Their results were compared to the data of healthy population. Results. Significant differences in most of the tests have been found, especially in the global evaluation (23.735). Romberg tests with foam were the most sensitive to differentiate both populations (6.966 and 14.258). The results obtained from the evaluation scales showed no differences between both groups. The sensorial indexes were also altered, above all, somatosensorial (21.075) and vestibular (17.905). Patients with whiplash injury predominantly used the hip or middle-lateral strategy (56.994) to compensate their instability. Conclusion. The analysis of the kinetic parameters obtained from the tests of balance and gait, unlike the evaluation scales, makes it possible to differentiate the population with whiplash injury from the healthy one. The most suitable tests are those of Romberg with foam (open and closed eyes)

Oxidation of nitrobenzene by O3/UV: the influence of H2O2 and Fe(ll). Experiences in a pilot plant.

Abstract The degradation of nitrobenzene using some advanced oxidation processes (O3/UV, O3/UV/H2O2 and O3/UV/Fe(III)) has been investigated. In the combined O3/UV process, the effect of pH and ozone was studied. In the other combinations, the influence of the amount of hydrogen peroxide and ferric ion in the degradation rate and TOC evolution, has been studied. Under our conditions, the combination O3/UV did not improve the degradation rate obtained by ozonation. The best TOC decrease was obtained when the O3/UV process was carried out at low ferric ion concentrations.

Use of Fenton reagent to improve organic chemical biodegradability.

Fenton reagent has been used to test the degradation of different organic compounds (formic acid, phenol, 4-chlorophenol, 2,4-dichlorophenol and nitrobenzene) in aqueous solution. A stoichiometric coefficient for the Fenton reaction was found to be 0.5 mol of organic compound/mol of hydrogen peroxide, except for the formic acid where a value of approximately one was obtained (due to the direct formation of carbon dioxide). The treatment eliminates the toxic substances and increases the biodegradability of the treated water (measured as the ratio BOD5/COD). Biodegradability is attained when the initial compound is removed.

Traumatismos de diagnóstico difícil en Atención Primaria

Dentro del variado conjunto de lesiones traumáticas con que podemos encontrarnos en la práctica diaria hay un grupo de ellas que se distinguen por las dificultades de diagnóstico que pueden plantear. La revisión de la casuística de nuestro servicio de Urgencias nos ha permitido caracterizar un grupo de diez lesiones traumáticas que pueden pasar inadvertidas.La importancia de conocer estas lesiones para el médico de Atención Primaria, que ha de prestar la primera asistencia a un paciente traumatizado, radica en poder sospechar su existencia.Y, como en cualquier actuación médica, la herramienta fundamental para establecer la sospecha diagnóstica será el interrogatorio y la exploración física.Este artículo pretende recopilar los conocimientos mínimos necesarios sobre tales lesiones para evitar que pasen inadvertidas durante la atención urgente (AU)