Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis.

OBJECTIVE: To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome. METHODS: We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old. RESULTS: We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 - 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 - 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 - 0.72 and OR 0.38; 95%CI 0.24 - 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate. CONCLUSION: The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

High vs. low tidal volume and pulmonary complications in patients with cervical spinal cord injury on mechanical ventilation: systematic review.

Introduction: Cervical spinal cord injury (CSCI) patients on mechanical ventilation often lack standardized guidelines for optimal ventilatory support. This study reviews existing literature to compare outcomes between high tidal volume (HTV) and low tidal volume (LTV) strategies in this unique patient population. Methods: We searched for studies published up to August 30, 2023, in five databases, following a PECO/PICO strategy. We found six studies for quantitative analysis and meta-analyzed five studies. Results: This meta-analysis included 396 patients with CSCI and mechanical ventilation (MV), 119 patients treated with high tidal volume (HTV), and 277 with low tidal volume (LTV). This first meta-analysis incorporates the few studies that show contradictory findings. Our meta-analysis shows that there is no significant statistical difference in developing VAP between both comparison groups (HTV vs. LTV) (OR 0.46; 95% CI 0.13 to 1.66; p > 0.05; I2: 0%), nor are there differences between the presence of other pulmonary complications when treating with HTV such as acute respiratory distress syndrome (ARDS), atelectasis, onset of weaning. Conclusion: In patients with CSCI in MV, the use of HTV does not carry a greater risk of pneumonia compared to LTV; in turn, it is shown as a safe ventilatory strategy as it does not establish an increase in other pulmonary complications such as ARDS, atelectasis, the onset of weaning nor others associated with volutrauma. It is necessary to evaluate the role of HTV ventilation in this group of patients in primary RCT-type studies.

Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis / Pronação consciente em pacientes com COVID-19 não intubados e com síndrome do desconforto respiratório agudo: revisão sistemática e metanálise

ABSTRACT Objective: To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome. Methods: We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old. Results: We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 - 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 - 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 - 0.72 and OR 0.38; 95%CI 0.24 - 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate. Conclusion: The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

RESUMO Objetivo: Revisar sistematicamente o efeito da posição prona na intubação endotraqueal e na mortalidade em pacientes com COVID-19 não intubados com síndrome do desconforto respiratório agudo. Métodos: Registramos o protocolo (CRD42021286711) e pesquisamos quatro bancos de dados e literatura cinzenta desde o início até 31 de dezembro de 2022. Incluímos estudos observacionais e ensaios clínicos. Não houve limite de data ou idioma de publicação. Excluímos relatos de casos, séries de casos, estudos não disponíveis em texto completo e estudos que incluíram pacientes < 18 anos de idade. Resultados: Incluímos 10 estudos observacionais, 8 ensaios clínicos, 3.969 pacientes, 1.120 eventos de intubação endotraqueal e 843 mortes. Todos os estudos tinham baixo risco de viés (ferramentas Newcastle-Ottawa Scale e Risk of Bias 2). Observamos que a pronação consciente reduziu as chances de intubação endotraqueal em 44% (RC 0,56; IC95% 0,40 - 0,78) e a mortalidade em 43% (RC 0,57; IC95% 0,39 - 0,84) em pacientes com COVID-19 não intubados com síndrome do desconforto respiratório agudo. Esse efeito protetor sobre a intubação endotraqueal e a mortalidade foi mais robusto naqueles que passaram > 8 horas por dia na pronação consciente (RC 0,43; IC95% 0,26 - 0,72 e OR 0,38; IC95% 0,24 - 0,60, respectivamente). A certeza da evidência, de acordo com os critérios GRADE, foi moderada. Conclusão: A pronação consciente diminuiu as chances de intubação endotraqueal e mortalidade, especialmente quando os pacientes passaram > 8 horas por dia na pronação consciente e tratamento na unidade de terapia intensiva. Contudo, nossos resultados devem ser interpretados com cautela devido às limitações na avaliação de ensaios clínicos randomizados, ensaios clínicos não randomizados e estudos observacionais. Não obstante, apesar das revisões sistemáticas com metanálises de ensaios clínicos randomizados, devemos ter em mente que esses estudos permanecem heterogêneos do ponto de vista clínico e metodológico.

Β-glucans and MOS, essential oil, and probiotics in diets of broilers challenged with Eimeria spp. and Clostridium perfringens.

The aim of this study was to evaluate the effectiveness of ß-glucans and MOS, essential oil (mixture of carvacrol and thymol), and the probiotic based on Saccharomyces boulardi, as an alternative to anticoccidial agents. In this experiment, six hundred seventy-two 1-day-old male broiler chicks were housed in batteries for 28 d. The experimental design of 4 randomized blocks with 24 cages each, and 7 birds per cage, consisted of an initial phase from 1 to 14 d of age, and a growth phase, from 15 to 28 d of age. The rations were formulated based on corn and soybean meal as energy and protein ingredients, respectively. All birds were inoculated with Eimeria spp and C. Perfringes at 14 d of age, and with C. Perfringes only at 21 d of age. The results showed the best weight gain in the initial phase when the anticoccidial agent was applied, whereas the use of additives in growth and entire experimental phases showed superior results in all treatments for this parameter. The birds that did not receive additives in the rations had the worst feed conversion in both phases and along raising. The results showed no significant differences between the treatments for the scores of lesions in the digestive tract and counts in the cecum, however, the red lesions increased numerically in the duodenum and jejunum of birds fed diets without the inclusion of additives. The use of additives indicated effectiveness for the parameters of performance in broilers challenged with C. Perfringes and Eimeria spp. at 14 d of age, and with C. Perfringes at 21 d of age.

Efficient NiO/F-TiO2 nanocomposites for 4-chlorophenol photodegradation.

This work aimed to study NiO/F-TiO2 composites in the photocatalytic degradation of 4-chlorophenol. F-TiO2 support was prepared by in-situ fluorination of TiO2 using the sol-gel method. The heterostructured materials were prepared by wet impregnation method, varying NiO content (0.5, 1.0, and 2.0% wt). The solids were characterized by X-ray fluorescence, X-ray diffraction, nitrogen physisorption, diffuse reflectance UV-Vis spectrophotometry, infrared spectroscopy, and X-ray photoelectron spectroscopy. The characterization studies showed that the coupling of TiO2 with fluoride ions promoted the generation of ≡Ti-F surface species that could be responsible for the decrease in the recombination frequency of charge carriers and the increased photoactivity. In addition, it was found that the coupling of NiO/F-TiO2 semiconductors improved the photocatalytic properties of the fluorinated support, obtaining higher percentages of degradation and mineralization of the phenolic contaminant. These results are possibly a consequence of factors such as the formation of larger crystallites, lower band gap energies, and the generation of p-n type interfacial heterojunctions that potentiate the proper separation of electron-hole pairs. An effect of NiO content on photoactivity was observed, being a percentage of 1.0% wt the optimum in this photocatalytic treatment.

Perception of risk and impact of the COVID-19 pandemic on patients with rheumatic diseases: a case-control study.

OBJECTIVES: Risk perception of the COVID-19 pandemic may affect chronic disease outcomes among patients with rheumatic diseases (RD). To describe and compare the perception of risk and effects of the COVID-19 pandemic on patients with RD from two health care centers compared with a control group. METHODS: A retrospective case-control study was conducted. Patient respondents completed an online survey to measure risk perception and effects of the COVID-19 pandemic. The case group consisted of patients with a confirmed diagnosis of RD, coming from two third-level health care centers. The control group was a population group without RD from a public university. RESULTS: A total of 3944 participants were included: 986 patients with an RD (cases) from the two hospital centers and 2958 controls without RD. A greater perception of risk severity and perception of contagion was observed in the group of patients with RD, OR: 1.70, 95% CI 1.44‒2.01 and OR: 2.0, 95% CI 1.79‒2.23, respectively; more significant deterioration in family life OR: 1.14, 95% CI 1.01‒1.29; greater economic impact, OR 3.94, 95% CI 3.48‒4.46; as well as negative emotions and feelings (alarmed, anxiety, depression, confusion, fear, isolation, and discrimination). This impact was maintained when the model was adjusted for comorbidities. CONCLUSION: In the face of an unexpected and catastrophic event such as the COVID-19 pandemic, patients with RD report apparently greater impact on their mental state and economic situation than the control population, as well as increased perception of discrimination. Key Points • The multidisciplinary analyses of risk perception are required to promote actions that can enhance the preparedness and responses of public efforts for possible future pandemics in a way that considers the specific needs of vulnerable people like patients with rheumatic diseases. • Identifying risk perceptions of possible effects of the pandemic, sources of communication, and opinions is essential to ensure self-care in rheumatic disease. • The impact of COVID-19 has been much greater for people with rheumatic disease, especially in terms of the perceived severity of the pandemic, impacts on family and economy, preventive behaviors, and uncertainty.

AMAZONIA CAMTRAP: A data set of mammal, bird, and reptile species recorded with camera traps in the Amazon forest.

The Amazon forest has the highest biodiversity on Earth. However, information on Amazonian vertebrate diversity is still deficient and scattered across the published, peer-reviewed, and gray literature and in unpublished raw data. Camera traps are an effective non-invasive method of surveying vertebrates, applicable to different scales of time and space. In this study, we organized and standardized camera trap records from different Amazon regions to compile the most extensive data set of inventories of mammal, bird, and reptile species ever assembled for the area. The complete data set comprises 154,123 records of 317 species (185 birds, 119 mammals, and 13 reptiles) gathered from surveys from the Amazonian portion of eight countries (Brazil, Bolivia, Colombia, Ecuador, French Guiana, Peru, Suriname, and Venezuela). The most frequently recorded species per taxa were: mammals: Cuniculus paca (11,907 records); birds: Pauxi tuberosa (3713 records); and reptiles: Tupinambis teguixin (716 records). The information detailed in this data paper opens up opportunities for new ecological studies at different spatial and temporal scales, allowing for a more accurate evaluation of the effects of habitat loss, fragmentation, climate change, and other human-mediated defaunation processes in one of the most important and threatened tropical environments in the world. The data set is not copyright restricted; please cite this data paper when using its data in publications and we also request that researchers and educators inform us of how they are using these data.

[Factors associated with a lack of postnatal care]. / Factores asociados a la falta de control posnatal materno.

Background: Postnatal care is essential to identify and treat at the appropriate time adverse health events in the puerperium. In Mexico, the factors that affect postnatal care have not been documented. Objective: To identify the factors associated with the lack of postnatal care. Material and methods: Cross-sectional study of 202 women of reproductive age affiliated with six primary care clinics of the Mexican Institute for Social Security. We analyzed these factors: (1) sociodemographic: age, education, schooling, distance between home and clinic; (2) psychosocial: social support; (3) obstetric and gynecologic: number of pregnancies, type of delivery, presence of comorbidity and suspected depression, and (4) health services: deficient prenatal control and incomplete postpartum hospital care. We performed multiple Poisson regression with a robust variance. Results: 49.5% of women had postnatal control. Factors associated with a higher probability of lack of postnatal control were: distance ≥ 5 km between home and clinic (adjusted prevalence ratio [aPR] 1.48, 95% confidence interval [95% CI] 1.16-1.88, p = 0.001), poor prenatal care (aPR 1.21, 95% CI 1.001-1.46, p = 0.049), and incomplete postpartum care (aPR 1.42, 95% CI 1.23-1.63, p < 0.001). Conclusions: The low attendance of postnatal care in primary care clinics highlights the need to seek and implement feasible healthcare alternatives, such as home care or telemedicine, to women who cannot attend to postnatal consultations.

Introducción: el control posnatal es esencial para identificar y tratar oportunamente las afecciones de salud de la mujer en el puerperio. En México no se han documentado los factores que limitan la atención posnatal. Objetivo: identificar los factores asociados a la falta de control posnatal. Material y métodos: estudio transversal con 202 mujeres en edad reproductiva adscritas a seis clínicas de atención primaria del Instituto Mexicano del Seguro Social. Analizamos los siguientes factores: (1) sociodemográficos: edad, escolaridad, distancia entre domicilio y clínica de atención; (2) psicosociales: apoyo social; (3) ginecoobstétricos: número de embarazos, tipo de parto, presencia de comorbilidad y sospecha de depresión; (4) servicios de salud: control prenatal deficiente y atención hospitalaria posparto incompleta. El análisis incluyó regresión múltiple de Poisson con varianza robusta. Resultados: 49.5% de las mujeres acudieron a control posnatal. Los factores asociados con mayor probabilidad de falta de control prenatal fueron: distancia ≥ 5 km entre domicilio y clínica de atención (razones de prevalencia ajustadas [RPa] 1.48, intervalo de confianza del 95% [IC 95%] 1.16-1.88, p = 0.001), control prenatal deficiente (RPa 1.21, IC 95% 1.001-1.46, p = 0.049) y atención posparto incompleta (RPa 1.42, IC 95% 1.23-1.63, p < 0.001). Conclusiones: la baja asistencia a control posnatal en las clínicas de atención primaria destaca la necesidad de buscar e implementar alternativas factibles, como teleasistencia y consultas a domicilio, para facilitar que las mujeres que viven lejos de su clínica de atención primaria reciban atención posnatal.

Caffeine photocatalytic degradation using composites of NiO/TiO2-F and CuO/TiO2-F under UV irradiation.

The interest in the removal of emerging contaminants has increased in the last decade. Photocatalytic degradation using p-n heterojunctions could effectively provide the degradation of these type of substances that are persistent in the environment. In this work, the synthesis, characterization, and photocatalytic evaluation of TiO2-F as well as CuO/TiO2-F and NiO/TiO2-F composite materials were studied in the photo-assisted degradation of caffeine using UV radiation. The fluorination of titanium dioxide induced changes in some physicochemical properties of the materials, which contributed to a decrease in surface area and bandgap energy as well as an increase in crystallite size as compared to pristine TiO2. ≡Ti-F species were evidenced to be formed, which could favor charge separation processes. A highest segregation of CuO species in comparison with NiO on the surface of TiO2-F could be formed, which could increase defect sites and decrease the band gap. The formation of a heterojunction between the semiconductors was evidenced, responsible for the observed improvements in photocatalytic properties of the composite materials. The photocatalytic tests evidenced an important degradation of caffeine; however, mineralization was incomplete. The stability of the composite materials and their potential use in the photocatalytic treatment of caffeine was evaluated by reuse tests.

Poder mecánico como predictor de mortalidad en pacientes críticos con síndrome de distrés respiratorias agudo por Covid-19 en la unidad de cuidados intensivos / Mechanical power as a predictor of mortality in critical ill patients with acute respiratory distress syndrome by Covid-19 in the intensive care unit

La ventilación mecánica invasiva como estrategia terapéutica no está exenta de complicaciones. Es imperativo tener parámetros de ventilación protectiva en aquellos pacientes que están sometidos a ello. Se pretende demostrar si la potencia mecánica como parámetro ventilatorio tiene validez pronóstica de mortalidad en pacientes críticos con ventilación mecánica invasiva prolongada. Material y Métodos: Se realizó un estudio transversal analítico de pacientes críticos en ventilación mecánica invasiva prolongada debido a Síndrome de Distrés Respiratorio Agudo por COVID-19 que ingresaron a la Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo durante el periodo de marzo 2020 a marzo del 2021. Resultados: La potencia mecánica, como parámetro ventilatorio, se asocia a mortalidad (RPa 1.061; IC 95% 1.037-1.085; p=0.00) al igual que la presión plateau y siendo la driving pressure y compliance estática factores protectores para mortalidad. La potencia mecánica como parámetro ventilatorio tiene validez pronóstica para mortalidad severa por COVID-19(AU)

Invasive mechanical ventilation as a therapeutic strategy is not without complications. It is imperative to have protective ventilation parameters in those patients who are subjected to it. We aim to demonstrate whether mechanical power as a ventilatory parameter has prognostic validity for mortality in critically ill patients with prolonged invasive mechanical ventilation. Material and Methods: An analytical cross-sectional study was carried out of critically ill patients on prolonged invasive mechanical ventilation due to Acute Respiratory Distress Syndrome due to COVID-19 who were admitted to the Intensive Care Unit of the Hospital Regional de Trujillo during the March 2020 to March 2021 period. Results: Mechanical power, as a ventilatory parameter, is associated with mortality (RPa 1.061; 95% CI 1.037-1.085; p = 0.00) as well as plateau pressure, and driving pressure and static compliance are protective factors for mortality. Mechanical power as a ventilatory parameter has prognostic validity for mortality in critically ill patients with invasive mechanical ventilation due to severe acute respiratory distress syndrome due to COVID-19(AU)

Mortalidad en pacientes críticos con síndrome de distrés respiratorio agudo por Covid-19 en la unidad de cuidados intensivos de un hospital público del norte de Perú / Mortality in critical patients with acute respiratory distress syndrome by Covid-19 in the intensive care unit of a public hospital in northern Peru

La enfermedad COVID-19 tiene como complicación el de Síndrome Agudo Respiratorio Severo (SDRA), que es considerada la principal causa de mortalidad dentro de las unidades de cuidados intensivos, a pesar de brindar soporte ventilatorio precoz y óptimo. Sin embargo, es necesario identificar los factores que se asocian a mortalidad en estos pacientes. Objetivo: Determinar cuáles son los factores asociados a mortalidad en pacientes críticos con Síndrome de distrés respiratorio agudo severo por COVID-19 en unidad de cuidados intensivos. Material y métodos: Estudio transversal analítico. Se usó una base de datos obtenida de 176 historias clínicas de los pacientes con distrés respiratorio agudo severo por COVID-19 en un hospital público de Trujillo desde marzo 2020 a junio 2021. Se dividieron un grupo de pacientes que sobreviven y otro grupo de los que fallecen, subdividiéndose según presentaron o no factores de mortalidad asociados. Se realizó un análisis bivariado y con los factores que resultaron estadísticamente significativos se realizó un análisis multivariado para determinar variables asociadas a mortalidad. Resultados: Se halló una mortalidad de 57% del total de pacientes, al realizar el análisis multivariado se encontró asociación estadística significativa en la presencia de comorbilidades medidas con el Índice de Charlson (RPa=1,348; IC 95%: 1,01-1,79; p=0,040) y dentro de los parámetros ventilatorios a la presión pico (RPa=1,261 IC; 95%: 1,13-1,40; p<=0,000). Es necesario identificar aquellas variables de riesgo de mortalidad para estratificar a pacientes y optimizar la terapéutica(AU)

The COVID-19 disease is complicated by severe acute respiratory syndrome (ARDS), which is considered the main cause of mortality within intensive care units, despite providing early and optimal ventilatory support. However, it is necessary to identify the factors associated with mortality in these patients. Objective: To determine the factors associated with mortality in critically ill patients with severe acute respiratory distress syndrome due to COVID-19 in the intensive care unit. Material and methods: Analytical cross-sectional study. A database obtained from 176 medical records of patients with severe acute respiratory distress due to COVID-19 was used in a public hospital in Trujillo from March 2020 to June 2021. A group of patients who survived and another group of those who died were divided, being subdivided according to whether or not they present associated mortality factors. A bivariate analysis was performed and with the factors that were statistically significant, a multivariate analysis was performed to determine variables associated with mortality. Results: A mortality of 57% of the total number of patients was found, when performing the multivariate analysis, a significant statistical association was found in the presence of comorbidities measured with the Charlson Index (RPa = 1.348; 95% CI: 1.01-1.79; p = 0.040) and within the ventilatory parameters at peak pressure (RPa = 1.261 CI; 95%: 1.13-1.40; p <= 0.000). It is necessary to identify those mortality risk variables to stratify patients and optimize therapy(AU)

Riesgo de progresión de COVID-19 severo mediante la escala call en un hospital público del norte de Perú / Risk of progression of severe COVID-19 through call scale in a public hospital in northern Peru

Establecer la validez diagnóstica de la escala CALL como predictor de mortalidad en pacientes con COVID-19 severo en Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo desde abril del 2020 hasta julio del 2021. Material y métodos: Se llevó a cabo un estudio analítico, retrospectivo, en el cual se incluyeron a 177 pacientes con COVID-19 severo internados en Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo, según criterios de selección, se calculó la escala CALL para cada uno y se asoció con la mortalidad encontrada; aplicándose la prueba estadística chi cuadrado; posteriormente se realizó un análisis de regresión multivariante para identificar los factores de riesgo asociados a la mortalidad. A su vez se utilizó el AUROC (área bajo la curva ROC) para establecer el rendimiento predictivo de la escala CALL. Resultados: De una muestra de 177 pacientes, al analizar la información mediante la curva ROC, se obtuvo un valor de corte 6 puntos para la escala CALL, con un área bajo la curva (AUC) de 0.612 (p=0,014); sensibilidad, especificidad, valor predictivo positivo y negativo de 86%, 29%, 60% y 62% respectivamente. No se encontraron diferencias significativas estadísticamente en cuanto a sexo, edad, shock séptico, SOFA, índice de comorbilidad de Charlson, necesidad de TRR ni compliance estática. En cambio, se evidenció asociación con la PaO2/FiO2(AU)

To establish the diagnostic validity of the CALL score as a predictor of mortality in patients with severe COVID-19 in the Intensive Care Unit of the Trujillo Regional Teaching Hospital from April 2020 to July 2021.Material and methods: An analytical, retrospective study was carried out, in which 177 patients with severe COVID-19 admitted to the Intensive Care Unit of the Regional Teaching Hospital of Trujillo were included, according to selection criteria, the CALL score was calculated for each one and was associated with the mortality found; applying the statistical chi 2 test; Subsequently, a multivariate regression analysis was performed to identify risk factors associated with mortality. In turn, the AUROC (area under the ROC curve) was used to establish the predictive performance of the CALL score. Results: From a sample of 177 patients, when analyzing the information using the ROC curve, a cut-off value of 6 points was obtained for the CALL score, with an area under the curve (AUC) of 0.612 (p=0.014); sensitivity, specificity, positive and negative predictive value of 86%, 29%, 60% and 62% respectively. No statistically significant differences were found in terms of sex, age, septic shock, SOFA, Charlson comorbidity index, need for renal replacement therapy (RRT) or static compliance. On the other hand, an association with PaO2 / FiO2 was evidenced(AU)

Factores sociodemográficos, clínicos y asistenciales asociados al impacto de la Covid-19 en la capacidad funcional respiratoria post alta hospitalaria / Sociodemographic, clinical and healthcare factors associated with the impact of Covid-19 on respiratory functional capacity after hospital discharge

La COVID-19 es una enfermedad infecciosa que causa importantes disfunciones respiratorias con repercusión a largo plazo, perdurando después del alta médico. En este estudio, se determinó la asociación entre los factores sociodemográficos, clínicos y asistenciales con el impacto de la COVID-19 en la capacidad funcional respiratoria post alta hospitalaria. Material y métodos: estudio observacional, analítico, transversal. La muestra conformada por 385 pacientes con diagnóstico de COVID-19. Se aplicó una ficha de recolección de datos, se estimó la capacidad funcional respiratoria. Se realizó un análisis bivariado mediante la prueba de chi cuadrado y razón de prevalencias considerando una significancia del 95% (p<0,05). Resultados: De los 385 pacientes, 228 (59,2%) se les percibió capacidad respiratoria normal y, disminuida en 157 (40,8%). Los adultos contemporáneos (55,84%) y masculinos (67,80%) fueron mayormente afectados. La comorbilidad (p= 0,292) y Co-Rads (p= 0,797) no mostraron estar directamente asociadas a la afectación respiratoria; contrario a RALE ≥ 3 en Radiografía de tórax (p=0,000). El tiempo en hospitalización, UCI y ventilación mecánica sugiere estar relacionado con la disminución respiratoria. Sin embargo, por RPc no hubo evidencia estadísticamente significativa. Pero, clínica severa 3.029 [1.611 ­ 5.696] p= 0.001 y RALE ≥3 4.079 [2.248 ­ 7.401] p= 0,000, arrojaron asociación. Conclusión: se identificaron como factores asociados el grado de severidad y RALE≥ 3 en radiografía de tórax. Se sugiere realizar estudios que confirme los hallazgos de esta investigación y se proponga un protocolo de rehabilitación integral dirigido a pacientes post covid-19 que les permita recuperar la normalidad en la capacidad funcional respiratoria(AU)

COVID-19 is an infectious disease that causes significant respiratory dysfunctions with long-term repercussions, lasting after medical discharge. In this study, association between socio-demographic, clinical and healthcare factors with the impact of COVID-19 on post-discharge respiratory functional capacity was determinated. Material and methods: observational study, analytical, cross-sectional study. The sample made up of 385 patients diagnosed with COVID-19. A data collection form was applied; the respiratory functional capacity was estimated. A bivariate analysis was performed using the fe chi square test and prevalence ratio, considering a significance of 95% (p<0.05). Results: of the 385 patients, 228 (59.2%) had normal respiratory capacity, and decreased in 157 (40.8%). Contemporary adults (55.84%) and males (67.80%) were mostly affected. Comorbidity (p= 0,292) and Co-Rads (p= 0,797) were not shown to be directly associated with respiratory involvement; contrary to RALE ≥ 3 in chest X-ray (p=0,000). The time in hospitalization, ICU and mechanical ventilation suggests to be related to the respiratory decrease. However, by PCR there was no statically significant evidence. But, clinical severe 3,029 [1,611 ­ 5,696] p= 0.001 and RALE ≥3 4,079 [2,248 ­ 7,401] p= 0,000, showed association. Conclusion: the degree of severity and RALE ≥ 3 in chest X-ray were identified as associated factors. It is suggest to carry out studies that confirm the findings of this research and propose a comprehensive rehabilitation protocol aimed at post-covid-19 patients that allows them to recover normal respiratory functional capacity(AU)

Escala News2 y Quick COVID-19 Severity Index: Predictores de mortalidad en adultos con infección por SARS­CoV­2 / News2 scale and Quick COVID-19 Severity Index: Predictors of mortality in adults with SARS­CoV­2 infection

La alta morbi-mortalidad asociada con COVID-19, se ha desarrollado herramientas de estratificación de riesgo clínico para estos pacientes, con el fin de predecir la progresión a enfermedad grave y/o mortalidad. En este estudio se comparó la Escala Quick COVID19 Severity Index con News2 como predictor de mortalidad en adultos con infección por SARS ­ CoV-2, precisando su validez diagnóstica. Materiales y métodos: Estudio observacional, retrospectivo, analítico, de pruebas diagnósticas. Se incluyeron a 255 pacientes, mayores de 18 años, hospitalizados en el Hospital II ­ I Moyobamba con diagnóstico de COVID-19, con requerimiento de oxígeno ≤6 Lt/min, en el periodo de enero a diciembre del 2020. Resultados: 13% (32/255) de los pacientes fallecieron, con predominio del sexo masculino 62,5% (20/32), con edad promedio de 50 años, los parámetros bioclínico valorados no demostraron asociación estadísticamente significativa, a excepción de la glucemia p: 0.01. En cuanto a las escalas, considerándose como puntaje alto ≥ 7 puntos; Quick Covid-19 Severity Index no tiene asociación significativa como predictor de mortalidad, con una sensibilidad y especificidad de 43,75% y 63,23% respectivamente; mientras que NEWS-2 arrojo sensibilidad de 87,50%; especificidad de 50,67%; AUC 0,768 (IC: 0,684-0,853; p 0,00); es decir existe más del 75% de probabilidad de pronóstico. Conclusión: la escala NEWS-2estadisticamente mostró ser una buena herramienta para el pronóstico de mortalidad en pacientes con infección con SARS ­ CoV ­ 2, se sugiere realizar estudios que confirme los hallazgos de esta investigación y valorar su aplicabilidad y reproducibilidad en otras poblaciones(AU)

Due to the high morbidity and mortality associated with COVID-19, clinical risk stratification tools have been developed for these patients, in order to predict progression to severe disease and/or mortality. In this study, the Quick COVID19 Severity Index Scale was compared with News2 as a predictor of mortality in adults with SARS-CoV-2 infection, specifying its diagnostic validity. Materials and methods: Observational, retrospective, analytical study of diagnostic tests. 255 patients were included, over 18 years of age, hospitalized in Hospital II - I Moyobamba with a diagnosis of COVID-19, with an oxygen requirement of ≤6 Lt/min, from January to December 2020. Results: 13% (32/255) of the patients died, with a predominance of males 62.5% (20/32), with an average age of 50 years, the bioclinical parameters evaluated did not show a statistically significant association, except for the blood glucose p: 0.01. Regarding the scales, considering a high score ≥ 7 points; Quick Covid-19 Severity Index has no significant association as a predictor of mortality, with a sensitivity and specificity of 43.75% and 63.23%, respectively; while NEWS-2 showed sensitivity of 87.50%; specificity of 50.67%; AUC 0.768 (CI: 0.684-0.853, p 0.00); that is, there is more than 75% probability of prognosis. Conclusion: the NEWS-2 scale statistically showed to be a good tool for the prognosis of mortality in patients infected with SARS - CoV - 2, it is suggested to carry out studies that confirm the findings of this research and assess its applicability and reproducibility in other populations(AU)

Saturación de oxígeno versus índice de oxigenación: predictores de mortalidad en pacientes críticos con síndrome distrés respiratorio agudo por COVID-19 / Oxygen saturation versus oxygenation index: predictors of mortality in critically ill patients with acute respiratory distress syndrome due to COVID-19

El COVID-19 es la causa más frecuente de SDRA generando cuadros clínicos leves, moderados y graves, en esta última, los pacientes podrían evolucionar a la necesidad de intubación orotraqueal y soporte ventilatorio avanzado; reportándose mortalidad de 26-90%, en estos casos. Es por ello, la necesidad de identificar factores de riesgos y herramientas predictores de mortalidad. En este estudio se determinó la validez diagnóstica de los índices de saturación de oxígeno y oxigenación como predictores de pronóstico de mortalidad en pacientes con SDRA severo por COVID-19 que requirieron de ventilación mecánica invasiva. Material y métodos: estudio transversal, analítico y retrospectivo. La muestra estuvo constituida por 176 historias clínicas de pacientes críticos. Se realizó análisis bivariado, y multivariado, además de determinar especificidad, sensibilidad, VPP, VPN y AUC. Resultados: 57,37% (101/176) de los pacientes fallecieron, con predominio del sexo masculino 79% (80/101); con edad promedio de 56 años. El lactato (p=0,115), no mostró asociación estadísticamente significativa. Contrariamente, en el análisis multivariado, el sexo masculino (p=0.04), glicemia (p=0,02) y, OI (p=0.00), arrojaron asociación. En cuanto a los índices, OSI registró sensibilidad y especificidad de 33% y 96% respectivamente; mientras que, IO tuvo 33,6% de sensibilidad y, 97,33% de especificidad; AUC 0,773 (IC: 0,677-0,868); es decir más del 77,3% de probabilidad de pronóstico a mortalidad. Conclusión: OSI y OI son adecuados predictores de mortalidad, teniendo OI mejor validez diagnóstico. Además, se ratifica, al sexo masculino y, aumento de valores glicémicos, como factores asociados a riesgo de desarrollar cuadros graves por COVID-19(AU)

COVID-19 is the most frequent cause of ARDS, generating mild, moderate and severe clinical symptoms, in the latter, patients could evolve to the need for orotracheal intubation and advanced ventilatory support; reporting mortality of 26-90% in these cases. This is why there is a need to identify risk factors and predictive tools for mortality. In this study, the diagnostic validity of the oxygen saturation and oxygenation indices as predictors of mortality prognosis in patients with severe ARDS due to COVID-19 who required invasive mechanical ventilation was determined. Material and methods: cross-sectional, analytical and retrospective study. The sample consisted of 176 medical records of critically ill patients. Bivariate and multivariate analyzes were performed, in addition to determining specificity, sensitivity, PPV, NPV, and AUC. Results: 57.37% (101/176) of the patients died, with a predominance of males 79% (80/101); with an average age of 56 years. Lactate (p=0.115) did not show a statistically significant association. Results: 57.37% (101/176) of the patients died, with a predominance of males 79% (80/101); with an average age of 56 years. Lactate (p=0.115) did not show a statistically significant association. Regarding the indices, OSI registered sensitivity and specificity of 33% and 96%, respectively; while IO had 33.6% sensitivity and 97.33% specificity; AUC 0.773 (CI: 0.677-0.868); that is, more than 77.3% probability of prognosis for mortality. Conclusion: OSI and OI are adequate predictors of mortality, with OI having better diagnostic validity. In addition, the male sex and increased glycemic values are confirmed as factors associated with the risk of developing serious conditions due to COVID-19(AU)

Factores asociados a la falta de control posnatal materno / Factors associated with a lack of postnatal care

Introducción: el control posnatal es esencial para identificar y tratar oportunamente las afecciones de salud de la mujer en el puerperio. En México no se han documentado los factores que limitan la atención posnatal. Objetivo: identificar los factores asociados a la falta de control posnatal. Material y métodos: estudio transversal con 202 mujeres en edad reproductiva adscritas a seis clínicas de atención primaria del Instituto Mexicano del Seguro Social. Analizamos los siguientes factores: (1) sociodemográficos: edad, escolaridad, distancia entre domicilio y clínica de atención; (2) psicosociales: apoyo social; (3) ginecoobstétricos: número de embarazos, tipo de parto, presencia de comorbilidad y sospecha de depresión; (4) servicios de salud: control prenatal deficiente y atención hospitalaria posparto incompleta. El análisis incluyó regresión múltiple de Poisson con varianza robusta. Resultados: 49.5% de las mujeres acudieron a control posnatal. Los factores asociados con mayor probabilidad de falta de control prenatal fueron: distancia ≥ 5 km entre domicilio y clínica de atención (razones de prevalencia ajustadas [RPa] 1.48, intervalo de confianza del 95% [IC 95%] 1.16-1.88, p = 0.001), control prenatal deficiente (RPa 1.21, IC 95% 1.001-1.46, p = 0.049) y atención posparto incompleta (RPa 1.42, IC 95% 1.23-1.63, p < 0.001). Conclusiones: la baja asistencia a control posnatal en las clínicas de atención primaria destaca la necesidad de buscar e implementar alternativas factibles, como teleasistencia y consultas a domicilio, para facilitar que las mujeres que viven lejos de su clínica de atención primaria reciban atención posnatal

Background: Postnatal care is essential to identify and treat at the appropriate time adverse health events in the puerperium. In Mexico, the factors that affect postnatal care have not been documented. Objective: To identify the factors associated with the lack of postnatal care. Material and methods: Cross-sectional study of 202 women of reproductive age affiliated with six primary care clinics of the Mexican Institute for Social Security. We analyzed these factors: (1) sociodemographic: age, education, schooling, distance between home and clinic; (2) psychosocial: social support; (3) obstetric and gynecologic: number of pregnancies, type of delivery, presence of comorbidity and suspected depression, and (4) health services: deficient prenatal control and incomplete postpartum hospital care. We performed multiple Poisson regression with a robust variance. Results: 49.5% of women had postnatal control. Factors associated with a higher probability of lack of postnatal control were: distance ≥ 5 km between home and clinic (adjusted prevalence ratio [aPR] 1.48, 95% confidence interval [95% CI] 1.16-1.88, p = 0.001), poor prenatal care (aPR 1.21, 95% CI 1.001-1.46, p = 0.049), and incomplete postpartum care (aPR 1.42, 95% CI 1.23-1.63, p < 0.001). Conclusions: The low attendance of postnatal care in primary care clinics highlights the need to seek and implement feasible healthcare alternatives, such as home care or telemedicine, to women who cannot attend to postnatal consultations

Heterogeneity of COVID-19 Risk Perception: A Socio-Mathematical Model.

The perception of risk has been a key element in the experiences, containment and differential impact of the COVID-19 pandemic worldwide. The complexity of this phenomenon requires the interdisciplinary integration of theoretical and methodological aspects, as this integration informs the objective of developing a mathematical proposal based on a conceptual model located within the social theory of risk at the micro-social level. The mathematical risk model used here was developed from a secondary analysis of a study of 12,649 individuals on the experiences of the COVID-19 pandemic in a population in which the quantity and quality of the information made it possible to define a risk factor and its relationship to emotions and the sources of information used. Four sequential strategies were used to construct the model: choosing the variables for the questionnaire that theoretically corresponded to the conceptual model, constructing the risk vector and initial grouping of individuals by perception of risk, modeling by using principal component analysis and applying network methods. The theoretical model of risk, proposed and constructed through the analysis of groupings by quartiles and by networks in the studied population from a social and mathematical perspective, demonstrates the heterogeneity of risk perception as manifested by differences in perception by age, gender, expression of feelings and media consulted in a university community. The knowledge and methodology generated in these analyses contribute to the body of knowledge informing the response to future epidemiological contingencies.

Comparison between Covid-19 and influenza A(H1N1) pandemic experiences and risk perception in a Mexican university / Experiencias y percepción de riesgo ante la influenza A(H1N1) y Covid-19 en universitarios mexicanos

Abstract: Objective: To compare the perceptions and experiences between the A(H1N1) and Covid-19 pandemics in a university population. Materials and methods: Online surveys were administered during the influenza A(H1N1) -originated in Mexico in 2009- and Covid-19 epidemics. Measures: sociodemographic characteristics, knowledge, information and communication, perception of risk, physical and mental health, effects on daily life, and preventive behaviors. Results: This study included 24 998 respondents, 51.36% from the A(H1N1) group and 48.63% from the Covid-19 group. Differences were observed in the perception of severity. During the influenza A(H1N1) pandemic worry was the feeling reported most frequently, while for Covid-19 it was anxiety. Covid-19 had greater impact on students' family economy and caused a higher uncertainty. Conclusions: The perceptions and experiences of the two pandemics were similar but the impact has been much greater for Covid-19, especially in terms of the severity, family economy, preventive behaviors, and uncertainty.

Resumen: Objetivo: Comparar las experiencias y percepciones de riesgo entre las pandemias de A(H1N1) y Covid-19 en universitarios. Material y métodos: Encuestas en línea comparables de las epidemias de influenza A(H1N1) -originada en México en 2009- y Covid-19. Evaluaciones: características sociodemográficas, conocimientos, información y comunicación, percepción de riesgo, salud física y mental, efectos en la vida cotidiana, conductas preventivas. Resultados: Participaron 24 998 sujetos; 51.36% de grupo de A(H1N1) y 48.63% del grupo de Covid-19. Se observaron diferencias en la percepción de las epidemias. En influenza A(H1N1) la preocupación fue el sentimiento más frecuente y para Covid-19, la ansiedad. En Covid-19 hubo mayor impacto en la economía familiar y mayor incertidumbre para el regreso a clases. Conclusión: Las percepciones y experiencias de las dos pandemias fueron similares, pero el impacto ha sido mucho mayor para Covid-19 especialmente en la gravedad, economía familiar, conductas preventivas y en la incertidumbre.

"He Fell in and That's How He Became a Fossil!": Engagement With a Storytelling Exhibit Predicts Families' Explanatory Science Talk During a Museum Visit.

Parent-child conversations in everyday interactions may set the stage for children's interest and understanding about science. Studies of family conversations in museums have found links to children's engagement and learning. Stories and narratives about science may spark children's interest in science topics. This study asks whether a museum exhibit that provides opportunities for families to create narratives might encourage families' explanatory science talk throughout the rest of the exhibit. The project focused on the potential impact of a hands-on story-telling exhibit, the "spin browser" embedded within a larger exhibition focused on fossilized mammoth bones-Mammoth Discovery! at Children's Discovery Museum of San Jose. Participants were 83 families with children between 3 and 11 years (mean age 7 years). We coded families' narrative talk (telling stories about the living mammoth or the fossil discovery) and connecting talk (linking the story to other nearby exhibits) while families visited the spin browser, and we also coded families' explanatory science talk at the exhibits that contained authentic fossil bones and replica bones. The parents in families who visited the spin browser (n = 37) were more likely to engage in science talk at the fossil exhibits than those in families who did not visit the spin browser (n = 46). Further, a regression analysis showed that family science talk at the fossil exhibits was predicted by parents' connections talk and children's narrative talk at the spin browser. These findings suggest that families' narratives and stories may provide an entry point for science-related talk, and encourage future study about specific links between storytelling and science understanding.

In ovo administration of Bacillus subtilis serotypes effect hatchability, 21-day performance, and intestinal microflora.

Recent research has tried to maximize broiler chick health and performance by utilizing commercial in-feed probiotics to inoculate fertile hatching eggs, and thus expose birds earlier to beneficial bacteria. However, the in ovo inoculation of a specific serotype of Bacillus subtilis was detrimental for broiler hatchability. Therefore, the objective of this study was to determine if other B. subtilis serotypes negatively affect hatchability or if it is associated with a specific serotype. It was also of interest to determine if the B. subtilis serotype influence chick performance and intestinal microflora. On d18 of incubation, 1886 fertile broiler eggs were in ovo inoculated with the following treatments (T): T1 = Marek's vaccine (MV), T2 = MV + B. subtilis (ATCC 6051), T3 = MV + B. subtilis (ATCC 8473), and T4 = MV + B. subtilis (ATCC 9466). It should be noted that in a previous study, T2 was detrimental to hatchability. Inoculated eggs were transferred to 3 hatchers/T. At hatch, chicks were weighed, feather sexed, and hatch residue analysis was conducted. Male chicks were randomly assigned to 40 raised wire cage so that there were 10 birds/cage. On d 0, 7, 14, and 21 of the grow-out, chicks and feed were weighed to calculate performance data. On these days, the ileum and ceca were aseptically collected to enumerate total aerobes and coliforms. No differences were observed for percentage of mid dead embryos, cracked eggs, and cull chicks (P > 0.05). However, hatch of transfer was significantly reduced by T2 compared to T1, T3, and T4 (P < 0.001). T2 had significantly higher percentages of late dead embryos and pips when compared to the other treatments (P = 0.002 and P < 0.001, respectively). Chicks hatched from T2 were not vigorous and, thus, not used for the grow-out trial. No differences were observed for growth performance characteristics for any of the treatments (P > 0.05). For bacterial enumeration, the ileum had equal or fewer bacterial counts for T3 and T4 when compared to T1 on most sampling days, except on d21 where T4 had higher aerobic and coliform counts (P ≤ 0.0001). For the ceca, T3 and T4 had equal or fewer bacterial counts than T1 on every sampling day (P ≤ 0.0001). These data demonstrate that not all B. subtilis evaluated are detrimental to hatchability, but rather, serotype dependent. In addition, different B. subtilis serotypes can modify the intestinal microflora with potential to reduce pathogenic bacteria present in young broiler, without impacting overall performance.