SARS-CoV-2: relação da deficiência de micronutrientes com a gravidade da doença e sua suplementação

The SARS-CoV-2 pandemic took the world by surprise, leaving behind millions of deaths. With time, multiple risk factors to develop severe cases of the illness were identified, those having in common malnutrition and/or micronutrients deficiencies associated. The aim of this review of the literature is to identify the relation between the severity of the illness with deficiency of specific micronutrients and the available recommendations for their supplementation as a modifier of the course of the infection in patients hospitalized and in the intensive care unit. It was found that there is not enough evidence to supplement none of the micronutrients raised and there is a big space to develop further studies. La pandemia por SARS-CoV-2 tomó al mundo por sorpresa, dejando a su paso millones de muertes. Con el tiempo se identificaron múltiples factores de riesgo para desarrollar cuadros severos de la enfermedad y que tienen en común un estado de malnutrición y/o un déficit de micronutrientes asociado. El objetivo de esta revisión de la literatura es identificar la relación de la severidad de la enfermedad con déficit de micronutrientes específicos y las recomendaciones disponibles para su suplementación como un modificador del curso de la infección en pacientes hospitalizados y en la Unidad de Cuidados Intensivos. Se encontró que no hay evidencia suficiente para suplementar ninguno de los micronutrientes planteados y aún se requiere realizar estudios adicionales

“SARS-CoV-2: relación de la deficiencia de micronutrientes con la severidad de la enfermedad y su suplementación”.

La pandemia por SARS-CoV-2 tomó al mundo por sorpresa, dejando a su paso millones de muertes. Con el tiempo se identificaron múltiples factores de riesgo para desarrollar cuadros severos de la enfermedad y que tienen en común un estado de malnutrición y/o un déficit de micronutrientes asociado. El objetivo de esta revisión de la literatura es identificar la relación de la severidad de la enfermedad con déficit de micronutrientes específicos y las recomendaciones disponibles para su suplementación como un modificador del curso de la infección en pacientes hospitalizados y en la Unidad de Cuidados Intensivos. Se encontró que no hay evidencia suficiente para suplementar ninguno de los micronutrientes planteados y aún se requiere realizar estudios adicionales

“SARS-CoV-2: relación de la deficiencia de micronutrientes con la severidad de la enfermedad y su suplementación”.

La pandemia por SARS-CoV-2 tomó al mundo por sorpresa, dejando a su paso millones de muertes. Con el tiempo se identificaron múltiples factores de riesgo para desarrollar cuadros severos de la enfermedad y que tienen en común un estado de malnutrición y/o un déficit de micronutrientes asociado. El objetivo de esta revisión de la literatura es identificar la relación de la severidad de la enfermedad con déficit de micronutrientes específicos y las recomendaciones disponibles para su suplementación como un modificador del curso de la infección en pacientes hospitalizados y en la Unidad de Cuidados Intensivos. Se encontró que no hay evidencia suficiente para suplementar ninguno de los micronutrientes planteados y aún se requiere realizar estudios adicionales

Competencias básicas 4 villas : currículo integrado, cuidado del medio ambiente y fomento de la convivencia

El trabajo obtuvo un premio de la Modalidad B de los Premios Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso 2011Se describen los proyectos llevado a cabo en el IESO Cuatro Villas (Berlanga, Badajoz) que promueven el trabajo por competencias básicas: el proyecto integrado 'Re-ambientemos', la unidad didáctica integrada 'Construimos papeleras', el corto audiovisual '¿Reciclas?' y la unidad didáctica integrada 'Convivencia en nuestros pueblos'ExtremaduraES

Interatrial block and atrial remodeling assessed using speckle tracking echocardiography

BACKGROUND: To evaluate the possibility of left atrial (LA) remodeling using speckle tracking echocardiography (STE) in patients with interatrial block (IAB). METHODS: We performed a cross-sectional study with three groups of patients: 56 without IAB, 21 with partial IAB (pIAB), and 22 with advanced IAB (aIAB). Transthoracic echocardiographic (TTE) STE was performed and clinical and echocardiographic findings were analyzed. RESULTS: TTE showed higher LA volume/body surface area in the patients with IAB. With STE, the absolute value of strain rate during atrial booster pump function (SRa) and early reservoir period (SRs) decreased in the pIAB group and even more in the aIAB group, compared to the group without IAB. The independent variables were the echocardiographic measures of LA size and function. After adjusting for confounders, both multiple linear regression and multivariate multinomial regression showed good correlation with dependent variables: longer P-wave duration on electrocardiography and with the type of IAB, respectively. SRa (p < 0.001), SRs (p < 0.001), and maximal peak LA longitudinal strain in the reservoir period (p = 0.009) were independently associated with P-wave duration. SRa was also associated with the presence of pIAB (OR = 11.5; 95% confidence interval (CI): 2.7-49.0; p = 0.001) and aIAB, (OR = 98.2; 95% CI: 16-120.4; p < 0.001) and SRs was associated with pIAB (OR: 0.03; CI: 0.003-0.29; p = 0.003) and with aIAB (OR: 0.008; CI: 0.001-0.12; p = 0.004). CONCLUSIONS: IAB correlates directly with structural remodeling and a decrease in the absolute value of LA SRa and SRs determined using STE

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society