Efectos cardiovasculares de un protocolo de reacondicionamiento físico en pacientes críticos de tres centros asistenciales en Bogotá, Colombia

ABSTRACTThe deconditioning syndrome is a frequent complication among prolonged hospital in-staying patients. It is composed by muscle atrophy which mainly affects type II fibers and it is associated with a neuromuscular junction damage. All this leads to many metabolic and systemic alterations, standing out mechanic ventilation weaning difficulty, fatigue, late return to daily activities and prolonged rehabilitation periods. The purpose was to describe the cardiovascular changes in Intensive Care Unit patients, once a guided physical activity protocol took place as part of the rehabilitation. It is a one year series of cases – descriptive study that took place in three polyvalent type – Intensive Care Units, with a sample of above 72 hours in-stay 23 patients which were having mechanical ventilation support simultaneously. As cardiovascular parameters where checked blood pressure and heart rate at three different times: before, during and after each one of the physical activity loads which were adjusted by a physical and sports medicine physician according to the clinical progress and registered according a 1 to 32 load scale. Cardiovascular data was analyzed with non-parametrical statistics. No significant differences were found; concluding that among in-stay critical care patients, idoneus specialist guided physical activity loads, have no considerable cardiovascular effect and can be kept as a part of a rehabilitation protocol. MÉD.UIS. 2016;29(2):161-73.Keywords: Atrophy. Locomotion. Physical Conditioning, Human. Early Medical Intervention. Muscle Weakness.El síndrome de desacondicionamiento físico es una complicación frecuente en los pacientes con reposo prolongado; su principal característica es la atroia muscular que afecta principalmente las ibras musculares tipo II y se asocia a un daño de la placa neuromuscular. Esto conlleva a múltiples alteraciones metabólicas y sistémicas, como la diicultad para abandonar la ventilación mecánica, la fatiga, el retorno tardío a las actividades de la vida cotidiana y períodos de rehabilitación prolongados. El presente estudio tuvo como objetivo describir los cambios cardiovasculares en pacientes hospitalizados en unidades de cuidado intensivo, al aplicar un protocolo de actividad física dirigida como parte de la rehabilitación. Se trata de un estudio descriptivo tipo serie de casos que se realizó en tres unidades de cuidado intensivo de tipo polivalente durante un año con una muestra de 23 pacientes que tuvieron una estancia superior a 72 horas y que como parte del manejo recibieron ventilación mecánica. Se evaluaron como parámetros cardiovasculares la presión arterial y la frecuencia cardíaca antes, durante y después de cada una de las cargas aplicadas, las cuales fueron ajustadas por un especialista en medicina de la actividad física y del deporte de acuerdo a la evolución clínica y posteriormente registradas en una escala del uno al treinta y dos. Se analizaron los datos de las variables cardiovasculares por medio de estadísticas no paramétricas sin encontrar diferencias signiicativas concluyendo que en pacientes críticos, la utilización de cargas orientadas por parte del especialista idóneo, no tiene efecto cardiovascular considerable y puede mantenerse como parte de los protocolos de rehabilitación. MÉD.UIS. 2016;29(2):161-73.Palabras clave: Atrofia. Locomoción. Acondicionamiento Físico Humano. Intervención Médica Temprana. Debilidad Muscular

Efectos cardiovasculares de un protocolo de reacondicionamiento físico en pacientes críticos de tres centros asistenciales en Bogotá, Colombia

El síndrome de desacondicionamiento físico es una complicación frecuente en los pacientes con reposo prolongado; su principal característica es la atroia muscular que afecta principalmente las ibras musculares tipo II y se asocia a un daño de la placa neuromuscular. Esto conlleva a múltiples alteraciones metabólicas y sistémicas, como la diicultad para abandonar la ventilación mecánica, la fatiga, el retorno tardío a las actividades de la vida cotidiana y períodos de rehabilitación prolongados. El presente estudio tuvo como objetivo describir los cambios cardiovasculares en pacientes hospitalizados en unidades de cuidado intensivo, al aplicar un protocolo de actividad física dirigida como parte de la rehabilitación. Se trata de un estudio descriptivo tipo serie de casos que se realizó en tres unidades de cuidado intensivo de tipo polivalente durante un año con una muestra de 23 pacientes que tuvieron una estancia superior a 72 horas y que como parte del manejo recibieron ventilación mecánica. Se evaluaron como parámetros cardiovasculares la presión arterial y la frecuencia cardíaca antes, durante y después de cada una de las cargas aplicadas, las cuales fueron ajustadas por un especialista en medicina de la actividad física y del deporte de acuerdo a la evolución clínica y posteriormente registradas en una escala del uno al treinta y dos. Se analizaron los datos de las variables cardiovasculares por medio de estadísticas no paramétricas sin encontrar diferencias signiicativas concluyendo que en pacientes críticos, la utilización de cargas orientadas por parte del especialista idóneo, no tiene efecto cardiovascular considerable y puede mantenerse como parte de los protocolos de rehabilitación

Cardiovascular effects as a result of a physical conditioning protocol on a critical care in-patient, at three medical centers in Bogotá – Colombia

El síndrome de desacondicionamiento físico es una complicación frecuente en los pacientes con reposo prolongado; su principal característica es la atrofia muscular que afecta principalmente las fibras musculares tipo II y se asocia a un daño de la placa neuromuscular. Esto conlleva a múltiples alteraciones metabólicas y sistémicas, como la dificultad para abandonar la ventilación mecánica, la fatiga,elretorno tardío a las actividades de la vida cotidiana yperíodos de rehabilitación prolongados. El presente estudio tuvo como objetivo describir los cambios cardiovasculares en pacientes hospitalizados en unidades de cuidado intensivo, al aplicar un protocolo de actividad física dirigida como parte de la rehabilitación. Se trata de un estudio descriptivo tipo serie de casos que se realizó en tres unidades de cuidado intensivo de tipo polivalente durante un año con una muestra de 23 pacientes que tuvieron una estancia superior a 72 horas y que como parte del manejo recibieron ventilación mecánica. Se evaluaron como parámetros cardiovasculares la presión arterial y la frecuencia cardíaca antes, durante y después de cada una de las cargas aplicadas, las cuales fueron ajustadas por un especialista en medicina de la actividad física y del deporte de acuerdo a la evolución clínica y posteriormente registradas en una escala del uno al treinta y dos. Se analizaron los datos de las variables cardiovasculares por medio de estadísticas no paramétricas sin encontrar diferencias significativas concluyendo que en pacientes críticos, la utilización de cargas orientadas por parte del especialista idóneo, no tiene efecto cardiovascular considerable y puede mantenerse como parte de los protocolos de rehabilitación.The deconditioning syndrome is a frequent complication among prolonged hospital in-staying patients. It is composed by muscle atrophy which mainly affects type II fibers and it is associated with a neuromuscular junction damage. All this leads to many metabolic and systemic alterations, standing out mechanic ventilation weaning difficulty, fatigue, late return to daily activities and prolonged rehabilitation periods. The purpose was to describe the cardiovascular changes in Intensive Care Unit patients, once a guided physical activity protocol took place as part of the rehabilitation. It is a one year series of cases – descriptive study that took place in three polyvalent type – Intensive Care Units, with a sample of above 72 hours in-stay 23 patients which were having mechanical ventilation support simultaneously. As cardiovascular parameters where checked blood pressure and heart rate at three different times: before, during and after each one of the physical activity loads which were adjusted by a physical and sports medicine physician according to the clinical progress and registered according a 1 to 32 load scale. Cardiovascular data was analyzed with non-parametrical statistics. No significant differences were found;concluding that among in-stay critical care patients, idoneus specialist guided physical activity loads, have no considerable cardiovascular effect and can be kept as a part of a rehabilitation protocol

Justificación y diseño del estudio Concordancia entre RFF e iFR en lesiones del tronco común.: Estudio iLITRO-EPIC-07

Introduction and objectives: Patients with left main coronary artery (LMCA) stenosis have been excluded from the trials that support the non-inferiority of the instantaneous wave-free ratio (iFR) compared to the fractional flow reserve (FFR) in the decision-making process of coronary revascularization. This study proposes to prospectively assess the concordance between the two indices in LMCA lesions and to validate the iFR cut-off value of 0.89 for clinical use. Methods: National, prospective, and observational multicenter registry of 300 consecutive patients with intermediate lesions in the LMCA (angiographic stenosis, 25% to 60%. A pressure gudiewire study and determination of the RFF and the iFR will be performed: in the event of a negative concordant result (FFR > 0.80/iFR > 0.89), no treatment will be performed; in case of a positive concordant result (FFR ≤ 0.80/iFR ≤ 0.89), revascularization will be performed; In the event of a discordant result (FFR> 0.80/iFR ≤ 0.89 or FFR ≤ 0.80/iFR> 0.89), an intravascular echocardiography will be performed and revascularization will be delayed if the minimum lumen area is > 6 mm2. The primary clinical endpoint will be a composite of cardiovascular death, LMCA lesion-related non-fatal infarction or need for revascularization of the LMCA lesion at 12 months. Conclusions: Confirm that an iFR-guided decision-making process in patients with intermediate LMCA stenosis is clinically safe and would have a significant clinical impact. Also, justify its systematic use when prescribing treatment in these potentially high-risk patients. Registered at ClinicalTrials.gov ( Identifier: NCT03767621).Introducción y objetivos: Los pacientes con estenosis en el tronco coronario izquierdo (TCI) han sido excluidos de los ensayos que apoyan la no inferioridad del cociente de presiones en el índice diastólico instantáneo sin ondas (iFR) respecto a la reserva fraccional de flujo (RFF) en la toma de decisiones sobre revascularización coronaria. El presente estudio propone valorar de manera prospectiva la concordancia entre los dos índices en lesiones del TCI y validar el valor de corte del iFR de 0,89 para su uso clínico. Métodos: Registro multicéntrico nacional, prospectivo, observacional, con la inclusión de 300 pacientes consecutivos con lesiones intermedias (estenosis angiográfica 25-60%) en el TCI. Se realizará un estudio con guía de presión y determinación de RFF e iFR. En caso de resultado concordante negativo (RFF > 0,80 / iFR > 0,89), no se realizará tratamiento; en caso de resultado concordante positivo (RFF ≤ 0,80 / iFR ≤ 0,89), se realizará revascularización; en caso de resultado discordante (RFF > 0,80 / iFR ≤ 0,89 o RFF ≤ 0,80 / iFR > 0,89), se realizará estudio con ecocardiografía intravascular y se considerará diferir la revascularización si el área luminal mínima es > 6 mm2. El criterio de valoración clínico primario será la incidencia del combinado de muerte cardiovascular, infarto no mortal relacionado con la lesión del TCI o necesidad de revascularización de la lesión del TCI a los 12 meses. Conclusiones: La demostración de la seguridad clínica en la toma de decisiones del iFR en pacientes con lesiones intermedias en el TCI tendría un impacto clínico importante y justificaría su uso sistemático para la decisión del tratamiento en estos pacientes de potencial alto riesgo. Registrado en ClinicalTrials.gov (identificador: NCT03767621)

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on $10^3$ pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on $10^3$ pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on $10^3$ pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype