Tipo de lactancia relacionado con el desarrollo psicomotor en niños de 0 a 6 meses, Hospital Distrital Vista Alegre – Trujillo 2019

La presente investigación determinó la relación que existe entre el tipo de lactancia y el desarrollo psicomotor en niños/as de 0 a 6 meses que se atienden en el servicio de Control de Crecimiento y Desarrollo del Hospital Distrital Vista Alegre, Trujillo 2019. Se fundamenta en los conceptos de la teoría del autocuidado de Dorothea Orem. Fue un estudio de enfoque cuantitativo, de diseño no experimental - transversal y correlacionar. La muestra fue de 100 niños. Se utilizó un cuestionario para indagar el tipo de lactancia con una confiabilidad de 0.824 en Alfa de Crombach. Para el desarrollo psicomotor se evaluó mediante el test de escala de evaluación del desarrollo psicomotor (EEDP). Los resultados señalan que el 54% del total de niños tienen Lactancia Materna Exclusiva, el 31% es Mixta y el 15% es Artificial. En los resultados del desarrollo psicomotor se observa que no hay niños que tengan Retraso en su Desarrollo Psicomotor, el 31% se encuentran en Riesgo y el 69% se encuentran Normal. El resultado final de las dos variables fue que el 7% del total de niños que tienen Lactancia Artificial presentan un Desarrollo Psicomotor Normal y el 8 % en riesgo. El 48% del total de niños que tienen Lactancia Materna Exclusiva tienen un Desarrollo Psicomotor Normal y el 6 % en riesgo. Y el 14% del total de niños que tienen Lactancia Mixta presentan un Desarrollo Psicomotor normal y el 17 % en riesgo. Se concluye que al relacionar las variables el valor Chi cuadrado es de 21.72 teniendo una significancia asintótica menor que el 5% (p = 0.000) por lo que existe relación directa entre ambas variables

Current Positioning against Severe Infections Due to Klebsiella pneumoniae in Hospitalized Adults

Klebsiella pneumoniae; Cefiderocol; Nosocomial pneumoniaKlebsiella pneumoniae; Cefiderocol; Neumonía nosocomialKlebsiella pneumoniae; Cefiderocol; Pneumònia nosocomialInfections due to Klebsiella pneumoniae have been increasing in intensive care units (ICUs) in the last decade. Such infections pose a serious problem, especially when antimicrobial resistance is present. We created a task force of experts, including specialists in intensive care medicine, anaesthesia, microbiology and infectious diseases, selected on the basis of their varied experience in the field of nosocomial infections, who conducted a comprehensive review of the recently published literature on the management of carbapenemase-producing Enterobacterales (CPE) infections in the intensive care setting from 2012 to 2022 to summarize the best available treatment. The group established priorities regarding management, based on both the risk of developing infections caused by K. pneumoniae and the risk of poor outcome. Moreover, we reviewed and updated the most important clinical entities and the new antibiotic treatments recently developed. After analysis of the priorities outlined, this group of experts established a series of recommendations and designed a management algorithm

Impact of non-invasive mechanical ventilation (niv) in critical patients with influenza (H1N1) PDM09

The use of non-invasive mechanical ventilation (NIV) in patients with influenza A (H1N1)pdm09 admitted to intensive care units (ICU) has been controversial

Peripheral maintenance of the axis SIRT1-SIRT3 at youth level may contribute to brain resilience in middle-aged amateur rugby players

Physical exercise performed regularly is known to improve health and to reduce the risk of age-related diseases. Furthermore, there is some evidence of cognitive improvement in physically active middle-aged and older adults. We hypothesized that long-term physically active middle-aged men may have developed brain resilience that can be detected with the analysis of peripheral blood markers. We aimed to analyze the activation of pathways potentially modulated by physical activity in a cohort of healthy amateur rugby players (n = 24) and control subjects with low physical activity (n = 25) aged 45-65 years. We had previously reported neuropsychological improvement in immediate memory responses in the player group compared to the controls. Here, we tested the expression of selected genes of longevity, inflammation, redox homeostasis, and trophic signaling in whole blood mRNA. Analyses were also performed on blood samples of young (aged 15-25 years) control subjects with low physical activity (n = 21). Physical activity and other lifestyle factors were thoroughly recorded with standardized questionnaires. Interestingly, middle-aged control subjects showed lower levels of expression of SIRT1, SIRT3, CAT, and SOD1 than the young controls, although rugby players maintained the expression levels of these genes at a young-like level. Middle-aged players showed lower levels of IL1B than the non-physically active groups. However, there was a tendency towards a decrease in trophic and transduction factors in middle-aged groups as compared to the young controls. A statistical study of Spearman's correlations supported a positive effect of sporting activity on memory and executive functions, and on peripheral gene expression of SIRT1, SIRT3 and downstream genes, in the middle-aged rugby players. Our results indicate that the SIRT1-SIRT3 axis, and associated neuroprotective signaling, may contribute to the anti-aging resilience of the brain mediated by physical exercise

Pandemic and post-pandemic Influenza A (H1N1) infection in critically ill patients

Background: There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. Methods: A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. Results: Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. Conclusion: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection

Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009-2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the binominal distributions of the true (+) and true (−) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT <0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT <0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock

Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19:a multinational, multicentre study, prospective, observational study

Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes. Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Opportunistic detection of atrial fibrillation in subjects aged 65 years or older in primare care: a randomised clinical trial of efficacy. DOFA-AP study protocol.

Clinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers.post-print290 K

Prevenció de la infecció respiratòria

Infecció respiratòria; Prevenció; Atenció sanitàriaInfección respiratória; Prevención; Atención sanitáriaRespiratory infection; Prevention; Health careMonografia sobre temes concrets relacionats amb la prevenció de la infecció respiratòria relacionada amb l‟atenció sanitària. Ha estat elaborada per un comitè d‟experts amb una àmplia trajectòria en el camp de l'atenció a pacients amb problemes respiratoris. El document comença fent una posada al dia de l‟epidemiologia i l‟etiopatogènia de les infeccions respiratòries nosocomials i, sense voler repetir capítols de la monografia d'aïllaments, continua fent una pinzellada de les mesures que cal dur a terme per evitar la transmissió de les infeccions respiratòries dins dels centres sanitaris. Tot seguit, s‟aborden de manera pràctica situacions quotidianes, com el maneig de la via aèria, i es fan algunes recomanacions sobre com dur-les a terme. Una part important i poc coneguda per molts professionals és la prevenció de la infecció respiratòria de causa instrumental, motiu pel qual en el darrer capítol es fa una revisió minuciosa de com procedir per reutilitzar aquests aparells.Monografía sobre temas concretos relacionados con la prevención de la infección respiratoria con la atención sanitaria. Ha sido elaborada por un comité de expertos con una amplia trayectoria en el campo de la atención a pacientes con problemas respiratorios. El documento empieza haciendo una puesta al día de la epidemiologia y la etiopatogenia de las infecciones respiratorias nosocomiales y, sin querer repetir capítulos de la monografía de aislamientos, continua haciendo una pincelada de las medidas que son necesarias para evitar la transmisión de las infecciones respiratorias dentro de los centros sanitarios. Seguidamente se tratan de manera práctica situaciones cotidianas, como el manejo de la vía aérea y se hacen algunas recomendaciones sobre como llevarlas a cabo. Una parte importante y poco conocida para muchos profesionales es la prevención de la infección respiratoria de causa instrumental, motivo por el cual en el último capítulo se hace una revisión minuciosa de como proceder para reutilizar estos aparatos