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Introduction: ICU-acquired weakness (ICUAW) is a long-recognised phenomenon, featuring a prevalence of 25-80%. Early mobilisation is anaccepted intervention that may attenuate ICUAW and improve outcomes [1, 2]. Method(s): Prospective observational study in polyvalent ICU analysing the effect of early rehabilitation (eRHB) on quality of life one year after discharge (D/C).Patients who required invasive mechanical ventilation > 24 h and survived SARS-CoV2 respiratory infection between 5/3/2020 and 12/01/2022 were included. Patients were classified into two groups: eRHB or not eRHB. Demographic and clinical data were collected, and a telephone survey was conducted one year after D/C. Clinical Frailty Scale at ICU admission (T1) and one year after D/C (T5);Medical Research Council (MRC) at the start of rehabilitation (T2) and hospital D/C (T4);Barthel Index at ICU D/C (T3), T4 and T5;and the SF-36 health questionnaire at T5 were also collected. Statistical analysis was performed between subgroups: Pearson's Chi-square test or Mann-Whitney U test to find significant differences. ART-ANOVA was used to analyse the survey results. Result(s): Of 99 patients, 64.6% belonged to the eRHB group. There were no statistically significant differences in the analysis of clinicdemographic variables. We observed a significant improvement of the MRC, a better Barthel Index in the eRHB group, and a statistically significant positive impact on several components of the SF-36 in the eRHB group (physical functioning, vitality, social functioning, bodily pain, general health, and self-reported health transition). Conclusion(s): Patients who received eRHB had better physical functioning and higher vitality recovery. In addition, they suffered less impact on their social life, had better pain control, and reported improved general health. All this emphasises the need for eRHB protocols in the ICU, promoting multidisciplinary care of our patients.
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Introduction: AlthoughCOVID-19 and anemia are associated with higher risk for Acute Kidney Injury (AKI), to the best of our knowledge no studies have analyzed the association of admission hemoglobin with Major Adverse Kidney Events (MAKE) in patients with COVID-19 and AKI. Method(s): Retrospective cohort study of 412 hospitalized patients with severe COVID-19. MAKE was defined as a composite of 28-day mortality, progression to AKI stage 3, and renal replacement therapy. A COX regression analysis was used to determine the independent association of hemoglobin level with risk of MAKE. Result(s): The mean age of the 412 patients was 55+/-15 years, 35.9% were male, had a mean Body Mass Index (BMI) of 28.2+/-5.5 kg/m2, and median in-hospital stay was 10 (6-17) days. Overall, patients had a mean hemoglobin level of 12.8+/-2.8g/dL, and 62.1%, 23.8%, 8.7%, and 5.3% presented a 24-hour hemoglobin >13g/dL, 10-13g/dL, 9.9-8g/dL, and < 8g/dL, respectively. Likewise, the 28-day mortality was 20.4%, 22.3% progressed to AKI stage 3 and 9.5% required RRT. The univariate analysis showed that a 24-hour hemoglobin >13 g/dL had a lower risk for 28-day mortality (HR=0.634 [0.503-0.800]), AKI at any stage (0.457 [0.304-687]), progression to AKI stage 3 (0.666 [0.527-0.841]) and RRT requirement (0.626 [0.489-0.801]). After COX regression analysis, a hemoglobin >13g/dL was associated with lower risk to present MAKE (0.541 [0.338-0.866]), independently of age, sex, BMI, diabetes, hypertension, chronic kidney disease, mechanical ventilation, and proinflammatory markers. Conclusion(s):A hemoglobin >13 g/dL level was independently associated with lower risk to present MAKE in hospitalized patients with severe COVID-19. [Formula presented] Conclusion(s): A hemoglobin >13 g/dL level was independently associated with lower risk to present MAKE in hospitalized patients with severe COVID-19. No conflict of interestCopyright © 2023
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Background: COVID-19 and Acute kidney injury (AKI) are associated with increased mortality and worse kidney outcomes. Although vaccines against SARS-CoV-2 have decreased the rate COVID-19 morbimortality, the role of immune protection against SARS-CoV-2 in the setting of AKI has not been fully yielded Methods: Retrospective case-control study that included clinical and biochemical data of 412 (78 vaccinated and 334 non-vaccinated) patients with severe COVID-19. Cox regression analyses were used to evaluate the effect of the vaccine in mortality and AKI outcomes Results: The mean age of the patients was 55+/-15 years, 64% were women, the mean body mass index was 28+/-5 kg/m2, and median in-hospital stay was 10(6-16) days. The rate of mortality and AKI 3 was 29% vs 10% and 27% vs 13%, for unvaccinated and vaccinated patients, respectively. Cox proportional hazard ratios for survival and prevention of AKI are shown in table 1 Conclusion(s): The SARS-CoV-2 vaccine was independently associated with lower mortality and AKI progression in patients with severe COVID-19.
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Food security and hunger, linked to rural poverty, in Mexico are among the greatest challenges since they include large sectors of the population, which are exacerbated by the COVID-19 pandemic. The objective of this essay is to analyze the food security of family farming and rural poverty in Mexico. A systemic analytical framework was developed, which considered the food crisis, food security, agriculture and the agricultural development modality followed by Mexico. Family farming was addressed through the stratification developed by SAGARPA and FAO, as well as the conditions of marginalization and income poverty. According to the analysis, with the neoliberal model, Mexico specialized agricultural production towards export crops and agricultural growth, production that increased in recent years, achieving a surplus agri-food balance, which means food availability, but not food security for people in extremely rural poverty. It is concluded that there is a close relationship between rural poverty and food security, the latter linked to social inequality in income distribution, among other inequalities, which generates a circle of low income-poverty-food insecurity that occurs and reproduces socially in family farming. The strengthening of assets, agri-food production and income in family farming are fundamental for overcoming rural poverty and building a more equitable society.
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Background/Introduction: Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID);it is considered as relatively safe and is widely used in the world. However, at the beginning of the COVID-19 pandemic, ibuprofen was associated with an increase in severity or mortality of the infection [1-4]. Objective/Aim: To conduct a meta-analysis of the association between ibuprofen use and SARS-CoV-2 infection severity or mortality. Methods: We searched PubMed, EMBASE, Google Scholar and the Cochrane Database of Systematic Reviews for observational studies published between January 2020 and May 2021. Studies were included if they contained data on ibuprofen use and SARS-CoV-2 infection severity or mortality. Information upon study design, location, year of publication, number of participants, sex, age at baseline, outcome and exposure definitions was gathered. The quality of studies included was assessed with the Newcastle-Ottawa Scale (NOS). The analysis was performed based on a random-effects model;the summary effect and its confidence interval were calculated. Results: Eight observational studies comprising a total of 1785.730 participants were identified for inclusion (cohort, 5;case-control, 2;cross-sectional, 1). Mean age was 54.4 (SD 12.6) years-old and 50.2% were men. The mean NOS score of included studies was 7.7 (range 7-9). The studies were from Austria, Denmark (2), Israel, Saudi Arabia, UK (2) and USA. Patients exposed to ibuprofen while infected with SARS-CoV-2 had not higher severity or mortality;summary odds ratios were 0.81 (95% CI 0.58-1.12, p = 0.14) and 0.95 (95% CI 0.79-1.14, p = 0.42), respectively. Conclusion: At present, the available evidence does not support the hypothesis of an increased SARS-CoV-2 risk associated with ibuprofen. However, more evidence needs to accumulate before this controversy can be resolved.
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Background and aims: There´s emerging evidence on the association of GBS with SARS-CoV-2 infection. Neurotropism by coronavirus has been documented as well as various neurological manifestations such as encephalitis, stroke, encephalopathy and peripheral nerve disease. Methods: A 67-year-old male, no comorbidities presents three weeks prior to admission with fever, cough, taste and smell disturbances, myalgias, asthenia, clumsy hand movements and progressive lower limbs weakness. 15 days prior to admission: difficulty swallowing, diaphoresis. At admission: breathing difficulty and palpitations. Glasgow 13 E4 V5 M4, bulbar compromise, bradylalia, diminished gag reflex, sternocleidomastoid and trapezius weakness, MRC scale upper and lower limbs: proximal 3/5 distal 2/5, generalized areflexia, distal diffuse hypoesthesia Results: Ferritin 519 LDH 236 D Dimer >10,000 Hgb 19 WBC 11590 L 12% N 80% P 241,000 CK 111 CK MB 17. Chest CT: COVID19 pneumonia, CO-RADS 3. Pulmonary angiography: Posterior right lower lobe segmental PE. Scores: PESI 108, Geneva 10. SARS-CoV-2 PCR negative, SARS-CoV-2 IgG/IgM: Positive. Lumbar puncture not performed due to PE. Met Asbury GBS criteria, HUGHES 4, mEGOS 8 at admission, EGRIS 4. Progression of ascending symmetrical bilateral flaccidity with respiratory failure requiring mechanical ventilation for 10 days, tracheostomy and gastrostomy were performed. Discharged at day 60 with muscle strength recovery, upper limbs 4/5 and lower limbs 3/5, Sensitivity recovery, diminished lower limb reflexes. Therapy: Enoxaparin 60mg every 12h, Immunoglobulin 0.4mg/kg/day/5 doses. Discharge HUGHES 3. [Formula presented] [Formula presented] Conclusions: GBS is caused by an anomalous response of the immune system to an infectious agent. This particular patient presents with a GBS associated with SARS-CoV-2 infection and PE.