Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

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

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

El Ferial de Torrelavega

El proyecto dentro del programa Cantabria en las Aulas se llevó a cabo en el CP José Luis Hidalgo de Torrelavega, varios profesores participaron en él estableciendo los siguientes objetivos divididos por áreas de conocimiento: Lenguaje: 1. Enriquecer el vocabulario usual con el específico de las transacciones y explotaciones ganaderas. 2. Preparar y desarrollas entrevistas. 3. Lectura y elaboración de artículos para medios de difusión. 4. Correspondencia de los alumnos con otros centros en cuyas localidades existan mercados o ferias de la comunidad, de otros o también de fuera de España. Matemáticas: 1. Dominar las cuatro operaciones fundamentales a través de las transacciones de ganado y precio de la leche. 2. Convertir estos valores en euros. 3. Utilizar las medidas de capacidad sobre la leche y las medidas de superficie en los terrenos, explotaciones ganaderas, ferial, etc. Conocimiento del Medio Natural y Social: 1. Localizar las principales zonas ganaderas de Cantabria con influencia de climas y de condiciones geográficas en las explotaciones ganaderas. 2. Estudiar la evolución de la ganadería a través del tiempo, así como los utensilios utilizados. 3. Estudiar la leche como materia prima y la elaboración de productos derivados. Idioma: 1. Conocer el vocabulario de la ganadería y comercialización. 2. Mantener entrevistas cualificadas del ferial en el idioma inglés. Artística: 1. Elaborar murales con vacas de distinta raza y paisaje. 2 Elaborar dibujos y croquis del ferial. 3. Recitar canciones o poemas referentes a la ganadería. Tema Transversal: Respetar y dar un trato debido a los animales. Conocer las ordenanzas de transporte de los animales. Para ello pusieron en marcha las siguientes actividades: Salidas al Ferial para conocer tratos de compraventa, vocabulario utilizado, etc. Realizar entrevistas a ganaderos y tratantes para tener una visión de la Feria. Mapas de la geografía de nuestra Comunidad haciendo referencia a las explotaciones ganaderas. Climogramas. Visita a alguna explotación ganadera. Visita a otro mercado fuera de la Comunidad. Visita a una fábrica de productos lácteos. El material utilizado fue: material fungible de papelería y del aula, libros, material de vídeo, etc..Gobierno de CantabriaCantabriaES

Paleoenvironmental and Geoarchaeological reconstruction from Late Holocene slope records (Lower Huerva Valley, Ebro Basin, NE Spain)

Slope deposits in semiarid regions are known to be very sensitive environments, especially those that occurred during the minor fluctuations of the late Holocene. In this paper we analyse Holocene colluvium genesis, composition, and paleoenvironmental meaning through the study of slope deposits in NE Spain. Two cumulative slope stages are described during this period. In the study area, both slope accumulations are superimposed and this has enabled an excellent preservation of the aggregative sequence and the paleosols corresponding to stabilisation stages. 14C and TL dating, as well as archaeological remains, provide considerable chronological precision for this sequence. The origin of the accumulation of the lower unit is placed around 4295–4083 cal yr BP/2346–2134 cal yr BC (late Chalcolithic) and it developed until the Iron Age in a cooler and wetter climate (Cold Iron Age). Under favourable conditions, a soil A-horizon was formed on top of this unit. A new slope accumulation was formed during the Little Ice Age. Within the slope two morphogenetic periods ending with A-horizons are distinguished and related with two main cold–wet climatic events. The study of these slopes provides a great amount of data for the paleoenvironmental and geoarchaeological reconstruction of the late Holocene in NE Spain.Fil: Pérez Lambán, Fernando. Universidad de Zaragoza; EspañaFil: Peña Monné, José Luis. Universidad de Zaragoza; EspañaFil: Fanlo Loras, Javier. Universidad de Zaragoza; EspañaFil: Picazo Millán, Jesús V.. Universidad de Zaragoza; EspañaFil: Badía Villas, David. Universidad de Zaragoza; EspañaFil: Rubio Fernández, Virginia. Universidad Autónoma de Madrid; EspañaFil: García Giménez, Rosario . Universidad Autónoma de Madrid; EspañaFil: Sampietro Vattuone, Maria Marta. Universidad Nacional de Tucuman. Facultad de Cs.naturales E Instituto Miguel Lillo. Laboratorio de Geoarqueologia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Alimentación saludable

El proyecto no ha sido publicado. Resumen basado en ficha elaborada por los autoresEl trabajo se ha realizado en el CP José María Pereda, participando en él los 22 profesores con los que cuenta el centro. Los objetivos del proyecto son conocer los habitos alimenticios del alumnado, dar a conocer hábitos saludables en la alimentación, sustituir golosinas y otros productos no saludables por fruta del tiempo y frutos secos, analizar las etiquetas de distintos alimentos y golosinas, trabajar para conocer enfermedades relacionadas con la alimentación, conocer la gastronomía de otros países, analizar la influencia de la publicidad sobre los hábitos alimenticios. Para esto se han realizado diferentes actividades como son la realización de desayunos y meriendas con los alumnos, el reparto de fruta en los recreos, trabajo con la rueda de alimentos, análisis de alimentos, salidas al mercado, etc. Para la valoración de los resultados obtenidos gracias al proyecto, se han realizado encuestas entre los alumnos antes y después de la realización del mismo, para así poder valorar los cambios en los hábitos alimenticios; De las respuestas a esos formularios se decanta que el proyecto crea hábitos alimenticios saludables en los alumnos, quienes aprenden a proteger su salud, desarrollan interés por la alimentación y aprenden a ser críticos. Se han empleado distintos materiales relacionados con el mundo de la alimentación y la salud.Consejería de Educación y Juventud de CantabriaVarias empresas de alimentación de CantabriaCantabriaES

Pictavia Aurea

Este volumen, titulado Pictavia aurea, reúne 131 estudios que constituyen una granada muestra de los debates y las presentaciones en torno a la cultura hispánica del Siglo de Oro que entre los días 11 y 15 de julio de 2011 se dieron en la ciudad de Poitiers (Francia) en el marco del IX congreso de la Asociación Internacional “Siglo de Oro”. Auspiciada por la Universidad de Poitiers, a través del Centro de Estudios de la Literatura española de Entre Siglos (siglos xvii-xviii) (CELES XVII-XVIII) y el laboratorio «Formes et Représentations en Linguistique et Littérature» (FoReLL), la convocatoria reunió en la ciudad francesa a 276 participantes y a un centenar de asistentes en la novena edición del Congreso de la Asociación, que celebró entonces la efeméride del 450o aniversario del nacimiento de Luis de Góngora.A Isaías Lerner, maestro de la filología hispánic

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective