Assessment of panobacumab as adjunctive immunotherapy for the treatment of nosocomial Pseudomonas aeruginosa pneumonia.

The fully human anti-lipopolysaccharide (LPS) immunoglobulin M (IgM) monoclonal antibody panobacumab was developed as an adjunctive immunotherapy for the treatment of O11 serotype Pseudomonas aeruginosa infections. We evaluated the potential clinical efficacy of panobacumab in the treatment of nosocomial pneumonia. We performed a post-hoc analysis of a multicenter phase IIa trial (NCT00851435) designed to prospectively evaluate the safety and pharmacokinetics of panobacumab. Patients treated with panobacumab (n = 17), including 13 patients receiving the full treatment (three doses of 1.2 mg/kg), were compared to 14 patients who did not receive the antibody. Overall, the 17 patients receiving panobacumab were more ill. They were an average of 72 years old [interquartile range (IQR): 64-79] versus an average of 50 years old (IQR: 30-73) (p = 0.024) and had Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of 17 (IQR: 16-22) versus 15 (IQR: 10-19) (p = 0.043). Adjunctive immunotherapy resulted in an improved clinical outcome in the group receiving the full three-course panobacumab treatment, with a resolution rate of 85 % (11/13) versus 64 % (9/14) (p = 0.048). The Kaplan-Meier survival curve showed a statistically significantly shorter time to clinical resolution in this group of patients (8.0 [IQR: 7.0-11.5] versus 18.5 [IQR: 8-30] days in those who did not receive the antibody; p = 0.004). Panobacumab adjunctive immunotherapy may improve clinical outcome in a shorter time if patients receive the full treatment (three doses). These preliminary results suggest that passive immunotherapy targeting LPS may be a complementary strategy for the treatment of nosocomial O11 P. aeruginosa pneumonia.

Composição mineral de maçãs 'Gala' e 'Fuji' produzidas no Sul do Brasil

O objetivo deste trabalho foi avaliar a composição mineral de maçãs 'Gala' e 'Fuji', em pomares de diferentes regiões do Sul do Brasil. Foram avaliados pomares em vários municípios de Santa Catarina e do Rio Grande do Sul, agrupados em macrorregiões denominadas de Fraiburgo, Vacaria e São Joaquim, durante o período de 1991 a 2007. Os teores médios (em matéria fresca) de Ca, K, Mg, N e P nos frutos foram, respectivamente, 47, 1.027, 52, 419 e 116 mg kg‑1, para 'Gala', e de 41, 1.043, 46, 373 e 116 mg kg‑1, para 'Fuji'. Os valores médios das relações (K+Mg)/Ca e N/Ca foram respectivamente de 24 e 9,6, para 'Gala', e de 28 e 9,7, para 'Fuji'. Maçãs 'Gala' e 'Fuji' apresentaram teores médios de Ca e P acima dos níveis críticos mínimos (40 e 100 mg kg‑1, respectivamente), e relações médias de (K+Mg)/Ca e N/Ca acima dos níveis críticos máximos (30 e 14), considerados adequados para maior conservação da qualidade pós‑colheita (QPC). Maçãs de pomares de São Joaquim apresentaram maiores teores de Ca e P, menores teores de N e menores relações (K+Mg)/Ca e N/Ca, independentemente da cultivar. O percentual de amostras, com alto risco de perdas em QPC, foi maior para 'Fuji' do que para 'Gala', quanto aos teores de Ca e P e às relações (K+Mg)/Ca e N/Ca.

¿Favorece la publicación en abierto el impacto de los artículos científicos? Un estudio empírico en el ámbito de la medicina intensiva

Peer-reviewed

Systematic review protocol to define classical IgE-associated diseases from birth to adolescence: the MeDALL study

BACKGROUND: Classical disease phenotypes are mainly based on descriptions of symptoms and the hypothesis that a given pattern of symptoms provides a diagnosis. With refined technologies there is growing evidence that disease expression in patients is much more diverse and subtypes need to be defined to allow a better targeted treatment. One of the aims of the Mechanisms of the Development of Allergy Project (MeDALL,FP7) is to re-define the classical phenotypes of IgE-associated allergic diseases from birth to adolescence, by consensus among experts using a systematic review of the literature and identify possible gaps in research for new disease markers. This paper describes the methods to be used for the systematic review of the classical IgE-associated phenotypes applicable in general to other systematic reviews also addressing phenotype definitions based on evidence. METHODS/DESIGN: Eligible papers were identified by PubMed search (complete database through April 2011). This search yielded 12,043 citations. The review includes intervention studies (randomized and clinical controlled trials) and observational studies (cohort studies including birth cohorts, case-control studies) as well as case series. Systematic and non-systematic reviews, guidelines, position papers and editorials are not excluded but dealt with separately. Two independent reviewers in parallel conducted consecutive title and abstract filtering scans. For publications where title and abstract fulfilled the inclusion criteria the full text was assessed. In the final step, two independent reviewers abstracted data using a pre-designed data extraction form with disagreements resolved by discussion among investigators. DISCUSSION: The systematic review protocol described here allows to generate broad,multi-phenotype reviews and consensus phenotype definitions. The in-depth analysis of the existing literature on the classification of IgE-associated allergic diseases through such a systematic review will 1) provide relevant information on the current epidemiologic definitions of allergic diseases, 2) address heterogeneity and interrelationships and 3) identify gaps in knowledge.

Fluència verbal i funcions neuropsicològiques en la malaltia del Parkinson

S'han estudiant les funcions neuropsicològiques en una mostra de 96 pacients amb malaltia de Parkinson (MP) i 42 controls aparellats per gènere, edat, escolaritat i intel.ligència verbal. Els resultats indiquen que els pacients afectats per MP, com a grup, presenten alteracions en les funcions visuoespacials, en la memòria i en les funcions frontals, però que aquests dèficits no estan sempre presents en tots els pacients. L'anàlisi de clusters realitzat ens mostra que les alteracions neuropsicològiques presents en la MP estan distribuides en subgrups. En un dels grups es va observar la presència d'afectació cognitiva generalitzada, mentre que el segon subgrup va mostrar absència de dèficits cognitius i, finalment, el darrer subgrup presentava alteracions específiques en les funcions visuoespacials i frontals. La puntuació verbal mostrava el mateix patró de deteriorament que les funcions frontals i es va trobar una diferència significativa entre els pacients i el grup control en aquesta funció. La presencia de depressió estava present en un 50% dels pacients i estava fortament relacionada amb els dèficits frontals. Els resultats d'aquest estudi mostren la importància d'avaluar les funcions neuropsicobiològiques i del llenguatge en els pacients afectats per MP, amb la finalitat de conèixer el patró de deteriorament, per tal d'afavorir-ne el funcionament i la qualitat de vida.

Toimittajaverkoston ja päähankkijan rajapintojen yhdistäminen

Kansainvälisen kaupan ja kanssakäymisen lisääntyminen onpakottanut veturiyritykset verkostoitumaan toisten yritysten kanssa, joustavuuden, tehokkuuden ja kilpailukyvyn parantamiseksi. Tällöin tarvitaan nopeita sähköisen tiedonsiirronvälineitä tilaus- ja toimitusprosesseissa. Tutkimuksen tavoitteena oli saada kehitysmalli kansainvälisen päähankkijan, järjestelmätoimittajan ja toimittajaverkoston välille sähköisen tiedonsiirron kehittämiseksi sellaiselle tasolle, missä voidaan saavuttaa kokonaiskustannushyöty koko toimittajaketjulle. Tutkimuksen mukaan järjestelmätoimittajan ja päähankkijan sähköinen tiedonsiirto oli valtaosassa tutkituista järjestelmätoimittajista hyvällä tasolla. Monessa verkoston yrityksessä sähköisen tiedonsiirron kehitys oli pysähtynyt järjestelmätoimittajatasolle, eikä sitä ole kehitetty edelleen toimittajaverkostoon päin. Ainoastaan yhden tutkimuksessa mukana olleen järjestelmätoimittajan kehityssuunnitelma vastaa päähankkijan asettamia lähitulevaisuuden tavoitteita sähköisen tiedonsiirron kehittämisestä toimittajaverkostossa. Tutkimuksessa havaittiin, ettei sähköinen tiedonsiirtokehity toimittajaverkostossa, elleivät järjestelmätoimittajat ota suurempaa vastuuta sen kehittämiseksi omassa toimittajaverkostossa. Tutkimustulosten perusteella kaikkien osapuolien päähankkijan, järjestelmätoimittajan ja toimittajaverkoston aktiivinen tuki sähköisen tiedonsiirron kehittämiselle parantaa kokonaiskustannusten hallinnan ja imuohjauksen kautta kilpailukykyä.

Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial.

BACKGROUND: Enteral nutrition (EN) is recommended for patients in the intensive-care unit (ICU), but it does not consistently achieve nutritional goals. We assessed whether delivery of 100% of the energy target from days 4 to 8 in the ICU with EN plus supplemental parenteral nutrition (SPN) could optimise clinical outcome. METHODS: This randomised controlled trial was undertaken in two centres in Switzerland. We enrolled patients on day 3 of admission to the ICU who had received less than 60% of their energy target from EN, were expected to stay for longer than 5 days, and to survive for longer than 7 days. We calculated energy targets with indirect calorimetry on day 3, or if not possible, set targets as 25 and 30 kcal per kg of ideal bodyweight a day for women and men, respectively. Patients were randomly assigned (1:1) by a computer-generated randomisation sequence to receive EN or SPN. The primary outcome was occurrence of nosocomial infection after cessation of intervention (day 8), measured until end of follow-up (day 28), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00802503. FINDINGS: We randomly assigned 153 patients to SPN and 152 to EN. 30 patients discontinued before the study end. Mean energy delivery between day 4 and 8 was 28 kcal/kg per day (SD 5) for the SPN group (103% [SD 18%] of energy target), compared with 20 kcal/kg per day (7) for the EN group (77% [27%]). Between days 9 and 28, 41 (27%) of 153 patients in the SPN group had a nosocomial infection compared with 58 (38%) of 152 patients in the EN group (hazard ratio 0·65, 95% CI 0·43-0·97; p=0·0338), and the SPN group had a lower mean number of nosocomial infections per patient (-0·42 [-0·79 to -0·05]; p=0·0248). INTERPRETATION: Individually optimised energy supplementation with SPN starting 4 days after ICU admission could reduce nosocomial infections and should be considered as a strategy to improve clinical outcome in patients in the ICU for whom EN is insufficient. FUNDING: Foundation Nutrition 2000Plus, ICU Quality Funds, Baxter, and Fresenius Kabi.

Predictors of favourable outcome in first-episode patients who refuse medication: results from the FEPOS study

There are suggestions that some first-episode psychosis (FEP) patients can have favourable outcome without antipsychotic medication. However, there is very limited data regarding patients' characteristics on which the decision to propose medication free treatment could be based. FEPOS is a fi le-based study of an epidemiological sample of 704 FEP patients treated at EPPIC, Melbourne, between 1998 and 2000. Among the 661 patients where data was available, 108 consistently refused medication during the entire duration of their treatment at EPPIC. In this paper we compared, within this sub-group, patients who had a favourable outcome with those who did not. Patients were aged between 15 and 29 years (M = 21.9, SD = 3.40) and the majority were male (70.4%, n = 76). Symptomatic remission data was available on 105 patients; of these patients 41.0% (n = 41) had achieved remission. Functional remission data was available on 100 patients; of these patients 33.0% (n = 33) had achieved functional remission. Combined remission was evident in 23.0% (n = 23) of patients. Three factors were associated with symptomatic remission: better premorbid functioning (based on GAF, OR = 1.07, p = 0.006), higher number of years of education (OR = 1.43, p = 0.020), and being employed or studying at service entry (OR = 2.59, p = 0.034). Three factors were associated with functional remission: shorter duration of prodrome (OR = 0.50, p = 0.043), severity of psychopathology (CGI-S, OR = 0.51, p = 0.024), and vocational status at service entry (OR = 4.29, p = 0.003). While various aspects of pre-morbid functioning seem to correlate with the possibility of a favourable outcome in FEP patients who refuse medication, various limitations need to be taken into account in this study.

Detección Precoz de los factores de riesgo cardiovasculares en los Centros de Atención Primaria de Cataluña Central

Las enfermedades cardiovasculares son actualmente la principal causa de muerte prematura, por lo que es necesario controlar los factores que podrían reducir el riesgo cardiovascular. El presente estudio se centra en la ejecución de los protocolos de prevención cardiovascular en los Centros de Atención Primaria de Cataluña central, ya que se cree que una prevención adecuada podría reducir significativamente la mortalidad por esta enfermedad. Para lograr este objetivo, se propone utilizar una muestra poblacional de 100 individuos entre 45 y 65 años y realizar un estudio cuantitativo descriptivo. Basándose éste, en el control de las diferentes variables que afectan en poseer factores de riesgo cardiovascular: el alcohol, el tabaco, la obesidad, la inactividad física, la diabetes y el colesterol.

Educación de Enfermería para el autocuidado y control de la Hipertensión Arterial (HTA) en personas con HTA Crónica

La Hipertensión Arterial (HTA) es uno de los principales factores de riesgo de morbilidad y mortalidad cardíaca y cerebrovascular, que afecta mundialmente, por lo que conlleva a un problema de salud pública universal. Es por ello que, el JNC7 recomienda una serie de actividades de autocuidado (AC), que se dividen en el tratamiento farmacológico y no-farmacológico, en el que deberá intervenir el personal sanitario, entre ellos, enfermería, para lograr el control de la enfermedad y evitar complicaciones.