Practical document on the management of hyponatremia in critically ill patients. / Documento práctico del manejo de la hiponatremia en pacientes críticos.

Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient.

Nature versus design: synthetic biology or how to build a biological non-machine.

The engineering ideal of synthetic biology presupposes that organisms are composed of standard, interchangeable parts with a predictive behaviour. In one word, organisms are literally recognized as machines. Yet living objects are the result of evolutionary processes without any purposiveness, not of a design by external agents. Biological components show massive overlapping and functional degeneracy, standard-free complexity, intrinsic variation and context dependent performances. However, although organisms are not full-fledged machines, synthetic biologists may still be eager for machine-like behaviours from artificially modified biosystems.

Towards light-mediated sensing of bacterial comfort.

UNLABELLED: Bacterial comfort is central to biotechnological applications. Here, we report the characterization of different sensoring systems, the first step within a broader synthetic biology-inspired light-mediated strategy to determine Escherichia coli perception of environmental factors critical to bacterial performance. We did so by directly 'asking' bacterial cultures with light-encoded questions corresponding to the excitation wavelength of fluorescent proteins placed under the control of environment-sensitive promoters. We built four genetic constructions with fluorescent proteins responding to glucose, temperature, oxygen and nitrogen; and a fifth construction allowing UV-induced expression of heterologous genes. Our engineered strains proved able to give feedback in response to key environmental factors and to express heterologous proteins upon light induction. This light-based dialoguing strategy reported here is the first effort towards developing a human-bacteria interphase with both fundamental and applied implications. SIGNIFICANCE AND IMPACT OF THE STUDY: The results we present here are at the core of a larger synthetic biology research effort aiming at establishing a dialogue with bacteria. The framework is to convert the human voice into electric pulses, these into light pulses exciting bacterial fluorescent proteins, and convert light-emission back into electric pulses, which will be finally transformed into synthetic voice messages. We report here the first results of the project, in the form of light-based determination of key parameters for bacterial comfort. The ultimate goal of this strategy is to combine different engineered populations to have a combined feedback from the pool.

[Prognostic value of the sTREM-1 plasma values in patients with sepsis: a cohort study]. / Valor pronóstico de los niveles plasmáticos de sTREM-1 en pacientes con sepsis: un estudio de cohortes.

OBJECTIVE: To evaluate the association between plasma levels of soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) and mortality of patients with sepsis. DESIGN: Prospective cohort study. SETTING: Two general Intensive Care Units. PATIENTS: Patients with sepsis in whom sTREM-1 plasma levels were determined daily in the first 3 days of their presentation. VARIABLES OF INTEREST: Mortality at 28 days. RESULTS: We analyzed 121 patients (23% severe sepsis, 44% septic shock, 33% non-severe sepsis). Mortality at 28 days was 24.8%. The initial sTREM-1 levels were slightly higher in nonsurvivors than in survivors (median 366.9 versus 266.5 pg/ml, p=0.2668). An increase in sTREM-1 levels higher than 90 pg/ml within the first 3 days (delta-TREM) was associated with an excess of mortality (hazard ratio [HR] 2.68, p=0.0047), with a sensitivity of 47% and a specificity of 78%. This excess of mortality disappeared after adjusting for severity by Cox analysis (adjusted HR 1.07, p=0.8665). CONCLUSIONS: The increase in the levels of sTREM-1 during the first 3 days of evolution is associated with an excess of mortality in critically ill patients with sepsis. This is explained by the greater initial severity of these patients. The discriminative capacity of this finding is insufficient to be clinically useful.

Effects of Bacillus thuringiensis Cry1Ab and Cry3Aa endotoxins on predatory Coleoptera tested through artificial diet-incorporation bioassays.

Traditional approaches to studying the effects of genetically modified (GM) crops on beneficial insects involve either field assays, comparing insect population levels between control and GM crops or tritrophic bioassays with contaminated insects - usually larvae or eggs of Lepidoptera - as preys. Here, we report the results of a bioassay using an artificial diet, suitable for predatory Coleoptera, to supply Bacillus thuringiensis (Bt) solubilized Cry1Ab and Cry3Aa as well as trypsin-activated Cry1Ab to Atheta coriaria and Cryptolaemus montrouzieri adults and young larvae of Adalia bipunctata. Water, solubilization buffer and trypsin-treated solubilization buffer were used as controls. In total, 1600 insects were assayed. Assays showed a relatively low mortality rate in the controls, ranging from as low as 7% after 15 days (C. montrouzieri) to about 15-20% after five days (A. bipunctata) or 15 days (A. coriaria). For all three predators, there were no statistical differences between the mortality recorded in any of the treatment groups and the corresponding controls. These results indicate a lack of short- (A. bipunctata) and long-term (A. coriaria and C. montrouzieri) mortality associated with oral ingestion of Cry1Ab and Cry3Aa at the high dose tested (50 microg ml-1). We discuss the relevance of these findings for the ecology of beneficial Coleoptera and compatibility with Bt and GM Bt crops.

[Gender bias in women with myocardial infarction: ten years after]. / Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después.

OBJECTIVE: Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. DESIGN: Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. SETTING: ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. PATIENTS: We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. RESULTS: Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. CONCLUSIONS: The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.

Experiencia en la colocación del catéter para diálisis peritoneal por parte de la unidad de cirugía mayor ambulatoria / No disponible

Introducción: Se ha realizado un estudio retrospectivo con el objetivo de demostrar la disminución en la morbilidad de los pacientes con insuficiencia renal crónica, a los que se les implantó un catéter para diálisis peritoneal en el servicio de cirugía mayor ambulatoria, frente a una etapa anterior en la que se realizó de forma no reglada en urgencias. Material y métodos: Los 87 pacientes se distribuyeron en dos grupos: I (julio 1997-abril 2000): 42 intervenidos en urgencias y por personal quirúrgico “no específico” y II (mayo 2000-noviembre 2004): 45 operados en el servicio de CMA. Se han colocado un total de 94 catéteres, 47 en el grupo I y 47 en el II; consumiendo ingreso sólo en el 10% de los pacientes del grupo I. Resultados: En el seguimiento realizado durante las 4 primeras semanas, la infección del orificio de salida del catéter se redujo del 54,75% (grupo I) al 4,5% (grupo II). En cuanto a la incidencia de peritonitis en los primeros 6 meses del implante, se pasó del 28,6% (grupo I) al 2,25% (grupo II). Los desplazamientos del catéter disminuyeron del 21% (grupo I) al 2% (grupo II), así como las hemorragias postcirugía, que del 24% (grupo I) se situaron en un 7% (grupo II). Algo similar sucedió con las fugas de líquido pericatéter, del 11,9% en el I al 4,45% del grupo II, y el desarrollo de eventraciones paraumbilicales, del 19% en el I al 8,9% en el II. Discusión: La UCMA contribuye al bienestar de nuestros pacientes y a la consecución de una adecuada técnica dialítica (AU)

Introduction: A retrospective study has been carried out, having as an objective the demonstration of the decrease in morbidity of patients with chronic renal failure, to whom a catheter for peritoneal dialysis was implanted in the ambulatory major surgery service, against a previous stage in which it was made in anonregulated way in urgencies. Material and methods: The 87 patients were distributed in two groups: I (July 1997-April 2000): 42 persons being operated upon in urgencies by nonspecific surgical personnel and II (May 2000-November 2004): 45 patients operated in the ambulatory major surgery service. A total of 94 catheters have been placed, 47 in group I and 47 in group II; having the need to be hospitalized by only the 10% of the patients from group I. Results: Throughout the monitoring done during the first four weeks, the catheter’s exit orifice’s infection reduced from 54.75% (group I) to 4.5% (group II). According to peritonitis’ incidence in the first 6 months after the implant, it passed from 28.06% (group I) to 2.25% (group II). The catheter’s displacements decreased from 21% (group I) to 2% (group II), as so did the post surgery haemorrhages, which from 24% (group I) went to 7% (group II). A similar situation happened with the pericatheter liquid leaks, from 11.9% in I to 4.45% from group II, and the development of paraumbilical eventrations, from 19% in group I to 8.9% in group II. Discussion: The ambulatory major surgery service contributes to our patients’ wellbeing and to an adequate dialitic technique achievement (AU)

Pathogenicity of intrathoracically administrated Bacillus thuringiensis spores in Blatta orientalis.

The ability of Bacillus thuringiensis to produce septicaemia in Periplaneta americana and Blatta orientalis has been investigated. Spores and crystals from several wild-type strains as well as spores of a B. thuringiensis crystal-deficient mutant, were first orally administrated at high doses, and no significant mortality was recorded. Intrathoracic injection of spore suspensions in P. americana revealed that this species is not very susceptible to B. thuringiensis spores. B. orientalis, by contrast, was found to be very susceptible to B. thuringiensis, with a LD(50) of about 35,000 spores, that is similar to that reported on Lepidoptera challenged with parenterally injected B. thuringiensis.

Bradicardia refleja extrema durante lalaringoscopia / Extreme bradycardia reflex during laryngoscopy

No disponible

Estudio descriptivo de úlceras cutáneas en la residencia de ancianos de Forcall / Descriptive study of cutaneous ulcers in the Forcall nursing home

Las úlceras cutáneas son uno de los problemas más frecuentes con los que se encuentra el personal de enfermería que trabaja en el campo de la geriatría. Es por ello que la atención diaria y la relación directa enfermeraanciano juega un gran papel en el cuidado de las úlceras cutáneas (1-3). La prevención, detección, tratamiento y curación de las úlceras cutáneas es uno de los objetivos que persigue el equipo de enfermería de la "Residencia de Ancianos de Forcall". Dada su importancia se realiza un estudio descriptivo retrospectivo para determinar la prevalencia y describir las características de las úlceras cutáneas en el centro desde su apertura en junio de 1998. En este estudio se evidencia la necesidad de aplicar medidas preventivas y de tratamiento adecuadas, pues son determinantes para la correcta evolución de las úlceras cutáneas. Asimismo cabe destacar que el seguimiento continuado (registros de úlceras cutáneas) y la unificación de criterios en el cuidado y tratamiento de las úlceras cutáneas ha contribuido a la evolución favorable de las mismas (AU)

Molecular and insecticidal characterization of a Bacillus thuringiensis strain isolated during a natural epizootic.

A new Bacillus thuringiensis strain belonging to the serovar aizawai was isolated from a dead larva of the lepidopteran Mythimna loreyi collected in a corn crop in Spain during a natural epizootic. This strain, which was named Leapi01, was compared with the kurstaki and aizawai strains isolated from Dipel(R) and Xentari(R), by electron microscopy, SDS-PAGE, plasmid pattern, PCR and insecticidal activity. This strain showed similar morphological and biochemical characteristics to the standard strains. The content in cry genes of Leapi01 was analysed with a set of general and specific primers recognizing most of the cry genes reported to date. DNA amplification was obtained with primers corresponding to six genes and, to clearly determine the identity of the genes, the amplified fragments were sequenced and corresponded to cry1Aa, cry1Ab, cry1Ca, cry1Da, cry2Ab and cry1Ia. However, the proteins encoded by two of these genes, Cry2 and Cry1I, were not detected in the SDS-PAGE of the purified parasporal bodies. The insecticidal activity of Leapi01 was determined by bioassays against two Lepidoptera species, Helicoverpa armigera and Spodoptera littoralis, that were found to be very susceptible to Leapi01 purified crystals. Since two of the cry genes identified in Leapi01 appear to be silent, other factors may be involved in the toxicity of the strain. As a result of this study, the potential of Leapi01 as biological control agent is discussed, with special emphasis on the high toxicity and relatively broad spectrum activity compared with two B. thuringiensis strains that are the active ingredients of commercial preparations commonly used as bioinsecticides.

Isolation and characterization of Bacillus thuringiensis strains from aquatic environments in Spain.

Samples collected from aquatic environments from Spain were analyzed for the occurrence and dipteran toxicity of Bacillus thuringiensis. From a total of 41 samples, 122 isolates were obtained, yielding a B. thuringiensis index of 0.22. Isolates were assigned to 13 different serovars, with serovar thuringiensis (serotype H1) the most frequently found. Toxicity tests carried out revealed that eight isolates (6.6% out of the total) were active against Tipula oleracea larvae. Serological tests assigned these toxic isolates to serovar thuringiensis. The toxicity found in these isolates against the tipulid was approximately seven times lower than that shown by the standard strain B. thuringiensis ser. israelensis IPS-82. Implication of Cry2A protein in toxic activity is hypothesized.

Characterization of Bacillus thuringiensis ser. balearica (Serotype H48) and ser. navarrensis (serotype H50): two novel serovars isolated in Spain.

The novel strains of Bacillus thuringiensis PM9 and NA69, isolated from soil samples in Spain, were classified and characterized in terms of their crystal proteins, plasmid profile, cry genes content, and their toxicological properties against several species of Lepidoptera, Coleoptera, and Diptera. Both strains share morphological and biochemical characteristics with previously described B. thuringiensis strains, although their unique H antigens identify them as two new serotypes. Two new serovar names, B. thuringiensis serovar balearica (H serotype 48) and B. thuringiensis serovar navarrensis (H serotype 50) are proposed for the type strains PM9 and NA69, respectively.

Identification and characterization of the new bacillus thuringiensis serovars pirenaica (serotype H57) and iberica (serotype H59)

Two new Bacillus thuringiensis strains have been classified by the H antigen of the cells and differentiated by their morphological, biochemical and molecular characteristics. The flagellar agglutination showed that both strains bore specific H antigens which allowed their classification as the new serotypes H57 and H59. The serovar names proposed for the type strains characterized in this work are B. thuringiensis ser. pirenaica, for the H serotype 57, and B. thuringiensis ser. iberica, for the H serotype 59. Further characterization of these strains, by means of SDS-PAGE, Western inmunodetection, plasmid profile and cry-gene identification by polymerase chain reaction, confirmed the originality of the two novel serotypes. Toxicity tests carried out against several insect species, belonging to the orders Lepidoptera, Diptera and Coleoptera, showed no detectable insecticidal activity for either of the B. thuringiensis strains.

Characterization of Bacillus thuringiensis serovar bolivia (serotype H63), a novel serovar isolated from the Bolivian high valleys.

The type strain Bacillus thuringiensis var. bolivia (serotype H63), isolated from the Bolivian high valleys, has been characterized at different levels. Its parasporal crystal has an unusual shape and it is composed of a protein of 155 kDa which shows two bands of 75 and 80 kDa after activation. Analysis by PCR shows the presence of cry1 genes, and amplification with specific primers gave products for cry1 E, cry1 D, cry4 A and cry4 B with sizes different to those expected. Immunoblotting tests showed positive reaction for Cry1 E, Cry3 A, Cry4 A and Cry11 A crystal proteins. The plasmid pattern revealed two large and two small plasmids. Toxicity tests were performed against 14 insects and a slight toxicity was found against Plutella xylotella and Trichoplusia ni.

[Intracranial hemorrhage following second thrombolytic treatment of myocardial reinfarction]. / Hemorragia intracraneal tras un segundo tratamiento trombolítico por reinfarto de miocardio.

Intracranial hemorrhage was observed in a man, aged 66, after a second thrombolytic treatment due to myocardial reinfarction. The patient presented no potential risk factors which have often been associated to intracranial hemorrhage whereas no complications had occurred when thrombolytic therapy was given some months before because of the first infarction. This report emphasizes that a previous thrombolytic treatment with no secondary effects involves no lack of intracranial hemorrhage risk for a second thrombolysis. More research is needed in order to elucidate intracranial hemorrhage mechanisms associated to thrombolytic therapy.