A parallel-group, multicenter randomized, double-blinded, placebo-controlled, phase 2/3, clinical trial to test the efficacy of pyridostigmine bromide at low doses to reduce mortality or invasive mechanical ventilation in adults with severe SARS-CoV-2 infection: the Pyridostigmine In Severe COvid-19 (PISCO) trial protocol

© 2020, The Author(s). Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the causative agent of coronavirus disease 2019 (COVID-19), may lead to severe systemic inflammatory response, pulmonary damage, and even acute respiratory distress syndrome (ARDS). This in turn may result in respiratory failure and in death. Experimentally, acetylcholine (ACh) modulates the acute inflammatory response, a neuro-immune mechanism known as the inflammatory reflex. Recent clinical evidence suggest that electrical and chemical stimulation of the inflammatory reflex may reduce the burden of inflammation in chronic inflammatory diseases. Pyridostigmine (PDG), an ACh-esterase inhibitor (i-ACh-e), increases the half-life of endogenous ACh, therefore mimicking the inflammatory reflex. This clinical trial is aimed at evaluating if add-on of PDG leads to a decrease of invasive mechanical ventilation and death among patients with severe COVID-19. Methods: A parallel-group, multicenter, randomized, double-blinded, placebo-controlled, phase 2/3 clinical trial to test the efficacy of pyridostigmine bromide 60 mg/day P.O. to reduce the need for invasive mechanical ventilation and mortality in hospitalized patients with severe COVID-19. Discussion: This study will provide preliminary evidence of whether or not -by decreasing systemic inflammation- add-on PDG can improve clinical outcomes in patients with severe COVID-19. Trial registration: ClinicalTrials.gov NCT04343963 (registered on April 14, 2020)

Using Genetic Diversity in Deep Root Systems of Perennial Forage Grasses and Rice to Capture Carbon in Tropical Soils

Agricultural soils have the potential not only to be sinks of carbon dioxide (CO2) but also to mitigate the emissions of this gas to the atmosphere, thus, alleviating global warming. Perennial tropical grasses and rice upland and lowland varieties exhibit a large untapped genetic diversity in their root systems (e.g., deep rooting ability, exudation rates and chemical composition) that, if unlocked, could contribute to increased food production in crop-livestock systems while enhancing soil organic carbon (SOC) in tropical regions. Naturebased solutions that improve crop adaptation and SOC storage in tropical soils could help to remove CO2 from the atmosphere and thereby benefit the global climate system. With the launch of Future Seeds, one of the world’s largest repositories of tropical crop varieties, the Bezos Earth Fund (BEF) granted a major project within the Program of Future of Food. The focus of this BEF funded project is to: (i) develop novel high-throughput phenotyping methods to evaluate genetic diversity of root systems of tropical grasses and rice; (ii) unravel the potential of root systems in crop-livestock systems to replenish soil organic carbon (SOC) in human-intervened areas in tropical soils; (iii) identify and target hotspots/agroecological niches for SOC storage in tropical soils; and (iv) build capacity in conducting research on root systems and SOC storage towards carbon farming in tropical regions. Implementation of land-based SOC storage practices/projects (through carbon markets) based on deep rooting ability of perennial tropical forage grasses and rice cultivars in crop-pasture rotational systems could significantly reduce net emissions from tropical soils

Resistant starch can improve insulin sensitivity independently of the gut microbiota

Background: Obesity-related diseases, including type 2 diabetes and cardiovascular disease, have reached epidemic proportions in industrialized nations, and dietary interventions for their prevention are therefore important. Resistant starches (RS) improve insulin sensitivity in clinical trials, but the mechanisms underlying this health benefit remain poorly understood. Because RS fermentation by the gut microbiota results in the formation of physiologically active metabolites, we chose to specifically determine the role of the gut microbiota in mediating the metabolic benefits of RS. To achieve this goal, we determined the effects of RS when added to a Western diet on host metabolism in mice with and without a microbiota. Results: RS feeding of conventionalized mice improved insulin sensitivity and redressed some of the Western diet-induced changes in microbiome composition. However, parallel experiments in germ-free littermates revealed that RS-mediated improvements in insulin levels also occurred in the absence of a microbiota. RS reduced gene expression of adipose tissue macrophage markers and altered cecal concentrations of several bile acids in both germ-free and conventionalized mice; these effects were strongly correlated with the metabolic benefits, providing a potential microbiota-independent mechanism to explain the physiological effects of RS. Conclusions: This study demonstrated that some metabolic benefits exerted by dietary RS, especially improvements in insulin levels, occur independently of the microbiota and could involve alterations in the bile acid cycle and adipose tissue immune modulation. This work also sets a precedent for future mechanistic studies aimed at establishing the causative role of the gut microbiota in mediating the benefits of bioactive compounds and functional foods

Implicaciones metodológicas e inconsistencias de la Tercera Comunicación Nacional sobre Cambio Climático de Colombia

Las Comunicaciones Nacionales sobre Cambio Climático (CNCC) son un mecanismo para que los países informen sus avances en mitigación y adaptación, y constituyen uno de los elementos de base para la política sobre cambio climático a escala nacional. Colombia ha emitido tres CNCC. La tercera plantea un escenario que considera las proyecciones de diversos modelos incluidos en la quinta fase del Proyecto de Comparación de Modelos Acoplados (Coupled Model Intercomparison Project, CMIP), el cual se estima como el promedio de las proyecciones correspondientes a las cuatro trayectorias de concentración representativa (Representative Concentration Pathways,RCP) presentadas en el quinto reporte de evaluación del Panel Intergubernamental sobre Cambio Climático. Cada una de estas RCP representa una trayectoria de concentración de gases de efecto invernadero (GEI) para un escenario particular de crecimiento poblacional, económico y tecnológico que conduce a una posible trayectoria de evolución del sistema climático. En este estudio se comparan las proyecciones presentadas en la Tercera CNCC con las obtenidas directamente de los modelos empleados. Nuestros resultados demuestran que al utilizarse un promedio de RCP se pierden escenarios alternos que podrían ser importantes a la hora de considerar posibles futuros diferentes y anulan la utilidad de plantear diversas trayectorias de emisiones de GEI. Más aun, una comparación entre la Segunda y la Tercera CNCC muestra proyecciones de precipitación opuestas para diferentes regiones del país, lo cual es de particular importancia, pues el escenario de cambio climático planteado en la Tercera CNCC sirve de referencia para la toma de decisiones en materia de cambio climático a nivel nacional

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe