Instauración de la lactancia materna exclusiva durante el Puerperio en Pacientes con esclerosis múltiple: Una Revisión Bibliográfica

Introducción: la esclerosis múltiple es una enfermedad inflamatoria del sistema nervioso central que afecta sobre todo a mujeres jóvenes entre 25 y 35 años. Esta época es coincidente con el periodo fértil de la mujer, por lo que es frecuente que las pacientes se planteen numerosas preguntas sobre cómo puede afectar su enfermedad al periodo de la gestación, parto y puerperio. Tanto la gestación como la lactancia materna exclusiva en mujeres con esclerosis múltiple no son perjudiciales para la madre y el bebé. Aunque a pesar de la existencia de dicha evidencia científica, todavía existe desconocimiento e inseguridades en esta población. Y por ello, este estudio se centra en mujeres con esclerosis múltiple que introducen la lactancia materna exclusiva durante el puerperio para examinar el impacto que tiene en las manifestaciones clínicas y progresión de la enfermedad. Objetivo: analizar el impacto de la lactancia materna exclusiva en las manifestaciones clínicas y progresión de la enfermedad en mujeres con esclerosis múltiple durante el puerperio. Metodología: se realizó una revisión bibliográfica en las bases de datos biomédicas mas relevantes; PubMed, Scopus, ScienceDirect, Web of Science, Cuiden y Scielo. La búsqueda en las bases de datos se reportó siguiendo los criterios de Declaración PRISMA 2020. Un total de 9 artículos fueron seleccionados en base a los criterios de selección. Resultados: las mujeres con esclerosis múltiple que optaron por la lactancia materna exclusiva tenían significativamente menos recaídas que las que no amamantaban exclusivamente, debido a numerosos factores neuroprotectores de la misma. Además, la duración de la lactancia materna debe ser controlada durante un periodo de tiempo, para asegurar una correcta neuroprotección, indicando la mayor parte de los estudios una duración de 2 meses como mínimo. Conclusión: la lactancia materna exclusiva se considera un factor protector para evitar brotes de gran relevancia clínica frente a la lactancia materna mixta o artificial, mostrando ambas tasas similares de recaída. El personal de enfermería junto con su equipo multidisciplinar deberá llevar un buen control del puerperio como de la lactancia materna, para asegurar un correcto seguimiento y así evitar brotes de la enfermedad. Palabras clave: "esclerosis múltiple"; "lactancia materna"; "lactancia materna exclusiva", "puerperio; posparto". <br /

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation