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

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

Consultorías empresariales y negocios internacionales

On entrepreneurship, innovation, competitiveness, logistic performance, sales, marketing, among other everyday concepts of the economic world, you can continue writing full pages for the enjoyment of a reader, but achieve interact experiences of entrepreneurships that have the chapters of the book along with the The conformation of the foreign trade observatories (OCE) is a contribution with non-everyday ingredients to a task with many edges for understanding. Research to identify the factors that determine the logistics performance of SMEs in the logistics operator sector will provide the reader with a clear summary of a field work. Entrepreneurship and innovation as key factors in competitiveness are broken down between expectations and challenges of business development. The authors show us the perspective of the social and corporate fabric from the disruptive scenarios of recovery. In the chapters referring to the three experiences with a descriptive approach: identify the weaknesses and business development of the productive units of the beekeeping sector in the Department of Sucre, Colombia. Analyze the negotiating profile of sales employees of the hardware sector in Valledupar and shared the design of the marketing-based organizational philosophy for the tourism association (ATAV) in the village of Agua de la Virgen, jurisdiction of Ocaña, Norte de Santander Colombia Undoubtedly, the conformation of the foreign trade observatories (OCE) as a strategic academic body for universities corresponds to the best argument of diligent propositive alliances for the benefit of the regional and national economic sector in Colombia with the product of research has been the Response to the challenges of trade. For the previous comments and with the certainty that the narrations of the book will catch you, I invite you to enjoy it. My thanks to the Costa Atlántica Polytechnic, the Latin American University Corporation, the University of the Coast, the American University Corporation, the Simón Bolívar University and the Caribbean University Corporation, for the invitation deference, clarification from the observer's platform, their personal efforts and with The confidence for a better memory in alliances to continue with his legacy to the community.Sobre emprendimiento, innovación, competitividad, desempeño logístico, ventas, marketing, entre otros conceptos cotidianos del mundo económico se podrán seguir escribiendo páginas completas para el disfrute de un lector, pero lograr interactuar las experiencias de emprendimientos que muestran los capítulos del libro junto con la conformación de los observatorios de comercio exterior (OCE) es un aporte con ingredientes no cotidiano a una tarea de muchas aristas para el entendimiento. La investigación para Identificar los factores que determinan el desempeño logístico de las pymes del sector de operadores logísticos proporcionará al lector con claridad el resumen de un trabajo de campo. El emprendimiento e innovación como factores claves en la competitividad se desglosan entre expectativas y retos del desarrollo empresarial. Nos muestran sus autores la prospectiva del tejido social y corporativo a partir de los escenarios disruptivos de recuperación del mismo. En los capítulos referido a las tres experiencias con enfoque descriptivo: identifican las debilidades y fortalecimiento empresarial de las unidades productivas del sector apícola en Departamento de Sucre, Colombia.  Analizan del perfil negociador de los empleados de ventas del sector ferretero en Valledupar y comparten el diseño de la filosofía organizacional basado en el marketing para la asociación de turismo (ATAV) en la vereda del Agua de la Virgen, jurisdicción de Ocaña, Norte de Santander, Colombia. Sin duda, la conformación de los observatorios de comercio exterior (OCE) como un organismo académico estratégico para las Universidades corresponde  el mejor argumento de alianzas propositivas diligentes para el beneficio del sector económico Regional y Nacional en Colombia con el producto de las investigaciones  ha sido la respuesta a los retos del comercio. Por los comentarios anteriores y con la seguridad que las narraciones del libro lo atraparan,   le invito a disfrutarlo. Mis agradecimientos al Politécnico Costa Atlántica, la Corporación Universitaria Latinoamericana, la Universidad de la Costa, Corporación Universitaria Americana, Universidad Simón Bolívar y a la Corporación Universitaria Del Caribe,  por la deferencia de invitarme, aclamo desde la tribuna del observador, sus gestiones  individuales  y  con la confianza por un mejor porvenir en  alianzas  para continuar  con su legado a la comunidad. &nbsp

CONSULTORIAS EMPRESARIALES Y NEGOCIOS INTERNACIONALES

The purpose of this document is to present the analysis of the negotiating profileof the employees of the sales area of a hardware store in the city of Valledupar inwhich 31 salespeople were surveyed according to the criteria of the profile of thenegotiator of the Marrero and Ortiz model. It was possible to identify through anexploratory and confirmatory factorial analysis that the orientation of the employeesof the company was directed to the collaboration and satisfaction of the collectiveneeds of the individuals involved, in the same way it was established that in theemployees of this union the Compliance with duty with responsibility and ethicsplays a very important role when it comes to establishing negotiations.El prop´osito del presente documento es el de exponer el an´alisis del perfil negociadorde los empleados del ´area de ventas de una ferreter´ıa en la ciudad de Valleduparen la que se encuestaron a 31 vendedores de acuerdo a los criterios del perfil delnegociador del modelo de Marrero y Ortiz (2016). Se logr´o identificar mediante unan´alisis factorial exploratorio y confirmatorio que la orientaci´on de los empleadosde la empresa estaba dirigida a la colaboraci´on y a la satisfacci´on de las necesidadescolectivas de los individuos involucrados, de la misma manera se estableci´o que enlos empleados de este gremio el cumplimiento del deber con responsabilidad y ´eticajuega un papel muy importante a la hora de establecer negociaciones

Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort : 2004-2013

To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004-2013). Cox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS. Of 7165 new HIV diagnoses, 46.9% (CI:45.7-48.0) were LP, 240 patients died.First-year mortality was the highest (aHR = 10.3[CI:5.5-19.3]); between 1 and 4 years post-diagnosis, aHR = 1.9(1.2-3.0); an

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation

Pneumonia treated in the internal medicine department: Focus on healthcare-associated pneumonia

Patients with pneumonia treated in the internal medicine department (IMD) are often at risk of healthcare-associated pneumonia (HCAP). The importance of HCAP is controversial. We invited physicians from 72 IMDs to report on all patients with pneumonia hospitalized in their department during 2weeks (one each in January and June 2010) to compare HCAP with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). We analysed 1002 episodes of pneumonia: 58.9% were CAP, 30.6% were HCAP and 10.4% were HAP. A comparison between CAP, HCAP and HAP showed that HCAP patients were older (77, 83 and 80.5years; p<0.001), had poorer functional status (Barthel 100, 30 and 65; p<0.001) and had more risk factors for aspiration pneumonia (18, 50 and 34%; p<0.001). The frequency of testing to establish an aetiological diagnosis was lower among HCAP patients (87, 72 and 79; p<0.001), as was adherence to the therapeutic recommendations of guidelines (70, 23 and 56%; p<0.001). In-hospital mortality increased progressively between CAP, HCAP and HAP (8, 19 and 27%; p<0.001). Streptococcus pneumoniae was the main pathogen in CAP and HCAP. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) caused 17 and 12.3% of HCAP. In patients with a confirmed aetiological diagnosis, the independent risk factors for pneumonia due do difficult-to-treat microorganisms (Enterobacteriaceae, P. aeruginosa or MRSA) were HCAP, chronic obstructive pulmonary diseases and higher Port Severity Index. Our data confirm the importance of maintaining high awareness of HCAP among patients treated in IMDs, because of the different aetiologies, therapy requirements and prognosis of this population. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases