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

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas

Plant and livestock waste compost compared with inorganic fertilizer: nutrient contribution to soil

The use of livestock and plant wastes, as sources of nutrients and organic material to the soil, is a viable alternative to chemical fertilizers, which eventually cause serious risks to agroecosystems. The present study was conducted in 2013 in a greenhouse at FACIATEC-UACH, Chihuahua, México. Four composts made with (a) cow manure, (b) hen manure, (c) sawdust and (d) maize stover were evaluated for their contribution of the soil macronutrients NO3-, P=, K+, Ca++, Mg++ and Na+ and compared with urea as a synthetic fertilizer and a control without fertilizer. The experiment was based on a completely randomized design; statistical analysis included an analysis of variance using the statistical package SAS (Statistical Analysis System) version 9.3.1 and comparison of means with the Tukey procedure (a = 0.05). Results suggest that five of the compost treatments increased the concentration of NO3-. Hen manure significantly outperformed cow manure in providing NO3- and P=. Likewise, the sawdust-based compost significantly affected the content of NO3-, outperforming the treatment based on maize stover. The concentration of Ca++ and Mg++ in soils resulting from the applied composts was lower than in the treatment with inorganic fertilizer, but that of Na+ was statistically higher than in the inorganic fertilizer treatment. This evidence suggests that the use of organic fertilizers, of either animal or plant origin, is a beneficial source of soil nutrients with high potential in sustainable agriculture

A robust 2D shallow water model for solving flow over complex topography using homogenous flux method

A robust Godunov-type numerical scheme solver is proposed for solving 2D SWEs and is applied to simulate flow over complex topography with wetting and drying. In reality, the topography is usually complex and irregular; therefore, to avoid the numerical errors generated by such features, a Homogenous Flux Method is used to handle the bed slope term in the SWEs. The method treats the bed slope term as a flux to be incorporated into the flux gradient and so maintains the balance between the two in a Godunov-type shock-capturing scheme. The main advantages of the method are: first, it is simple and easy to implement; second, numerical experiments demonstrate that it can handle discontinuous or vertical bed topography without any special treatment and third, it is applicable to both steady and unsteady flows. It is demonstrated how the approach set out here can be applied to the nonlinear hyperbolic system of the SWEs. The two-dimensional hyperbolic system is then solved by use of a second-order total-variation-diminishing version of the weighted average flux method in conjunction with a Harten-Lax-van Leer-Contract approximate Riemann solver incorporating the new flux gradient term. Several benchmark tests are presented to validate the model and the approach is verified against experimental measurements from the European Union Concerted Action on Dam Break Modelling project. These show very good agreement. Finally, the method is applied to a volcano-induced outburst flood over an initially dry channel with complex irregular topography to demonstrate the technique's capability in simulating a real flood

Seven Epidemic Waves of COVID-19 in a Hospital in Madrid: Analysis of Severity and Associated Factors

(1) Background: COVID-19 has evolved during seven epidemic waves in Spain. Our objective was to describe changes in mortality and severity in our hospitalized patients. (2) Method: This study employed a descriptive, retrospective approach for COVID-19 patients admitted to the Hospital de Fuenlabrada (Madrid, Spain) until 31 December 2022. (3) Results: A total of 5510 admissions for COVID-19 were recorded. The first wave accounted for 1823 (33%) admissions and exhibited the highest proportion of severe patients: 65% with bilateral pneumonia and 83% with oxygen saturation under 94% during admission and elevated levels of CRP, IL-6, and D-dimer. In contrast, the seventh wave had the highest median age (79 years) and comorbidity (Charlson: 2.7), while only 3% of patients had bilateral pneumonia and 3% required intubation. The overall mortality rate was 10.3%. The first wave represented 39% of the total. The variables related to mortality were age (OR: 1.08, 1.07–1.09), cancer (OR: 1.99, 1.53–2.60), dementia (OR: 1.82, 1.20–2.75), the Charlson index (1.38, 1.31–1.47), the need for high-flow oxygen (OR: 6.10, 4.94–7.52), mechanical ventilation (OR: 11.554, 6.996–19.080), and CRP (OR: 1.04, 1.03–1.06). (4) Conclusions: The variables associated with mortality included age, comorbidity, respiratory failure, and inflammation. Differences in the baseline characteristics of admitted patients explained the differences in mortality in each wave. Differences observed between patients admitted in the latest wave and the earlier ones suggest that COVID-19 has evolved into a distinct disease, requiring a distinct approach

Visiones de fin de siglo

La presente publicación concentra los trabajos presentados por investigadores nacionales y extranjeros en el "Il Encuentro Internacional de Historia. El siglo XX en Bolivia y América Latina. Visiones de fin de siglo", que se realizó en la ciudad de Cochabamba entre el 27 y el 31 de julio de 1998. El encuentro fue organizado por la "Coordinadora de Historia. Investigadores Asociados" y contó con el auspicio del Centro Cultural Portales con sede en esa ciudad, así como con el apoyo de las siguientes instituciones: Facultad de Humanidades de la Universidad Mayor de San Andrés de La Paz, Plural Editores, Anden Silver Corporation, Embajada de México, Lloyl Aéreo Boliviano, Compañía Industrial de Tabacos S.A., Banco Mercantil y La Estrella. La Coordinadora de Historia, que reúne a más de 20 historiadores/as bolivianos/as, desarrolló en 1994 un encuentro similar sobre el siglo XIX en la ciudad de Sucre. Las actas del mismo, al que asistieron renombrados historiadores de Europa, Estados Unidos, Latinoamérica y Bolivia, ya han sido publicadas. En esta oportunidad, 48 expositores abordaron las siguientes temáticas planteadas por los organizadores del Congreso: - Archivos documentales bolivianos del siglo XX. - Proyectos y modelos de sociedad en Bolivia. - Estructuras y practicas políticas en Bolivia y America Latina. - Proyectos, estructuras y modelos económicos en Bolivia y América Latina. - Movimientos, actores y estructuras sociales en Bolivia y America Latina. - Culturas hegemónicas y contraculturas en Bolivia y America Latina. Diez de ellos, Horacio Cerruti, Francisco Zapata, Antonio García de Léon, Antonio Mitre, Melvin Burke, H.C.F, Mansilla, Janvier Sanjinés, Jorge Lazarte, René Antonio Mayorga y Gonzalo Sánchez de Lozada, estuvieron encargados de desarrollar "ponencias magistrales", las que se caracterizaron por intentar visiones más globales o de síntesis sobre las temáticas generales trabajadas en cada una de las jornadas. El encuentro sobre el siglo XX, tuvo la particularidad de reunir a especialistas nacionales extranjeros de distintas disciplinas de las ciencias sociales y humanas como historiadores, sociólogos, antropólogos, economistas y literatos, con el objetivo de lograr el intercambio de visiones y perspectivas de análisis bajo una óptica multirdisciplinaria. Ello permitió romper barreras entre las disciplinas que muchas veces son resultado de prejuicos y celos y desarrollar un rico y creativo débale que muy pocas yeces se realiza en nuestro medio

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization