Impact of infection prevention and control practices, including personal protective equipment, on the prevalence of hospital-acquired infections in acute care hospitals during COVID-19: a systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has posed an unprecedented challenge to healthcare systems globally. Personal protective equipment has played a fundamental role in protecting healthcare workers and patients, but its effectiveness in reducing hospital-acquired infections (HAIs) during the pandemic remains a subject of debate.

AIM

To conduct a synthesis and meta-analysis of the best available evidence of the prevalence of HAIs using a before/after approach.

METHODS

A three-step search strategy was undertaken to locate published and unpublished studies. A search was performed in MEDLINE, CINAHL, Embase, PsycINFO, and Google Scholar. Screening of studies, data extraction and critical appraisal were performed by four independent reviewers. Meta-analysis was conducted using Review Manager. The review is reported in accordance with PRISMA and JBI guidelines for systematic reviews.

FINDINGS

Fifteen studies were included in the review. Three studies indicated a statistically significant increase in the number of positive cultures during the COVID-19 period compared to the pre-COVID-19 period. Pooled data showed a non-significant decrease in the number of patients with positive cultures in the COVID-19 period compared to pre-COVID-19. There were no significant differences in various bacterial infections except for a significant decrease in respiratory infections. Pooled data for central line-associated bloodstream infections (CLABSIs) indicated a significant increase during the COVID-19 period, but one study reported an increase in CLABSI incidence.

CONCLUSION

The evidence from this review demonstrates a mixed impact of the COVID-19 pandemic precautions on HAIs.

Prospective study of HDR brachytherapy (BT), external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT): 10-years experience of an MRI-guided approach

OBJECTIVES

To evaluate the predictive factors for biochemical failure and distant metastases in a prospective cohort of patients with localized prostate cancer treated with the combination of HDR BT and EBRT.

METHODS AND MATERIALS

Patients with intermediate (IR) or high-risk (HR) prostate adenocarcinoma received a single fraction of HDR of 15 Gy combined with RT of 37.5 Gy in 15 fractions. ADT duration was used depending on risk-group. Descriptive analyses were performed. Univariate and multivariate Hazard Ratios were obtained. Finally, the Kaplan-Meier model was used to describe the survival of the events of interest.

RESULTS

309 patients were treated prospectively (199 were IR and 110 HR). Median age was 72 years; 58.3 % were MRI stage ≤ T2c, 34.1 % T3a and 7.6 % T3b; ISUP-grade 1-3 in 78.9 % and ISUP 4-5 in 21.1 %. 71.8 % of patients had ≤ 50 % positive-cores in biopsy and 28.2 % had > 50 %. Median pre-treatment PSA was 9.9 ng/mL. After a median follow-up of 88 months, 41 patients presented biochemical failure and 18 developed distant metastases. Multivariate cox-regression analyses found that MR-T3b Stage (HR 3.88, p = 0.001) and ADT use (HR 3.99, p = 0.03) were the only predictive factors for biochemical failure and the number of positive cores (>50 %) the only independent predictive factor of distant metastases (HR 4.36, p = 0.002).

CONCLUSIONS

Patients with mpMRI evidence of invasion of the SV and involvement of more than 50% of the cores in the prostate biopsy are patients with a higher risk of presenting a biochemical recurrence or developing metastasis due to their prostate cancer, respectively.

The acquisition of clinical experience during GP training - how can we mitigate for the impact of COVID-19?

The COVID-19 pandemic has profoundly impacted the way general practice is run and this is expected to have had a knock-on effect upon GP training. A questionnaire-based study was designed to investigate what was happening to GP trainees 16 months into the pandemic in terms of opportunities to develop clinical experience and clinical decision-making. We also asked trainers and trainees for ideas on how we might mitigate for the effects of COVID-19. In particular, there has been decreased exposure to clinical examination during the pandemic and there appear to be gaps in opportunities to learn from urgent and unscheduled care settings and to develop skills in rapid clinical decision-making. It is interesting to consider what general practice will look like when the pandemic is over and how this will this affect the GP training curriculum going forwards. Although response rates were low, we were able to determine some emerging themes for national, local and educational review going forwards to help shape and improve GP training for the future.

“My quality of life was not the best” experiences of Australians during the COVID pandemic

Background

The social and economic impacts that have occurred during the pandemic can disproportionally affect those already experiencing poverty. The social determinants of health aggravate inequalities and can adversely affect wellbeing. This study aims to gain rich insight into Australian adults’ experiences of the social determinants of health and the impact on their wellbeing during the COVID-19 pandemic.

Methods

A descriptive qualitative study using purposive sampling to recruit participants for semi-structured interviews, conducted via videoconferencing between March-August 2021. Thematic analysis was performed with the support of NVivo 12.

Results

Participants included 20 Australian adults from various socioeconomic areas ranging in age from 21 to 65 years. Three main themes emerged from the analysis of the data: Food-related concerns; Housing outcomes; and Psychological and emotional impact. Accessing food, during the COVID-19 pandemic, for most participants who resided in low socioeconomic areas, was described as stressful and challenging. Along with the burden of food security, many participants from low socioeconomic areas expressed emotional distress in relation to securing and maintaining adequate housing.

Conclusions

The pandemic has amplified existing social determinants of health experienced by those within low socioeconomic areas, particularly those who are female and from migrant communities. The wellbeing of participants from low socioeconomic areas decreased in response to their experiences and challenges with food insecurity and housing instability, highlighting the need for housing affordability strategies and funding of emergency food relief initiatives. Food access for those in areas with high socioeconomic disadvantage, can be improved to address some of the barriers associated with food security by providing supermarket meal vouchers, access to community gardens, and school food programs.

Key messages

• The housing and food insecurity experienced by participants in this study during the pandemic has influenced their overall wellbeing.

• The pandemic has amplified existing social determinants of health experienced by those in low socioeconomic areas.

Opposite evolution on voltage and thickness from paroxysmal to persistent AF

Background

There is a controversy about correlation between voltage and thickness in the atrial myocardium and their evolution from paroxysmal to persistent atrial fibrillation (AF).

Purpose

This is an observational study to compare voltage and thickness of different areas on the left atrium in paroxysmal and persistent atrial fibrillation.

Methods

Twenty-one patients underwent atrial fibrillation ablation. Points with electrical information from an electroanatiomical map in sinus rhythym were acquiered during the ablation procedure covering the whole atrial surface. CT was acquired in all patients before the procedure and endo- and epicardium from the atrium was segmented for the atrial thickness calculation. All the points from the electromecanical map were projected on the thickness map to have both information on the same location. 3D atrium was segmented in 5 areas for the analysis: Lateral, Anterior, Septal, Inferior-Posterior and Superior-Posterior (Figure 1). Voltage and thickness values among different areas and between AF type were compared.

Results

11 paroxysmal and 10 persistent AF patients were analyzed acquiring 452±207 points per patient and 1897±750 points per area. There was no linear correlation between voltage and thickness comparing all the patients nor among different areas nor between AF type (R<0.2 in all cases).

Regarding paroxysmal AF patients, septum showed significatly lower voltage compared with the other segments, posterior, lateral, anterior and roof (1.3±1.4, 2±1.8, 2±1.6, 1.7±1.5, 2±1.6, P<0.001). Posterior segment showed the highest voltage. The thickness analysis showed the septum segment as thinner segment and lateral as thicker segment (1.3±1.5,1.7±0.8, P<0.001) (Figure 2).

Regarding persisten AF patients: septum showed significatly lower voltage compared with the other segments, posterior, lateral, anterior and roof who shows higher voltage (1±0.8*, 1.5±1.2, 1.9±1.7, 1.5±1.4, 2±1.6) (Figure 2). The thickness analysis showed the anterior segment as thinner segment and lateral as the thickest segment (1.6±0.8, 1.9±0.9 (P<0.001), different like on paroxysmal AF population.

Comparing voltage and thicknes between paroxysmal and persistent AF, all the segments on persistent population showed lower voltage values, with significant differences on septal, posterior and anterior walls (1±0.8 vs 1.3±1.4, 1.5±1.2 vs 2±1.8, 1.5±1.4 vs 1.7±1.5, P<0.001). On the other hand, all segments on persistent population showed statisticaly signignificant thicker myocardium in camparison with paroxysmal population (Figure 2).

Conclusions

According to our findings, there is no linear correlation between voltage and thickness. Persistent AF atria show thicker walls but with lower voltages in comparison with paroxysmal AF atria.

Funding Acknowledgement

Type of funding sources: None.

Discontinuity in Equilibrium Wave-Current Ripple Size and Shape and Deep Cleaning Associated With Cohesive Sand-Clay Beds

Mixtures of cohesive clay and noncohesive sand are widespread in many aquatic environments. Ripple dynamics in sand-clay mixtures have been studied under current-alone and wave-alone conditions but not combined wave-current conditions, despite their prevalence in estuaries and the coastal zone. The present flume experiments examine the effect of initial clay content, C ₀, on ripples by considering a single wave-current condition and, for the first time, quantify how changing clay content of substrate impacts ripple dimensions during development. The results show inverse relationships between C ₀ and ripple growth rates and clay winnowing transport rates out of the bed, which reduce as the ripples develop toward equilibrium. For C ₀ ≤ 10.6%, higher winnowing rates lead to clay loss, and thus the presence of clean sand, far below the base of equilibrium ripples. This hitherto unquantified "deep-cleaning" of clay does not occur for C ₀ > 10.6%, where clay-loss rates are much lower. The clay-loss behavior is associated with two distinct types of equilibrium combined flow ripples: (a) Large asymmetric ripples with dimensions and plan geometries comparable to their clean-sand counterparts for C ₀ ≤ 10.6% and (b) small, flat ripples for C ₀ > 10.6%. The 10.6% threshold, which may be specific to the experimental conditions, corresponds to a more general 8% threshold found beneath the ripple base, suggesting that clay content here must be <8% for clean-sand-like ripples to develop in sand-clay beds. This ripple-type discontinuity comprises a threefold reduction in ripple height, with notable implications for bed roughness.

Social determinants of health during the COVID-19 pandemic: a systematic review

Introduction

The emergence of COVID-19 has created global transmission. While effective at reducing the spread, public health measures implemented may impact individuals differently leaving them susceptible to the detrimental effects on their health and wellbeing. Therefore this review aims to synthesise the best available evidence on the relationship between the social determinants of health and health outcomes among adults during the COVID-19 pandemic.

Methods

A three-step search strategy was used to find both published and unpublished papers. The databases searched included: MEDLINE, CINAHL, EMBASE, and Google Scholar. Following the search, all identified citations were uploaded into Endnote X9, with duplicates removed. Methodological quality of eligible papers was assessed independently by two reviewers, with meta-synthesis conducted in accordance with JBI methodology.

Results

Fifteen papers were included. Three synthesized conclusions were established a) Vulnerable populations groups, particularly those from a racial minority and those with low incomes, are more susceptible and have been disproportionately affected by COVID-19 including mortality; b) Gender inequalities and family violence have been exacerbated by COVID-19, leading to diminished wellbeing among women; and c) COVID-19 is exacerbating existing social determinants of health through loss of employment/income, disparities in social class leading to lack of access to healthcare, housing instability, homelessness and difficulties in social distancing.

Conclusions

Vulnerable population groups have been disproportionately impacted by COVID-19, including health outcomes such as hospitalisations and mortality. The COVID-19 pandemic has highlighted the need for action on health inequalities and the social determinants of health. Reflection on social and health policies implemented are necessary to ensure that the COVID-19 pandemic does not exacerbate health inequalities into the future.

Key messages

Vulnerable populations including racial minority groups and low income earners have been disproportionately impacted by COVID-19.

Action on social determinants of health is required to ensure COVID-19 does not exacerbate health inequalities into the future.

Life during a pandemic in Australia: wellbeing and social determinants of health

Background

The COVID-19 pandemic has had effects on populations worldwide. The social determinants of health affect an individual's capacity to cope during a crisis which could potentially impact on their wellbeing. The aim of this study was to examine the relationship between wellbeing and the social determinants of health among Australian adults during the COVID-19 pandemic.

Methods

A cross-sectional study of adults residing in Australia was conducted using SurveyMonkey (an online survey) between August - October 2020. Participants were recruited via social media. Wellbeing was measured using the 10-item Multicultural Quality of Life Index and social determinants of health were measured using validated tools and investigator developed questions. Data were analysed using SPSS version 25. Inferential statistics, including independent t-test and one-way ANOVA were undertaken. Multiple regression analysis was used to investigate the predictors of wellbeing.

Results

In total, 1211 responses were received. Females accounted for 80.7% of the responses, men 16.7% and transgender/non-binary 2.6%. The mean age of the respondents was 43 years (SD 14.5). The mean score for total wellbeing was 62.58 (SD 21.22). Housing insecurity (p = 0.000), food insecurity (p = 0.000, social support (p = 0.000) and access to health care (p = 0.000) were all predictors of poor total wellbeing. Being a male (p = .0380) was the only predictor of higher wellbeing.

Conclusions

This study demonstrates that adults in Australia who had poor social support, had difficultly accessing health care, had insecure housing and food insecurity had significantly poorer wellbeing during the COVID-19 pandemic. This study exposes the social determinants of health that are responsible for health and social inequalities. It shows that the COVID-19 pandemic has exacerbated the social vulnerabilities and highlights the need take action on the social determinants of health and inequalities.

Key messages

The COVID-19 pandemic has further exposed the longstanding health and social inequalities that exist in Australia.

Action on social determinants of health is required in a post COVID-19 world to rebuild social protection and safeguard populations from any future public health emergencies.

Vector Competence of Peruvian Mosquitoes for Two Orthobunyaviruses Isolated From Mosquitoes Captured in Peru

We evaluated the potential for mosquitoes collected in the Amazon Basin, near Iquitos, Peru, to become infected with and transmit Murutucu (MURV) and Itaqui viruses (ITQV) (Order Bunyavirales, Family: Peribunyaviridae, Genus: Orthobunyavirus). Viremia levels in Syrian hamsters peaked 2 d after infection with either virus, and both viruses were highly lethal in hamsters with virtually all hamsters dying prior to 3-d postinfection. For almost all of the mosquito species tested some individuals were susceptible to infection and some developed a disseminated infection after oral exposure to either MURV or ITQV. However, only the Culex species (Culex (Culex) coronator Dyar and Knab [Diptera, Culicidae], Culex (Melanoconian) gnomatos Sallum, Huchings, and Ferreira [Diptera, Culicidae], Culex (Mel.) pedroi Sirivanakarn and Belkin [Diptera, Culicidae], and Culex (Mel.) vomerifer Komp [Diptera, Culicidae]) successfully transmitted virus by bite. However, even among these species, only about 37% of the individuals with a disseminated infection successfully transmitted these viruses, indicating a significant salivary gland barrier. Although little is known about the medical or veterinary importance of many members of the genus Orthobunyavirus, we have demonstrated that Culex spp. (Diptera, Culicidae) could be potential vectors.

The calcium sensing receptor modulates H+-ATPase activity in intercalated cells

Previous studies found that calcium sensing receptor (CaSR) it's expressed in intercalated cells of the collecting duct and that its activation by calcium in the luminal membrane promotes acidification of urine. Therefore, the aim of the study was to analyze the effects of CaSR stimulus on the biochemical activity of the vacuolar H⁺-ATPase in a cellular model of intercalated cells, MDCK-C11 cells. Biochemical activity of H⁺-ATPase was performed using cell homogenates and the inorganic phosphate released was determined by a colorimetric method. Changes in cytosolic ionized calcium ([Ca²⁺]_i) were also determined using Fluo-4. A significant increase of vacuolar H⁺-ATPase activity was observed when the CaSR was stimulated with agonists such as Gd³⁺ (300 μM), neomycin (200 μM) and by the calcimimetic R-568 (1 μM). This activity was also stimulated in a dose-dependent fashion by changes in extracellular Ca²⁺ concentration ([Ca²⁺]_o) between 10^-2 and 2 mM. The calciolytic NPS 2143 (150 nM) significantly reduced the vacuolar H⁺-ATPase activity observed with 2 mM [Ca²⁺]_o. Inhibition of phospholipase C (PLC) activity with U73122 (5 x 10^-7 M) reversed the increase in pump activity observed in the presence of Gd³⁺. Activation of CaSR by the specific CaSR agonist R-568 produced a sustained rise of [Ca²⁺]_i, an effect that disappears when extracellular calcium was removed in the presence of thapsigargin. In summary, CaSR stimulation induces an increase in the vacuolar H⁺-ATPase activity of MDCK-C11 cells, an effect that involves an increase in [Ca²⁺]_i and require PLC activity. The consequent decrease in intratubular pH could lead to increase ionization of luminal calcium, potentially reducing the formation of calcium phosphate stones.

Hemodynamic forces and myocardial deformation using cine MRI in Marfan syndrome

Funding Acknowledgements

Type of funding sources: None.

Introduction. Cardiovascular assessment of Marfan syndrome (MS) patients has normally focused on the aortic root and vascular manifestations due to the high risk of aortic dissection.

Although primary myocardial impairment has long been suspected, the evidence has been controversial. Advanced in CMR may support the early detection of cardiac dysfunction. Beyond left ventricle ejection fraction (EF) and myocardial strain (S), a new parameter is emerging, the hemodynamic forces (HF) exchanged between the blood flowing in the heart and the myocardium.  The application of these techniques to MS could be useful in demonstrating the presence of primary myocardial impairment.

Aim. The aim of this study is to explore myocardial function in MS through the evaluation in cine CMR of EF, S and cardiac HF exchanged between the blood and the myocardium and compare these data with those of a control group (C).

Methods. We retrospectively analysed CMR cine images of MS (diagnosed according revised Ghent criteria) without valvular disease or previous cardio surgery, and C, in standard long-axis projections, to define endocardial borders for subsequent quantification of left ventricular volumes, EF, longitudinal, circumferential and radial S, apex-to-base and lateral-to-septum HF (expressed in mN and as a percentage of gravity acceleration). The analysis were performed on Medical Imaging Systems (QStrain version 1.3.0.79; MEDIS) (Figure 1).

Results. 108 MS and 44 C had a good quality study, suitable for MEDIS analysis. The mean age was 33 ± 13 ys in MS, 35 ± 12 ys in C; 39% were male in MS, 50% in C.

The results of left ventricular function were: EF 63 ± 7% in MS vs 66 ± 5% in C group, p .008, global longitudinal S -24.5 ± 4.1% in MS vs -26.2 ± 4.1 in C, p .014; global circumferential S -30.6 ± 6.3% in MS vs -33.8 ± 4.4 in C, p .002; radial S 64.5 ± 16.2% in MS vs 72.7 ± 15.9 in C, p .005; apex-to-base HF 13.2 ± 4.7% in MS vs 17.8 ± 7.6% in C, p .000; lateral-to-septum 2.6 ± 1.3% in MS vs 3.1 ± 1.4% in C, p .048.

Moreover, 4.6% MS patients had mid reduced EF (40-50%); 9.2% had global longitudinal S reduction (cut off -19.3%); 7.4% had global circumferential S reduction (cut-off -21.7%).

Conclusion. These data provide support for the existence of a cardiomyopathy in MS. In our opinion, the term "primary cardiomyopathy" is not appropriate to describe this condition: patients with MS have changes in aortic stiffness and probably in cardiac afterload. The HF data are the most interesting of this study, both in the validation of this new parameter and in early detection a cardiomyopathy in MS

Moreover, the reduction of global circumferential S, as wall as global longitudinal S, in MS patients may help provide new elements to characterize the MS cardiomyopathy: sure enough, in literature, circumferential strain abnormalities are related to afterload increase. HF analysis is really a new challenge of cardiac imaging, as sensitive markers of subtle systolic dysfunction.

Abstract Figure. Figue 1. Analisis exemple.

Perceptions of Indigenous Australians towards cardiovascular primary prevention programs

Background

Indigenous Australians have disproportionately poorer health outcomes than their non-Indigenous counterparts. Preventable chronic diseases, such as cardiovascular disease, are primary factors that contribute to their lower life expectancy. Health risk behaviors such as smoking, physical inactivity, poor nutrition and obesity largely contribute to the enduring health divide. Therefore, the aim of this qualitative review was to synthesize the best available evidence on the perceptions of Indigenous Australians towards cardiovascular primary prevention programs.

Methods

A search using MEDLINE, CINAHL, EMBASE, Google Scholar, MedNar, ProQuest and Index to Theses for published and unpublished studies was conducted in January 2020. The methodological quality of the included studies was assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tool. Meta-aggregation was conducted in accordance with JBI methodology.

Results

Eleven studies involving 249 participants were included. Three synthesized findings were developed 1) External factors can affect participants' experiences of prevention programs. Support from family motivates participation and behavioral change. Support from health professionals that is free from judgment facilitates participation; 2) The complexities of an individual's life influence Indigenous Australian's experiences and participation in prevention programs and health risk behavioral change; 3) A personal desire to change behaviors and participate in prevention programs requires development of knowledge on healthy lifestyles, creation of new social norms and overcoming internal struggles.

Conclusions

Indigenous Australians participation in primary prevention for cardiovascular risk factors and adoption of a healthy lifestyle are influenced by social support, social determinants and personal desire. Future programs need to tackle structural drivers and create a supportive environment to assist in behavior change.

Key messages

Social determinants affect Indigenous Australians experiences and participation in prevention programs for behaviour change. Prevention programs must create a supportive environment with the inclusion of family.

Perceived and anticipating stigma in schizophrenia in relationship with depressive symptoms and functionality degree

Introduction

Perceived and anticipated stigma is relevant issues in patients with schizophrenia. Stigma has negative consequences both in quality of life and in the course of illness.

Objectives

To analyze the degree of perceived and anticipated stigma and discrimination in patients with schizophrenia and their relationship with clinical and socio-demographic variables.

Methods

A cross-sectional study was carried out in a sample of 100 patients with diagnosis of schizophrenia, 18 or more years old, clinically stabilized, without axis I DSM-IV comorbidity. Patients received treatment in the outpatient services of a catchment area in Madrid. Perceived and anticipated discrimination was evaluated trough the DISC-12 (Discrimination and Stigma scale). Other study variables were: socio-demographic characteristics, symptoms of depression (Calgary Scale) and functionality degree measured by Global Assessment of Function (GAF).

Results

The presence of symptoms of depression evaluated by the Calgary Scale and low degree of functionality measured by GAF are associated with greater feelings of discrimination and stigma, especially in the sub-scales of experienced and anticipated discrimination of the DISC 12. Anticipated stigma is higher in men than in women while the rest sub scales of the DISC-12 do not correlate with gender or other sociodemographic variables.

Conclusions

Preventive strategies to avoid the stigma in schizophrenia should consider some characteristics associated with disease, especially the degree of functionality and presence of depressive symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

P4421Increased circulating levels of VCAM-1 correlate with left atrial remodeling in highly trained athletes

Introduction

Reports have shown increased risk of atrial fibrillation (AF) in athletes. Vascular cell adhesion molecule-1 (VCAM1) is associated with new onset AF in general population. VCAM1 and its relation with left atrial (LA) remodeling have not been investigated in athletes.

Purpose

To study VCAM1 and LA remodeling in marathon runners.

Methods

Study of 36 male marathon runners in the training period previous to race (42 km) and 18 sedentary controls with no risk factors. Athletes were divided in two groups according to highest training intensity reached (group 1, >100 km/week; group 2, 50–100 km/week). Previous to race in all subjects, VCAM1 serum levels were measured by ELISA and an echocardiogram was performed. In athletes, VCAM1 was measured immediately post-race. Wilcoxon and Spearman were used.

Results

See table. Group 1 showed a significant increment in VCAM1 post-race (651±350 to 905±373 ng/mL; p=0.002) as compared to group 2 with no increment (533±133 to 651±138 ng/mL; p=0.117). In athletes, a moderate correlation between LA volume and VCAM1 was found (rho: 0.483; p=0.007).

Baseline characteristics Group 1 (n=18) Group 2 (n=18) Controls (n=18) p value Age (years) 37±6 38±5 36±4 0.373 Heart rate (bpm) 53±8 57±7 69±6 * 0.001 Body surface area (m2) 1.8±0.1 1.8±0.1 1.9±0.1 0.075 LV diastolic diameter (mm) 49±5 48±5 46±4 0.404 LV systolic diameter (mm) 29±5 30±5 30±4 0.879 Septal wall (mm) 9.1±1.2† 8.2±1.1 8.1±0.8 0.005 Posterior wall (mm) 9.3±2.1† 8.5±1.2 7.6±0.8 0.001 Ejection fraction (%) 55±3 55±6 57±4 0.110 LV mass index (g/m2) 106±27† 78±18 58±11 0.001 LA volume (mL/m2) 42±8† 30±11 25±9 0.001 E wave (cm/sec) 78±13 84±12 77±15 0.217 A wave (cm/sec) 50±12 53±10 48±16 0.438 DT (msec) 233±65 229±65 221±66 0.184 VCAM1 (ng/mL) 651±350† 533±133 440±98 0.022 Mean ± SD. *p<0.05 vs group 1 and 2 post Kruskall-Wallis; †p<0.05 vs other groups post Kruskall-Wallis. LV, left ventricle; LA, left atrium; DT, deceleration time.

Conclusions

Most trained athletes had increased levels of VCAM1 as compared to controls and less trained athletes. They also showed an increment post-effort. VCAM1 is related to LA remodeling in athletes. VCAM1 could be a potential biomarker of AF in athletes which should be confirmed.

Acknowledgement/Funding

FONDECYT 1170963 (LG); FONDAP 15130011 (LG,SL)

Active cushing syndrome patients have increased ectopic fat deposition and bone marrow fat content compared to cured patients and healthy subjects: a pilot 1H-MRS study

OBJECTIVE

Glucocorticoid excess is one of the most important causes of bone disorders. Bone marrow fat (BMF) has been identified as a l new mediator of bone metabolism. Cushing syndrome (CS), is a main regulator of adipose tissue distribution but its impact on BMF is unknown. The objective of the study was to evaluate the effect of chronic hypercortisolism on BMF.

DESIGN

This was a cross-sectional study. Seventeen active and seventeen cured ACTH-dependent CS patients along with seventeen controls (matched with the active group for age and sex) were included.

METHODS

the BMF content of the femoral neck and L3 vertebrae were measured by 1H-MRS on a 3-Tesla wide-bore magnet. BMD was evaluated in patients using dual-energy X-ray absorptiometry.

RESULTS

Active CS patients had higher BMF content both in the femur (82.5±2.6%) and vertebrae (70.1±5.1%) compared to the controls (70.8±3.6%, p=0.013 and 49.0±3.7% p=0.005, respectively). In cured CS patients (average remission time of 43 months), BMF content was not different from controls at both sites (72.3±2.9% (femur) and 46.7%±5.3% (L3)). BMF content was positively correlated with age, fasting plasma glucose, HbA1c, triglycerides and visceral adipose tissue in the whole cohort and negatively correlated with BMD values in the CS patients .

CONCLUSIONS

Accumulation of BMF is induced by hypercortisolism. In remission patients BMF reached values of controls. Further studies are needed to determine whether this increase in marrow adiposity in CS is associated with bone loss.

The aminoglycoside antibiotic gentamicin is able to alter metabolic activity and morphology of MDCK-C11 cells: a cell model of intercalated cells

It is well known that the aminoglycoside antibiotic gentamicin is capable of causing damage to kidney cells. Given the known involvement of Ca²⁺ in the nephrotoxic action of gentamicin, the purpose of this study was to establish a relationship between the concentration of intracellular Ca²⁺ ([Ca²⁺]_i) and cellular cytotoxicity using MDCK-C11 cells, a clone that has several properties that resemble those of intercalated cells of the distal nephron. Changes in [Ca²⁺]_i was determined using fluorescence microscopy. Cell viability was evaluated by the neutral red method, and cell cytotoxicity by the MTT method. The [Ca²⁺]_i gradually increased when cells were exposed to 0.1 mM gentamicin for 10, 20, and 30 min. The presence of extracellular Ca²⁺ was found to be necessary to stimulate the increase in [Ca²⁺]_i induced by gentamicin, since this stimulus disappeared by using 1.8 mM EGTA (a Ca²⁺ chelator). Morphological changes were observed with scanning electron microscopy in epithelial cells exposed to the antibiotic. Furthermore, with the MTT method, a decrease in metabolic activity induced by gentamicin was observed, which indicates a cytotoxic effect. In conclusion, gentamicin was able to alter [Ca²⁺]_i, change the morphology of MDCK-C11 cells, and promote cytotoxicity.

Three members of a peptide family are differentially distributed and elicit differential state-dependent responses in a pattern generator-effector system

C-type allatostatins (AST-Cs) are pleiotropic neuropeptides that are broadly conserved within arthropods; the presence of three AST-C isoforms, encoded by paralog genes, is common. However, these peptides are hypothesized to act through a single receptor, thereby exerting similar bioactivities within each species. We investigated this hypothesis in the American lobster, Homarus americanus, mapping the distributions of AST-C isoforms within relevant regions of the nervous system and digestive tract, and comparing their modulatory influences on the cardiac neuromuscular system. Immunohistochemistry showed that in the pericardial organ, a neuroendocrine release site, AST-C I and/or III and AST-C II are contained within distinct populations of release terminals. Moreover, AST-C I/III-like immunoreactivity was seen in midgut epithelial endocrine cells and the cardiac ganglion (CG), whereas AST-C II-like immunoreactivity was not seen in these tissues. These data suggest that AST-C I and/or III can modulate the CG both locally and hormonally; AST-C II likely acts on the CG solely as a hormonal modulator. Physiological studies demonstrated that all three AST-C isoforms can exert differential effects, including both increases and decreases, on contraction amplitude and frequency when perfused through the heart. However, in contrast to many state-dependent modulatory changes, the changes in contraction amplitude and frequency elicited by the AST-Cs were not functions of the baseline parameters. The responses to AST-C I and III, neither of which is COOH-terminally amidated, are more similar to one another than they are to the responses elicited by AST-C II, which is COOH-terminally amidated. These results suggest that the three AST-C isoforms are differentially distributed in the lobster nervous system/midgut and can elicit distinct behaviors from the cardiac neuromuscular system, with particular structural features, e.g., COOH-terminal amidation, likely important in determining the effects of the peptides. NEW & NOTEWORTHY Multiple isoforms of many peptides exert similar effects on neural circuits. In this study we show that each of the three isoforms of C-type allatostatin (AST-C) can exert differential effects, including both increases and decreases in contraction amplitude and frequency, on the lobster cardiac neuromuscular system. The distribution of effects elicited by the nonamidated isoforms AST-C I and III are more similar to one another than to the effects of the amidated AST-C II.

Health outcomes for youth with type 1 diabetes at 18 months and 30 months post transition from pediatric to adult care

AIMS

To identify (a) determinants of glycated haemoglobin (HbA1c) at 18 and 30 months following transition in young people with Type 1 diabetes mellitus (T1DM) to a youth-specific diabetes service; and to (b) evaluate the impact of the service on acute admissions with diabetic ketoacidosis (DKA) over a 14-year period.

METHODS

An audit of records of youth with T1DM referred from paediatric services to the multidisciplinary transition service at Westmead Hospital, from 2001 to 2012, and followed-up to 2014.

RESULTS

Data from 439 adolescents and young adults (Median age: 18) were analysed. The recommended standard of glycaemic control, HbA1c < 7.5% (58 mmol/mol), was achieved by 23% at baseline, 22% at 18-months, and 20% at 30-month. After adjusting for lag time (>3 months) and diabetes duration (>7 years), glycaemic control at first visit predicted subsequent glycaemic control at 18-month and 30-month follow-up. From 2001 to 2014, only 8.6% were lost to follow-up; admissions and readmissions for DKA reduced from 72% (32/47) to 4% (14/340) (p < 0.001). Furthermore, mean length of stay (LOS) significantly decreased from 6.56 to 2.36 days (p < 0.001).

CONCLUSIONS

Continuing engagement with the multidisciplinary transition service prevented deterioration in HbA1c following transition. Age-appropriate education and regular follow-up prevents DKA admissions and significantly reduced admission LOS.

Immunohistochemical Study of Pepsinogen C Expression in Cutaneous Malignant Melanoma: Association with Clinicopathological Parameters

Background

The aim of this study was to evaluate the pepsinogen C expression in malignant cutaneous melanomas and analyze its possible relationship to clinical and pathological parameters. Pepsinogen C is an aspartyl proteinase primarily involved in the digestion of proteins in the stomach and represents one of the main androgen-inducible proteins in breast cancer cells.

Method

Tumoral pepsinogen C expression was retrospectively analyzed in 35 paraffin-embedded tissues from patients with primary malignant cutaneous melanoma and in 10 samples from 10 benign lesions (4 dermal melanocytic nevi, 4 compound melanocytic nevi and 2 dysplastic melanocytic nevi), using immunohistochemical methods.

Results

The benign lesions were consistently negative for pepsinogen C, whereas 20 of the 35 malignant melanomas (57%) showed positive immunostaining for pepsinogen C. The percentage of pepsinogen C-positive tumors was significantly higher in men than in women (p=0.01) and in epithelioid melanomas than in fusocellular or mixed type melanomas (p=0.003). In addition, the percentage of pepsinogen-C positive tumors was positively and significantly correlated with lesion thickness (p=0.003), Clark's level of invasion (p=0.028) and tumor stage (p<0.001).

Conclusion

Pepsinogen C could be a new prognosticator of unfavorable outcome in cutaneous malignant melanoma.

Non-amidated and amidated members of the C-type allatostatin (AST-C) family are differentially distributed in the stomatogastric nervous system of the American lobster, Homarus americanus

The crustacean stomatogastric nervous system (STNS) is a well-known model for investigating neuropeptidergic control of rhythmic behavior. Among the peptides known to modulate the STNS are the C-type allatostatins (AST-Cs). In the lobster, Homarus americanus, three AST-Cs are known. Two of these, pQIRYHQCYFNPISCF (AST-C I) and GNGDGRLYWRCYFNAVSCF (AST-C III), have non-amidated C-termini, while the third, SYWKQCAFNAVSCFamide (AST-C II), is C-terminally amidated. Here, antibodies were generated against one of the non-amidated peptides (AST-C I) and against the amidated isoform (AST-C II). Specificity tests show that the AST-C I antibody cross-reacts with both AST-C I and AST-C III, but not AST-C II; the AST-C II antibody does not cross-react with either non-amidated peptide. Wholemount immunohistochemistry shows that both subclasses (non-amidated and amidated) of AST-C are distributed throughout the lobster STNS. Specifically, the antibody that cross-reacts with the two non-amidated peptides labels neuropil in the CoGs and the stomatogastric ganglion (STG), axons in the superior esophageal (son) and stomatogastric (stn) nerves, and ~ 14 somata in each commissural ganglion (CoG). The AST-C II-specific antibody labels neuropil in the CoGs, STG and at the junction of the sons and stn, axons in the sons and stn, ~ 42 somata in each CoG, and two somata in the STG. Double immunolabeling shows that, except for one soma in each CoG, the non-amidated and amidated peptides are present in distinct sets of neuronal profiles. The differential distributions of the two AST-C subclasses suggest that the two peptide groups are likely to serve different modulatory roles in the lobster STNS.

Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus-United States, May 2013-August 2016

November 11, 2016/65(44);1234-1237. What is already known about this topic? Candida auris is an emerging pathogenic fungus that has been reported from at least a dozen countries on four continents during 2009-2015. The organism is difficult to identify using traditional biochemical methods, some isolates have been found to be resistant to all three major classes of antifungal medications, and C. auris has caused health care-associated outbreaks. What is added by this report? This is the first description of C. auris cases in the United States. C. auris appears to have emerged in the United States only in the last few years, and U.S. isolates are related to isolates from South America and South Asia. Evidence from U.S. case investigations suggests likely transmission of the organism occurred in health care settings. What are the implications for public health practice? It is important that U.S. laboratories accurately identify C. auris and for health care facilities to implement recommended infection control practices to prevent the spread of C. auris. Local and state health departments and CDC should be notified of possible cases of C. auris and of isolates of C. haemulonii and Candida spp. that cannot be identified after routine testing.

Evaluation of Bone Mineral Density in Patients with Type 1 Gaucher Disease in Argentina

The purpose of this study was to evaluate the frequency of osteoporosis (OP) in patients with Gaucher disease (GD) in Argentina. GD patients from 28 centers were consecutively included from April 2012 to 2014. Bone mineral density (BMD) was determined by dual X-ray absorptiometry in the lumbar spine and the femoral neck or the total proximal femur for patients ≥20 yr of age, and by whole-body scan in the lumbar spine in patients <20 yr of age. In children, mineral density was calculated using the chronological age and Z height. OP diagnosis was determined following adult and pediatric official position of the International Society for Clinical Densitometry. A total of 116 patients were included, of which 62 (53.5%) were women. The median age was 25.8 yr. All patients received enzyme replacement therapy, with a median time of 9.4 yr. Normal BMD was found in 89 patients (76.7%), whereas low bone mass (LBM) or osteopenia was found in 15 patients (13%) and OP in 12 patients (10.3%). The analysis of the pediatric population revealed that 4 patients (9.3%) had LBM and 3 (7%) had OP (Z-score ≤ -2 + fractures height-adjusted by Z), whereas in the adult population (n = 73), 11 patients (15%) had LBM or osteopenia and 9 (12.3%) had OP. Bone marrow infiltration and the presence of fractures were significantly correlated with the presence of OP (p = 0.04 and <0.001, respectively). This is the first study in Argentina and in the region describing the frequency of OP or LBM in GD patients treated with imiglucerase using the official position of the International Society for Clinical Densitometry.