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Objective: To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. Design: Cohort study, longitudinal, analytical. Setting: Intensive care unit of a third level hospital in Spain. Patients: Patients admitted for SARS-CoV-2 infection with admission to the ICU between March 2020 and March 2022. Interventions: Bayesian analysis with the beta binomial model. Main variables of interest: Bayes factor, mechanical power. Results: A total of 253 patients were analyzed. Baseline respiratory rate (BF10: 3.83 × 106), peak pressure value (BF10: 3.72 × 1013) and neumothorax (BF10: 17,663) were the values most likely to be different between the two groups of patients compared. In the group of patients with MP < 17 J/min, a BF10 of 12.71 and a BF01 of 0.07 were established with an 95%CI of 0.27-0.58. For the group of patients with MP ≥ 17 J/min the BF10 was 36,100 and the BF01 of 2.77e-05 with an 95%CI of 0.42-0.72. Conclusions: A MP ≥ 17 J/min value is associated with extreme evidence with 28-day mortality in patients requiring MV due to respiratory failure secondary to SARS-CoV-2 disease.
ABSTRACT
OBJECTIVE: To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. DESIGN: Cohort study, longitudinal, analytical. SETTING: Intensive care unit of a third level hospital in Spain. PATIENTS: Patients admitted for SARS-CoV-2 infection with admission to the ICU between March 2020 and March 2022. INTERVENTIONS: Bayesian analysis with the beta binomial model. MAIN VARIABLES OF INTEREST: Bayes factor, mechanical power. RESULTS: A total of 253 patients were analyzed. Baseline respiratory rate (BF10: 3.83 × 106), peak pressure value (BF10: 3.72 × 1013) and neumothorax (BF10: 17,663) were the values most likely to be different between the two groups of patients compared. In the group of patients with MP < 17 J/min, a BF10 of 12.71 and a BF01 of 0.07 were established with an 95%CI of 0.27-0.58. For the group of patients with MP ≥ 17 J/min the BF10 was 36,100 and the BF01 of 2.77e-05 with an 95%CI of 0.42-0.72. CONCLUSIONS: A MP ≥ 17 J/min value is associated with extreme evidence with 28-day mortality in patients requiring MV due to respiratory failure secondary to SARS-CoV-2 disease.
ABSTRACT
Objective To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. Design Cohort study, longitudinal, analytical. Setting Intensive care unit of a third level hospital in Spain. Patients Patients admitted for SARS-CoV-2 infection with admission to the ICU between March 2020 and March 2022. Interventions Bayesian analysis with the beta binomial model. Main variables of interest Bayes factor, mechanical power. Results A total of 253 patients were analyzed. Baseline respiratory rate (BF10: 3.83 × 106), peak pressure value (BF10: 3.72 × 1013) and neumothorax (BF10: 17,663) were the values most likely to be different between the two groups of patients compared. In the group of patients with MP < 17 J/min, a BF10 of 12.71 and a BF01 of 0.07 were established with an 95%CI of 0.27-0.58. For the group of patients with MP ≥ 17 J/min the BF10 was 36,100 and the BF01 of 2.77e-05 with an 95%CI of 0.42-0.72. Conclusions A MP ≥ 17 J/min value is associated with extreme evidence with 28-day mortality in patients requiring MV due to respiratory failure secondary to SARS-CoV-2 disease.
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Objetivo: precisar el grado de fuerza probatoria de las hipótesis estadísticas en relación a la mortalidad a 28 días y el valor umbral de 17 J/min de potencia mecánica (PM) en pacientes con insuficiencia respiratoria secundaria a SARS-CoV-2. Diseño: estudio de cohortes, longitudinal, analítico. Ámbito: Unidad de Cuidados Intensivos de un Hospital de Tercer Nivel en España. Pacientes: enfermos ingresados por infección por SARS-CoV-2 con ingreso en UCI entre Marzo de 2020 y Marzo de 2022 Intervenciones: análisis bayesiano con el modelo binomial beta. Variables de interés principales: Factor de Bayes, Mechanical Power. Resultados: Fueron analizados 253 pacientes. La frecuencia respiratoria inicial (BF10: 3.83x106), el valor de la Presión Pico (BF10: 3.72x1013) y el desarrollo de neumotórax (BF10: 17663) fueron los valores con más probabilidad de ser diferentes entre los dos grupos de pacientes comparados. En el grupo de pacientes con PM<17 J/min se estableció un BF10 de 12,71 y un BF01 de 0,07 con un IdC95% de 0,27-0,58;Para el grupo de pacientes con PM≥ 17J/min el BF10 fue de 36100 y el BF01 de 2.77e-05 con un IdC95% de 0,42-0,72. Conclusiones: un valor de PM≥17 J/min se asocia con una evidencia extrema con la mortalidad a 28 días en pacientes que necesitaron VM por insuficiencia respiratoria secundaria a enfermedad por SARS-CoV-2.
ABSTRACT
La inserción laboral es un ámbito de intervención socioeducativa que puede contribuir a la inclusión social de diferentes personas y grupos. A partir de una revisión de la literatura sobre elementos de protección en los procesos de inserción sociolaboral, y teniendo en cuenta especialmente la situación vivida durante la pandemia por COVID-19 en los años 2020-2022, en este estudio se ha identificado -a través de 109 cuestionarios y 21 entrevistas realizadas de forma grupal a agentes socioeducativos- cuáles de estos elementos están presentes en proyectos de inserción que se desarrollan actualmente en 4 países del contexto iberoamericano y se ha explorado cómo definen las 'buenas prácticas' en este ámbito y qué acciones efectivas existen. Los resultados, desglosados por países (Brasil, España, Colombia y México), indican que en los diferentes proyectos socioeducativos se trabajan elementos de protección de tres tipos: desarrollo de competencias personales y profesionales;apoyo del contexto familiar y social;y elementos propiamente institucionales relacionados con las intervenciones de intermediación sociolaboral y apoyo social. En cuanto a las buenas prácticas, los agentes técnicos que trabajan en los proyectos de inserción asocian este término con características metodológicas de su intervención (acompañamiento, empatía, personalización) y/o con el logro de resultados (calidad de vida, empoderamiento, empleabilidad). Los informantes identifican nuevos retos surgidos durante la pandemia, como la alfabetización digital o la salud mental, e ilustran con algunos ejemplos prácticas exitosas que desarrollan. El artículo concluye con la mención al enfoque socioeducativo en los programas de inserción sociolaboral y la presentación de dos propuestas de profundización en el tema de estudio.Alternate :Labour insertion is an area of socio-educational intervention that can contribute to the social inclusion of different individuals and groups. Based on a literature review on protective elements in socio-occupational integration processes, and taking into account especially the situation experienced during the COVID-19 pandemic in the years 2020-2022, in this study we have identified, through 109 questionnaires and 21 group interviews with socio- educational agents, which of these elements are present in integration projects currently being developed in 4 Latin American countries, and we have explored how they define 'good practices' in this area and what effective actions exist. The results, explained by country (Brazil, Spain, Colombia and Mexico), indicate that three types of protection elements are considered in the different socio-educational projects: development of personal and professional competences;support from the family and social context;and institutional elements related to socio-occupational intermediation and social support interventions. In relation to good practices, the technical agents working in insertion projects associate this term with methodological characteristics of their intervention (accompaniment, empathy, personalisation) and/ or with the achievement of results (quality of life, empowerment, employability). They identify new challenges that have arisen during the pandemic, such as digital literacy or mental health, and illustrate with some examples of successful practices they are developing. The article ends with a mention of the socio-educational approach in socio-labour insertion programmes and the presentation of two proposals for further study.Alternate :A integração no mercado de trabalho é uma área de intervenção sócio-educativa que pode contribuir para a inclusão social de diferentes indivíduos e grupos. Com base numa revisão da literatura sobre elementos protectores nos processos de inserção sócio-profissional, e tendo especialmente em conta a situação vivida durante a pandemia da COVID-19 nos anos 2020-2022, este estudo identificou - através de 109 questionários e 21 entrevistas de grupo com agentes sócio-educati os - quais destes elementos estão presentes em projectos de inserção actualmente em desenvolvimento em 4 países no contexto Ibero-Americano, e explorou a forma como eles definem 'boas práticas' nesta área e quais as acções eficazes que existem. Os resultados, repartidos por país (Brasil, Espanha, Colômbia e México), indicam que os diferentes projectos sócio-educativos trabalham sobre três tipos de elementos de protecção: desenvolvimento de competências pessoais e profissionais;apoio ao contexto familiar e social;e elementos institucionais relacionados com intervenções de intermediação sócio-laboral e apoio social. Em termos de boas práticas, os agentes técnicos que trabalham em projectos de inserção associam este termo às características metodológicas da sua intervenção (acompanhamento, empatia, personalização) e/ou à obtenção de resultados (qualidade de vida, empowerment, empregabilidade). Os informadores identificam novos desafios que surgiram durante a pandemia, tais como a alfabetização digital ou a saúde mental, e ilustram com alguns exemplos de práticas bem sucedidas que estão a desenvolver. O artigo conclui com uma menção à abordagem sócio-educativa em programas de integração sócio-profissional e a apresentação de duas propostas para estudo mais aprofundado.
ABSTRACT
As intracellular parasites, viruses exploit cellular proteins at every stage of infection. Adenovirus outbreaks are associated with severe acute respiratory illnesses and conjunctivitis, with no specific antiviral therapy available. An adenoviral vaccine based on human adenovirus species D (HAdV-D) is currently in use for COVID-19. Herein, we investigate host interactions of HAdV-D type 37 (HAdV-D37) protein IIIa (pIIIa), identified by affinity purification and mass spectrometry (AP-MS) screens. We demonstrate that viral pIIIa interacts with ubiquitin-specific protease 9x (USP9x) and Ran-binding protein 2 (RANBP2). USP9x binding did not invoke its signature deubiquitination function but rather deregulated pIIIa-RANBP2 interactions. In USP9x-knockout cells, viral genome replication and viral protein expression increased compared to wild type cells, supporting a host-favored mechanism for USP9x. Conversely, RANBP2-knock down reduced pIIIa transport to the nucleus, viral genome replication, and viral protein expression. Also, RANBP2-siRNA pretreated cells appeared to contain fewer mature viral particles. Transmission electron microscopy of USP9x-siRNA pretreated, virus-infected cells revealed larger than typical paracrystalline viral arrays. RANBP2-siRNA pretreatment led to the accumulation of defective assembly products at an early maturation stage. CRM1 nuclear export blockade by leptomycin B led to the retention of pIIIa within cell nuclei and hindered pIIIa-RANBP2 interactions. In-vitro binding analyses indicated that USP9x and RANBP2 bind to C-terminus of pIIIa amino acids 386-563 and 386-510, respectively. Surface plasmon resonance testing showed direct pIIIa interaction with recombinant USP9x and RANBP2 proteins, without competition. Using an alternative and genetically disparate adenovirus type (HAdV-C5), we show that the demonstrated pIIIa interaction is also important for a severe respiratory pathogen. Together, our results suggest that pIIIa hijacks RANBP2 for nuclear import and subsequent virion assembly. USP9x counteracts this interaction and negatively regulates virion synthesis. This analysis extends the scope of known adenovirus-host interactions and has potential implications in designing new antiviral therapeutics.
Subject(s)
Adenoviridae Infections , Adenoviruses, Human , COVID-19 , Active Transport, Cell Nucleus , Adenoviridae/genetics , Adenoviruses, Human/genetics , Humans , Molecular Chaperones , Nuclear Pore Complex Proteins , RNA, Small Interfering , Ubiquitin Thiolesterase/genetics , Ubiquitin-Specific Proteases , Viral Proteins/geneticsABSTRACT
The SARS-CoV-2 health emergency has led to a restructuring of health care systems and the reassignment of medical specialists from their usual duties to attend COVID-19 patients. The aim of this paper is to describe the levels of insomnia, anxiety, depression, and the impact on quality of life of doctors who were on the frontline of COVID-19 during the first two waves of the pandemic. Self-report surveys were conducted on said physicians during both waves, with 83 and 61 responses in the first and second waves, respectively. The reported presence of insomnia was frequent (71.8%), although it decreased in the second survey. Anxiety was moderate, decreasing from 57.1% to 43.1% between measurements. Overall, depression rates decreased between the two surveys. Substance use was found to have an indirect correlation with personal and professional satisfaction. In the light of the unforeseeable evolution of the pandemic and the medium- to long-term repercussions on professionals, we believe the adaptation of health resources is crucial to meet the new unpredictable mental health needs of this group.
Subject(s)
COVID-19 , Physicians , Anxiety/epidemiology , Anxiety/psychology , COVID-19/epidemiology , Depression/epidemiology , Depression/psychology , Humans , Personal Satisfaction , Quality of Life/psychology , SARS-CoV-2 , Sleep QualityABSTRACT
Glucagonomas are neuroendocrine tumors (NETs) that arise from the alpha cells of the pancreatic islets. They are typically slow-growing tumors associated with abnormal glucagon secretion, resulting in one or more non-specific clinical features, such as necrolytic migratory erythema (NME), diabetes, diarrhea, deep vein thrombosis, weight loss, and depression. Here, we report the case of a 44-year-old male with a history of diabetes mellitus, presenting with a pruritic and painful disseminated cutaneous eruption of erythematous plaques, with scales and peripheral pustules, misdiagnosed as disseminated pustular psoriasis and treated for 2 years with oral retinoid and glucocorticoids. During this period, the patient complained of weight loss of 32 kg and diarrhea and developed deep vein thrombosis. These symptoms, together with an inadequate response to therapy of the skin lesions, led to the reassessment of the initial diagnosis. Laboratory tests confirmed elevated plasma glucagon levels (>1000 pg/mL) and computed tomography (CT) scans revealed a 35/44 mm tumor in the pancreatic tail. Due to considerable disease complications and the COVID-19 pandemic, the surgical removal of the tumor was delayed for nearly 2 years. During this time, somatostatin analogue therapy efficiently controlled the glucagonoma syndrome and likely prevented tumor progression. As in other functional pancreatic NETs, the early clinical recognition of hormonal hypersecretion syndrome and the multidisciplinary approach are the keys for best patient management.
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BACKGROUND & AIMS: The evidence suggests that most vulnerable subjects to COVID-19 infection suffer from patients with comorbidities or immunosuppression, including liver transplant recipients. Liver graft dysfunction may be a rare complication. Some patients complain about the post-COVID-19 syndrome. The aim of this study was to assess medium- and short-term outcomes in liver transplant patients. PATIENTS AND METHODS: A retrospective case series was performed at a tertiary referral center. We screened 845 patients who had liver transplant (LT) in our center. All consecutive LT patients with COVID-19 during the Spanish outbreak from March 2020 to April 2021 were included. Demographics, pre-existing comorbidities, clinical and radiological data of COVID-19 infection, complications, and liver graft function were assessed at diagnosis and 3-month follow-up. RESULTS: Overall, 20 LT patients were diagnosed with confirmed COVID-19. We included 16 patients that met the inclusion criteria, 8 nonhospitalized (50%) and 8 (50%) hospitalized patients were analyzed. The median follow-up was 5.33 months (IQR 3.06-8.26). One patient died during the follow-up. All patients presented some grade of respiratory or functional symptoms. Dyspnea and fatigue were the most prevalent symptoms during the 3-month follow-up. No liver graft dysfunction were reported despite of partial immunosuppression withdrawal in four patients (25%). One patient had cardiovascular complications. CONCLUSIONS: Our results suggest the presence of post-COVID-19 syndrome with mild residual physical and psychological dysfunction in this subgroup of patients at 3 months after COVID-19. However, no cases of loss or liver graft dysfunction were reported.
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BACKGROUND: Homeless population has been severely affected by the COVID-19 pandemic. Their living conditions, comorbidity with different pathologies and a greater frequency of mental disorders, make this population vulnerable. METHOD: We implemented a program of serial visits in a hostel for confined homeless of the city council social services, for the monitoring and treatment of mental disorders and substance abuse problems. Accompanied by serial phone and email contacts. RESULTS: A highly significant percentage (63%) had mental disorders or substance abuse, requiring pharmacological intervention, and 37% began follow-up in resources of the Mental Health and Addiction network of the Psychiatric Service at the end of the program. Hospital emergency service visits were drastically reduced. None of them were infected with COVID-19. An individualized Social plan was drawn up in order to reintegrate them with support in the community. CONCLUSIONS: The Results have been really positive, meeting all the objectives and opening up developing new programs in the future, in the pandemic outbreak and out of it.
Subject(s)
COVID-19/prevention & control , Community Mental Health Services/organization & administration , Ill-Housed Persons/psychology , Mental Disorders/therapy , Substance-Related Disorders/therapy , Adult , Drug Therapy , Female , Humans , Male , Program Evaluation , Psychotherapy , Spain , Vulnerable PopulationsABSTRACT
The COVID-19 pandemic reached world-wide causing a great impact on healthcare services. The aim of this work is to describe the response of the Mental Health Network of the Salamanca´ Area (Spain) to this crisis and the reorganization of its resources within the first 8 weeks after the state of alarm was declared. The Psychiatry Service applied a contingency plan which included the reorganization of the human resources, the closure of some of the units and the implementation of telemedicine programs along with two specific programs, namely a mental health assistance program in the context of the infection by coronavirus, and another program for homeless people. 9.038 phone interviews were carried out in the outpatients and community mental health programs. The activity in subacute and acute wards, as well as that of the day hospital programs was decreased to 50%. Based on that this real-world response provided we concluded that the usage of telemedicine is promising in patients with any kind of disorder. Its implementation in daily practice will be considered in the future. Research must continue on COVID-19's impact on patients with mental disorders and Psychiatry's necessary adaptations and new approaches to them.