Effectiveness of a thrombin-gelatin flowable for treating severe liver bleeding: an experimental study.

BACKGROUND: Current scientific evidence has pointed out the relevance of hemostatic products for improving clinical outcomes in liver trauma, including increased survival rates and reductions in bleeding-related complications. The purpose of this study was to compare the use of the gelatin-thrombin flowable (Flowable) versus the standard technique of Packing in a new experimental liver injury model. METHODS: Twenty-four swine were prospectively randomized to receive either Flowable or standard packing technique. We used a novel severe liver injury model, in which the middle and left suprahepatic veins were selectively injured, causing an exsanguinating hemorrhage. The main outcome measure was the percentage of lost blood volume. RESULTS: The median total percentage of total blood volume per animal lost, from injury to minute 120, was significantly lower in the Flowable group (15.2%; interquartile range: 10.7-46.7%) than in the Packing group (64.9%; Interquartile range: 53.4-73.0%) (Hodges-Lehmann median difference: 41.1%; 95% CI: 18.9-58.0%, p = 0.0034). The 24-hour survival rate was significantly higher in the Flowable group (87.0%) than in the Packing group (0.0%) (Hazard ratio (HR) 0.08; 95% confidence interval 0.102 to 0.27; p < 0.0001). Mean-arterial pressure was significantly lower at minute 60 and 120 in the Flowable group than in the packing group (p = 0.0258 and p = 0.0272, respectively). At minute 120, hematocrit was higher in the Flowable than in the packing group (Hodges-Lehmann median difference: 5.5%; 95%CI: 1.0 to11.0, p = 0.0267). Finally, the overall-surgical-procedure was significantly shorter with Flowable than with Packing (Hodges-Lehmann median difference: 39.5 s, 95% CI: 25.0 to 54.0 s, p = 0.0004). CONCLUSIONS: The use of the Flowable was more effective in achieving hemostasis, reducing blood loss, and improving survival rates than standard packing in a severe porcine-liver bleeding model.

Government strategies in confronting COVID-19 in the republic of Cuba.

BACKGROUND: In Cuba, the first cases of coronavirus 2019 (COVID-19) were confirmed on March 11, 2020, when the World Health Organization (WHO) officially declared the pandemic and the Ministry of Public Health of Cuba (MINSAP) began to execute the COVID-19 Prevention and Control Plan. This plan was prepared two months earlier by MINSAP working together with the National Civil Defense and the government approved it at the end of January. OBJECTIVE: The aim of this research is to assess the effectiveness of the government strategies to deal with COVID-19, by analyzing the role of the different agencies involved in the pandemic management. METHODS: A bibliographical review of the following documents was conducted: information issued by MINSAP and other ministries, archives of the Pedro Kouri Institute (IPK) and Cuban journals regarding the high impact in the field of medicine. The data were processed with different tools (diagrams, bar graphs, analysis and synthesis, etc.) that allowed measuring the effectiveness of the strategies implemented. RESULTS: The government's strategies focused on: the integration of all state agencies and some private institutions to confront COVID-19; the collaboration between MINSAP specialists, country's research centers and universities for the creation of vaccines to contain the pandemic; the production of medical equipment and instruments; the design of the organization processes of the services, such as planning techniques and distribution of ambulances, allocation of hospitals and isolation centers for sufferers and direct contacts respectively. CONCLUSION: The analysis carried out showed that the interrelations between the different organizations involved had positive influences on the treatment of the pandemic.

IFIH1 rs1990760 variants, systemic inflammation and outcome in critically-ill COVID-19 patients

RationaleOutcomes in patients with severe SARS-CoV-2 infection (COVID-19) are conditioned by virus clearance and regulation of inflammation. Variants in IFIH1, a gene coding the cytoplasmatic RNA sensor MDA5, regulate the response to viral infections. ObjectiveTo characterize the impact of IFIH1 rs199076 variants on host response and outcomes after severe COVID-19. MethodsPatients admitted to an intensive care unit (ICU) with confirmed COVID-19 were prospectively studied and rs1990760 variants determined. Peripheral blood gene expression, cell populations and immune mediators were measured. Peripheral blood mononuclear cells from healthy volunteers were exposed to an MDA5 agonist and dexamethasone ex-vivo, and changes in gene expression assessed. ICU discharge and hospital death were modelled using rs1990760 variants and dexamethasone as factors in this cohort and in-silico clinical trials. Measurements and Main Results227 patients were studied. Patients with the IFIH1 rs1990760 TT variant showed a lower expression of inflammation-related pathways, an anti-inflammatory cell profile and lower concentrations of pro-inflammatory mediators. Cells with TT variant exposed to a MDA5 agonist showed an increase in IL6 expression after dexamethasone treatment. All patients with the TT variant not treated with steroids (N=14) survived their ICU stay (HR 2.49, 95% confidence interval 1.29-4.79). Patients with a TT variant treated with dexamethasone (N=50) showed an increased hospital mortality (HR 2.19, 95% confidence interval 1.01-4.87) and serum IL-6. In-silico clinical trials supported these findings. ConclusionsCOVID-19 patients with the IFIH1 rs1990760 TT variant show an attenuated inflammatory response and better outcomes. Dexamethasone may reverse this anti-inflammatory phenotype.

Intervención de enfermería sobre conocimientos de dengue sustentada en la teoría de Swanson / Nursing intervention on knowledge about dengue based on Swanson's theory

RESUMEN Fundamento: la infección del dengue puede cursar en forma asintomática o expresarse con un espectro clínico amplio que incluye las expresiones graves y las no graves. Objetivo: evaluar la intervención de Enfermería sobre conocimientos en dengue sustentada en la teoría de Swanson. Métodos: investigación cuantitativa de diseño pre experimental con pre y post test, contextualizada en el consultorio del médico y enfermera de la familia No. 5 del Policlínico Dr. Rudesindo Antonio García del Rijo del municipio y provincia Sancti Spíritus, desde noviembre 2018 a noviembre de 2019. Variables de estudio: nivel de conocimientos de los pacientes sobre dengue, edad, sexo, escolaridad. Se utilizó entrevista estructurada a los pacientes, para conocer el conocimiento sobre la enfermedad, después de aplicada la intervención se compararon las proporciones poblacionales mediante Prueba de McNemar. Resultados: el grupo más representativo estuvo comprendido entre las edades de 45-54 años y de sexo masculino. El nivel de escolaridad secundaria terminada representa la mayor cantidad de individuos. Una vez concluidas las actividades educativas los pacientes incluidos en la investigación alcanzaron resultados adecuados. Los resultados obtenidos son alentadores, se elevó el nivel de conocimientos de los pacientes después de la intervención. Conclusiones: la intervención de enfermería resultó efectiva en el incremento del nivel de conocimientos sobre dengue en pacientes de un consultorio médico de la familia.

ABSTRACT Background: Dengue infection can be asymptomatic or express itself with a broad clinical spectrum that includes severe and non-severe expressions. Objective: to evaluate the Nursing intervention on knowledge in dengue based on Swanson's theory. Methods: quantitative research of pre-experimental design with pre and post test, contextualized in the Family Physician and Nurse Office No. 5 of the Dr. Rudesindo Antonio García del Rijo Polyclinic of the municipality and province of Sancti Spíritus, in the period of November 2018 to November 2019. Study variables: level of knowledge of patients about dengue, age, sex, education. A structured interview with the patients was used to learn about the knowledge about the disease. After the intervention was applied, the population proportions were compared using the McNemar test. Results: the most representative group was between the ages of 45-54 years and male sex. The level of completed secondary schooling represents the largest number of individuals. Once the educational activities were completed, the patients included in the research achieved adequate results. The results obtained are encouraging, significantly raising the level of knowledge of the patients after the intervention. Conclusions: the nursing intervention was effective in increasing the level of knowledge about dengue in patients from a family doctor's office.

The role of connectivity on COVID-19 preventive approaches

Preventive and modelling approaches to address the COVID-19 pandemic have been primarily based on the age or occupation, and often disregard the importance of heterogeneity in population contact structure and individual connectivity. To address this gap, we developed models based on Erd[o]s-Renyi and a power law degree distribution that first incorporate the role of heterogeneity and connectivity and then can be expanded to make assumptions about demographic characteristics. Results demonstrate that variations in the number of connections of individuals within a population modify the impact of public health interventions such as lockdown or vaccination approaches. We conclude that the most effective strategy will vary depending on the underlying contact structure of individuals within a population and on timing of the interventions. Author summaryThe best strategy for public health interventions, such as lockdown or vaccination, depends on the contact structure of the population and the timing of the intervention. In general, for heterogeneous contact structures that mimic the COVID-19 spread, which is characterized by the presence of super spreaders, vaccinating the most connected individuals first was the most effective strategy to prevent infections and deaths, especially when coupled to serological tests. Models considering heterogeneity in human interactions need be used to identify the best potential vaccine prioritization strategies.

AI-based multi-modal integration of clinical characteristics, lab tests and chest CTs improves COVID-19 outcome prediction of hospitalized patients

The SARS-COV-2 pandemic has put pressure on Intensive Care Units, and made the identification of early predictors of disease severity a priority. We collected clinical, biological, chest CT scan data, and radiology reports from 1,003 coronavirus-infected patients from two French hospitals. Among 58 variables measured at admission, 11 clinical and 3 radiological variables were associated with severity. Next, using 506,341 chest CT images, we trained and evaluated deep learning models to segment the scans and reproduce radiologists annotations. We also built CT image-based deep learning models that predicted severity better than models based on the radiologists reports. Finally, we showed that adding CT scan information--either through radiologist lesion quantification or through deep learning--to clinical and biological data, improves prediction of severity. These findings show that CT scans contain novel and unique prognostic information, which we included in a 6-variable ScanCov severity score.

Correlation between prevalence of tobacco smoking and risk and severity of COVID-19 at the national level in the European Union: an ecological study.

The Angiotensin-converting enzyme 2 (ACE2) protein is the receptor for different coronaviruses, including Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus disease 2019 (COVID-19). Previous studies suggested the hypothesis that nicotine could downregulate the expression of the ACE2. Due to the high level of nicotine intake, the objective of this preliminary study was to assess, at the ecological level, the correlation between tobacco smoking and the attack rate and severity of COVID-19 in the European Union (EU). We have found that there is a statistically significant negative correlation between the age-standardized prevalence of tobacco smoking and the attack rate of COVID-19 in member states of the EU [Spearmans correlation coefficient = -0.476 (95% confidence interval -0.117, -0.725) (p-value = 0.012)], meaning that in member states with a higher age-standardized prevalence of tobacco smoking the attack rate of COVID-19 has been so far lower. Further research is needed to understand the possible effect of nicotine exposure in the expression of the ACE2 protein.