Clinical factors associated with a Candida albicans Germ Tube Antibody positive test in Intensive Care Unit patients

Background: Poor outcomes of invasive candidiasis (IC) are associated with the difficulty in establishing the microbiological diagnosis at an early stage. New scores and laboratory tests have been developed in order to make an early therapeutic intervention in an attempt to reduce the high mortality associated with invasive fungal infections. Candida albicans IFA IgG has been recently commercialized for germ tube antibody detection (CAGTA). This test provides a rapid and simple diagnosis of IC (84.4% sensitivity and 94.7% specificity). The aim of this study is to identify the patients who could be benefited by the use of CAGTA test in critical care setting. Methods: A prospective, cohort, observational multicentre study was carried out in six medical/surgical Intensive care units (ICU) of tertiary-care Spanish hospitals. Candida albicans Germ Tube Antibody test was performed twice a week if predetermined risk factors were present, and serologically demonstrated candidiasis was considered if the testing serum dilution was >= 1: 160 in at least one sample and no other microbiological evidence of invasive candidiasis was found. Results: Fifty-three critically ill non-neutropenic patients (37.7% post surgery) were included. Twenty-two patients (41.5%) had CAGTA-positive results, none of them with positive blood culture for Candida. Neither corrected colonization index nor antifungal treatment had influence on CAGTA results. This finding could corroborate that the CAGTA may be an important biomarker to distinguish between colonization and infection in these patients. The presence of acute renal failure at the beginning of the study was more frequent in CAGTA-negative patients. Previous surgery was statistically more frequent in CAGTA-positive patients. Conclusions: This study identified previous surgery as the principal clinical factor associated with CAGTA-positive results and emphasises the utility of this promising technique, which was not influenced by high Candida colonization or antifungal treatment. Our results suggest that detection of CAGTA may be important for the diagnosis of invasive candidiasis in surgical patients admitted in ICU.

Análisis de la influencia de la orientación de las fibras metálicas en la resistencia de la matriz de hormigón de acuerdo al Ensayo Barcelona

[ES]El objetivo de este trabajo de fin de grado es analizar la influencia que tiene la cuantía y orientación de fibras metálicas presentes en el interior de probetas de hormigón autocompactante y cuyo objetivo es reforzar y aumentar la resistencia a tracción de este material. Se expondrán las propiedades que combina el HACRFA gracias a la autocompactación del hormigón y la inclusión de fibras en su interior y los beneficios que este nuevo material aporta. Por otro lado, se tratara de situar este estudio en un contexto, analizando a la vez cuál es el alcance y los objetivos más importantes que se han tenido en cuenta. A continuación, y a modo de complementación de su contexto, este trabajo tiene un estado del arte, en el que se mencionarán métodos y ensayos necesarios para llegar a un resultado que permita predecir cuál será la resistencia del material, y por tanto su tenacidad o capacidad de absorber energía, sin necesidad de emplear más que un método fácil y rápido, obviando el resto de ensayos destructivos utilizados en este trabajo. Para tal fin, se establece una metodología que, gracias a ensayos de laboratorio, permita establecer una relación entre el método sencillo que se ha mencionado, el método inductivo, y un resultado teórico de la tenacidad que presenta el HACRFA. Se observará cómo la desviación entre los ensayos experimentales y los resultados teóricos obtenidos es prácticamente nula, despreciando situaciones en las que se presenten comportamientos muy diferentes debido a fallos durante los ensayos.

Effectiveness of a Multi-Component Smoking Cessation Support Programme (McSCSP) for Patients with Severe Mental Disorders: Study Design

Only a few studies have examined the efficacy and safety of smoking cessation programmes in patients with mental disorders. The aim of this paper is to describe in detail the methodology used in the study as well as the Multi-component Smoking Cessation Support Programme in terms of pharmacological treatments and psychological interventions. An open-label 9-month follow-up study was conducted in Spain. A total of 82 clinically stable outpatients with schizophrenia, schizoaffective or bipolar disorder were enrolled. Treatment consisted of a programme specifically developed by the research team for individuals with severe mental disorders. The programme consisted of two phases: (1) weekly individual motivational therapy for 4-12 weeks, and (2) a 12-week active treatment phase. During this phase, at each study visit patients received a one- or two-week supply of medication (transdermal nicotine patches, varenicline or bupropion) with instructions on how to take it, in addition to group psychotherapy for smoking cessation. Evaluations were performed: (1) at the time of enrolment in the study, (2) during the 12-week active treatment phase of the study (weekly for the first 4 weeks and then biweekly), and (3) after the end of this phase (two follow-up assessments at weeks 12 and 24). Evaluations included: (1) smoking history, (2) substance use, (3) psychopathology, (4) adverse events, and (5) laboratory tests. The importance of this study lies in addressing a topical issue often ignored by psychiatrists: the unacceptably high rates of tobacco use in patients with severe mental disorders.