Nutritional management and clinical outcome of critically ill patients with COVID-19: A retrospective study in a tertiary hospital.

BACKGROUND & AIMS: Severe COVID-19 infection is characterized by an inflammatory response and lung injury that can evolve into an acute respiratory distress syndrome that needs support treatment in intensive care unit. Nutritional treatment is an important component of the management of critically ill patients and should be started in the first 48 h of ICU admission to avoid malnutrition. This study describes the characteristics of the patients treated in a tertiary hospital in Madrid during the months of March-May 2020 (first wave), the medical nutrition treatment employed and its influence in the clinical outcome of these patients. METHODS: This is a retrospective study including COVID-19 patients admitted in ICU that needed medical nutrition treatment (MNT). Collected variables included sex, age, BMI, underlying diseases, time from hospitalisation to ICU admission, type of respiratory support (invasive mechanical ventilation (IMV) or high flow nasal cannula (HFNC) or non-invasive ventilation (non-IMV)), caloric and protein requirements (25 kcal/kg adjusted body weight (ABW), 1.3 g/kg ABW/day), MNT type (enteral nutrition (EN), parenteral nutrition (PN), mixed EN + PN), total calories (including propofol) and proteins administered, percentage of caloric and protein goal in ICU day 4th and 7th, metabolic complications, acute kidney failure (AKF), length of stay (LOS) and mortality. Data are expressed as mean ± SD, median (IQR) or frequencies. Statistical analysis was performed with the IBM SPSS Statistics for Windows, Version 25.0. p < 0.05 were considered statistically significant. RESULTS: A total of 176 patients were included (72.7% male), 60.1 ± 13.5 years, BMI 29.9 ± 5.4 kg/m2. Underlying diseases included 47.4% overweight, 39.8% obesity, 49.1% hypertension, 41.4% dyslipidaemia. 88.6% of patients needed IMV, 89.1% prone position, 2.9% ECMO. Time to ICU admission: 2 (4.75) days. Estimated caloric and protein requirements were 1775 ± 202 kcal and 92.4 ± 10.3 g. Calories and proteins administered at days 4th and 7th were 1425 ± 577 kcal and 66 ± 26 g and 1574 ± 555 and 74 ± 37, respectively. Most of the patients received PN (alone or complementary to EN) to cover nutritional requirements (82.4% at day 4th and 77.9% at day 7th). IVM patients received more calories and proteins during the first week of ICU admission. Complications included 77.8% hyperglycaemia, 13.2% hypoglycaemia, 83.8% hypertriglyceridemia, and 35.1% AKF. ICU LOS was 20.5 (26) days. The mortality rate was 36.4%. CONCLUSIONS: In our series, the majority of patients reached energy and protein requirements in the first week of ICU admission due to the use of PN (total or complementary to EN). Patients with HFNC or non-IMV may be at risk of malnutrition if total or complementary PN to oral diet/ONS/tube feeding is not used to cover nutritional requirements. Therefore, if EN is not possible or insufficient, PN can be safely used in critically ill patients with COVID-19 with a close monitoring of metabolic complications.

Monitoring of minor compounds in corn oil oxidation by direct immersion-solid phase microextraction-gas chromatography/mass spectrometry. New oil oxidation markers.

The aim of this study is to shed light on the evolution of the minor compounds in the corn oil oxidation process, through the information provided by direct immersion-microextraction in solid phase followed by gas chromatography/mass spectrometry (DI-SPME-GC/MS). This methodology enables one, in a single run, to establish the identity and abundance both of original oil minor components, some with antioxidant capacity, and of other compounds coming from both main and minor oil components oxidation. For the first time, some of the compounds formed from oil minor components degradation are proposed as new markers of oil incipient oxidation. Although the study refers to corn oil, the methodology can be applied to any other edible oil and constitutes a new approach to characterizing the oxidation state of edible oils.

Breast mass or sternalis muscle?

This is the first description of the sternalis muscle being found among the cadavers used during the last two decades in the dissection laboratories of the San Juan Bautista School of Medicine.

Manejo quirurgico de granuloma piogénico atípico: presentación de caso / Surgical management of atypical pyogenic granuloma: a case report

El Granuloma Piogénico (G. P.) es una reacción hiperplásica del tejido de granulación originada en mucosa bucal a consecuencia de agentes inflamatorios diversos que evoluciona hacia la ulceración, esta lesión puede ser iniciada por microtraumatismos repetitivos. Se trata de paciente femenina de 20 años de edad, de raza negra, la cual acudió a consulta al Post-grado de Cirugía Bucal de la Facultad de Odontología de la Universidad Central de Venezuela por presentar lesión recidivante en la zona postero- superior derecha del maxilar. Al examen intrabucal se observó lesión tumoral, localizada en reborde postero-superior derecho entre el 15 y el 18, de aproximadamente 3cm de diámetro, móvil, base sésil, color rosado oscuro, algunas zonas eritematosas y ulceradas, se encontraba cubierta por una membrana blanquecina en zonas traumatizadas por el molar antagonista, presenta placa e irritantes locales. 15 y 16 desplazados y vestibularizados con movilidad grado II a III, ausencia de 17 y 18. En la evaluación imagenológica se observó pérdida ósea y no se observó cortical definida del seno maxilar del lado derecho. En el acto quirúrgico se decidió realizar biopsia excisional de la lesión, exodoncia de 14, 15, 16 y 18 y por la comunicación bucosinusal se realizó rotación del colgajo palatino hacia el defecto óseo-mucoso. La planificación del caso se realizó tomando en cuenta cada una de las variables del caso como fue la eliminación de proceso patológico y adicionalmente a esto solucionar los defectos quirúrgicos que queden en el paciente. Permitiendo de esta manera lograr una mejor rehabilitación del paciente

The Pyogenic Granulome (P.G.) is a hyperplasic reaction of the granulation tissue originated on the buccal mucous as a consequence of diverse inflammatory agents that develops in the ulceration. Such lesion can be generated by repeated micro traumatisms. It is about a 20 years-old, female, African-American patient who came to the consulting room at the post-graduate school of buccal surgery because of a relapsing lesion on the back-right side of the upper maxillary. A tumor lesion was observed during the intrabuccal examination. It was located on the upper-right border between the 15 and the 18, of 3 mm. In diameter approximately, mobile, of sessile base, dark pink, with some erythomatosic and ulcerated regions. It was covered with a whitish membrane which was traumatized by the antagonistic molar. It presented plaque and local irritants. 15 and 16 were vestibularized with mobility grade I and II, and absence of 17 and 18. Osseous loss was observed in the imageneologic evaluation and no defined cortical of the maxillary sinus on the right hand side was observed. It was decided to perform an excisional biopsy; an endodoncy of 14, 15 16 and 18; and a rotation of the palatial flesh tissue in the direction of the osseous mucous defect. The case planning was performed taking into consideration each one of the variables as it was the elimination of the pathological process and, in addition to this, the solution of the surgical defects left on the patient thus allowing for better rehabilitation of the patient

Enfermedad vascular de dieulafoy como una emergencia quirúrgica: revisión / Vascular dieulafoy disease how a surgical emergency: review

Se presenta un caso de enfermedad de dieulafoy en una paciente de 51 años quien presentó hemorragia digestiva superior profusa, con deterioro hemodinámico. Se realizó intervención quirúrgica encontrándose lesión fúndica, sangrante, compatible con la enfermedad de dieulafoy y situs abdominalis inversus, falleciendo en el postoperatorio inmediato. Esta enfermedad poco frecuente es causa de hemorragia digestiva superior y se diagnostica por endoscopia en el curso de una laparatomia, observándose arteria de mediano calibre sangrante en las porciones altas del estómago. El tratamiento suele ser quirúrgico pero recientemente la endoscopia superior ha tomado la pauta diagnóstica y terapéutica. Se hacen consideraciones teórico-analíticas de tan inusual patología

Factores de riesgo de accidentes en niños menores de 15 años / Accidents risk factors in children smaller than 15 years

Los accidentes constituyen la epidemia humana cuyos factores de riesgo, previsibles en su totalidad, siguen provocando un número creciente de morbilidad y mortalidad, con fatales consecuencias para la salud. Se realizó un estudio de casos y controles con el propósito de conocer cómo se asocian algunos de ellos en los niños menores de 15 años. Para ello, se estudiaron 150 infantes que sufrieron esta tragedia y 150 controles. A todos se les realizó un cuestionario y se midieron las variables: edad, sexo, ocupación de la madre, lugar de residencia, escolaridad de los padres, condiciones de la vivienda. A los casos se les determinó además, el lugar de ocurrencia, horario de accidente, día de la semana, tipo de lesión y nivel de información de los padres. La edad de 1 a 4 años fue la de mayor número de accidentes (RP= 1.88, IC de 95 por ciento, 1.26, 2.80, p= 0.0015). Las malas condiciones de la vivienda (RP= 1.50, IC de 95 por ciento, 0.82, 2.74, p= 0.20). El sexo masculino (RP= 1.26, IC de 95 por ciento, 0.88, 1.93, p= 0.30). En los hijos de madre trabajadora (RP= 0.96, IC de 95 por ciento, 0.69, 1.34, p= 0.86). Los niños de madre con escolaridad menor de 9° (RP= 0.88, IC de 95 por ciento, 0.54, 1.41, p= 0.64). En los que el padre tenía escolaridad inferior a 9° (RP= 0.68, IC de 95 por ciento, 0.45, 1.03, p= 0.07). Concluimos que la edad entre 1 y 4 años constituye un riesgo importante de accidentes en niños (AU)

Estudio de eficacia y seguridad de ofloxacina en diversas infecciones bacterianas / Study of ofloxacin efficacy and safe in diversity

Se estudiarón 64 pacientes infectados con rango de edad entre 16 y 84 años, a quienes se les administró ofloxacina. Las enfermedades incluídas en el estudio fuerón: infección de partes blandas 41,93 por ciento, infección del tracto respiratorio inferior 26,8 por ciento, infecciones del tracto urinario 24,2 por ciento, y otras infecciones (sepsis, meningitis bacteriana, complicación post-parto y politraumatismo) 6,4 por ciento. De acuerdo al grado de severidad la distribución fue la siguiente: leves: 3,23 por ciento, moderadas: 51,61 por ciento y severas: 41,94 por ciento. El tratamiento con ofloxacina se administró en dosis promedio de 800 mg/día durante 3-17 días (promedio=9,75+3,37). La evolución clínica fue curación en el 83,87 por ciento, mejoría 12,90 por ciento (curación + mejoría = 96,7 por ciento), no determinada 3,22 por ciento y fracaso 0 por ciento. La evaluación de la eficacia bacteriológica mostró erradicación 70 por ciento, erradicación/superinfección 12 por ciento, persistencia 2 por ciento, resistencia 0 por ciento y no determinado 16 por ciento. La evaluación global del tratamiento fue clasificada como excelente en el 67,24 por ciento de los pacientes, buena 27,59 por ciento (excelente +buena =94,8 por ciento), regular 5,17 por ciento. Ningún paciente fue considerado con evolución inadecuada. En cuanto a la toxicidad de la droga, se registraron reacciones adversas: ardor local, nauseas, mareos, sudoración, acidez, insomnio y rash. Estas fueron clasificadas según su severidad en leve (2) moderada (2) y severa (1) este último caso ameritó la suspensión de la droga. En conclusión, ofloxacina puede considerarse eficaz y segura para el tratamiento de infecciones bacterinas

Effect of ketoconazole on plasma sex hormones, lipids, lipoproteins, and apolipoproteins in hyperandrogenic women.

The aim of the current study of 18 hyperandrogenic women was to determine the affects of ketoconazole (KTZ), an oral synthetic antifungal imidazole derivative that inhibits gonadal and adrenal steroidogenesis, on lipids, lipoprotein cholesterols, apolipoproteins, endogenous sex steroid hormones, and their interactions. Eighteen hyperandrogenic women, ages 18 to 35, with a history of severe acne and/or hirsutism, were randomly divided into two groups of nine, both receiving KTZ (group 1, 400 mg/d; group 2,800 mg/d) for 10 days. In groups 1 and 2, KTZ therapy reduced cholesterol (10%, P less than or equal to .01; 19%, P less than or equal to .05) and low-density lipoprotein (LDL)-cholesterol (13%, P less than or equal to .05; 33%, P less than or equal to .025), and increased apolipoprotein (apo) A1 (7%, P less than or equal to .005; 13%, P less than or equal to .01). KTZ, 800 mg/d, decreased apo B (21%, P less than or equal to .005), and lowered the ratio of LDL-cholesterol to high-density lipoprotein (HDL)-cholesterol (40%, P less than or equal to .01). KTZ therapy more than doubled the levels of estradiol (E2) in both groups (136%, P less than or equal to .01; 171%, P less than or equal to .01) and, in the high-dose group, decreased the levels of free testosterone (FT) (48%, P less than or equal to .05) and dehydroepiandrosterone-sulfate (DHEA-S) (36%, P less than or equal to .005). The reductions of total and LDL-cholesterol appear to be attributable to the increases in E2 and possibly to the decrease in FT. KTZ therapy may have beneficial effects on atherogenic lipid and lipoprotein patterns in women with hyperandrogenicity.

Susceptibility testing of Entamoeba histolytica.

The growth of Entamoeba histolytica in microtiter plates in vitro in a variety of environments with reduced oxygen tensions is reported. With 3% O2, 3% CO2, and 94% N2, the parasite growth in microtiter plates was identical to that in screw-capped culture tubes, as measured by [3H]thymidine incorporation and by quantitative parasite counts. There were no significant differences between the drug concentrations necessary to inhibit parasite growth by 50% based on [3H]thymidine incorporation vs those defined by quantitative parasite counts for the 15 antimicrobial agents tested (including seven drugs used for the treatment of amebiasis). This technique provides a reproducible method to quantitate the activity of potential antiamebic agents in vitro. The isotopic method should be of particular value in defining the metabolism of the parasite and effects of antimicrobial agents on it, whereas the morphologic method may be more valuable for workers with limited resources available to them.