Impacto en la mortalidad por el uso de amikacina inhalatoria en pacientes con neumonía grave / Impact of the use of inhaled amikacin on mortality in patients with severe Pneumonia

Introducción: En la actualidad, la resistencia antimicrobiana es un elemento importante en las unidades de cuidados intensivos.Objetivo: Evaluar el impacto del uso de los aminoglucósidos inhalatorios en la mortalidad de pacientes con neumonía grave.Métodos: Estudio analítico longitudinal retrospectivo en el periodo diciembre 2021 - marzo 2023. Universo: 84 pacientes, con diagnóstico de neumonía grave, mediante cultivo de secreciones respiratorias, positivo a Klebsiella pneumoniae, Pseudomona o Enterobacter al ingreso en UCI. Muestreo probabilístico error alfa 1,96, confiabilidad de 0,05. Todos recibieron iguales pautas de tratamiento. Se dividieron en tres grupos Grupo 1-Amikacina inhalatoria y Cefalosporinas; Grupo 2: amikacina, cefalosporinas 3 era y ciprofluoxacino; Grupo 3: Cefalosporinas 3 era y ciprofluoxacino.Resultados: Al ingreso, distribución similar entre grupos de APP p= 0,87. Sexo p=0,09. Distribución de cultivos negativos a los 5 días Klebsiella (grupo 2 -77 %) (Grupo 1 - 60 %) (Grupo 3-27 %) P=0,06. Enterobacter (grupo 2 - 83 %) p = 0,302. Mortalidad global en el orden de 32 %. Sobrevida al egreso (grupo 1 - 13 pacientes con 72 %). Grupo 2 - 15 (83 %). Grupo 3- 8 (7 %) P=0,06. Luego de reagrupar los pacientes según el uso del fármaco inhalatorio mortalidad grupo 1-2 donde se utilizó el fármaco inhalatorio sobrevida 28 pacientes (78 %). P=0,02. OR 0,25 IC 0,74-0,87.Conclusiones: El uso de los fármacos aminoglucósidos es una estrategia viable en la terapéutica de los pacientes graves y críticos con Neumonía. Reduce la mortalidad de pacientes con gérmenes dentro del espectro de actividad. No se evidenció elementos de toxicidad local ni sistémica

Uso del Captopril como fármaco alternativo en el tratamiento del edema agudo del pulmón hipertensivo / Use of Captopril as an alternative drug in the treatment of acute hypertensive pulmonary edema

Fundamento: La insuficiencia cardiaca aguda es un cuadro clínico de rápida aparición. Los inhibidores de la enzima convertidora de angiotensina se utilizan en la variante crónica del tratamiento de esta entidad pero su uso en el edema agudo del pulmón hipertensivo ha sido controversial.Objetivos: evaluar la eficacia del uso del Captopril como fármaco alternativo en la primera línea de tratamiento de pacientes con edema pulmonar hipertensivo.Método: Se realizó un analítico longitudinal retrospectivo, con los pacientes atendidos en la Unidad de Cuidados Intensivos Emergentes por edema pulmonar agudo hipertensivo del Hospital Militar Dr. Carlos J. Finlay, de febrero hasta septiembre de 2019. El universo de 36 pacientes que fueron divididos en 2 grupos de 18 individuos según el uso o no del fármaco en estudio. Todos los pacientes recibieron el mismo tratamiento protocolizado para esta enfermedad pero además en un grupo se administró Captopril 50 mg triturados por vía sublingual luego de la primera dosis de nitroglicerina sublingual y en el otro grupo no. Resultados: las variables poblacionales fueron edad 72±12 años, 32 % mujeres, el 13 % obesos y el 38 % diabéticos, 22% eran cardiópatas, el 77% consumían nitratos, el 47% beta bloqueadores, el 55% IECAs, el 5% digital y el 41% diuréticos. Presión arterial media (Grupo 2=117) y (Grupo 1=102) x2=0,000 donde se administró Captopril existió una diferencia con significación estadística; mayor ritmo diurético en ese mismo grupo (Grupo 2=28 min) y (Grupo 1=16) x2=0,000. La frecuencia cardiaca fue menor en (Grupo 2=106 Lat/min) y (Grupo 1=97 Lat/min) x2=0,002.Conclusiones: el uso del Captopril pudiera ser una opción válida como coadyuvante en el tratamiento del paciente con edema agudo del pulmón hipertensivo si se tiene en cuenta que mejora los parámetros hemodinámicos y reduce el tiempo de estadía en la Unidad de cuidados Intensivos y Emergencias en comparación al tratamiento habitual.Palabras claves: edema agudo del pulmón, Captopril, tratamiento, hemodinámica.AbstractBackground: Acute heart failure is a fast-onset clinical picture. Angiotensin-converting enzyme inhibitors are used in the chronic variant of the treatment of this entity, but their use in acute hypertensive lung edema has been controversial.Objectives: to evaluate the efficacy of the use of Captopril as an alternative drug in the first line of treatment of patients with hypertensive pulmonary edema.Method: A retrospective study was carried out with the patients treated in the Emerging Intensive Care Unit for acute hypertensive pulmonary edema of the Dr. Carlos J. Finlay Military Hospital, from February to September 2019. The universe of 36 patients who were divided in 2 groups of 18 individuals. Both received the protocolized treatment for this disease but in addition one group was administered Captopril 50 mg crushed sublingually after the first sublingual nitroglycerin and before the second dose, and the other group did not.Results: the population variables were age 72 ± 12 years, 32% women, 13% obese and 38% diabetic, 22% were heart disease, 77% consumed nitrates, 47% beta-blockers, 55% ACE inhibitors, 5 % digital and 41% diuretics. Mean arterial pressure (Group 2 = 117) and (Group 1 = 102) x2 = 0,000 where Captopril was administered, there was a difference with statistical significance; higher diuretic rhythm in the same group (Group 2 = 28 min) and (Group 1 = 16) x2 = 0,000. Heart rate was lower in group 2 (Group 2 = 106 beats / min) and (Group 1 = 97 beats / min) x2 = 0,002.Conclusions: the use of Captopril could be a valid option as an adjunct in the treatment of patients with acute edema of the hypertensive lung if it is taken into account that it improves hemodynamic parameters and reduces the length of stay in the Intensive Care and Emergency Unit in comparison to the usual treatment.Key words: acute lung edema, Captopril, treatment, hemodynamics. Introducción: La insuficiencia cardiaca aguda es un cuadro clínico de rápida aparición. Los inhibidores de la enzima convertidora de angiotensina se utilizan en la variante crónica del tratamiento de esta entidad, pero su uso en el edema agudo del pulmón hipertensivo ha sido controversial.Objetivo: Evaluar la eficacia del uso del Captopril como fármaco alternativo en la primera línea de tratamiento de pacientes con edema pulmonar hipertensivo.Métodos: Se realizó un analítico longitudinal retrospectivo, con los pacientes atendidos en la Unidad de Cuidados Intensivos Emergentes por edema pulmonar agudo hipertensivo del Hospital Militar Central "Dr. Carlos J. Finlay", de febrero hasta septiembre de 2019. El universo de 36 pacientes que fueron divididos en dos grupos de 18 individuos, de acuerdo al uso o no del fármaco en estudio. Todos los pacientes recibieron el mismo tratamiento protocolizado para esta enfermedad, pero además en un grupo se administró Captopril 50 mg triturados por vía sublingual luego de la primera dosis de nitroglicerina sublingual y en el otro grupo no.Resultados: Las variables poblacionales fueron edad 72 ± 12 años, 32 % mujeres, el 13 % obesos y el 38 % diabéticos, 22 % eran cardiópatas, el 77 % consumían nitratos, el 47 % beta bloqueadores, el 55 % de los inhibidores de la enzima convertidora de la angiotensina, el 5 % digital y el 41 % diuréticos. Presión arterial media (Grupo 1= 117) y (Grupo 2= 102) x2=0,000 donde se administró Captopril existió una diferencia con significación estadística. Mayor ritmo diurético en ese mismo grupo (Grupo 1= 28 min) y (Grupo 2= 16) x2= 0,000. La frecuencia cardiaca fue menor en grupo 2 (Grupo 1=106 Lat/min) y (Grupo 2=97 Lat/min) x2=0,002.Conclusiones: El uso del Captopril pudiera ser una opción válida como coadyuvante en el tratamiento del paciente con edema agudo del pulmón hipertensivo si se tiene en cuenta que mejora los parámetros hemodinámicos y reduce el tiempo de estadía en la Unidad de cuidados Intensivos y Emergencias en comparación al tratamiento habitual

Measurement of the top quark forward-backward production asymmetry and the anomalous chromoelectric and chromomagnetic moments in pp collisions at √s = 13 TeV

Abstract The parton-level top quark (t) forward-backward asymmetry and the anomalous chromoelectric (d̂ t) and chromomagnetic (μ̂ t) moments have been measured using LHC pp collisions at a center-of-mass energy of 13 TeV, collected in the CMS detector in a data sample corresponding to an integrated luminosity of 35.9 fb−1. The linearized variable AFB(1) is used to approximate the asymmetry. Candidate t t ¯ events decaying to a muon or electron and jets in final states with low and high Lorentz boosts are selected and reconstructed using a fit of the kinematic distributions of the decay products to those expected for t t ¯ final states. The values found for the parameters are AFB(1)=0.048−0.087+0.095(stat)−0.029+0.020(syst),μ̂t=−0.024−0.009+0.013(stat)−0.011+0.016(syst), and a limit is placed on the magnitude of | d̂ t| < 0.03 at 95% confidence level. [Figure not available: see fulltext.

Measurement of b jet shapes in proton-proton collisions at root s=5.02 TeV

We present the first study of charged-hadron production associated with jets originating from b quarks in proton-proton collisions at a center-of-mass energy of 5.02 TeV. The data sample used in this study was collected with the CMS detector at the CERN LHC and corresponds to an integrated luminosity of 27.4 pb(-1). To characterize the jet substructure, the differential jet shapes, defined as the normalized transverse momentum distribution of charged hadrons as a function of angular distance from the jet axis, are measured for b jets. In addition to the jet shapes, the per-jet yields of charged particles associated with b jets are also quantified, again as a function of the angular distance with respect to the jet axis. Extracted jet shape and particle yield distributions for b jets are compared with results for inclusive jets, as well as with the predictions from the pythia and herwig++ event generators.Peer reviewe

Measurement of the azimuthal anisotropy of Y(1S) and Y(2S) mesons in PbPb collisions at root s(NN)=5.02 TeV

The second-order Fourier coefficients (v(2)) characterizing the azimuthal distributions of Y(1S) and Y(2S) mesons produced in PbPb collisions at root s(NN) = 5.02 TeV are studied. The Y mesons are reconstructed in their dimuon decay channel, as measured by the CMS detector. The collected data set corresponds to an integrated luminosity of 1.7 nb(-1). The scalar product method is used to extract the v2 coefficients of the azimuthal distributions. Results are reported for the rapidity range vertical bar y vertical bar < 2.4, in the transverse momentum interval 0 < pT < 50 GeV/c, and in three centrality ranges of 10-30%, 30-50% and 50-90%. In contrast to the J/psi mesons, the measured v(2) values for the Y mesons are found to be consistent with zero. (C) 2021 The Author(s). Published by Elsevier B.V.Peer reviewe

Calibration of the CMS hadron calorimeters using proton-proton collision data at root s=13 TeV

Methods are presented for calibrating the hadron calorimeter system of theCMSetector at the LHC. The hadron calorimeters of the CMS experiment are sampling calorimeters of brass and scintillator, and are in the form of one central detector and two endcaps. These calorimeters cover pseudorapidities vertical bar eta vertical bar ee data. The energy scale of the outer calorimeters has been determined with test beam data and is confirmed through data with high transverse momentum jets. In this paper, we present the details of the calibration methods and accuracy.Peer reviewe

Measurement of the Jet Mass Distribution and Top Quark Mass in Hadronic Decays of Boosted Top Quarks in pp Collisions at root s=13 TeV

A measurement is reported of the jet mass distribution in hadronic decays of boosted top quarks produced in pp collisions at root s = 13 TeV. The data were collected with the CMS detector at the LHC and correspond to an integrated luminosity of 35.9 fb(-1). The measurement is performed in the lepton + jets channel of t (t) over bar events, where the lepton is an electron or muon. The products of the hadronic top quark decay t -> bW -> bq (q) over bar' are reconstructed as a single jet with transverse momentum larger than 400 GeV. The t (t) over bar cross section as a function of the jet mass is unfolded at the particle level and used to extract a value of the top quark mass of 172.6 +/- 2.5 GeV. A novel jet reconstruction technique is used for the first time at the LHC, which improves the precision by a factor of 3 relative to an earlier measurement. This highlights the potential of measurements using boosted top quarks, where the new technique will enable future precision measurements.Peer reviewe

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe

MUSiC : a model-unspecific search for new physics in proton-proton collisions at root s=13TeV

Results of the Model Unspecific Search in CMS (MUSiC), using proton-proton collision data recorded at the LHC at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb(-1), are presented. The MUSiC analysis searches for anomalies that could be signatures of physics beyond the standard model. The analysis is based on the comparison of observed data with the standard model prediction, as determined from simulation, in several hundred final states and multiple kinematic distributions. Events containing at least one electron or muon are classified based on their final state topology, and an automated search algorithm surveys the observed data for deviations from the prediction. The sensitivity of the search is validated using multiple methods. No significant deviations from the predictions have been observed. For a wide range of final state topologies, agreement is found between the data and the standard model simulation. This analysis complements dedicated search analyses by significantly expanding the range of final states covered using a model independent approach with the largest data set to date to probe phase space regions beyond the reach of previous general searches.Peer reviewe