Maniobras de Prono en el Síndrome de Distrés Respiratorio del Adulto ¿Hasta cuándo? Una Revisión Sistemática

Introducción: La pandemia del COVID-19 ha supuesto un reto en las UCI de todo el mundo. Muchos pacientes han desarrollado un síndrome de distrés respiratorio del adulto (SDRA) necesitando ventilación mecánica invasiva, a pesar de cuya optimización y en situación de hipoxemia refractaria ha sido preciso utilizar alternativas terapéuticas como las maniobras de prono. Diversos estudios la consideran una práctica efectiva, segura y fácil de implementar. Sin embargo, su uso hasta la pandemia ha sido reducido y la evidencia sobre la mejor forma de realizarlo sin estandarizar, en especial el número de sesiones y sus criterios de cese.Métodos: Se ha realizado una búsqueda en Pubmed, Web Of Science, Embase, Medline, Scopus y Alcorze. Los términos empleados han sido “síndrome de distrés respiratorio”, “posición prono”, “ventilación mecánica”, “duración” y “respondedor”. Se han incluido estudios publicados durante los últimos 5 años en pacientes mayores de 18 años con SDRA, intubados a los que se les realizó prono. El objetivo primario fue el número de sesiones de prono más eficaz; y el secundario, los criterios de cese.Resultados: Un total de 20 artículos cumplieron los criterios de selección. La mayoría realizados durante la pandemia del COVID-19 y con una duración inferior al año. Los pacientes fueron mayoritariamente varones de 50-65 años sin comorbilidades respiratorias. No se vio reflejado el uso del protocolo ARDSnet ni del PROSEVA. La primera sesión de prono fue realizada con SDRA moderado-severo, generalmente a los 2 días de la intubación. La mediana de sesiones fue 2, con mínimo 16 horas por sesión. En más del 60% de los estudios no se registraron los criterios de cese ni la aparición de complicaciones. Por último, la mediana de estancia en UCI fue 17.25 días, con una mortalidad del 44%. Una limitación encontrada, inherente a las revisiones sistemáticas, ha sido la heterogeneidad.Conclusiones: Iniciar precozmente y alargar las sesiones de prono más de 16 horas, parece reducir el número de sesiones necesarias y obtener mejores resultados clínicos, aunque falta evidencia al respecto. Son necesarios protocolos y estudios de prono que estandaricen criterios, especialmente sobre cuándo finalizarlo.Palabras clave: Síndrome de distrés respiratorio del adulto, posición prono, ventilación mecánica invasiva, duración, respondedor.<br /

How important is donor age in liver transplantation?

The age of liver donors has been increasing in the past several years because of a donor shortage. In the United States, 33% of donors are age 50 years or older, as are more than 50% in some European countries. The impact of donor age on liver transplantation (LT) has been analyzed in several studies with contradictory conclusions. Nevertheless, recent analyses of the largest databases demonstrate that having an older donor is a risk factor for graft failure. Donor age is included as a risk factor in the more relevant graft survival scores, such as the Donor Risk Index, donor age and Model for End-stage Liver Disease, Survival Outcomes Following Liver Transplantation, and the Balance of Risk. The use of old donors is related to an increased rate of biliary complications and hepatitis C virus-related graft failure. Although liver function does not seem to be significantly affected by age, the incidence of several liver diseases increases with age, and the capacity of the liver to manage or overcome liver diseases or external injuries decreases. In this paper, the importance of age in LT outcomes, the role of donor age as a risk factor, and the influence of aging on liver regeneration are reviewed

The HCPro from the Potyviridae family : an enviable multitasking Helper Component that every virus would like to have

RNA viruses have very compact genomes and so provide a unique opportunity to study how evolution works to optimize the use of very limited genomic information. A widespread viral strategy to solve this issue concerning the coding space relies on the expression of proteins with multiple functions. Members of the family Potyviridae, the most abundant group of RNA viruses in plants, offer several attractive examples of viral factors which play roles in diverse infection-related pathways. The Helper Component Proteinase (HCPro) is an essential and well-characterized multitasking protein for which at least three independent functions have been described: (i) viral plant-to-plant transmission; (ii) polyprotein maturation; and (iii) RNA silencing suppression. Moreover, multitudes of host factors have been found to interact with HCPro. Intriguingly, most of these partners have not been ascribed to any of the HCPro roles during the infectious cycle, supporting the idea that this protein might play even more roles than those already established. In this comprehensive review, we attempt to summarize our current knowledge about HCPro and its already attributed and putative novel roles, and to discuss the similarities and differences regarding this factor in members of this important viral family

Intention-to-treat survival analysis of HCV/HIV co-infected liver transplant: Is it the waiting list?

In human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients, the accelerated severity of liver disease, associated comorbidities, and mortality on the waiting list could change the possibility and results of liver transplantation (LT). Intention-to-treat survival analysis (ITTA) can accurately estimate the applicability and efficacy of LT. The primary objective of this study was to compare the survival of patients with HCV with and without HIV infection. We analyzed a cohort of 199 patients with HCV infection enrolled for LT between 1998 and 2015; 17 were also infected with HIV. The patients with HCV/HIV coinfection had higher mortality on the waiting list than those with HCV monoinfection (35.3% versus 4.6%; P¿¿70 years (hazard ratio [HR]¿=¿3.12; P¿<¿0.05), United Network for Organ Sharing status 1 (HR¿=¿10.1; P¿<¿0.01), Model for End-Stage Liver Disease (HR¿=¿1.13; P¿<¿0.001), and HIV coinfection (HR¿=¿2.65; P¿<¿0.05) had independent negative predictive value for survival. In conclusion, our study indicates that HIV coinfection is a factor in mortality prior to transplantation and associated with higher mortality on the waiting list

Influence of competition on performance factors in under-19 soccer players at national league level

[EN] The aim of this study was to analyse and quantify the acute effects of competition on several performance factors in under-19 male soccer players. To this end, 198 national league players (17.56 ± 0.78 years) performed various tests to measure jump capacity, kicking velocity and sprint times immediately pre-match (T1), at half-time (T2) and post-match (T3). Tests included kicking the ball to measure ball velocity (KICK), sprinting for 40 meters, timing the first 30 meters (30mACCEL), the last 10 meters (10mACCEL) and the total distance (40mACCEL), and performing countermovement jumps (CMJ). For subsequent analysis, the sample was divided into 5 playing positions: goalkeepers (n = 24), defenders (n = 51), midfielders (n = 36), wingers (n = 54) and forwards (n = 33). For all positions, we found a significant decline in performance (p<0.05) for kicking velocity (2.91% - 6.51%) and sprinting (0.44%-5.85%). For the CMJ, all positions except defenders presented a significant decline in performance that ranged from 1.5% to 4.56%. These findings highlight the need to individualise fitness training, taking into account the match needs and demands of the different playing positions in order to minimise the effects of match fatigue and accelerate post-match recovery.S

Pediatric mortality for non intentional injury in Havana. 2003-2012

Introduction: unintentional accidents and injuries mean a world health problem, and turn out to be the first pediatric cause of death. Objective: to describe the epidemiologic behavior of pediatric mortality due to unintentional accidents and injuries in Havana. Material and Methods: a descriptive and retrospective study about 216 deaths by this cause that did occurs between 2003-2012, in ages from 0-14 years old, according to data offered by the statistic department of the provincial health headquarters, and the variables studied were: year, age, sex, municipality, drowning sites, and kinds according to the international classification of diseases X edition. The percentage method was used; tables and graphs were made by means of the program XLSTAT, the rates were calculated x 100 000 inhabitants. Results: decreasing death rates in the decade from 0, 92 and 0, 76 (2003) to 0, 68 y 0, 25 (2012) in males and females respectively. The most frequent causes were: traffic (41,2%), drowning (24%), suffocation (6,4%), and intoxication (5,5%). The adolescents and schoolmate pedestrian died in more proportion for traffic accidents. The drowning, happening mostly in school (40,3%) and pre-school (30,7%) in pools and sea both with 19,2% and places without security aquatic 26,9%.  The intoxication showed up same proportion in adolescent and pre-school with 46,1% and the asphyxia in nurslings with 84,6%. The traffic accidents and drowning showed bigger deaths in the municipality Boyeros. Conclusions: Mortality due to accidents still turns out to be a cardinal health problem in pediatric ages Key words: accidents, child mortality, prevention, Immersion accident; epidemiology, primary care.</p

Efficacy and safety of an aflibercept treat-and-extend regimen in treatment-naive patients with macular oedema secondary to central retinal vein occlusion (CRVO): a prospective 12-month, single-arm, multicentre trial

Objectives: to evaluate efficacy and safety of an aflibercept treat-and-extend (TAE) regimen in patients with macular oedema (MO) secondary to central retinal vein occlusion (CRVO). Design setting and patients: phase IV, prospective, open-label, single-arm trial in 11 Spanish hospitals. Treatment-naïve patients with <6 month diagnosis of MO secondary to CRVO and best-corrected visual acuity (BCVA) of 73-24 ETDRS letters were included between 23 January 2015 and 17 March 2016. Intervention: intravitreal aflibercept 2 mg monthly (3 months) followed by proactive individualized dosing. Main outcomes: mean change in BCVA after 12 months. Results: 24 eyes (24 patients) were included; mean (SD) age: 62.8 (15.0) years; 54.2% male; median (IQR) time since diagnosis: 7.6 (3.0, 15.2) days. Mean BCVA scores significantly improved between baseline (56.0 (16.5)) and Month 12 (74.1 (17.6)); mean (95% CI) change: 14.8 (8.2, 21.4); P=0.0001. Twelve (50.0%) patients gained ≥15 ETDRS letters. Foveal thickness improved between baseline (mean: 569.4 (216.8) µm) and Month 12 (mean 257.4 (48.4) µm); P < 0.0001. At Month 12, 8.3% patients had MO. The mean (SD) number of injections: 8.3 (3.0). No treatment-related AEs were reported. Five (20.8%) patients experienced ocular AEs. Two nonocular serious AEs were reported. Conclusions: an aflibercept TAE regimen improves visual acuity in patients with MO secondary to CRVO over 12 months with good tolerability

The role of retinal fluid location in atrophy and fibrosis evolution of patients with neovascular age-related macular degeneration long-term treated in real world

Purpose: To assess the effect of clinical factors on the development and progression of atrophy and fibrosis in patients with neovascular age-related macular degeneration (nAMD) receiving long-term treatment in the real world. Methods: An ambispective 36-month multicentre study, involving 359 nAMD patients from 17 Spanish hospitals treated according to the Spanish Vitreoretinal Society guidelines, was designed. The influence of demographic and clinical factors, including the presence and location of retinal fluid, on best-corrected visual acuity (BCVA) and progression to atrophy and/or fibrosis were analysed. Results: After 36 months of follow-up and an average of 13.8 anti-VEGF intravitreal injections, the average BCVA gain was +1.5 letters, and atrophy and/or fibrosis were present in 54.8% of nAMD patients (OR = 8.54, 95% CI = 5.85-12.47, compared to baseline). Atrophy was associated with basal intraretinal fluid (IRF) (OR = 1.87, 95% CI = 1.09-3.20), whereas basal subretinal fluid (SRF) was associated with a lower rate of atrophy (OR = 0.40, 95% CI = 0.23-0.71) and its progression (OR = 0.44, 95% CI = 0.26-0.75), leading to a slow progression rate (OR = 0.34, 95% CI = 0.14-0.83). Fibrosis development and progression were related to IRF at any visit (p < 0.001). In contrast, 36-month SRF was related to a lower rate of fibrosis (OR = 0.49, 95% CI = 0.29-0.81) and its progression (OR = 0.50, 95% CI = 0.31-0.81). Conclusion: Atrophy and/or fibrosis were present in 1 of 2 nAMD patients treated for 3 years. Both, especially fibrosis, lead to vision loss. Subretinal fluid (SRF) was associated with good visual outcomes and lower rates of atrophy and fibrosis, whereas IRF yields worse visual results and a higher risk of atrophy and especially fibrosis in routine clinical practice

The HCPro from the Potyviridae family : an enviable multitasking Helper Component that every virus would like to have

RNA viruses have very compact genomes and so provide a unique opportunity to study how evolution works to optimize the use of very limited genomic information. A widespread viral strategy to solve this issue concerning the coding space relies on the expression of proteins with multiple functions. Members of the family Potyviridae, the most abundant group of RNA viruses in plants, offer several attractive examples of viral factors which play roles in diverse infection-related pathways. The Helper Component Proteinase (HCPro) is an essential and well-characterized multitasking protein for which at least three independent functions have been described: (i) viral plant-to-plant transmission; (ii) polyprotein maturation; and (iii) RNA silencing suppression. Moreover, multitudes of host factors have been found to interact with HCPro. Intriguingly, most of these partners have not been ascribed to any of the HCPro roles during the infectious cycle, supporting the idea that this protein might play even more roles than those already established. In this comprehensive review, we attempt to summarize our current knowledge about HCPro and its already attributed and putative novel roles, and to discuss the similarities and differences regarding this factor in members of this important viral family

Mortalidad pediátrica por lesiones no intencionales en La Habana. 2003-2012

Introduction: unintentional accidents and injuries mean a world health problem, and turn out to be the first pediatric cause of death. Objective: to describe the epidemiologic behavior of pediatric mortality due to unintentional accidents and injuries in Havana. Material and Methods: a descriptive and retrospective study about 216 deaths by this cause that did occurs between 2003-2012, in ages from 0-14 years old, according to data offered by the statistic department of the provincial health headquarters, and the variables studied were: year, age, sex, municipality, drowning sites, and kinds according to the international classification of diseases X edition. The percentage method was used; tables and graphs were made by means of the program XLSTAT, the rates were calculated x 100 000 inhabitants. Results: decreasing death rates in the decade from 0, 92 and 0, 76 (2003) to 0, 68 y 0, 25 (2012) in males and females respectively. The most frequent causes were: traffic (41,2%), drowning (24%), suffocation (6,4%), and intoxication (5,5%). The adolescents and schoolmate pedestrian died in more proportion for traffic accidents. The drowning, happening mostly in school (40,3%) and pre-school (30,7%) in pools and sea both with 19,2% and places without security aquatic 26,9%.  The intoxication showed up same proportion in adolescent and pre-school with 46,1% and the asphyxia in nurslings with 84,6%. The traffic accidents and drowning showed bigger deaths in the municipality Boyeros. Conclusions: Mortality due to accidents still turns out to be a cardinal health problem in pediatric ages Key words: accidents, child mortality, prevention, Immersion accident; epidemiology, primary care.Introducción: los accidentes o lesiones no intencionales representan un problema de salud mundial. La población pediátrica es aún más vulnerable. Objetivo: describir las causas de mortalidad ocurridas por lesiones no intencionales en menores de 15 años en La Habana entre 2003 y 2012. Material y Método: se realizó un estudio descriptivo de 216 defunciones por accidentes ocurridas durante 2003 a 2012 en edades de 0-14 años, según datos ofrecidos por el Departamento de Estadísticas de la Dirección Provincial de Salud. Las variables estudiadas fueron: año, edad, sexo, municipio de residencia y tipos de accidentes, según la Clasificación Internacional de Enfermedades. Se estimaron porcentajes, se elaboraron tablas y figuras mediante el programa XLSTAT y se calculó la tasa x 100, 000 habitantes. Resultados: la mortalidad mostró tasas decrecientes de 0,92 y 0,76 en 2003 a 0,68 y 0,25 en 2012 según el sexo masculino y femenino, respectivamente. Las causas que mostraron mayor frecuencia resultaron ser: tránsito 41,2%, ahogamientos 24%, asfixia 6,4% e intoxicación 5,5%. Los adolescentes, escolares y pre-escolares como peatones fallecieron en mayor proporción por accidentalidad vial. Los ahogamientos ocurrieron en su mayoría en escolares (40,3%) y pre-escolares (30,7%) en piscinas y mar, ambos con 19,2%,y lugares sin seguridad acuática (26,9%). La intoxicación mostró igual proporción en adolescentes y pre-escolares (46,1%); la asfixia en lactantes alcanzó 84,6%. Los accidentes de tránsito y ahogamientos exhibieron mayores defunciones en el municipio Boyeros. Conclusiones: la mortalidad por accidentes aun representa un problema cardinal de salud en pediatría.Palabras clave: accidentes, mortalidad, prevención, ahogamiento, epidemiología, atención primaria de salud.ABSTRACTIntroduction: unintentional accidents and injuries mean a world health problem, and turn out to be the first pediatric cause of death. Objective: to describe the epidemiologic behavior of pediatric mortality due to unintentional accidents and injuries in Havana. Material and Methods: a descriptive and retrospective study about 216 deaths by this cause that did occurs between 2003-2012, in ages from 0-14 years old, according to data offered by the statistic department of the provincial health headquarters, and the variables studied were: year, age, sex, municipality, drowning sites, and kinds according to the international classification of diseases X edition. The percentage method was used; tables and graphs were made by means of the program XLSTAT, the rates were calculated x 100 000 inhabitants. Results: decreasing death rates in the decade from 0, 92 and 0, 76 (2003) to 0, 68 y 0, 25 (2012) in males and females respectively. The most frequent causes were: traffic (41,2%), drowning (24%), suffocation (6,4%), and intoxication (5,5%). The adolescents and schoolmate pedestrian died in more proportion for traffic accidents. The drowning, happening mostly in school (40,3%) and pre-school (30,7%) in pools and sea both with 19,2% and places without security aquatic 26,9%.  The intoxication showed up same proportion in adolescent and pre-school with 46,1% and the asphyxia in nurslings with 84,6%. The traffic accidents and drowning showed bigger deaths in the municipality Boyeros. Conclusions: Mortality due to accidents still turns out to be a cardinal health problem in pediatric ages Key words: accidents, child mortality, prevention, Immersion accident; epidemiology, primary care