Tendencias de la investigación en Ingeniería Ambiental

Esta obra incluye las memorias del Simposio “Tendencias de la Investigación en Ingeniería Ambiental”, organizado por el Grupo de Investigaciones y Mediciones Ambientales (GEMA), realizado en la Universidad de Medellín en agosto de 2007. El texto está conformado por 14 capítulos agrupados en cuatro partes. En la primera se agrupan los trabajos relacionados con la calidad y alternativas de tratamiento del agua e hidráulica ambiental (capítulos 1 al 4). La segunda trata temas relacionados con la contaminación atmosférica y calidad del aire (capítulos 5 al 6). La tercera está relacionada con las tecnologías ambientales para la recuperación y conservación de suelos (capítulos 7 al 10) y la cuarta y última comprende las temáticas asociadas con la sostenibilidad ambiental del territorio (capítulos 11 al 14). En este sentido, estamos convencidos del valioso aporte que el libro dará a la comunidad científica, por ser este un documento de divulgación de resultados de investigación en ingeniería ambiental.PRÓLOGO............13 PRESENTACIÓN.............15 PRIMERA PARTE CALIDAD Y ALTERNATIVAS DE TRATAMIENTO DEL AGUA HIDRÁULICA AMBIENTAL Capítulo 1 PRETRATAMIENTO DE AGUAS RESIDUALES INDUSTRIALES MEDIANTE FOTO-FENTON SOLAR A ESCALA INDUSTRIAL ACOPLADO A BIOTRATAMIENTO CON FANGOS ACTIVOS INMOVILIZADOS Manuel Ignacio Maldonado, Isabel Oller, Wolfgang Gernjak, Sixto Malato 1.1 INTRODUCCIÓN............19 1.2 MATERIALES Y MÉTODOS.............21 1.2.1 Reactivos............21 1.2.2 Determinaciones analíticas.............22 1.2.3 Dispositivo experimental.............23 1.3 R ESULTADOS Y DISCUSIÓN............ 27 1.3.1 Tratamiento foto-Fenton solar............27 1.3.2 Biotratamiento mediante fangos activos inmovilizados.............33 1.3.3 Sistema combinado foto-Fenton solar-biológico aeróbico............35 1.4 CONCLUSIONES............. 42 Capítulo 2 DEGRADACIÓN DE LA ATRAZINA EN SOLUCIÓN ACUOSA USANDO RADIACIÓN UV Y PROCESOS DE OXIDACIÓN AVANZADA Margarita Hincapié, Gustavo Peñuela, Manuel I. Maldonado, Sixto Malato 2.1 INTRODUCCIÓN..............47 2.2 SECCIÓN EXPERIMENTAL..............53 2.2.1 Materiales.............53 2.2.2 Metodología...............53 2.2.3 Determinación analítica..............55 2.2.4 Determinación de la toxicidad...............55 2.3 R ESULTADOS Y DISCUSIÓN...............56 2.3.1 Hidrólisis..............56 2.3.2 Fotólisis y fotocatálisis con TiO2 Degussa P25.............56 2.3.3 Efecto de los agentes oxidantes peróxido de hidrógeno y persulfato de sodio en la fotocatálisis..............59 2.3.4 Proceso foto Fenton..............63 2.3.5 Evaluación de los aniones inorgánicos durante los dos tratamientos.............66 2.3.6 Cuantificación e identificación de los productos de degradación...............68 2.3.7 Evaluación de la toxicidad...............71 2.4 CONCLUSIONES...............74 Capítulo 3 HUMEDALES ARTIFICIALES PARA EL TRATAMIENTO DE AGUAS RESIDUALES Nazly E. Sánchez P., Gustavo A. Peñuela M., Juan C. Casas Z. 3.1 INTRODUCCIÓN...............81 3.2 MARCO TEÓRICO...............83 3.2.1 Humedales construidos para el tratamiento de aguas residuales..............84 3.2.2 Clasificación de los humedales.............85 3.2.3 Ventajas y desventajas de los humedales subsuperficiales..............87 3.2.4 Aspectos a considerar en los humedales subsuperficiales..............88 3.3 MATERIALES Y MÉTODOS.................89 3.3.1 Diseño y construcción de los humedales a escala piloto..............89 3.3.2 Componentes del agua residual sintética................90 3.3.3 Siembra y aclimatación de plantas............... 90 3.3.4 Muestreos............91 3.4 R ESULTADOS Y DISCUSIÓN..............91 3.4.1 pH..............91 3.4.2 Demanda bioquímica de oxígeno (DBO5)..............92 3.4.3 Carbono orgánico total (COT)................94 3.5 CONCLUSIONES................95 Capítulo 4 DESCRIPCIÓN DE LA DINÁMICA OCEANOGRÁFICA DEL GOLFO DE URABÁ UTILIZANDO MEDICIONES DE CAMPO Luis Javier Montoya Jaramillo, Francisco Mauricio Toro Botero 4.1 INTRODUCCIÓN...............103 4.2 DATOS Y MÉTODOS................107 4.3 DISCUSIÓN..............118 4.4 CONCLUSIONES............. 120 SEGUNDA PARTE CONTAMINACIÓN ATMOSFÉRICA Y CALIDAD DEL AIRE Capítulo 5 IMPACTO DE LAS MOTOCICLETAS EN LA CALIDAD DEL AIRE. ESTUDIO DE CASO: MONTERÍA Carlos Alberto Echeverri Londoño 5.1 INTRODUCCIÓN.................127 5.2 MATERIALES Y MÉTODOS...............131 5.2.1 S elección de los sitios de medición...............131 5.2.2 Período de medición................131 5.2.3 Parámetros seleccionados...............132 5.2.4 Equipos y materiales utilizados..............132 5.2.5 Índices de calidad del aire..............133 5.2.6 Legislación.............. 138 5.2.7 Inventario de emisiones..............141 5.3 RESULTADOS...............142 5.3.1 Calidad del aire y calidad acústica................142 5.3.2 Emisiones vehiculares.............150 5.3.3 Inventario de emisiones.............155 5.4 CONCLUSIONES.............. 158 5.5 RECOMENDACIONES............. 160 Capítulo 6 ROMPIMIENTO DE LA INVERSIÓN TÉRMICA EN EL VALLE DE ABURRÁ Ángela M. Rendón, José F. Jiménez, Carlos Palacio 6.1 INTRODUCCIÓN...............163 6.2 MEDICIÓN DE VARIABLES ATMOSFÉRICAS..............164 6.3 CAMPAÑAS DE MEDICIÓN.............165 6.4 RESULTADOS..............166 6.5 CONCLUSIONES................170 TERCERA PARTE TECNOLOGÍAS AMBIENTALES PARA LA RECUPERACIÓN Y CONSERVACIÓN DE SUELOS Capítulo 7 ESTRUCTURA MODELO DE LA PARTÍCULA FUNDAMENTAL DEL COMPOST Carlos E. Arroyave M., Carlos A. Peláez J. 7.1 INTRODUCCIÓN..............177 7.2 MATERIALES Y EQUIPOS.............178 7.2.1 Materias primas y planta de compostaje............178 7.2.2 Obtención de fracciones............. 182 7.2.3 Análisis estadístico.............184 7.3 RESULTADOS Y DISCUSIÓN.............184 7.3.1 Caracterización fisicoquímica del material de RSUsf...........184 7.3.2 Tamaño de partícula.............185 7.3.3 Análisis instrumental................187 7.3.4 Modelo de partícula..............194 7.4 CONCLUSIONES..............195 Capítulo 8 DEGRADACIÓN DE HEXACLOROCICLOHEXANO (HCH) CON HONGOS DE PODREDUMBRE DE LA MADERA Juan Carlos Quintero Díaz, Gumersindo Feijoo, Juan Manuel Lema 8.1 INTRODUCCIÓN..............199 8.2 MATERIALES Y MÉTODOS..............204 8.2.1 Microorganismos.............204 8.2.2 Ensayos de selección de los hongos de podredumbre de la madera.............204 8.2.3 Ensayos de degradación de HCH en medio líquido.............205 8.2.4 Ensayos de degradación de HCH en sobre suelo contaminado.............205 8.2.5 Extracción y análisis de los isómeros de HCH.............208 8.3 RESULTADOS Y DISCUSIÓN..............209 8.3.1 Selección de los microorganismos.............209 8.3.2 Degradación de HCH en medio líquido.............210 8.3.3 Degradación de HCH en fase sólida.............212 8.4 CONCLUSIONES.............. 220 Capítulo 9 AVANCES EN LA PROPAGACIÓN ASIMBIÓTICA IN VITRO DE ORQUÍDEAS CON ESPECIAL ÉNFASIS EN EL GÉNERO CATTLEYA Liliana R. Botero, María A. Jaramillo, Óscar O. Ossa R., Tatiana Saldarriaga F., Estefanía Ortiz R. 9.1 INTRODUCCIÓN...............227 9.2 MATERIALES Y MÉTODOS...............231 9.2.1 Evaluación de la metodología de desinfección de cápsulas de orquídeas.............231 9.2.2 Evaluación del efecto de un abono comercial y un suplemento comercial de banano............239 9.3 R ESULTADOS Y DISCUSIÓN..............242 9.3.1 Ensayos de desinfección...............242 9.3.2 Resultados del efecto de un abono comercial y un suplemento de banano comercial....246 9.4 CONCLUSIONES..............254 Capítulo 10 MOVILIDAD DEL BRAVONIL 720 (CLOROTALONILO) A TRAVÉS DE LA ZONA NO SATURADA Y SATURADA DE UN ACUÍFERO LIBRE SIMULADO Idalia Jacqueline López Sánchez, Gustavo Antonio Peñuela Mesa 10.1 INTRODUCCIÓN...............259 10.2 MATERIALES Y MÉTODOS...............261 10.3 RESULTADOS Y DISCUSIÓN..............269 10.4 CONCLUSIONES..............292 CUARTA PARTE SOSTENIBILIDAD AMBIENTAL DEL TERRITORIO Capítulo 11 LA RESPONSABILIDAD SOCIAL EMPRESARIAL COMO COMPONENTE DE SOSTENIBILIDAD AMBIENTAL John Fredy López Pérez 11.1 INTRODUCCIÓN...............299 11.2 UNA LECTURA DE LA SOSTENIBILIDAD AMBIENTAL DESDE UN PUNTO DE VISTA SOCIAL..............300 11.3 EL CONCEPTO DE LA RESPONSABILIDAD SOCIAL EMPRESARIAL...............303 11.4 LA RESPONSABILIDAD SOCIAL COMO ESPACIO PARA L A SOSTENIBILIDAD AMBIENTAL.............309 11.5 ESBOZOS DE UN CASO: EL SECTOR ELÉCTRICO COLOMBIANO..............311 11.6 CONCLUSIONES..............319 Capítulo 12 DETERMINACIÓN ESPACIAL DE ÁREAS DE IMPORTANCIA ESTRATÉGICA El caso de microcuencas abastecedoras de acueductos veredales del municipio de Medellín Joaquín Hincapié, Álvaro Lema 12.1 INTRODUCCIÓN................323 12.2 LA NOCIÓN DE ÁREA DE IMPORTANCIA ESTRATÉGICA...............325 12.3 LA IDEA DE LOS SERV ICIOS AMBIENTALES..............328 12.4 ESTRATEGIA METODOLÓGICA EN LA IDENTIFICACIÓN Y DETERMINACIÓN DE LAS ÁREAS DE IMPORTANCIA ESTRATÉGICA............332 12.5 L OS RESULTADOS DEL MODELO...............359 12.6 CONCLUSIONES............. 361 Capítulo 13 LA EDUCACIÓN AMBIENTAL EN LA TRANSFORMACIÓN DE LA CULTURA Luz Ángela Peña Marín, Alba Miriam Vergara Vargas 13.1 INTRODUCCIÓN..............369 13.2 APROXIMACIÓN CONCEPTUAL...............370 13.2.1 La reflexividad...............372 13.2.2 La construcción del otro...............374 13.2.3 El discurso.............. 372 13.2.4 La autonomía y la participación..............375 13.2.5 La educación ambiental y el desarrollo humano..............378 13.2.6 Base conceptual de la educación ambiental..............380 13.2.7 Contexto sociocultural..............382 13.2.8 Diagnóstico de la educación ambiental y la administración de los recursos naturales..............392 13.2.9 Criterios corporativos de educación ambiental.............394 13.3 CONCLUSIONES...............398 Capítulo 14 ENFOQUE CONCEPTUAL DE UN SISTEMA DE INDICADORES AMBIENTALES PARA LA EVALUACIÓN DE LOS POT: municipios del Valle de San Nicolás Oriente Antioqueño Carolina Arias Muñoz, Diana Elizabeth Valencia Londoño, Boris Puerto López 14.1 INTRODUCCIÓN...............401 14.2 ENFOQUE CONCEPTUAL DEL SISTEMA DE INDICADORES..............406 14.2.1 Primera aproximación: el enfoque de impacto ambiental..............406 14.2.2 Enfoque sistémico: de la sostenibilidad ambiental..............408 14.3 PROPUESTA FINAL DE INDICADORES E ÌNDICE DE SOSTENIBILIDAD AMBIENTAL DEL POT ISAPOT.............424 14.4 R EFLEXIONES FINALES..............42

Inducción a la formación profesional

Desarrolla a manera de módulos, la forma y la información que de se debe entregar a los aprendices al momento de que estos ingresen a la institución para conocer el contexto, deberes, derechos, entre otros, que los estarán rodeando en el ámbito académico.It develops as a module, the form and the information that must be given to the apprentices when they enter the institution to know the context, duties, rights, among others, that will be surrounding them in the academic field.Conocimiento e Integración Grupal -- Inducción al SENA -- Inducción a la Formación Profesional Integral -- Inducción al Centro, Programa o Proyecto -- Inducción al Programa de Formación Profesional -- Inducción a los Servicios al Alumnado -- Servicios al Alumnado: Biblioteca -- Servicios al Alumnado: Promoción y contratación de Aprendices -- Servicios al Alumnado: Trabajo Social -- Servicios al Alumnado: Capellanía -- Servicios al Alumnado: Registro y Certificación -- Servicios al Alumnado: Validación -- Servicios al Alumnado: Actividades Recreativas, Culturales y Deportivas.naPara sujetos de formación40 página

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Pregnancy-associated purpura fulminans (PF) Púrpura fulminans asociada al embarazo

&lt;p&gt;PF is a serious cutaneous purpuric disease, associated with an intravascular disseminated coagulation syndrome. Among its known causes, besides those of thrombophilia, are viral and bacterial infections, mostly Neisseria meningitidis. During pregnancy there are alterations in the hemostatic mechanism. However, by themselves, they have not been shown to lead to PF. The case of a 22-year-old woman who developed PF during pregnancy, presumably due to her Escherichia coli urinary tract infection, is presented including clinical, paraclinical, therapeutic and surgical aspects. She recovered but suffered amputation of the distant phalanges of three toes in the left foot &lt;/p&gt; La púrpura fulminans (pf) es una enfermedad cutánea purpúrica aguda asociada a un síndrome de coagulación intravascular diseminada (CID). Sus causas conocidas incluyen infecciones virales y bacterianas así como trombofilias. Es sabido que durante el embarazo existen alteraciones en los mecanismos hemostáticos, sin embargo, no se ha demostrado que estos fenómenos por sí solos ayuden al desarrollo de la PF. Se describe el caso de una mujer de 22 años, quien tuvo PF en circunstancias inusuales tales como el desarrollo de su cuadro durante el embarazo y el origen probable en una infección por E. coli. Se presentan los hallazgos clínicos, las intervenciones médicas y quirúrgicas y el desenlace. La paciente sobrevivió, pero hubo necesidad de amputarle las falanges distales de tres artejos del pie izquierdo

Treatment of Multisystem Inflammatory Syndrome in Children

BACKGROUND Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. RESULTS Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. CONCLUSIONS We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue

Treatment of Multisystem Inflammatory Syndrome in Children

BACKGROUND Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. RESULTS Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. CONCLUSIONS We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue. Copyright © 2021 Massachusetts Medical Society

Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol

Background: Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. Objectives: In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. Methods: ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was 13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43. Conclusions: In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402