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

Safety assessment of a traditionally used extract from leaves of Boldoa purpurascens.

ETHNOPHARMACOLOGICAL RELEVANCE: Boldoa purpurascens Cav. (Nyctaginaceae) is a plant species used in traditional medicine in Cuba as a diuretic. AIM OF THE STUDY: The aim of the present investigation was to evaluate the safety profile of a hydroalcoholic extract from leaves of Boldoa purpurascens. MATERIALS AND METHODS: First, an experimental study to assess the oral acute toxicity at a dose of 2000mg/kg body weight of the extract was carried out. Potential genotoxicity of the extract was evaluated using the Ames test and the micronucleus induction assay in mouse bone marrow. In the Ames test a concentration range of 50, 100, 150, 300 and 500µg/plate was tested. In the micronucleus induction assay, doses of 500, 1000 and 2000mg/kg of body weight were tested. For completeness, since the extract contains saponins, the evaluation of the hemolytic activity, ocular and skin irritation were included. RESULTS: No signs or symptoms of toxicity were observed in the oral acute toxicity test (body weight at baseline, seven days and end of the experiment of 236.41±20.07, 256.81±30.44 and 240.02±26.16 respectively for the treated group). The hydroalcoholic extract from the leaves was not mutagenic in the Ames test, and no genotoxicity was observed in the micronucleus assay. A hemolysis test at concentration of 1mg/mL confirmed hemolytic activity, which is not a safety concern since saponins are not absorbed after oral administration. In order to evaluate the percentage of protein denaturation, the ocular irritability index was calculated. The extract was found to be irritating. Finally, skin irritability was evaluated and the irritation index was equal to zero. CONCLUSIONS: Based on the toxicological evaluation of a traditionally used hydroalcoholic extract from the leaves of Boldoa purpurascens we can confirm the safety of its oral use

Determination of pharmacognostical and bromatological parameters, and evaluation of the antiparasitic activity of a preparation from bromelia pinguin L. fruits grown in Cuba

Bromelia pinguin L. ("maya" o "piña de ratón") es una planta ampliamente distribuida en Centroamérica y las islas del Caribe. Su fruto ha sido utilizado en la medicina tradicional como antihelmíntico. En este trabajo se muestran los resultados de los estudios farmacognósticos y bromatológicos que permitieron el establecimiento de los principales parámetros de rendimiento y calidad de la droga fruto de Bromelia pinguin L., en particular su contenido de proteínas (3,82 ± 0,31 mg/mL de proteína), actividad caseinolítica (17,06 ± 2,15 Ucas/mL) y azúcares (385,97 ± 76,36 mg/mL). Se ensayó la actividad antihelmíntica de la preparación proteolítica parcialmente purificada de los frutos de Bromelia pinguin L., con resultados positivos, y también mostró actividad contra Trichomonas vaginalis.Bromelia pinguin L. ("maya" or "mouse pineapple") is a plant broadly distributed in Central America and Caribbean's islands. Its fruit has been used in traditional medicine as anthelmintic. In this work results of pharmacognostical and bromatological study that allowed the establishment of the main yield parameters and quality of the drug fruit of Bromelia pinguin L. are shown, in particular its protein content (3.82 ± 0.31 mg/mL protein), caseinolitic activity (17.06 ± 2.15 Ucas/mL) and sugars content (385.97 ± 76.36 mg/mL). The antihelmintic activity of this partially purified proteolytic preparation of the fruits of Bromelia pinguin L. was tested, with positive results, which also showed activity against Trichomonas vaginalis.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Determination of pharmacognostical and bromatological parameters, and evaluation of the antiparasitic activity of a preparation from bromelia pinguin L. fruits grown in Cuba

Bromelia pinguin L. ("maya" o "piña de ratón") es una planta ampliamente distribuida en Centroamérica y las islas del Caribe. Su fruto ha sido utilizado en la medicina tradicional como antihelmíntico. En este trabajo se muestran los resultados de los estudios farmacognósticos y bromatológicos que permitieron el establecimiento de los principales parámetros de rendimiento y calidad de la droga fruto de Bromelia pinguin L., en particular su contenido de proteínas (3,82 ± 0,31 mg/mL de proteína), actividad caseinolítica (17,06 ± 2,15 Ucas/mL) y azúcares (385,97 ± 76,36 mg/mL). Se ensayó la actividad antihelmíntica de la preparación proteolítica parcialmente purificada de los frutos de Bromelia pinguin L., con resultados positivos, y también mostró actividad contra Trichomonas vaginalis.Bromelia pinguin L. ("maya" or "mouse pineapple") is a plant broadly distributed in Central America and Caribbean's islands. Its fruit has been used in traditional medicine as anthelmintic. In this work results of pharmacognostical and bromatological study that allowed the establishment of the main yield parameters and quality of the drug fruit of Bromelia pinguin L. are shown, in particular its protein content (3.82 ± 0.31 mg/mL protein), caseinolitic activity (17.06 ± 2.15 Ucas/mL) and sugars content (385.97 ± 76.36 mg/mL). The antihelmintic activity of this partially purified proteolytic preparation of the fruits of Bromelia pinguin L. was tested, with positive results, which also showed activity against Trichomonas vaginalis.Colegio de Farmacéuticos de la Provincia de Buenos Aire