Cálculo de los contenidos arterial y venoso de oxígeno, de la diferencia arteriovenosa de oxígeno, tasa de extracción tisular de oxígeno y shunt intrapulmonar con unas nuevas fórmulas, basadas en la saturación de oxígeno

La evaluación del estado de perfusión tisular en el paciente en estado crítico comporta, además del procedimiento de toma de gases arteriales y venosos, la ejecución de numerosos cálculos basados en fórmulas matemáticas preestablecidas. El desarrollo de estos cálculos conlleva la posibilidad de error (más grande cuánto más complejas las fórmulas), además de la iatrogenia derivada del procedimiento de toma de gases en sí mismo. En un intento por simplificar las operaciones matemáticas necesarias para la evaluación gasimétrica, se efectuó una revisión de las fórmulas tradicionales evaluando  la posibilidad de reducir algunos de sus elementos, particularmente el contenido de oxígeno disuelto en sangre, en el cálculo de la diferencia arterio- venosa de oxígeno (Dav02); la tasa de extracción de oxígeno (Tex 02); el contenido arterial, venoso y capilar de oxígeno (Co02); y el "shunt" intrapulmonar (QS/QT). Se llevó a cabo una simulación computadorizada retrospectiva comparando los resultados obtenidos con la fórmula tradicional y aquellos obtenidos con la simplificada, utilizando 100 muestras seleccionadas mediante la función Por último, se realizó un estudio prospectivo en dos unidades de cuidado intensivo de Santafé de Bogotá (Hospital San Juan de Dios y Clínica Palermo) comparando las dos modalidades de cálculo gasimétrico. En esta última etapa, además de establecer la correlación entre las fórmulas tradicionales y las simplificadas, también se compararon los resultados obtenidos cuando las fórmulas se desarrollaron con base en la saturación de oxígeno calculada con el equipo de  gases y aquella obtenida directamente por la lectura del oxímetro de pulso colocado, habitualmente, en el dedo índice del paciente. Mediante comparación de medias y el análisis de regresión lineal para cada grupo de fórmulas analizadas, se pudo establecer la existencia de altos índices de correlación entre unas y otras. Los resultados demuestran que es posible suprimir el cálculo del oxígeno disuelto en sangre para la evaluación del estado de perfusión tisular del enfermo crítico y que, adoptando como medida de la saturación arterial de oxígeno aquella obtenida directamente por el oxímetro de pulso, en muchas circunstancias clínicas se podría incluso, evitar la toma de gases arteriales.Arterial blood gases sampling is a very useful tool in the evaluation of the peripheral perfusion state in the critically ill. Although extensively used, there is a high possibility of doing a wrong process of data, because the complexity of the mathematical formulations. In an attempt to simplify the operations devoted to evaluate the tissue perfusíon of patients in the intensive care unit, we propose a new group of formulations eliminating the free oxygen content in blood in the estimation of: arterial - venous oxygen difference (Dav02); oxygen extraction rate (Tex 02); oxygen blood content (co02) and intrapulmonary shunt (QS/QT). First, we compare retrospectively the results obtained using the traditional formulations and the new ones in a group of 100 samples selected by means of "random number" function of Excel ®. Then, we perform a prospective follow-up in two intensive ca re units in Santafé de Bogotá comparing the two methods of blood gases evaluation. Furthermore, we made the calculations using the arterial blood oxygen saturation given by the blood gases determination and the one obtained directly by the pulse- oxymeter, ussuaIy located at the index finger of the patient By using media comparison as well as linear regression analysis we could establish a high correlation index between the two methods of evaluation. These results demonstrate that it is possible to eliminate the free plasma oxygen content to perform an accurate evaluation of the peripheral perfusión state of the critically ill. Furthermore, by using the blood oxygen saturation obtained with a pulse-oxymeter, it could be possible even to avoid the procedure of blood gases sampling in sorne clinical settings

Cálculo de los contenidos arterial y venoso de oxígeno, de la diferencia arteriovenosa de oxígeno, tasa de extracción tisular de oxígeno y shunt intrapulmonar con unas nuevas fórmulas, basadas en la saturación de oxígeno

La evaluación del estado de perfusión tisular en el paciente en estado crítico comporta, además del procedimiento de toma de gases arteriales y venosos, la ejecución de numerosos cálculos basados en fórmulas matemáticas preestablecidas. El desarrollo de estos cálculos conlleva la posibilidad de error (más grande cuánto más complejas las fórmulas), además de la iatrogenia derivada del procedimiento de toma de gases en sí mismo. En un intento por simplificar las operaciones matemáticas necesarias para la evaluación gasimétrica, se efectuó una revisión de las fórmulas tradicionales evaluando  la posibilidad de reducir algunos de sus elementos, particularmente el contenido de oxígeno disuelto en sangre, en el cálculo de la diferencia arterio- venosa de oxígeno (Dav02); la tasa de extracción de oxígeno (Tex 02); el contenido arterial, venoso y capilar de oxígeno (Co02); y el "shunt" intrapulmonar (QS/QT). Se llevó a cabo una simulación computadorizada retrospectiva comparando los resultados obtenidos con la fórmula tradicional y aquellos obtenidos con la simplificada, utilizando 100 muestras seleccionadas mediante la función Por último, se realizó un estudio prospectivo en dos unidades de cuidado intensivo de Santafé de Bogotá (Hospital San Juan de Dios y Clínica Palermo) comparando las dos modalidades de cálculo gasimétrico. En esta última etapa, además de establecer la correlación entre las fórmulas tradicionales y las simplificadas, también se compararon los resultados obtenidos cuando las fórmulas se desarrollaron con base en la saturación de oxígeno calculada con el equipo de  gases y aquella obtenida directamente por la lectura del oxímetro de pulso colocado, habitualmente, en el dedo índice del paciente. Mediante comparación de medias y el análisis de regresión lineal para cada grupo de fórmulas analizadas, se pudo establecer la existencia de altos índices de correlación entre unas y otras. Los resultados demuestran que es posible suprimir el cálculo del oxígeno disuelto en sangre para la evaluación del estado de perfusión tisular del enfermo crítico y que, adoptando como medida de la saturación arterial de oxígeno aquella obtenida directamente por el oxímetro de pulso, en muchas circunstancias clínicas se podría incluso, evitar la toma de gases arteriales.Arterial blood gases sampling is a very useful tool in the evaluation of the peripheral perfusion state in the critically ill. Although extensively used, there is a high possibility of doing a wrong process of data, because the complexity of the mathematical formulations. In an attempt to simplify the operations devoted to evaluate the tissue perfusíon of patients in the intensive care unit, we propose a new group of formulations eliminating the free oxygen content in blood in the estimation of: arterial - venous oxygen difference (Dav02); oxygen extraction rate (Tex 02); oxygen blood content (co02) and intrapulmonary shunt (QS/QT). First, we compare retrospectively the results obtained using the traditional formulations and the new ones in a group of 100 samples selected by means of "random number" function of Excel ®. Then, we perform a prospective follow-up in two intensive ca re units in Santafé de Bogotá comparing the two methods of blood gases evaluation. Furthermore, we made the calculations using the arterial blood oxygen saturation given by the blood gases determination and the one obtained directly by the pulse- oxymeter, ussuaIy located at the index finger of the patient By using media comparison as well as linear regression analysis we could establish a high correlation index between the two methods of evaluation. These results demonstrate that it is possible to eliminate the free plasma oxygen content to perform an accurate evaluation of the peripheral perfusión state of the critically ill. Furthermore, by using the blood oxygen saturation obtained with a pulse-oxymeter, it could be possible even to avoid the procedure of blood gases sampling in sorne clinical settings

Actas de la Facultad de Ciencias de la Tierra de la Universidad Autónoma de Nuevo León [volumen 9]

Con motivo de las celebraciones del 90 aniversario de la Universidad Autónoma de Nuevo León (UANL) y el 40 aniversario de la Facultad de Ciencias de la Tierra (FCT), se presenta el volumen número 9 de Actas de la Facultad de Ciencias de la Tierra, el cual tiene como objetivo mostrar los resultados de la divulgación de las investigaciones realizadas por Profesores-Investigadores, alumnos y exalumnos de esta Dependencia, así como trabajos en colaboración con Investigadores de otras de dependencias tanto de la UANL como de otras instituciones a nivel nacional. La Facultad de Ciencias de la Tierra desde su formación tiene dentro de sus objetivos la generación y divulgación de nuevo conocimiento a todos los sectores de la sociedad, lo cual se ha visto reflejado en volúmenes previos de Actas, es por eso, que en este volumen conmemorativo se presentan 22 trabajos de divulgación científica que permiten ser una ventana a la investigación realizada en esta dependencia. Actas de la Facultad de Ciencias de la Tierra ha sido el espacio dónde a través de los años se han documentado diversas investigaciones de interés local, nacional e internacional, es por eso, que en estas conmemoraciones de aniversario me complace presentar este nuevo volumen para que se conozca la diversidad del conocimiento generado en esta dependencia y su impacto en la sociedad

Interpretación de datos magnetotelúricos de la transecta del sur del Perú y su relación con la metalogenia

En este trabajo se presentan los resultados de la investigación magnetotelúrica (MT), realizada a lo largo de la Transecta P1, que se extiende desde Mollendo hasta Puno, en el sur de Perú. Al emplear este método, en combinación con data aeromagnética y grandes sistemas de fallas corticales del sur del Perú (Carlotto et al., 2009), se desea destacar la importancia del método en identificar cuerpos resistivos, asociados a cuerpos ígneos, así como zonas poco resistivas, asociadas con grandes sistemas de fallas corticales y con zonas de intenso magmatismo e hidrotermalismo y su implicancia en definir Unidades Tectonoestratigráficas, las cuales albergan depósitos minerales de distintas características y edades, permitiendo así enriquecer el conocimiento del mapa Metalogenético (Acosta et al. 2009,2010)

Learning to make informed health choices : Protocol for a pilot study in schools in Barcelona

The Informed Health Choices (IHC) project has developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore both the students' and teachers' experience when using these resources in the context of Barcelona (Spain). During the 2019-2020 school year, we will conduct a pilot study with 4 th and 5 th-year primary school students (9 to 11-year-olds) from three schools in Barcelona. The intervention in the schools will include: 1) assessment of the IHC resources by the teachers before the lessons, 2) non-participatory observations during the lessons, 3) semi-structured interviews with the students after a lesson, 4) assessment of the lessons by the teachers after a lesson, 5) treatment claim assessment by the students at the end of the lessons, and 6) assessment of the IHC resources by the teachers at the end of the lessons. We will use ad hoc questionnaires and guides to register the data. We will perform a quantitative and qualitative analysis of the data to explore understandability, desirability, suitability, usefulness, facilitators and barriers of the resources. The most relevant results will be discussed and some recommendations on how to use, how to adapt (if needed), and how to implement the IHC resources to this context will be agreed. The findings of the contextualization activities could inform the design of a cluster-randomised trial, to determine the effectiveness of the IHC resources in this context prior to scaling-up its use. The study protocol has obtained an approval exemption from the Ethics Committee of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain)

Métodos y técnicas de monitoreo y predicción temprana en los escenarios de riesgos socionaturales

Esta obra concentra los métodos y las técnicas fundamentales para el seguimiento y monitoreo de las dinámicas de los escenarios de riesgos socionaturales (geológicos e hidrometeorológicos) y tiene como objetivo general orientar, apoyar y acompañar a los directivos y operativos de protección civil en aterrizar las acciones y políticas públicas enfocadas a la gestión del riesgo local de desastre

Control of paratuberculosis: who, why and how. A review of 48 countries

Paratuberculosis, a chronic disease affecting ruminant livestock, is caused by Mycobacterium avium subsp. paratuberculosis (MAP). It has direct and indirect economic costs, impacts animal welfare and arouses public health concerns. In a survey of 48 countries we found paratuberculosis to be very common in livestock. In about half the countries more than 20% of herds and flocks were infected with MAP. Most countries had large ruminant populations (millions), several types of farmed ruminants, multiple husbandry systems and tens of thousands of individual farms, creating challenges for disease control. In addition, numerous species of free-living wildlife were infected. Paratuberculosis was notifiable in most countries, but formal control programs were present in only 22 countries. Generally, these were the more highly developed countries with advanced veterinary services. Of the countries without a formal control program for paratuberculosis, 76% were in South and Central America, Asia and Africa while 20% were in Europe. Control programs were justified most commonly on animal health grounds, but protecting market access and public health were other factors. Prevalence reduction was the major objective in most countries, but Norway and Sweden aimed to eradicate the disease, so surveillance and response were their major objectives. Government funding was involved in about two thirds of countries, but operations tended to be funded by farmers and their organizations and not by government alone. The majority of countries (60%) had voluntary control programs. Generally, programs were supported by incentives for joining, financial compensation and/or penalties for non-participation. Performance indicators, structure, leadership, practices and tools used in control programs are also presented. Securing funding for long-term control activities was a widespread problem. Control programs were reported to be successful in 16 (73%) of the 22 countries. Recommendations are made for future control programs, including a primary goal of establishing an international code for paratuberculosis, leading to universal acknowledgment of the principles and methods of control in relation to endemic and transboundary disease. An holistic approach across all ruminant livestock industries and long-term commitment is required for control of paratuberculosis

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat