Sustained high serum malondialdehyde levels are associated with severity and mortality in septic patients

This book digs into an area of international migration studies that has gained prominence in the past couple of decades: migrant smuggling. The regional focus is southern Europe, which receives immigrants from many African and Asian countries. Migrant smuggling is discussed in relation to EU and national policies, aimed at combating irregular migration, including increased surveillance and border controls.The authors are no newcomers to the field. Anna Triandafyllidou is a leading scholar in migration studies, having published extensively on various topics dealing with migration in Europe, and with a special interest in Greece and southern Europe. Thanos Maroukis, on the other hand, is an early career academic whose publications have focused specifically on migration in Greece. It is, therefore, not surprising that the authors approached this topic of migrant smuggling from Africa and Asia to Europe by focusing mainly on the situation in Greece and the Turkish-Greek route. The book is based on fieldwork, participant observation and interviews conducted in Athens. The empirical material is extensive, covering a broad range of actors.peer-reviewe

Influencia de los componentes de una dieta vegetariana en la prevalencia de enfermedades sistémicas

La prevalencia de enfermedades sistémicas como la obesidad, hiperlipidemia o cáncercada vez es mayor en nuestra sociedad, provocando millones muertes anuales. Con elpaso de los años, sabemos que un factor importante en el desarrollo de estas enfermedadeses la alimentación del individuo. Las dietas vegetarianas han mostrado beneficio tantopara la prevención como para el tratamiento de estas. Se han visto asociaciones como eltipo de aminoácido ingerido y la resistencia a la insulina o la ingesta de grasas saturadascon una mayor inflamación crónica y estrés oxidativo.En el deporte se plantean dos dudas con este tipo de dietas; rendimiento y la ingestasuficiente de proteínas. Diversos artículos han demostrado una mejora del rendimientodeportivo con la ingesta de zumo de remolacha y dan un papel importante a losantioxidantes de alimentos como ajos o cerezas. Por otra parte, una ingesta correcta deproteínas es perfectamente asumible con productos vegetales, incluso se han encontradovalores similares de aumento de masa muscular en deportistas con ingesta de suplementosde proteína de arroz integral y de suero de leche.La dieta omnívora presenta además otros problemas como son la propagación deenfermedades zoonóticas y por contribuir a una mayor resistencia antibiótica para loshumanos debido a piensos animales con antibióticos para mejora del producto.Además, sabemos que este tipo de dietas es compatible con cualquier etapa del ciclo dela vida y que aporta todos los nutrientes necesarios. Tras la revisión de artículos vemosque la única deficiencia vitamínica.<br /

Association between serum soluble CD40 ligand levels and mortality in patients with severe sepsis

INTRODUCTION: CD40 Ligand (CD40L) and its soluble counterpart (sCD40L) are proteins that exhibit prothrombotic and proinflammatory properties on binding to their cell surface receptor CD40. The results of small clinical studies suggest that sCD40L levels could play a role in sepsis; however, there are no data on the association between sCD40L levels and mortality of septic patients. Thus, the aim of this study was to determine whether circulating sCD40L levels could be a marker of adverse outcome in a large cohort of patients with severe sepsis. METHODS: This was a multicenter, observational and prospective study carried out in six Spanish intensive care units. Serum levels of sCD40L, tumour necrosis factor-alpha and interleukin-10, and plasma levels of tissue factor were measured in 186 patients with severe sepsis at the time of diagnosis. Serum sCD40L was also measured in 50 age- and sex-matched controls. Survival at 30 days was used as the endpoint. RESULTS: Circulating sCD40L levels were significantly higher in septic patients than in controls (P = 0.01), and in non-survivors (n = 62) compared to survivors (n = 124) (P = 0.04). However, the levels of CD40L were not different regarding sepsis severity. Logistic regression analysis showed that sCD40L levels >3.5 ng/mL were associated with higher mortality at 30 days (odds ratio = 2.89; 95% confidence interval = 1.37 to 6.07; P = 0.005). The area under the curve of sCD40L levels >3.5 ng/mL as predictor of mortality at 30 days was 0.58 (95% CI = 0.51 to 0.65; P = 0.03). CONCLUSIONS: In conclusion, circulating sCD40L levels are increased in septic patients and are independently associated with mortality in these patients; thus, its modulation could represent an attractive therapeutic target

LA DISFAGIA Y SU TRATAMIENTO EN ANCIANOS

El trabajo en concreto habla de la enfermedad de disfagia y las diferentes formas de tratarla según algunas patologías asociadas al envejecimiento Se explica qué es la deglución y su fisiología; la fisiopatología, complicaciones y causas, ejemplos de enfermedades, tratamiento y abordaje de la disfagia. <br /

An inverted Honeycomb plasmonic lattice as an efficient refractive index sensor

We present an efficient refractive index sensor consisting of a heterostructure that contains an Au inverted honeycomb lattice as a main sensing element. Our design aims at maximizing the out-of-plane near-field distributions of the collective modes of the lattice mapping the sensor surroundings. These modes are further enhanced by a patterned SiO2 layer with the same inverted honeycomb lattice, an SiO2 spacer, and an Au mirror underneath the Au sensing layer that contribute to achieving a high performance. The optical response of the heterostructure was studied by numerical simulation. The results corresponding to one of the collective modes showed high sensitivity values ranging from 99 to 395 nm/RIU for relatively thin layers of test materials within 50 and 200 nm. In addition, the figure of merit of the sensor detecting slight changes of the refractive index of a water medium at a fixed wavelength was as high as 199 RIU1. As an experimental proof of concept, the heterostructure was manufactured by a simple method based on electron beam lithography and the measured optical response reproduces the simulations. This work paves the way for improving both the sensitivity of plasmonic sensors and the signal of some enhanced surface spectroscopies

IMPACTO DE LA REDUCCIÓN DE RADIOGRAFÍAS TORÁCICAS EN LA MORBIMORTALIDAD DEL PACIENTE CRÍTICO

Introducción: Entre las pruebas diagnósticas más utilizadas en las Unidades de Cuidados Intensivos se encuentran las radiografías de tórax, que si bien son clave en muchas ocasiones para la prevención, diagnóstico y pronóstico de muchas enfermedades, la realización de forma rutinaria a todos los pacientes no comporta beneficios en términos de morbimortalidad, supone un coste superfluo y añade el riesgo de la iatrogenia inherente a la radiación. Objetivo: Comparar los resultados globales de dos estrategias diferentes en la solicitud de la radiografía de tórax en pacientes ingresados en una Unidad de Cuidados Intensivos polivalente, la primera basada en su realización sistemática y rutinaria y la segunda basada en indicaciones precisas de acuerdo a la condición clínico-evolutiva del paciente. Material y métodos: Estudio observacional, retrospectivo y unicéntrico comparando los resultados de dos estrategias aplicadas en periodos de tiempo diferentes en una UCI polivalente. En el primero, se solicitaron radiografías torácicas de forma rutinaria a los pacientes ingresados, mientras que en el segundo, la realización de radiografías torácicas venía determinada según la indicación clínica de los pacientes de acuerdo a una serie de características descritas en forma de protocolo. De igual forma se estudió de forma independiente a los pacientes pertenecientes al subgrupo que habían recibido ventilación mecánica, por ser éste el colectivo con mayor probabilidad de requerir radiografías torácicas por su vulnerabilidad respiratoria. Resultados: Con la aplicación del protocolo de reducción de radiografías torácicas se ha obtenido una reducción significativa de las radiografías totales por paciente a expensas sobretodo de las radiografías rutinarias, sin repercusión en la seguridad del paciente. Esto ha supuesto una disminución del 43% del total de radiografías torácicas, que se ha traducido en un considerable ahorro económico. Conclusiones: 1. Solicitar Rx de tórax de acuerdo con un protocolo de indicaciones ajustadas a las incidencias evolutivas del paciente ingresado en la UCI comporta ventajas en términos de reducción de costes, carga asistencial y menores dosis de radiación, sin comprometer la seguridad del paciente. 2. El estudio ha permitido establecer criterios de idoneidad en la solicitud de la radiografía de tórax, adecuados a la condición clínica del paciente. 3. El riesgo de exposición a la radiación ionizante inherente a la realización de radiografías sin un criterio clínico predefinido (rutinarias) no está justificado en orden a los hallazgos obtenidos, los efectos secundarios de la exploración y su influencia en la toma de decisiones terapéuticas

Matrix metalloproteinase-9, -10, and tissue inhibitor of matrix metalloproteinases-1 blood levels as biomarkers of severity and mortality in sepsis

INTRODUCTION: Matrix metalloproteinases (MMPs) play a role in infectious diseases through extracellular matrix (ECM) degradation, which favors the migration of immune cells from the bloodstream to sites of inflammation. Although higher levels of MMP-9 and tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) have been found in small series of patients with sepsis, MMP-10 levels have not been studied in this setting. The objective of this study was to determine the predictive value of MMP-9, MMP-10, and TIMP-1 on clinical severity and mortality in a large series of patients with severe sepsis. METHODS: This was a multicenter, observational, and prospective study carried out in six Spanish Intensive Care Units. We included 192 (125 surviving and 67 nonsurviving) patients with severe sepsis and 50 age- and sex-matched healthy controls in the study. Serum levels of MMP-9, MMP-10, TIMP-1, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-10 were measured in patients with severe sepsis at the time of diagnosis and in healthy controls. RESULTS: Sepsis patients had higher levels of MMP-10 and TIMP-1, higher MMP-10/TIMP-1 ratios, and lower MMP-9/TIMP-1 ratios than did healthy controls (P < 0.001). An association was found between MMP-9, MMP-10, TIMP-1, and MMP-9/TIMP-1 ratios and parameters of sepsis severity, assessed by the SOFA score, the APACHE-II score, lactic acid, platelet count, and markers of coagulopathy. Nonsurviving sepsis patients had lower levels of MMP-9 (P = 0.037), higher levels of TIMP-1 (P < 0.001), lower MMP-9/TIMP-1 ratio (P = 0.003), higher levels of IL-10 (P < 0.001), and lower TNF-alpha/IL-10 ratio than did surviving patients. An association was found between MMP-9, MMP-10, and TIMP-1 levels, and TNF-alpha and IL-10 levels. The risk of death in sepsis patients with TIMP-1 values greater than 531 ng/ml was 80% higher than that in patients with lower values (RR = 1.80; 95% CI = 1.13 to 2.87;P = 0.01; sensitivity = 0.73; specificity = 0.45). CONCLUSIONS: The novel findings of our study on patients with severe sepsis (to our knowledge, the largest series reporting data about MMP levels in sepsis) are that reduced MMP-9/TIMP-1 ratios and increased MMP-10 levels may be of great pathophysiologic significance in terms of severity and mortality, and that TIMP-1 levels may represent a biomarker to predict the clinical outcome of patients with sepsis

Survival and mitochondrial function in septic patients according to mitochondrial DNA haplogroup

INTRODUCTION: We recently found that platelet cytochrome c oxidase (COX) activities and quantities in 6-month-survival septic patients are significantly higher than those of patients who died before 6 months. Other studies suggested that the mitochondrial DNA (mtDNA) genotype could play a major role in sepsis survival. Given that COX catalytic subunits are encoded by mtDNA, the objective of the present study was to explore whether mtDNA population genetic variation could affect COX activity and quantity and favors sepsis survival. METHODS: A prospective, multicenter, observational study was carried out in six Spanish ICUs. We included 96 patients with severe sepsis. We determined the mtDNA haplogroup, the COX specific activity/citrate synthase specific activity (COXa/CSa) ratio and the COX quantity/citrate synthase specific activity (COXq/CSa) ratio in circulating platelets at the time of diagnosis, day 4 and day 8. We used survival at 1 and 6 months as endpoints. RESULTS: Patients with the JT mtDNA haplogroup (n = 15) showed higher COXq/CSa ratio at day 4 (P = 0.04) and day 8 (P = 0.02) than those with other haplogroups (n = 81). Logistic regression analysis showed that the JT mtDNA haplogroup (odds ratio = 0.18; 95% confidence interval = 0.04 to 0.94; P = 0.04) and COXq/CSa ratio (odds ratio = 0.53; 95% confidence interval = 0.30 to 0.93; P = 0.03) were associated with 1-month survival after controlling for age and lactic acid levels. CONCLUSIONS: The novel findings of our study are that 1-month surviving septic patients showed higher COXq/CSa ratio than nonsurviving individuals, that patients from the JT mtDNA haplogroup showed a higher COXq/CSa ratio and that JT patients had a higher 1-month survival than patients from other mtDNA haplogroups