Practical approach to inhaled sedation in the critically ill patient. Sedation, analgesia and Delirium Working Group (GTSAD) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC).

The use of sedatives in Intensive Care Units (ICU) is essential for relieving anxiety and stress in mechanically ventilated patients, and it is related to clinical outcomes, duration of mechanical ventilation, and length of stay in the ICU. Inhaled sedatives offer benefits such as faster awakening and extubation, decreased total opioid and neuromuscular blocking agents (NMB) doses, as well as bronchodilator, anticonvulsant, and cardiopulmonary and neurological protective effects. Inhaled sedation is administered using a specific vaporizer. Isoflurane is the recommended agent due to its efficacy and safety profile. Inhaled sedation is recommended for moderate and deep sedation, prolonged sedation, difficult sedation, patients with acute respiratory distress syndrome (ARDS), status asthmaticus, and super-refractory status epilepticus. By offering these significant advantages, the use of inhaled sedatives allows for a personalized and controlled approach to optimize sedation in the ICU.

Obtaining Cellulose Nanocrystals from Olive Tree Pruning Waste and Evaluation of Their Influence as a Reinforcement on Biocomposites.

The objective of this work is to improve the mechanical properties of polylactic acid (PLA) by incorporating cellulose nanocrystals (CNC) previously obtained from a cellulose pulp extracted from olive tree pruning (OTP) waste. Composites were manufactured by melt processing and injection moulding to evaluate the effect of the introduction of CNC with conventional manufacturing methods. This OTP-cellulose pulp was subjected to a further purification process by bleaching, thus bringing the cellulose content up to 86.1%wt. This highly purified cellulose was hydrolysed with sulfuric acid to obtain CNCs with an average length of 267 nm and a degradation temperature of 300 °C. The CNCs obtained were used in different percentages (1, 3, and 5%wt.) as reinforcement in the manufacture of PLA-based composites. The effect of incorporating CNC into PLA matrix on the mechanical, water absorption, thermal, structural, and morphological properties was studied. Maximum tensile stress and Young's modulus improved by 87 and 58%, respectively, by incorporating 3 and 5%wt. CNC. Charpy impact strength increased by 21% with 3%wt. These results were attributed to the good dispersion of CNCs in the matrix, which was corroborated by SEM images. Crystallinity index, glass transition, and melting temperatures were maintained.

Effect of Olive Pit Reinforcement in Polylactic Acid Biocomposites on Environmental Degradation.

Polylactic acid (PLA) is a biomaterial widely used as an alternative to petroleum-based polymeric matrices in plastic components. PLA-based biocomposites reinforced with lignocellulosic waste are currently receiving special attention owing to their mechanical properties, low toxicity, recyclability, and biodegradability. The influence of the percentage of waste on their properties and resistance to degradation are some of the points of great relevance. Therefore, a series of PLA-based biocomposites containing different percentages of olive pits (5, 15, 25 and 40% wt.) were manufactured and characterized both (a) immediately after manufacture and (b) after one year of storage under environmental conditions. The results obtained were analyzed to evaluate the influence of the incorporation of olive pits on the resistance to degradation (measured through Carbonyl Indices, CI), mechanical properties (tensile, flexural and impact strength), structure (Fourier Transform Infrared Spectroscopy, FT-IR; and, X-ray Diffraction, XRD), morphology (Scanning Electron Microscopy, SEM) and water absorption capacity of the manufactured materials. PLA degradation, corroborated by Differential Scanning Calorimetry (DSC), FT-IR, and XRD, resulted in a decrease in tensile and flexural strengths and an increase in the tensile and flexural moduli. This trend was maintained for the biocomposites, confirming that reinforcement promoted the PLA degradation.

Use of hospital resources in ICU inpatients with infections caused by carbapenem-resistant Gram-negative bacteria: A real clinical practice-based study in Spain / Uso de recursos hospitalarios en pacientes hospitalizados en UCI debido a infecciones causadas por bacterias gramnegativas resistentes a carbapenémicos: un estudio basado en la práctica clínica real en España

Introduction: Carbapenem-resistant Gram-negative bacteria (CRGN) are an urgent public health threat because of the limited treatment options, its rapid spreading and high clinical impact and mortality rates. However, the burden and the use of resources of these infections have not been investigated. The aim of the current study is to understand the use of resources associated to the clinical management of CRGN infections in real clinical practice conditions. Methods: An observational retrospective chart review study was performed. Data regarding patient demographics, clinical management and use of resources associated to hospitalization were retrieved from clinical charts of ICU inpatients with a confirmed CRGN infection. Three reference Spanish hospitals were selected according to their patient volume and geographical coverage. Descriptive analyses of the clinical management and the use of resources and its cost were performed and then total costs by type of resource were calculated. Results: A total of 130 patients were included in the study. The higher number of patients (n=43; 33%) were between 61 and 70 years old. Ninety-four (72%) patients were male and 115 (88%) suffered from comorbidities. The mean total cost associated to the resources used in patients with CRGN infections hospitalized in ICU was 96,878€ per patient. These total costs included 84,140€ of total hospital stay, 11,021€ of treatments (558€ of antibiotics; 10,463€ of other treatments) and 1717€ costs of diagnostic tests. Conclusions: CRGN infection causes a high use of hospital resources, being the length of stay either in hospital wards or ICU the driver of the total costs. Diagnostic tests and treatments, including antibiotics, represent the lowest part of the use of resources and costs (13% of total costs).(AU)

Introducción: Las bacterias gramnegativas resistentes a carbapenémicos (CRGN) son una amenaza urgente de salud pública por las limitadas opciones de tratamiento, su rápida dispersión y el alto impacto clínico y tasas de mortalidad. Sin embargo, la carga y el uso de recursos de estas infecciones no han sido investigadas. El objetivo de este estudio es comprender el uso de recursos asociado al manejo clínico de las infecciones por CRGN en condiciones de práctica clínica real. Métodos: Se llevó a cabo un estudio observacional retrospectivo de revisión de historias clínicas. Se recogieron datos demográficos, del manejo clínico y del uso de recursos asociado a la hospitalización de historias clínicas de pacientes hospitalizados en UCI con una infección confirmada por CRGN. Se seleccionaron tres hospitales españoles de referencia por su cobertura geográfica. Se realizaron análisis descriptivos del manejo clínico y el uso de recursos y sus costes en episodios de infecciones por CRGN, y se calcularon los costes totales para cada tipo de recurso. Resultados: Se incluyeron en el estudio un total de 130 pacientes. La mayoría de los pacientes (n=43;33%) tenían entre 61-70 años. Noventa y cuatro pacientes (72%) eran hombres y 115 (88%) presentaron comorbilidades. El coste medio total asociado a los recursos usados durante el episodio de infección por CRGN por paciente fue de 96.878€. Este coste total incluye 84.140€ de la estancia en el hospital, 11.021€ de los tratamientos (558€ de antibióticos y 10.463€ de otros tratamientos) y 1.717€ del coste de test diagnósticos. Conclusiones: El episodio de infección por CRGN causa un alto uso de recursos hospitalarios, siendo la duración de la estancia tanto en planta hospitalaria como en UCI el factor con mayor peso de los costes totales. Los test diagnósticos clínicos y los tratamientos, incluyendo los antibióticos, representan la parte más pequeña del uso de recursos y sus costes (13% del coste total).(AU)

Use of hospital resources in ICU inpatients with infections caused by carbapenem-resistant Gram-negative bacteria: A real clinical practice-based study in Spain.

INTRODUCTION: Carbapenem-resistant Gram-negative bacteria (CRGN) are an urgent public health threat because of the limited treatment options, its rapid spreading and high clinical impact and mortality rates. However, the burden and the use of resources of these infections have not been investigated. The aim of the current study is to understand the use of resources associated to the clinical management of CRGN infections in real clinical practice conditions. METHODS: An observational retrospective chart review study was performed. Data regarding patient demographics, clinical management and use of resources associated to hospitalization were retrieved from clinical charts of ICU inpatients with a confirmed CRGN infection. Three reference Spanish hospitals were selected according to their patient volume and geographical coverage. Descriptive analyses of the clinical management and the use of resources and its cost were performed and then total costs by type of resource were calculated. RESULTS: A total of 130 patients were included in the study. The higher number of patients (n=43; 33%) were between 61 and 70 years old. Ninety-four (72%) patients were male and 115 (88%) suffered from comorbidities. The mean total cost associated to the resources used in patients with CRGN infections hospitalized in ICU was 96,878€ per patient. These total costs included 84,140€ of total hospital stay, 11,021€ of treatments (558€ of antibiotics; 10,463€ of other treatments) and 1717€ costs of diagnostic tests. CONCLUSIONS: CRGN infection causes a high use of hospital resources, being the length of stay either in hospital wards or ICU the driver of the total costs. Diagnostic tests and treatments, including antibiotics, represent the lowest part of the use of resources and costs (13% of total costs).

Manufacture and Characterization of Recycled Polypropylene and Olive Pits Biocomposites.

The present work studies the use of olive pit (OP) as a reinforcement in the manufacture of composites based on a post-consumer recycled polypropylene (rPP). In this way, it is feasible to provide added value from olive pits, a by-product resulting from the olive industry operations, while promoting the circular economy and reducing the use of fossil-based polymers. For this purpose, suitable samples were manufactured using 25 wt% and 40 wt% of OP. Additionally, the effect of incorporating additives was studied: (a) a process control additive (PA), and (b) a coupling agent of maleic anhydride grafted polypropylene (MAPP). The results showed an improvement in Young's and flexural modulus with the OP addition. The incorporation of PA did not present any significant improvement in the properties of the materials, nevertheless it facilitated the biocomposite manufacturing process. As for the coupling agent, it significantly improved the mechanical properties, achieving the best results with the addition of the two types of additives and 40 wt% of OP. Moreover, the thermal properties were maintained, and there was an increase in crystallinity in all composites compared to rPP. According to the results of the fracture surface analysis, the coupling agent improves reinforcement-polymer matrix cohesion.

Role of Epitranscriptomic and Epigenetic Modifications during the Lytic and Latent Phases of Herpesvirus Infections.

Herpesviruses are double-stranded DNA viruses occurring at a high prevalence in the human population and are responsible for a wide array of clinical manifestations and diseases, from mild to severe. These viruses are classified in three subfamilies (Alpha-, Beta- and Gammaherpesvirinae), with eight members currently known to infect humans. Importantly, all herpesviruses can establish lifelong latent infections with symptomatic or asymptomatic lytic reactivations. Accumulating evidence suggest that chemical modifications of viral RNA and DNA during the lytic and latent phases of the infections caused by these viruses, are likely to play relevant roles in key aspects of the life cycle of these viruses by modulating and regulating their replication, establishment of latency and evasion of the host antiviral response. Here, we review and discuss current evidence regarding epitranscriptomic and epigenetic modifications of herpesviruses and how these can influence their life cycles. While epitranscriptomic modifications such as m6A are the most studied to date and relate to positive effects over the replication of herpesviruses, epigenetic modifications of the viral genome are generally associated with defense mechanisms of the host cells to suppress viral gene transcription. However, herpesviruses can modulate these modifications to their own benefit to persist in the host, undergo latency and sporadically reactivate.

Impact of Early Mobilization Added to Respiratory Physiotherapy Postextubation on Weaning Success

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Impact of simulation-based teamwork training on COVID-19 distress in healthcare professionals.

CONTEXT: Non-technical skills such as leadership, communication, or situation awareness should lead to effective teamwork in a crisis. This study aimed to analyse the role of these skills in the emotional response of health professionals to the COVID-19 pandemic. METHODS: Before the COVID-19 outbreak, 48 doctors and 48 nurses participated in a simulation-based teamwork training program based on teaching non-technical skills through simulation. In May 2020, this group of professionals from a COVID-19 referral hospital was invited to participate in a survey exploring stress, anxiety, and depression, using the PSS-14 (Perceived Stress Scale) and the HADS (Hospital Anxiety and Depression Scale) measures. A control group that did not receive the training was included. We conducted a logistic regression to assess whether having attended a simulation-based teamwork training program modified the probability of presenting psychological distress (PSS-14 > 18 or HADS> 12). RESULTS: A total of 141 healthcare professionals were included, 77 in the intervention group and 64 in the control group. Based on the PSS-14, 70.1% of the intervention group and 75% of the control group (p = 0.342) had symptoms of stress. Having contact with COVID-19 patients [OR 4.16(1.64-10.52)]; having minors in charge [OR 2.75 (1.15-6.53)]; working as a doctor [0.39(0.16-0.95)], and being a woman [OR 2.94(1.09-7.91)] were related with PSS14 symptoms. Based on the HADS, 54.6% of the intervention group and 42.2% of the control group (p = 0.346) had symptoms of anxiety or depression. Having contact with COVID-19 patients [OR 2.17(1.05-4.48)] and having minors in charge [OR 2.14(1.06-4.32)] were related to HADS symptoms. Healthcare professionals who attended COVID-19 patients showed higher levels of anxiety and depression [OR 2.56(1.03-6.36) (p = 0.043)]. CONCLUSION: Healthcare professionals trained in non-technical skills through simulation tended towards higher levels of anxiety and depression and fewer levels of stress, during the COVID-19 pandemic.

Extracorporeal Membrane Oxygenation Retrieval in Coronavirus Disease 2019: A Case-Series of 19 Patients Supported at a High-Volume Extracorporeal Membrane Oxygenation Center.

OBJECTIVE: To evaluate the performance of the extracorporeal membrane oxygenation retrieval team at a high-volume extracorporeal membrane oxygenation center during the coronavirus disease 2019 pandemic. DESIGN: Observational study including all adult patients with confirmed infection due to severe acute respiratory syndrome coronavirus-2 cannulated at other centers and transported on extracorporeal membrane oxygenation to the ICU of the Vall d'Hebron University Hospital between 15 March and 10 June 2020. SETTING: The ICU (capacity expanded to 200 during the pandemic) of the Vall d'Hebron University Hospital (a 1,100-bed public university hospital in Barcelona), the referral center for extracorporeal respiratory support in Catalonia (7.5 million inhabitants). PATIENTS: Extracorporeal membrane oxygenation was considered if the Pao2/Fio2 ratio less than 80 mm Hg (refractory to prone position) and/or Paco2 greater than 80 mm Hg and pH less than 7.25 for more than 6 hours, and no contraindications for extracorporeal support were present. INTERVENTIONS: Venovenous extracorporeal membrane oxygenation was initiated in the primary center. Then, patients were transferred to the ICU of the Vall d'Hebron University Hospital where they received support until respiratory improvement. After decannulation, patients were discharged for rehabilitation at the primary center. MEASUREMENTS AND MAIN RESULTS: Nineteen patients with severe acute respiratory syndrome coronavirus-2 infection and with a mean Pao2/Fio2 ratio of 71 mm Hg (57-118 mm Hg) despite prone positioning and a mean Paco2 of 70 mm Hg (47-110 mm Hg) were transferred to our center from their primary hospital after cannulation and received venovenous extracorporeal membrane oxygenation support. Prior to cannulation, six patients (31.5%) presented vascular thrombosis, and nine (47.4%) were already receiving anticoagulant therapy. Eighteen transfers were carried out with no significant complications. While on extracorporeal membrane oxygenation, thrombotic events were recorded in nine patients (47.4%) and hemorrhagic events in 13 (68.4%). Thirteen patients (68.4%) were successfully weaned, and 12 (63.1%) were discharged home. CONCLUSIONS: Extracorporeal membrane oxygenation retrieval can rescue young, previously healthy patients with severe coronavirus disease 2019 in whom all the conventional respiratory measures have failed. Thrombotic and hemorrhagic complications are frequent in this cohort.

Tórax inestable en paciente pediátrico: reporte de un caso / Flail chest in pediatric patient: case report

El tórax inestable se define por fractura de 3 o más costillas adyacentes, en 2 o más sitios, con movimiento paradojal del tórax afectado. Se presenta en el 2-4 % de los traumas de tórax contusos, con una mortalidad del 10-15 %.El tratamiento se realiza de forma conservadora, mediante analgesia y el uso de ventilación con presión positiva o, quirúrgicamente, mediante osteosíntesis de las fracturas costales.Se presenta el caso de una niña de 9 años con diagnóstico de traumatismo cerrado de tórax y tórax inestable. En la tomografía computada, se evidenciaron fracturas costales de 2da a 7maizquierdas, arcos medios y anteriores. Por inadecuado manejo del dolor, se colocó asistencia ventilatoria mecánica. A las 72 horas, se decidió la resolución quirúrgica mediante osteosíntesis de las costillas 3a-7a. La paciente evolucionó favorablemente. El manejo quirúrgico permitió reducir los días de ventilación mecánica y de internación.

Flail chest is defined by fracture of 3 or more adjacent ribs, at 2 or more sites, with paradoxical movement of the affected chest. It occurs in 2 to 4 % of blunt chest trauma, with a mortality of 10 to 15 %.Treatment is conservative, using analgesia and positive pressure ventilation, or surgical osteosynthesis of rib fractures.We present the case of a 9-year-old girl with blunt chest trauma and flail chest. Computed tomography showed rib fractures from 2nd to 7th left ribs, in middle and anterior arches. Due to inadequate pain management, it was placed in mechanical ventilation. After 72 hours the surgical resolution was decided, osteosynthesis of the 3rd to 7th ribs was performed. The patient evolved favorably. The surgical management allowed reducing days of mechanical ventilation and days of hospitalization.

[Flail chest in pediatric patient. Case report]. / Tórax inestable en paciente pediátrico. Reporte de un caso.

Flail chest is defined by fracture of 3 or more adjacent ribs, at 2 or more sites, with paradoxical movement of the affected chest. It occurs in 2 to 4 % of blunt chest trauma, with a mortality of 10 to 15 %. Treatment is conservative, using analgesia and positive pressure ventilation, or surgical osteosynthesis of rib fractures. We present the case of a 9-year-old girl with blunt chest trauma and flail chest. Computed tomography showed rib fractures from 2nd to 7th left ribs, in middle and anterior arches. Due to inadequate pain management, it was placed in mechanical ventilation. After 72 hours the surgical resolution was decided, osteosynthesis of the 3rd to 7th ribs was performed. The patient evolved favorably. The surgical management allowed reducing days of mechanical ventilation and days of hospitalization.

El tórax inestable se define por fractura de 3 o más costillas adyacentes, en 2 o más sitios, con movimiento paradojal del tórax afectado. Se presenta en el 2-4 % de los traumas de tórax contusos, con una mortalidad del 10-15 %. El tratamiento se realiza de forma conservadora, mediante analgesia y el uso de ventilación con presión positiva o, quirúrgicamente, mediante osteosíntesis de las fracturas costales. Se presenta el caso de una niña de 9 años con diagnóstico de traumatismo cerrado de tórax y tórax inestable. En la tomografía computada, se evidenciaron fracturas costales de 2da a 7ma izquierdas, arcos medios y anteriores. Por inadecuado manejo del dolor, se colocó asistencia ventilatoria mecánica. A las 72 horas, se decidió la resolución quirúrgica mediante osteosíntesis de las costillas 3a-7a. La paciente evolucionó favorablemente. El manejo quirúrgico permitió reducir los días de ventilación mecánica y de internación.

Iatrogenic Opioid Withdrawal in Critically Ill Patients: A Review of Assessment Tools and Management.

OBJECTIVE: To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. DATA SOURCES: We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management. Reference list of identified literature was searched for additional references as well as www.clinicaltrials.gov . STUDY SELECTION AND DATA EXTRACTION: We restricted articles to those in English and dealing with humans. DATA SYNTHESIS: We identified 2 validated pediatric critically ill opioid withdrawal assessment tools: (1) Withdrawal Assessment Tool-Version 1 (WAT-1) and (2) Sophia Observation Withdrawal Symptoms Scale (SOS). Neither tool differentiated between opioid and benzodiazepine withdrawal. WAT-1 was evaluated in critically ill adults but not found to be valid. No other adult tool was identified. For management, we identified 5 randomized controlled trials, 2 prospective studies, and 2 systematic reviews. Most studies were small and only 2 studies utilized a validated assessment tool. Enteral methadone, α-2 agonists, and protocolized weaning were studied. CONCLUSION: We identified 2 validated assessment tools for pediatric intensive care unit patients; no valid tool for adults. Management strategies tested in small trials included methadone, α-2 agonists, and protocolized sedation/weaning. We challenge researchers to create validated tools assessing specifically for opioid withdrawal in critically ill children and adults to direct management.

Propensity of lignin to associate: light scattering photometry study with native lignins.

Many studies of lignins in solution invoke association and aggregation phenomena to explain their solution behavior (e.g., reprecipitation onto pulp fibers, condensation, etc.). Following their colloidal (apparent) molecular weights in solution as a function of time allows us to explore observable dissociation phenomena. These measurements were carried out using multiple angle laser light scattering (MALLS) photometry in the static mode. The challenges and opportunities of measuring the specific refractive index increment (dn/dC) of lignin solutions and determining the kinetics of the dissociation process were thus investigated. Hardwood and softwood representative lignins were isolated, and method for their full dissolution in THF was further developed, which then lead to accurate dn/dC values being obtained as a function of time. When coupled to additional work using light scattering static measurements and Zimm plots for the same solutions, this effort offers insight into the aggregation and ensuing dissociative events that operate within the lignin macromolecules.

On the propensity of lignin to associate: a size exclusion chromatography study with lignin derivatives isolated from different plant species.

Despite evidence that lignin associates under both aqueous and organic media, the magnitude and nature of the underlying driving forces are still a matter of discussion. The present paper addresses this issue by examining both solution properties and size exclusion behaviour of lignins isolated from five different species of softwoods, as well as from the angiosperms Eucalyptus globulus and wheat straw. This investigation has used the recently described protocol for isolating enzymatic mild acidolysis lignin (EMAL), which offers lignin samples highly representative of the overall lignin present in the wood cell wall. The molecular weight distributions of these EMALs were found to be dependent upon the wood species from which they were isolated and upon the incubation conditions used prior to size exclusion chromatography. While the chromatograms of EMALs isolated from softwoods displayed a bimodal behaviour, the elution profiles of EMAL from E. globulus and straw were nearly unimodal. A marked tendency to dissociate prevailed under incubation at room temperature for all examined species with the exception of the straw lignin preparation; furthermore, lignin solutions incubated at 4 degrees C showed an associative behaviour manifested by an increase in the weight and number average molecular weights for some species. The extent of such association/dissociation, as well as the time needed for the process to reach completion, was also found to depend upon the wood species, i.e. lignins from softwoods were found to associate/dissociate to a greater extent than lignins from E. globulus and straw. The origin of such effects within the lignin structure is also discussed.

[Hospital practice in neonatal period to prevent infant sudden death syndrome]. / Síndrome de muerte súbita del lactante. Prevención en la práctica hospitalaria.

OBJECTIVE: To describe hospital care for newborns in the Instituto Mexicano del Seguro Social (IMSS), as well as all the recommendations given to parents to prevent sudden infant death syndrome (SIDS) at home. MATERIAL AND METHODS: There were twenty-eight IMSS hospitals randomly selected from four geographical areas of the country, under a stratified sampling method according to the number of births per year. The method used was newborns direct observation in the neonatal care areas, and to fill out a questionnaire applied by trained observers. This questionnaire was adapted from the Maternity Advice Study that includes hospital care for newborns and all the recommendations that parents have to do for newborns at home. RESULTS: The newborns in neonatal areas used to sleep in lateral position (80 and 67%). Baby cradles with medium firmness and elevated head-rest were predominant in the areas surveyed. Babies were generally wrapped-up from the neck to down, tightly enough that it prevented arm and leg movement. Parents received information on how to prevent SIDS at home, and up to 21% of them received no information at all. CONCLUSIONS: There were no specific practices at all the hospitals in this survey to diminish SIDS. It is necessary to organize specific health actions to diminish the risk of SIDS at home.

lntervención educativa para el manejo efectivo de diarrea en el hogar

Introducción. Objetivo: evaluar el impacto de una intervención educativa en el conocimiento de las madres sobre el manejo de la diarrea y su aplicación en el hogar. Material y métodos. Se capacitaron 150 madres de niños con diarrea, con evaluación de conocimientos antes y después de la intervención. Resultados. La mediana de calificación sobre los conocimientos correctos del manejo efectivo de casos de diarrea fue de 5 puntos antes de la intervención educativa y alcanzó el máximo de 10 puntos después (P <0.001). La sed fue el signo de deshidratación y de alarma menos identificado. El incremento en la frecuencia de la alimentación fue el componente menos aplicado. Conclusión. Se hizo evidente en este estudio la mejoría del conocimiento de las madres sobre el manejo de la diarrea en el hogar, después de una intervención educativa por el personal de salud.

Introduction. The aim of this work was to evaluate the impact of an educational intervention in mother's knowledge on the management of diarrhea at home. Material and methods. An educational intervention was carried out in 150 mothers of children having acute diarrhea. Using a questionnaire designed for that purpose, the knowledge of mothers was evaluated previously and after the intervention; the estimation of knowledge application at home was also evaluated. Data were analyzed using Wilcoxon and McNemar tests. Results. The median of the mother's score with correct knowledge about the effective management of diarrhea was 5 points before educational intervention and increased to 10 points after it (P <0.001). Thirst was the dehydration and alarm sign identified less frequently. The increase in the feeding frequency was the component which was less applied by mothers. Conclusions. It was evident that knowledge about diarrhea management at home applied by mothers improved after the educational intervention by health personnel.

Rotavirus diarrhea severity is related to the VP4 type in Mexican children.

This report is of a community-based case control study to assess whether the severity of acute diarrhea by rotavirus (RV) in young children is associated with a particular VP7 (G) or VP4 (P) RV serotype. Five hundred twenty children younger than 2 years of age with diarrhea lasting less than 3 days were age and gender matched with 520 children with no diarrhea. The G and P serotypes were determined with specific monoclonal antibodies, and the VP4 serotype specificity in a subgroup was confirmed by genotyping. Infection with a G3 serotype led to a higher risk of diarrhea than infection with a G1 serotype. Infection with a G3-nontypeable-P serotype was associated with more severe gastroenteritis than infection with a G3 (or G1) P1A[8] serotype. A child with diarrhea-associated dehydration was almost five times more likely to be infected with a G3-nontypeable-P serotype than a child without dehydration (P < 0.001). Moreover, the two predominant monotypes within serotype P1A[8] had significantly different clinical manifestations. In this study, the severity of RV-associated diarrhea was related to different P serotypes rather than to G serotypes. The relationship between serotype and clinical outcomes seems to be complex and to vary among different geographic areas.