The history of mechanical ventilation

The aim of mechanical ventilation is to substitute physiological respiratory function. The boom of mechanical ventilation came during the XVIII century with the development of Reanimation Societies in Europe, who promoted the use of positive pressure ventilation modes. This type of ventilation caused new complications due to excessive positive pressure in the airway. Therefore, during the XIX century negative pressure ventilation predominated, which became essential during the second half of the 19th century and first half of the 20th century. Positive pressure ventilation was relegated to operating rooms until 1952, when it was imposed over negative pressure ventilation during the Copenhagen polio epidemic. Björn Ibsen contributed significantly to this change of ventilation paradigm, which led to the latest ventilation strategies and the development of the actual intensive care units

COVID-19 and cardiovascular disease

En diciembre de 2019, en Wuhan, provincia de Hubei en China, se reportó un grupo de 27 pacientes con neumonía de etiología desconocida, vinculados con exposición al mercado de mariscos, pescado y animales vivos. El 7 de enero de 2020, se identificó una nueva sepa de coronavirus aislada en estos pacientes (SARS-CoV-2); la enfermedad producida por este virus ha sido denominada COVID-19. Durante las etapas iniciales de la pandemia y dados los pocos estudios publicados al respecto, se creía que este coronavirus causaba síntomas netamente respiratorios; sin embargo, a medida que el número de pacientes aumentó, se observó que la enfermedad cardiovascular tenía un papel fundamental en el desarrollo y pronóstico de la infección. Los factores de riesgo más importantes relacionados con mortalidad son la edad y la presencia de comorbilidades, especialmente de tipo cardiovascular. El incremento en niveles de troponina, péptidos natriuréticos y dímero-D tiene valor pronóstico en pacientes con infección por SARS-CoV-2. Los pacientes con COVID-19 tienen un aumento en el riesgo de infarto agudo del miocardio, miocarditis, insuficiencia cardiaca, choque, arritmias y muerte súbita, en relación con la respuesta sistémica al virus y a los tratamientos necesarios en la fase aguda. En este documento se revisa el compromiso cardiovascular por SARS-CoV-2 (COVID-19).In December 2019, in Wuhan in the province of Hubei in China, there was a report on a group of 27 patients with a pneumonia of unknown origin, linked to exposure in a market with shellfish, fish, and live animals. In January 2020, a new strain of coronavirus (SARS-CoV-2) was isolated in these patients. The disease caused by this virus has been given the name of COVID-19. During the initial stages of the pandemic, and given the scarcity of studies published about this, it was believed that this coronavirus only caused respiratory symptoms. However, as the number of patients increased, it was observed that cardiovascular disease had a fundamental role in the development and prognosis of the infection. The most important risk factors associated with mortality are age and the presence of comorbidities, particularly cardiovascular ones. The increase in the levels of troponin, natriuretic peptides, and D-dimer are of prognostic values in patients with an infection due to SARS-CoV-2. Patients with COVID-19 have an increased risk of acute myocardial infarction, myocarditis, heart failure, shock, arrhythmias, and sudden death, in relation to the systematic response to the virus and to the treatments needed in the acute phase. A review is presented in this article of the cardiovascular involvement due to SARS-CoV-2 (COVID-19)

La Imagen y la Narrativa como Herramientas para el Abordaje Psicosocial en Escenarios de Violencia. Ciudad Santiago de Cali

Este trabajo presenta la actividad final correspondiente al desarrollo Diplomado de Acompañamiento Psicosocial en Escenarios de Violencia el cual hace énfasis en el análisis del conflicto armado vivido en nuestro país, enfocándonos en el deterioro y secuelas irreparables por cuenta de la violencia en cada una de sus víctimas, resaltando como los daños y consecuencias de dicho conflicto y sus problemáticas pueden ser irreparables. De esta manera nos adentramos en relatos donde las vivencias de la violencia pueden llegar a ser individuales o colectivos, de estas situaciones se desencadenan diferentes tipos de efectos psicosociales, problemas de salud mental, perturbaciones de su bienestar social entre otros.Uno de los objetivos del trabajo es analizar el caso de la señora Ana Ligia, una víctima del conflicto a causa del desplazamiento forzado; quien intenta reconstruir su vida y la de su familia después de haber sufrido los rigores de la violencia como una valiente sobreviviente. También se analiza en segunda instancia el caso de las comunidades de la cuenca del Cacarica, las cuales han sufrido el impacto de la violenciaentre actores armados, siendo desplazados de sus territorios. Para dar desarrollo a éstos análisis, se abordaron los diferentes casos desde el debido estudio bibliográfico, enfatizando en temáticas como atención psicosocial en tiempos de crisis, acciones psicosociales con víctimas de violencia, desarrollo de la técnica de foto voz, formulación de preguntas en intervención psicosocial, temáticas abordados desde diferentes enfoques. Al analizar los casos y problemáticas encontramos debilidades, fortalezas que sirvieron como insumos para formular ejemplos de preguntas circulares, reflexivas y estratégicas orientadas a la intervención psicosocial del caso de Ana Ligia. Por otro lado se generaron estrategias de intervención en crisis, y se plantearon acciones de intervención psicosocial en el caso de las comunidades de la cuenca de la Cacarica. Como punto final se expone el desarrollo de la técnica Foto Voz, el cual se desarrolló en las diferentes comunidades donde habitan los miembros del grupo de trabajo, a través de un análisis colectivo de los distintos ejercicios se evidencian las formas de la violencia en el territorio.This report presents the final activity concerning to the development of a Diploma in Psychosocial Accompaniment in Scenarios of Violence, which emphasizes in the analysis of some psychosocial issues in the armed conflict in Colombia, focusing on the deterioration and irreparable consequences of violence on each of its victims. Highlighting how the damages and consequences of this conflict and its problems can be irreparable. We enter into stories where the experiences of violence can become individual or collective, from these situations different types of psychosocial effects are triggered, mental health problems, disturbances of their social well-being, among others. One of the objectives of the work is to analyze the case of Mrs. Ana Ligia, a victim of the conflict due to forced displacement; who tries to rebuild her life and her family’s after having suffered the rigors of violence as a brave survivor. The case of the communities of the CacaricaRiver, which have suffered the impact of violence between armed actors, being displaced from their territories is also analyzed in second instance. To develop these analyzes, the different cases were approached from the due bibliographic study, emphasizing themes such as psychosocial care in times of crisis, psychosocial actions with victims of violence, development of the photo-voice technique, formulation of questions in psychosocial intervention , themes studied from different approaches. When analyzing the cases and problems, we found weaknesses, strengths that served as inputs to formulate examples of circular, reflective, and strategic questions aimed at psychosocial intervention in the case of Ana Ligia. On the other hand, crisis intervention strategies were generated, and psychosocial intervention actions were proposed in the case of the communities of the Cacarica River. As a final point, the development of the Photo Voice technique is exposed, which was developed in the different communities where the members of the working group live. Through a collective analysis of the different exercises, the forms of violence in the territory are evident

The urban project. The end of degree project

Ésta es una publicación que explica nuestra experien¬cia docente en la invención de estrategias para el territorio urbano, basadas en el proyecto como instrumento de in¬tervención; un método que presenta características de los planes a la vez que de los proyectos arquitectónicos, con ideas que van más allá del artefacto que proponen y del lugar estricto en que se implantan. Comoquiera que este libro se dedica a presentar los pro¬yectos fin de carrera de los estudiantes de Arquitectura que han elegido elaborar propuestas que siguen esta línea arquitectónico-urbanística. Desde nuestra joven Escuela de Arquitectura de Granada, quisiéramos ver arraigar y desarrollar algunos de los atributos que se presentanen el prólogo de Joan Busquets, destacado urbanista y pro¬fesor. Obviamente, la generosa autoriza-ción para publicar este texto, quiere significar para noso¬tros, y así lo sugerimos a nuestros alumnos y lectores, una referencia de calidad para seguir profundizando y mejoran¬do en el camino emprendido. Que no es otro que el empeño de contribuir al bienestar más igualitario de los ciudadanos en los territorios en que transcurren sus vidas. The implication of the University in the problems of the so¬ciety and the territory of its environment and of its time, constitutes a major exigency more the university institution spreads toal most all the cities of our country, all more cons¬cience is of that the knowledge is an essential vector of our time and major they are the requirements of innovation to face the emergent problems of extensive urbanization and environmental deterioration. Thisuniversitycommitmentwithitsenviromentissufficientlyrecognizedwhenonespeaksaboutinvestigation but is re comforting also to recognize it in educational efforts like that here we preface. The teaching is formation of human resources and frame of possible confluence of universal concepts with the local conditions. To the margin of this confrontation of generic values with a few historical - social precise and local needs, those resources would not conform as share capital, as so¬lidary with a collective project. In these publications of the a Area of Urban development and Land management of one of its years in the Technical Top School of Architecture, it is necessary to admit this effort of commitment between the global thing and the lo¬cal thing, between the knowledge and the practice, between culture and society. It is necessary to recognize, to support its continuity and contagious diffusion it and it be grateful to all by those, teachers and pupils, who have collaborated both in the curses and in the publications.Junta de Andalucía y Universidad de Granad

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome