Human Stressors Are Driving Coastal Benthic Long-Lived Sessile Fan Mussel Pinna nobilis Population Structure More than Environmental Stressors.

Coastal degradation and habitat disruption are severely compromising sessile marine species. The fan shell Pinna nobilis is an endemic, vulnerable species and the largest bivalve in the Mediterranean basin. In spite of species legal protection, fan shell populations are declining. Models analyzed the contributions of environmental (mean depth, wave height, maximum wave height, period of waves with high energy and mean direction of wave source) versus human-derived stressors (anchoring, protection status, sewage effluents, fishing activity and diving) as explanatory variables depicting Pinna nobilis populations at a mesoscale level. Human stressors were explaining most of the variability in density spatial distribution of fan shell, significantly disturbing benthic communities. Habitat protection affected P. nobilis structure and physical aggression by anchoring reveals a high impact on densities. Environmental variables instead played a secondary role, indicating that global change processes are not so relevant in coastal benthic communities as human-derived impacts.Versión del editor4,411

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

Factors Affecting Vancomycin Trough Concentration; a Population Pharmacokinetic Model in Non-Critical Care Saudi Patients

Aymen Ali Alqurain,1 Laila Nasser Alrashidi,2 Shatha Khalid Aloraifej,2 Moayd Alkhalifah,3 Hawra Ali Alsayed,4 Salah Abohelaika,5,6 Mohammad A Alshabeeb,7,8 Amal Shibak Aldhafeeri,9 Moyad Almuslim,10 Thuraya Nasser Bumozah,11 Mukhtar Jawad Alomar,12 Azhar Abdullah Alshehab,13 Ahmed AbdulWahab Alamer,14 Jenan Al-Matouq,15 Keshore R Bidasee,16– 18 Fadhel A Alomar10 1Department of Clinical Practice, College of Pharmacy, Northern Border University, Rafha, 91911, Saudi Arabia; 2Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, 34222, Saudi Arabia; 3Department of Neurology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; 4Department of Pharmacy, Rashid Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates; 5Research Department, Qatif Central Hospital, Qatif, 32654, Saudi Arabia; 6Pharmacy Department, Qatif Central Hospital, Qatif, 32654, Saudi Arabia; 7Pharmaceutical Analysis Center, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 8King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 9Pharmacy Department, Al Mana General Hospitals, Al-Khobar, Saudi Arabia; 10Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia; 11Pharmacy Department, Maternity and Children Hospital in Huffuf, Al Hufuf, Saudi Arabia; 12Pharmaceutical Affair, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia; 13Medical Supply Department, Prince Saud Bin Jalawy Hospital, Mubarraz, Saudi Arabia; 14Pharmaceutical Care Department, King Abdulaziz Hospital in Alahssa, Ministry of National Guard, Mubarraz, Saudi Arabia; 15Department of Medical Laboratory Science, Mohammed Al-Mana College for Medical Sciences, Al Safa, Dammam, 34222, Saudi Arabia; 16Department of Pharmacology and Experiment Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA; 17Department of Environment and Occupational Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA; 18Nebraska Redox Biology Center, Lincoln, NE, 68588, USACorrespondence: Aymen Ali Alqurain, Department of Clinical Practice, College of Pharmacy, NBU, Rafha, Saudi Arabia, Tel +966538862355, Email [email protected] Fadhel A Alomar, Department of Pharmacology, College of Clinical Pharmacy, IAU, Dammam, Saudi Arabia, Email [email protected] and Objective: Vancomycin is commonly prescribed in treatment of methicillin-resistant Staphylococcus aureus infections. While, vancomycins’ pharmacokinetic vary among older patients, there is a paucity of data regarding specific characteristics influencing pharmacokinetics in Saudi adult patients. This study aims to establish a population-pharmacokinetic (Pop-PK) model for vancomycin in patients admitted to medical wards, with the focus on identification of patient characteristics influencing vancomycin trough concentrations.Methods: A multicenter retrospective study was conducted involving patients aged ≥ 40 years admitted to medical wards in the Eastern Province, Saudi Arabia and initiated on vancomycin, between January to December 2022. Non-linear mixed-effects modelling (Monolix) was employed to develop the Pop-PK model. A base model was selected based on the Akaike information criterion. Covariates considered included age, sex, body weight, C-reactive protein (CRP), serum creatinine, creatinine clearance (CrCl), and albumin levels. A P-value of < 0.05 was considered statistically significant for inclusion of covariates in the final model by stepwise addition. The simulation performance of the model was assessed by visual predictive check plot. The final model was simulated using Simulx software to assess the effect of the included covariates on vancomycin trough concentration.Results: A total of 172 vancomycin trough concentrations from 124 patients were analyzed. The final Pop-PK model characterized vancomycin trough concentrations was one compartment distribution with linear elimination. CrCl and CRP were the only covariates included in the final model, as they reduced the between-subject variability (BSV) for clearance (from 173% to 81%). The simulated model demonstrated that high CRP value and low CrCl contributed to increased vancomycin trough concentrations.Conclusion: This study highlights large BSV in trough concentrations among patients and emphasizes the influencing of CrCl and CRP on vancomycin pharmacokinetics in medical care settings.Keywords: vancomycin trough concentration, C-reactive protein, creatinine clearance, population pharmacokinetics, medical care patient

Interest of the evaluation of the LV area in the evaluation of the TID in MPS through IQ SPECT

Abstract Funding Acknowledgements Type of funding sources: None. Objectives To the determine the value as ischemic indicator of measurement of left ventricular areas under stress and rest conditions in the evaluation of the transient ischemic dilation. Methodology This quantitative, observational and  cross sectional study  included patient  undergoing myocardial perfusion SPECT/CT (MPS). Protocol   2-day exercise stress/rest, radiotracers tetrofosmin/MIBI Tc-99m, IQ- SPECT (smartzoom collimators, 17 slices, 20-sec/slice), with/without CT-based attenuation correction (NC and AC, respectively) and processing with Cedars-Sinai QPS software. A descriptive statistical analysis was performed to evaluate patient conditions; MPS results, left ventricular parameters (volume of cavity and area), transient dilation and area dilation ratios.  An agreement analysis according by Blend-Altman plots and correlation analysis was realized between TID y LV areas ratios. An univariate analysis by chi square test was used to determine whether there is a statistically significant difference between the frequecies of results of precited factors and TID Results 99 patiens with MPS were included.  They were categorized in two groups as 87.87%  with  normal TID (values : 0.9-1.26) and 12.13% with TID &amp;gt; 1.25 . The mean age  was 62,11 ± 10.29 years old and male  were 70,1%. The prevalence of clinical conditions were 62.1% of arterial hypertension , 19.5% of type-2 diabetes mellitus and 72.4% dyslipidemia.  The prevalence of cardiac disease were 60.9% ischemic cardiac disease, 17.2% cardiac rhythm alterations, 27.6% of cardiac valve disease, 13.8% myocardial hypertrophy and 4.6% dilated cardiomyopathy. There were no statistically significant differences of precited parameters between the two groups. There are  9.19% mild and 2.29% moderate ischemics MPS results in the normal TID group and 36.36% mild ischemic MPS result  in the TID &amp;gt; 1.25 group. (p &amp;lt; 0.05) In the normal TID group the  stress /rest area ratios were 1.016 ± 0.13 for NC studies and 1.016 ± 0.12 for AC studies (p &amp;gt; 0.05). In the TID &amp;gt; 1.25 group the  stress /rest area ratios were 1.13 ± 0.05 for NC studies and 1.12 ± 0.08 for AC studies (p &amp;gt; 0.05) The normal values limits 1.016 ± 0.26 for NC studies and 1.016 ± 0.24 for AC studies. The agreement using the Bland-Altman method showed that the mean difference between TID and stress/rest ratios by NC and AC studies was 0.02 ± 0.08 (-0.13 to 0.18; 95% confidence interval) and 4.04% within the 95% confidence interval. Pearson correlation coefficient obtained between TID and area ratios was 0.69 in the NC studies and 0.91 in AC studies. This is consistent with the recommendations for studies with detectors SMARTZOOM would advise the use of AC determinations. Conclusions The presence of left ventricular areas within normal values in patients with TID visualized in MPS suggests the existence of endocardial ischemia and no ventricular dilation. The joint assessment of these parameters adds value in those situations. </jats:sec