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

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Frecuencia de infección por VIH/sida en usuarios de preservativo Frequency of infection by HIV/ AIDS preservative users

El propósito fundamental del presente trabajo fue identificar la frecuencia de pacientes atendidos en el servicio de Medicina Interna del Hospital General de Zona No. 1 IMSS-Colima que habiendo utilizado el preservativo en todas sus coitos estuvieran infectados con VIH/sida descartando otra vía de transmisión; considerando su edad, sexo, estado civil, lugar de residencia, número de parejas sexuales y preferencia sexual. El objetivo de este trabajo fue identificar la frecuencia de pacientes infectados por VIH/sida en usuarios de preservativo. Es un estudio descriptivo transversal. Se estudió una muestra de 61 pacientes VIH/sida, durante los meses agosto-octubre, que acudieron a sus citas de control al servicio de medicina interna del Instituto Mexicano del Seguro Social de la ciudad de Colima a quienes se les invitó a participar garantizándoles el anonimato, se obtuvieron medidas de tendencia central. De los 61 pacientes con VIH/sida descartando otra vía de transmisión, 12 (20 %) refirieron haber utilizado en todas sus coitos el preservativo, de los cuales 3 (25 %) eran mujeres y 9 (75 %) hombres. El rango de 20 a 39 años de edad y los solteros fueron los más afectados. Número de parejas sexuales: 8 (67 %) varias parejas y 4 (33 %) una pareja. Preferencia sexual: 3 (25 %) heterosexuales, 7 (58 %) homosexuales y 2 (17 %) bisexuales. Se concluye que el preservativo no es del todo efectivo, para la protección de enfermedades de transmisión sexual como el VIH/SIDA.The primary purpose of this study was to identify the frequency of patients treated at the Internal Medicine Service of General Hospital Zone No. 1 IMSS, Colima having used preservative in all sexual intercourse were infected with HIV / AIDS discarding other means of transmission, considering his age, sex, marital status, place of residence, number of sexual partners and sexual preference. The aim of this study was to identify the frequency of patients infected with HIV / AIDS in preservative users. It is a cross-sectional study. The sample consisted of 61 patients with HIV / AIDS during the months from August to October, which came to control appointments to the service of internal medicine of the Instituto Mexicano del Seguro Social in Colima city who were invited to participate by guaranteeing anonymity, we obtained measures of central tendency. Of the 61 patients with HIV / AIDS discarding other means of transmission, 12 (20%) reported having used preservatives all their intercourse, of whom 3 (25%) were female and 9 (75%) men. The range of 20 to 39 years old and single were the most affected. Number of partners: 8 (67%) several partners, and 4 (33%) one partner. Sexual Preference: 3 (25%) heterosexual, 7 (58%) homosexual and 2 (17%) bisexual. We conclude that the preservative is not fully effective for the protection of sexually transmitted diseases like HIV/AIDS

Participación del óxido nítrico, proteína Fos y el tallo cerebral en la retención de glucosa encefálica durante la hipoxia Involvement of the nitric oxide, Fos protein and brain stem in the retention of brain glucose during hypoxia

Se ha descrito que el núcleo del tracto solitario (NTS), estructura del tallo cerebral y vía de relevo de las aferencias del los quimiorreceptores del senocuerpo carotídeo (RSCC), participa en el aumento en la retención de glucosa por el cerebro (RGC) ante una hipoxia. Es probable que en esta respuesta participe el óxido nítrico (NO) y la proteína Fos. En este trabajo se analiza el papel del NO en el NTS sobre la modificación de la RGC y la expresión de la proteína inmunorreactiva Fos (Fos-ir) en ratas in vivo. La inyección de un donador del NO como es el nitroprusiato de sodio (NPS) en el NTS, 4 min antes de la estimulación de los RSCC, disminuyó la RGC, pero incrementó la expresión de Fos-ir en un mayor número de neuronas en el NTS con respecto a las ratas control, que sólo recibieron líquido cefalorraquídeo artificial (LCRa) antes de la estimulación RSCC. En contraste, un inhibidor selectivo del NO como el N?-nitro-L-arginina metil éster (L-NAME) en el NTS 4 min antes de la estimulación RSCC con NaCN, aumentó la RGC, pero disminuyó el número de neuronas Fos-ir comparados con el control o con NPS. La detección inmunohistoquímica de la expresión de Fos-ir en las células del tallo cerebral indica que la estimulación RSCC activa vías dependientes de NO en el NTS, para regular la RGC. El estudio de esta población de células en el NTS, será importante para definir su caracterización.It has been said that the nucleus tractus solitarii (NTS), one structure of the brain stem and path of apherences of chemoreceptors of carotid sinus-body, is involved in the increased glucose retention by the brain in case of hypoxia. It is likely that nitric oxide and Fos protein also take part in this response. This paper analyzes the role of nitric oxide in the NTS on the change of glucose retention by the brain and the expression of inmunoreactive protein Fos (ir-Fos) in rats in vivo. The injection of a NO donor such as sodium nitroprusiate in the NTS four minutes before the stimulation of carotid sinus-body chemoreceptors decreased glucose retention by the brain but increased the expression of ir-Fos in a higher number of neurons in NTS with respect to control group rats which only received artificial cerebrospinal fluid before the stimulation. In contrast, the use of a selective NO inhibitor such as NO-nitro-L-arginine methyl ester (L-NAME) in the NTS four minutes before the stimulation of the chemoreceptors with NaCN, increased the glucose retention by the brain but reduced the number of neurons with ir-Fos expression when compared with the control group or the sodium nitroprusiate injection. The immunohistochemical detection of ir-Fos expression in the brain stem cells indicated that stimulation of carotid sinus-body chemoreceptors activated NO-dependent paths in the NTS to regulate glucose retention by the brain. The study of this cell population in the NTS will be important to define its characterization

La somatostatina en el núcleo del tracto solitario comisural modula la retención de glucosa cerebral postestimulación anóxica de los quimioreceptores carotídeos en ratas Somatostatin into the Commissural Nucleus Tractus Solitarius Modulates Brain Glucose Retention Post- Anoxic Stimulation of the Carotid Chemoreceptor in Rats

El núcleo del tracto solitario comisural (NTSc) es el centro de relevo de las fibras aferentes procedentes de los baro y quimiorreceptores carotídeos, por lo que modula la presión arterial y la glucemia ante los estímulos en dichos receptores. La estimulación anóxica con cianuro de sodio (NaCN) en los cuerpos carotídeos produce una respuesta hiperglucemiante. La somatostatina (SS) inhibe la secreción de la hormona del crecimiento y del glucagón lo que produce un efecto hipoglucemiante. La SS y sus receptores en el NTS tienen un efecto inhibidor. Se postula que la somatostatina modula la respuesta hiperglucemiante después de la estimulación de los quimiorreceptores carotídeos (QRC) con NaCN. En este trabajo, la infunsión de SS en el NTSc 4 min antes del estímulo anóxico de los QRC, disminuyó el reflejo hiperglucemiante y la retención de glucosa cerebral a los 10 min del estímulo anóxico. Se concluye que la SS en el NTSc modula la respuesta hiperglucemiante y la retención de glucosa cerebral post-estimulación anóxica de los cuerpos carotídeos en ratas.The commissural nucleus of the solitary tract (NTSc) is the relay center of the afferents fibers from the carotid baro and chemoreceptors, so that modulates blood pressure and blood sugar to stimuli in these receptors. Anoxic stimulation with sodium cyanide (NaCN) in the carotid bodies produces a hyperglycemic response. Somatostatin (SS) inhibits secretion of growth hormone and glucagon producing a hypoglycemic effect. The SS and its receptors in the NTS have an inhibitory effect. It is postulated that somatostatin modulates the hyperglycaemic response after stimulation of carotid chemoreceptors (QRC) with NaCN. In this work, the SS infusion into NTSc 4 min before the anoxic stimulation of the QRC, decreased the hyperglycemic reflex and cerebral glucose retention after 10 min of anoxic stimulus. We conclude that SS modulates the NTSc hyperglycemic response and brain glucose retention post-anoxic stimulation of the carotid bodies in rats

Naked eye microscopy

Depto. de Biodiversidad, Ecología y EvoluciónFac. de Ciencias BiológicasFALSEsubmitte