Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Educational program on oral health aimed at families with preschool children residing in the Balboa Neighborhood

Background: health promotion should begin at an early age of development, so that children acquire healthy lifestyles that will be beneficial in the future.Objective: to implement an educational oral health program, aimed at the families of children from three to five years old enrolled in the Educate your child Program, from clinics eight and nine of the Ramón Balboa neighborhood, in Lajas municipality.Methods: an intervention study was carried out, from September 2020 to July 2021, at the headquarters of the Educate your child program, with 35 family members and 35 children between three and five years old enrolled in this program. The analyzed variables were: knowledge about oral hygiene, dietary habits and deforming habits, measured before and after the educational intervention.Results: the female sex and age of four years prevailed. The relatives were between 20 and 34 years old. The main risk factors identified were poor oral hygiene, incorrect tooth brushing and cariogenic diet. Before the intervention, regular knowledge about oral hygiene, poor knowledge about dietary habits, and a poor level of knowledge about deforming habits prevailed. After the intervention, a higher percentage of good knowledge about oral hygiene, dietary habits and a good level of knowledge about deforming habits was observed.Conclusions: after applying the educational intervention, a notable improvement in knowledge about oral health was evidenced.</p

Low power laser radiation treatment in patients with recurrent aphthous stomatitis

Background: among the periodontal emergencies that require immediate attention is the RAS, due to the inconvenience or complications that it causes to the patient. The use of low power laser radiation can be effective in the treatment of this entity.Objective: to determine the therapeutic effect of treatment with low-power laser radiation in patients diagnosed with recurrent aphthous stomatitis.Methods: descriptive, cross-sectional study, carried out from May/2019 to May/2021, in the Dr. Enrique Barnet polyclinic’s dental service, in Lajas municipality, Cienfuegos province, which included 46 patients diagnosed with recurrent aphthous stomatitis. Document analysis, observation and questionnaire were used; in addition to the oral examination as a diagnostic method. Patients received treatment with low-power laser radiation. The EPIDAT 3.1 program was applied for the statistical data processing.Results: the female sex predominated, the age between 19-34 years, as well as minor aphthous ulcers. The lesions were located mainly on the lip. 97.83% of the patients reported remission of the lesion on the fifth day of treatment. All treated patients evolved favorably towards healing. Only one patient presented adverse reactions.Conclusions: the results allowed us to verify the therapeutic benefits of low power laser therapy in the treatment of recurrent aphthous stomatitis.</p

Source Identification, Toxicity, and Persistence of PAHs in Sediment Core from a Natural Protected Area in Mexico

Sediment cores maintain a historical record of the various sources of polycyclic aromatic hydrocarbons (PAHs). In 2020, one sediment core was collected within the oyster farming area of the Pom–Atasta lagoon system and the Terminos lagoon. A total of 16 PAH compounds were analyzed to identify the historical patterns of PAH inputs and the relationship with sediment materials. The core was classified into three strata at depths of 0.0–0.2 m, 0.2–0.6 m, and 0.6–1.1 m, in which the high content of silt–sand, organic matter, and carbonates indicates a system of high energy and productivity. The hydrology and characteristics of the sediment suggest a free access of adsorbed PAHs to the study area, mainly of pyrolytic origin. The concentration of ∑PAHs decreases from the surface (527.0 ng g−1 dw) to a greater depth (75.7 ng g−1 dw), which corresponds to 60% of the HMW (high molecular weight) of the total PAHs as combustion products at low temperatures, while LWM-PAH (low molecular weight) inputs are from discharges of petroleum products. The core sediments showed a low probability of toxicity quotient of 9%. The analysis of the carcinogenic toxic equivalent (TEQcarc) in each section of the core was variable, decreasing with the depth from 107.91 ng TEQ g−1 dw to 57.65 ng TEQ g−1 dw, with the compounds benzo(a)pyrene (53.55 ng TEQ g−1 dw) and dibenzo(a,h) anthracene (29.2 ng TEQcarc g−1 dw) having the highest TEQcarc. The anthropogenic activities around the study area may increase the carcinogenic and mutagenic risk to human health. However, in the present study, the low toxic carcinogenic equivalents (TEQBaP) and mutagenic equivalents (MEQBaP) indicate a low probability of sediment toxicity. The ecosystem could be under constant threat from increasing anthropogenic activity; therefore, monitoring programs for the conservation of these ecosystems and oyster farms should be considered

Consensus document on acute-on-chronic liver failure (ACLF) established by the Mexican Association of Hepatology

Acute-on chronic liver failure (ACLF) has been an intensively debated topic mainly due to the lack of a unified definition and diagnostic criteria. The growing number of publications describing the mechanisms of ACLF development, the progression of the disease, outcomes and treatment has contributed to a better understanding of the disease, however, it has also sparked the debate about this condition. As an attempt to provide medical professionals with a more uniform definition that could be applied to our population, the first Mexican consensus was performed by a panel of experts in the area of hepatology in Mexico. We used the most relevant and impactful publications along with the clinical and research experience of the consensus participants. The consensus was led by 4 coordinators who provided the most relevant bibliography by doing an exhaustive search on the topic. The entire bibliography was made available to the members of the consensus for consultation at any time during the process and six working groups were formed to develop the following sections: 1.- Generalities, definitions, and criteria, 2.- Pathophysiology of cirrhosis, 3.- Genetics in ACLF, 4.- Clinical manifestations, 5.- Liver transplantation in ACLF, 6.- Other treatments

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave : the global UNITE-COVID study

Purpose To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality