Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. Results: The median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO < 80% and 24% having DLCO < 60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO < 60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. Conclusion: Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities

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

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

Bioinformatic Analysis of Gene Variants from Gastroschisis Recurrence Identifies Multiple Novel Pathogenetic Pathways: Implication for the Closure of the Ventral Body Wall

We investigated whether likely pathogenic variants co-segregating with gastroschisis through a family-based approach using bioinformatic analyses were implicated in body wall closure. Gene Ontology (GO)/Panther functional enrichment and protein-protein interaction analysis by String identified several biological networks of highly connected genes in UGT1A3, UGT1A4, UGT1A5, UGT1A6, UGT1A7, UGT1A8, UGT1A9, UGT1A10, AOX1, NOTCH1, HIST1H2BB, RPS3, THBS1, ADCY9, and FGFR4. SVS&#8722;PhoRank identified a dominant model in OR10G4 (also as heterozygous de novo), ITIH3, PLEKHG4B, SLC9A3, ITGA2, AOX1, and ALPP, including a recessive model in UGT1A7, UGT1A6, PER2, PTPRD, and UGT1A3. A heterozygous compound model was observed in CDYL, KDM5A, RASGRP1, MYBPC2, PDE4DIP, F5, OBSCN, and UGT1A. These genes were implicated in pathogenetic pathways involving the following GO related categories: xenobiotic, regulation of metabolic process, regulation of cell adhesion, regulation of gene expression, inflammatory response, regulation of vascular development, keratinization, left-right symmetry, epigenetic, ubiquitination, and regulation of protein synthesis. Multiple background modifiers interacting with disease-relevant pathways may regulate gastroschisis susceptibility. Based in our findings and considering the plausibility of the biological pattern of mechanisms and gene network modeling, we suggest that the gastroschisis developmental process may be the consequence of several well-orchestrated biological and molecular mechanisms which could be interacting with gastroschisis predispositions within the first ten weeks of development

Whole exome sequencing identifies multiple novel candidate genes in familial gastroschisis

Abstract Background Genetic association studies for gastroschisis have highlighted several candidate variants. However, genetic basis in gastroschisis from noninvestigated heritable factors could provide new insights into the human biology for this birth defect. We aim to identify novel gastroschisis susceptibility variants by employing whole exome sequencing (WES) in a Mexican family with recurrence of gastroschisis. Methods We employed WES in two affected half‐sisters with gastroschisis, mother, and father of the proband. Additionally, functional bioinformatics analysis was based on SVS–PhoRank and Ensembl–Variant Effect Predictor. The latter assessed the potentially deleterious effects (high, moderate, low, or modifier impact) from exome variants based on SIFT, PolyPhen, dbNSFP, Condel, LoFtool, MaxEntScan, and BLOSUM62 algorithms. The analysis was based on the Human Genome annotation, GRCh37/hg19. Candidate genes were prioritized and manually curated based on significant phenotypic relevance (SVS–PhoRank) and functional properties (Ensembl–Variant Effect Predictor). Functional enrichment analysis was performed using ToppGene Suite, including a manual curation of significant Gene Ontology (GO) biological processes from functional similarity analysis of candidate genes. Results No single gene‐disrupting variant was identified. Instead, 428 heterozygous variations were identified for which SPATA17, PDE4DIP, CFAP65, ALPP, ZNF717, OR4C3, MAP2K3, TLR8, and UBE2NL were predicted as high impact in both cases, mother, and father of the proband. PLOD1, COL6A3, FGFRL1, HHIP, SGCD, RAPGEF1, PKD1, ZFHX3, BCAS3, EVPL, CEACAM5, and KLK14 were segregated among both cases and mother. Multiple interacting background modifiers may regulate gastroschisis susceptibility. These candidate genes highlight a role for development of blood vessel, circulatory system, muscle structure, epithelium, and epidermis, regulation of cell junction assembly, biological/cell adhesion, detection/response to endogenous stimulus, regulation of cytokine biosynthetic process, response to growth factor, postreplication repair/protein K63‐linked ubiquitination, protein‐containing complex assembly, and regulation of transcription DNA‐templated. Conclusion Considering the likely gene‐disrupting prediction results and similar biological pattern of mechanisms, we propose a joint “multifactorial model” in gastroschisis pathogenesis

Consenso mexicano de cáncer mamario. Manejo del cáncer de mama avanzado

El cáncer de mama es la neoplasia más frecuente y con mayor mortalidad en mujeres en todo el mundo. La décima actualización del Consenso Mexicano Sobre Diagnóstico y Tratamiento del Cáncer Mamario (2023) es publicada por sus autores en diferentes artículos. El presente artículo incluye el manejo de cáncer de mama avanzado, el tratamiento sistémico adyuvante, el papel de la cirugía y la radioterapia en enfermedad metastásica y el seguimiento posterior al tratamiento con intención curativa. La difusión de este consenso contribuye a la actualización y homogeneidad de criterios de manejo del cáncer mamario en etapas avanzadas

Consenso mexicano de cáncer mamario. Manejo del cáncer de mama temprano

El cáncer mamario en estadios tempranos tiene un manejo local (quirúrgico y radioterapia) y sistémico específico. Este tipo de cáncer incluye el carcinoma ductal in situ y los cánceres de mama en estadios I, IIA, IIB y IIIA. Esta décima actualización del Consenso Mexicano de Cáncer Mamario abordó el manejo de los estadios tempranos. La difusión de este consenso contribuye a la actualización y homogeneidad de criterios de manejo del cáncer mamario y el objetivo de este artículo es presentar la actualización en el manejo multidisciplinario del cáncer de mama

IV Congreso internacional 2019: memorias II

La Red de Dirección Estratégica en la Educación Superior (RED-DEES) celebró hace poco tiempo su 10mo Aniversario de constitución. Por ello, con mucho orgullo este libro permite crear un puente en el tiempo y la emoción para Ias 54 Instituciones de Educación Superior que hoy tienen el honor de ser parte de sus miembros. Hace unos 10 años pocos podrían soñar con que la Red hubiera recorrido el camino que nos ha traído hasta aquí; era una idea inicial, tan solo una semilla, que abriría las puertas a un futuro prometedor; se convirtió en un camino hacia la ilusión, ya que en los primeros años nos movíamos entre el deseo y la incertidumbre. Hoy no dejamos de reconocer que fue una decisión riesgosa, pero estábamos dispuestos a asumirla con muchos esfuerzos entre todos. (Apartes del texto)Contiene: 1. La Planificación Estratégica en la Educación Superior: Monitoreo y Seguimiento a la planificación operativa: Herramienta de apoyo para la toma de decisiones / Isaías Hernández Sánchez, María Catalina Tapia López -- La Planificación y su vinculación con los modelos para la calidad, caso UNAH / Javier Alexis Martínez Moncada -- Resultados de un trabajo planificado en la facultad de medicina de la UNNE- Argentina / Erika Sánchez, Silvia García, Patricia Demuth -- Rediseño estratégico y prospectivo de la arquitectura organizacional: experiencia en la Universidad de Managua. Nicaragua / Fernando Valle Meza, Mario Valle Dávila, Dora María Meza Cornavaca -- Factores que favorecen y dificultan la aplicación de la dirección estratégica en la educación superior / Jorge Juan Domínguez Menéndez -- La evaluación de la práctica de la planificación estratégica en instituciones de educación superior de Cuba. Metodología aplicada y principales resultados / José Luis Almuiñas Rivero, Judith Galarza López -- Modelo para el control de la estrategia institucional en la Universidad de Cienfuegos / Katia Rivero Alonso, Judith Galarza López -- Reconstrucción de la senda que se recorrió en los procesos de planificación y evaluación institucional de comunitaria intercultural / Adrián Puerta Ch., Julia Arguello M. -- 2. Evaluación Institucional y gestión de la calidad en las IES: Hacia la instauración de una cultura de mejora continua: Modelo de evaluación del desempeño en la UNAN -Managua / Isaías Hernández Sánchez, Saira del Rosario Figueroa Aguirre -- Estrategias para mejorar la gestión del proceso de autoevaluación institucional con fines de acreditación en la Universidad San Gregorio de Portoviejo / Ximena Guillén Vivas, José Luis Almuiñas Rivero, Judith Galarza López -- Visita de condiciones iniciales para la acreditación institucional en tiempos de pandemia y sus impactos. Relato de una experiencia. Fundación Universitaria Los Libertadores - Colombia / Patricia Martínez Barrios, Orlando Salinas Gómez, Luz Mercedes Flechas Mendoza -- 3. La formación profesional y la calidad de los procesos universitarios: La formación profesional y la calidad de los procesos universitarios / Observal - Honduras, Celeo Emilio Arias -- Describir la satisfacción estudiantil delos egresados del instituto tecnológico superior de tela, ubicado en la ciudad de tela, Atlantida, Honduras / Gustavo Adolfo Rodríguez, Espinoza Carlos Agurcia, Jairo Núñez -- La cadena valor percibido, satisfacción y lealtad para los egresados de la universidad / Katty Johanna Loor Avila, José Antonio Pedraza Rodríguez, Leonor Pérez Naranjo -- El avance del seguimiento a graduados en la universidad nacional de ingeniería / Melvis Daviel Martínez Cano -- Programa de seguimiento de egresados: estudio preliminar de tres servicios universitarios / Rodrigo Horjales -- La formación de valores éticos en los estudiantes de la carrera de derecho con un enfoque RSU: propuesta de una estrategia / Roger Martínez Isaac, Odette Martínez Pérez, Noemí Delgado Álvarez -- El seguimiento de graduados; oferta y demanda de profesionales veterinarios en el Uruguay / José Passarini, Paola Cabral, Brasiliano Rodríguez, Claudia Borlido -- 4. Vinculación con medio y responsabilidad social universitaria: Responsabilidad social y aprendizaje: ideas preliminares / Odette Martínez Pérez, Roxana Chiquito Chillán, Víctor Gómez Rodríguez -- Transversalización de los Objetivos de Desarrollo Sostenible en la Planeación Institucional de la UNAN-León / Marcos Vinicio Sandino Montes -- La Universidad de Pinar del Río del conocimiento y la innovación en función del desarrollo local sostenible / Maricela González Pérez, Carlos Cesar Torres Paez, Saray Nuñez González -- Educación superior socialmente responsable: propuesta de una metodología para su evaluación e implementación en la educación superior ecuatoriana / Odette Martínez Pérez, Luis Alberto Alzate Peralta, Rudy García Cobas -- 5. La Gestión de la Internacionalización de la educación superior: La gestión del proceso de internacionalización: experiencias en la movilidad académica, la formación doctoral del docente / Bernal Álava AF, Borroto Leal OE, Campozano Pluas, Vanessa Daniela -- La gestión de la internacionalización desde la perspectiva de la formación tecnológica: la experiencia del Instituto Superior Tecnológico Bolivariano de Tecnología ITB / Luis Alberto Alzate Peralta, Odette Martínez Pérez Elena Tolozano Benites -- 6.Las TIC y las Redes Sociales en la formación de los estudiantes / Las Redes sociales como gestoras de conocimiento formal en los participantes / Esteban de Jesús Gutiérrez Ortiz, Andrés Ernesto Manrique de la Cruz, Sheyla Monsait Valero Estrada, Carlos Jesús Rodríguez Saucedo -- Las NTIC como plataformas de nuevas habilidades digitales y cocreadoras de ecosistemas virtuales educomunicativos / Martín Hernández Oseguera, Oscar Ricardo Castillo BribiescaFundación Universitaria Los Libertadore