Secondary infections in mechanically ventilated patients with COVID-19: An overlooked matter?

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Ventilació mecànica; Pneumònia associada a ventilacióCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Ventilación mecánica; Neumonía asociada a ventilaciónCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Mechanical ventilation; Ventilator-associated pneumoniaIntroduction. The susceptibility to infection probably increases in COVID-19 patients due to a combination of virus and drug-induced immunosuppression. The reported rate of secondary infections was quite low in previous studies. The objectives of our study were to investigate the rate of secondary infections, risk factors for secondary infections and risk factors for mortality in COVID-19 critically ill patients. Material and methods. We performed a single-center retrospective study in mechanically ventilated critically ill COVID-19 patients admitted to our Critical Care Unit (CCU). We recorded the patients’ demographic data; clinical data; microbiology data and incidence of secondary infection during CCU stay, including ventilator-associated pneumonia (VAP) and nosocomial bacteremia (primary and secondary). Results. A total of 107 patients with a mean age 62.2 ± 10.6 years were included. Incidence of secondary infection during CCU stay was 43.0% (46 patients), including nosocomial bacteremia (34 patients) and VAP (35 patients). Age was related to development of secondary infection (65.2 ± 7.3 vs. 59.9 ± 12.2 years, p=0.007). Age ≥ 65 years and secondary infection were independent predictors of mortality (OR=2.692, 95% CI 1.068-6.782, p<0.036; and OR=3.658, 95% CI 1.385- 9.660, p=0.009, respectively). The hazard ratio for death within 90 days in the ≥ 65 years group and in patients infected by antimicrobial resistant pathogens was 1.901 (95% CI 1.198- 3.018; p= 0.005 by log-rank test) and 1.787 (95% CI 1.023-3.122; p= 0.036 by log-rank test), respectively. Conclusions. Our data suggest that the incidence of secondary infection and infection by antimicrobial resistant pathogens is very high in critically ill patients with COVID-19 with a significant impact on prognosis.Introducción. En pacientes con COVID-19 la susceptibilidad a la infección se encuentra probablemente incrementada debido a una combinación de inmunosupresión farmacológica y provocada por el virus. La incidencia de infecciones secundarias descrita en estudios previos es bastante baja. Los objetivos de nuestro estudio consistieron en investigar la incidencia de infecciones secundarias, los factores de riesgo de infecciones secundarias y los factores de riesgo de mortalidad en pacientes críticos con COVID-19. Material y métodos. Realizamos un estudio retrospectivo unicéntrico en pacientes críticos COVID-19 que precisaron ventilación mecánica ingresados en nuestra Unidad de Cuidados Críticos (UCC). Recopilamos datos demográficos; clínicos; microbiológicos y la incidencia de infección secundaria durante la estancia en la UCC, incluyendo neumonía asociada a ventilación mecánica (NAVM) y bacteriemia nosocomial (primaria y secundaria). Resultados. Se incluyeron un total de 107 pacientes con una edad media de 62,2 ± 10,6 años. La incidencia de infección secundaria durante el ingreso en la UCC fue 43,0% (46 pacientes), incluyendo bacteriemia nosocomial (34 pacientes) y NAVM (35 pacientes). La edad se asoció con el desarrollo de infección secundaria (65,2 ± 7,3 vs. 59,9 ± 12,2 años; p=0,007). La edad ≥ 65 años y la infección secundaria fueron predictores independientes de mortalidad (OR=2,692; IC 95% 1,068-6,782; p<0,036; y OR=3,658; IC 95% 1,385-9,660; p=0,009, respectivamente). Hazard ratio para mortalidad a los 90 días en el grupo ≥ 65 años y en pacientes infectados por patógenos resistentes a antimicrobianos fue 1,901 (IC 95% 1,198-3,018; p= 0,005 por test log-rank) y 1,787 (IC 95% 1,023-3,122; p= 0,036 por test log-rank), respectivamente. Conclusiones. Nuestros datos sugieren que la incidencia de infección secundaria y la infección por patógenos resistentes a antimicrobianos es muy alta en pacientes críticos con COVID-19 con un impacto significativo en el pronóstico.None to declar

Estimation of atmospheric attenuation at 99 GHz using a total power radiometer

A total power radiometer operating at 99 GHz was implemented for a propagation experiment aimed to estimate attenuation along a slant path, in Madrid. Valuable data was collected during a measurement campaign in mid-april of 2012. The retrieved time series of radiometric attenuation allow the use of this technique at this frequency to be validated, under clear sky and cloudy conditions, using a low cost instrument calibrated with simple procedures. In spite of some hardware limitations, this experiment shows an interesting application of radiometric technique in order to study atmospheric propagation at 99 GHz

Study of rapid ionisation for simulation of soft X-ray lasers with the 2D hydro-radiative code ARWEN

We present our fast ionisation routine used to study transient softX-raylasers with ARWEN, a two-dimensional hydrodynamic code incorporating adaptative mesh refinement (AMR) and radiative transport. We compute global rates between ion stages assuming an effective temperature between singly-excited levels of each ion. A two-step method is used to obtain in a straightforward manner the variation of ion populations over long hydrodynamic time steps. We compare our model with existing theoretical results both stationary and transient, finding that the discrepancies are moderate except for large densities. We simulate an existing Molybdenum Ni-like transient softX-raylaser with ARWEN. Use of the fast ionisation routine leads to a larger increase in temperature and a larger gain zone than when LTE datatables are used

Performance analysis of Energy Efficient Ethernet on video streaming servers

[EN] Current trends on traffic growth oversee a steady increase of video streaming services, and the subsequent development of the associated infrastructure to allocate and distribute such contents. One of the operational costs associated to this infrastructure is the power bill. Therefore any mechanism used to decrease it, reducing also the carbon footprint asso- ciated to it, is welcome. In this work we investigate the suitability of the recently standard- ized IEEE 802.3az Energy Efficient Ethernet (EEE) for video traffic generated by video- streaming servers. The conclusion of the analysis is positive about the achievable energy savings, due to the inherent features of traffic patterns of video-streaming servers which help reducing the number of transitions between active and low-power modes in EEE.Part of the research leading to these received funding from the European Community's Seventh Framework Programme (FP7-ICT-2009-5) under Grant agreement No. 258053 (MEDIEVAL project). Additionally, the authors would like to acknowledge the support to this work by the CAM-UC3M Greencom Research Grant (under code CCG10-UC3M/TIC-5624), the FIERRO Spanish project (TEC2010-12250-E) and the Google Research Award "New Protocol Semantics and Scheduling Primitives for Energy Efficiency: Burst Coalescing at the Link and Application Layers".De La Oliva, A.; Vargas Hernández, TR.; Guerri Cebollada, JC.; Alberto Hernandez, J.; Reviriego, P. (2012). Performance analysis of Energy Efficient Ethernet on video streaming servers. Computer Networks. 57(3):599-608. https://doi.org/10.1016/j.comnet.2012.09.019S59960857

Effect of TEA on the blue emission of ZnO quantum dots with high quantum yield

This work reports the luminescence, morphology and synthesis of ZnO quantum dots using a simple wet chemical method and different concentrations of Triethanolamine (TEA) as surfactant. Those nanoparticles emitted a strong blue emission band centered at 429 nm when they are dispersed in hexane. Spherical quantum dots with sizes ranging from 3 to 7 nm were obtained for concentrations from 0 to 0.7 ml. of TEA, whereas a mixture with oval-like nanoparticles was observed from concentrations above of 1.1 ml of TEA. It was also possible to control the values of the band gap in ZnO quantum dots depending on the content of TEA. Based on the high quantum yield of 81% measured for those ZnO nanoparticles respect to quinine sulfate dye (QS), it is suggested that such nanoparticles could be used for biolabeling and ZnO based LEDs

Non-Maxwellian electron distributions in time-dependent simulations of low-Z materials illuminated by a high-intensity X-ray laser

The interaction of high intensity X-ray lasers with matter is modeled. A collisional-radiative timedependent module is implemented to study radiation transport in matter from ultrashort and ultraintense X-ray bursts. Inverse bremsstrahlung absorption by free electrons, electron conduction or hydrodynamic effects are not considered. The collisional-radiative system is coupled with the electron distribution evolution treated with a Fokker-Planck approach with additional inelastic terms. The model includes spontaneous emission, resonant photoabsorption, collisional excitation and de-excitation, radiative recombination, photoionization, collisional ionization, three-body recombination, autoionization and dielectronic capture. It is found that for high densities, but still below solid, collisions play an important role and thermalization times are not short enough to ensure a thermal electron distribution. At these densities Maxwellian and non-Maxwellian electron distribution models yield substantial differences in collisional rates, modifying the atomic population dynamics

Intervención educativa en niños de 7 a 11 años portadores de maloclusiones. Área VII, Cienfuegos

Fundamento: según la Organización Mundial de la Salud, las maloclusiones son el tercer problema de salud en el mundo, por lo que constituye una prioridad detectarlas y tratarlas adecuadamente. Objetivo: evaluar el resultado de una intervención educativa aplicada a niños portadores de maloclusiones causadas por hábitos deformantes bucales. Métodos: se realizó un estudio cuasiexperimental, con 52 niños portadores de maloclusiones, en el período comprendido desde septiembre de 2010 a junio de 2011, en una escuela primaria de Cienfuegos. Inicialmente se realizó un diagnóstico; luego se aplicó el programa Agradable sonrisa, con una frecuencia semanal; por último, fueron evaluados los resultados de las acciones educativas, preventivas y terapéuticas, dirigidas a niños, padres y educadores, con el fin de lograr la reducción de las maloclusiones y sus manifestaciones clínicas. Resultados: se logró elevar el nivel de conocimientos de niños, padres y educadores de forma significativa, así como se erradicó el 64,6 % de las anomalías dentomaxilofaciales (cierre bilabial anormal, resalte aumentado, adaquia) y por lo tanto hubo una disminución de los niños portadores de maloclusiones. Conclusión: la intervención fue efectiva, pues logró elevar el nivel de conocimientos de niños, padres y educadores acerca de las anomalías dentomaxilofaciales, además de contribuir a la eliminación de este problema en los niños y, en general, a mejorar la armonía de los componentes del aparato estomatognático

COVID-19 PICU guidelines: for high- and limited-resource settings

BACKGROUND: Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU. METHODS: An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines. RESULTS: This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or antithrombotic therapies are also described. CONCLUSION: Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the worl

Social/economic costs and health-related quality of life in patients with epidermolysis bullosa in Europe

Background The aim of this study was to determine the social/economic costs and health-related quality of life (HRQOL) of patients with epidermolysis bullosa (EB) in eight EU member states. Methods We conducted a cross-sectional study of patients with EB from Bulgaria, France, Germany, Hungary, Italy, Spain, Sweden and the United Kingdom. Data on demographic characteristics, health resource utilisation, informal care, labour productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. Results A total of 204 patients completed the questionnaire. Average annual costs varied from country to country, and ranged from €9509 to €49,233 (reference year 2012). Estimated direct healthcare costs ranged from €419 to €10,688; direct non-healthcare costs ranged from €7449 to €37,451 and labour productivity losses ranged from €0 to €7259. The average annual cost per patient across all countries was estimated at €31,390, out of which €5646 accounted for direct health costs (18.0 %), €23,483 accounted for direct non-healthcare costs (74.8 %), and €2261 accounted for indirect costs (7.2 %). Costs were shown to vary across patients with different disability but also between children and adults. The mean EQ-5D score for adult EB patients was estimated at between 0.49 and 0.71 and the mean EQ-5D visual analogue scale score was estimated at between 62 and 77. Conclusion In addition to its negative impact on patient HRQOL, our study indicates the substantial social/economic burden of EB in Europe, attributable mostly to high direct non-healthcare costs