Relative efficacy of masks and respirators as source control for viral aerosol shedding from people infected with SARS-CoV-2: a controlled human exhaled breath aerosol experimental study.

BACKGROUND: Tight-fitting masks and respirators, in manikin studies, improved aerosol source control compared to loose-fitting masks. Whether this translates to humans is not known. METHODS: We compared efficacy of masks (cloth and surgical) and respirators (KN95 and N95) as source control for SARS-CoV-2 viral load in exhaled breath of volunteers with COVID-19 using a controlled human experimental study. Volunteers (N = 44, 43% female) provided paired unmasked and masked breath samples allowing computation of source-control factors. FINDINGS: All masks and respirators significantly reduced exhaled viral load, without fit tests or training. A duckbill N95 reduced exhaled viral load by 98% (95% CI: 97%-99%), and significantly outperformed a KN95 (p < 0.001) as well as cloth and surgical masks. Cloth masks outperformed a surgical mask (p = 0.027) and the tested KN95 (p = 0.014). INTERPRETATION: These results suggest that N95 respirators could be the standard of care in nursing homes and healthcare settings when respiratory viral infections are prevalent in the community and healthcare-associated transmission risk is elevated. FUNDING: Defense Advanced Research Projects Agency, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, the Bill & Melinda Gates Foundation, and The Flu Lab.

Emotional intelligence, leadership, and work teams: A hybrid literature review.

Emotional intelligence (EI) has been widely researched in different fields of knowledge. This paper reviews the literature on emotional intelligence, leadership, and teams in 104 peer-reviewed articles and reviews provided by the Web of Science and Scopus databases from 1998 to 2022. It is a hybrid or mixed review as it uses both quantitative and qualitative analysis techniques. The aims of this study are a performance analysis of the selected documents (years of publication, country, sectors, techniques used, most cited authors, authors with more publications, journals, journal quartiles, and scope of publication), as well as a co-word analysis using Atlas. ti v8. The results of the quantitative analysis indicate that the majority are empirical works. The qualitative analysis is a co-word analysis providing the following results: (i) classification of authors by major themes-categories (EI, leadership, team), (ii) classification of themes within each major theme: three subcategories in EI, 17 subcategories in leadership, and 19 subcategories in team and, lastly, (iii) classification according to the chronological development of main objectives from the most cited authors' articles we analyzed. Leadership (transformational, emergence, virtual, effective, health, effectiveness) is the major theme we studied. Our in-depth review of the articles has shown that emotionally intelligent leaders improve both behaviors and business results and have an impact on work team performance. It also highlighted a positive relationship between emotional competence and team members' attitudes about work. The new trends focus on the impacts of COVID19, the global crisis due to the Ukraine War, working in VUCA and BANI environments, comparative studies between generations, the application of artificial intelligence and the influence of mindfulness on organizations.

Nucleoporin Nup358 Downregulation Tunes the Neuronal Excitability in Mouse Cortical Neurons.

Nucleoporins (NUPs) are proteins that comprise the nuclear pore complexes (NPCs). The NPC spans the nuclear envelope of a cell and provides a channel through which RNA and proteins move between the nucleus and the cytoplasm and vice versa. NUP and NPC disruptions have a great impact on the pathophysiology of neurodegenerative diseases (NDDs). Although the downregulation of Nup358 leads to a reduction in the scaffold protein ankyrin-G at the axon initial segment (AIS) of mature neurons, the function of Nup358 in the cytoplasm of neurons remains elusive. To investigate whether Nup358 plays any role in neuronal activity, we downregulated Nup358 in non-pathological mouse cortical neurons and measured their active and passive bioelectrical properties. We identified that Nup358 downregulation is able to produce significant modifications of cell-membrane excitability via voltage-gated sodium channel kinetics. Our findings suggest that Nup358 contributes to neuronal excitability through a functional stabilization of the electrical properties of the neuronal membrane. Hypotheses will be discussed regarding the alteration of this active regulation as putatively occurring in the pathophysiology of NDDs.

Exhaled Breath Aerosol Shedding of Highly Transmissible Versus Prior Severe Acute Respiratory Syndrome Coronavirus 2 Variants.

BACKGROUND: Aerosol inhalation is recognized as the dominant mode of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Three highly transmissible lineages evolved during the pandemic. One hypothesis to explain increased transmissibility is that natural selection favors variants with higher rates of viral aerosol shedding. However, the extent of aerosol shedding of successive SARS-CoV-2 variants is unknown. We aimed to measure the infectivity and rate of SARS-CoV-2 shedding into exhaled breath aerosol (EBA) by individuals during the Delta and Omicron waves and compared those rates with those of prior SARS-CoV-2 variants from our previously published work. METHODS: Individuals with coronavirus disease 2019 (COVID-19) (n = 93; 32 vaccinated and 20 boosted) were recruited to give samples, including 30-minute breath samples into a Gesundheit-II EBA sampler. Samples were quantified for viral RNA using reverse-transcription polymerase chain reaction and cultured for virus. RESULTS: Alpha (n = 4), Delta (n = 3), and Omicron (n = 29) cases shed significantly more viral RNA copies into EBAs than cases infected with ancestral strains and variants not associated with increased transmissibility (n = 57). All Delta and Omicron cases were fully vaccinated and most Omicron cases were boosted. We cultured virus from the EBA of 1 boosted and 3 fully vaccinated cases. CONCLUSIONS: Alpha, Delta, and Omicron independently evolved high viral aerosol shedding phenotypes, demonstrating convergent evolution. Vaccinated and boosted cases can shed infectious SARS-CoV-2 via EBA. These findings support a dominant role of infectious aerosols in transmission of SARS-CoV-2. Monitoring aerosol shedding from new variants and emerging pathogens can be an important component of future threat assessments and guide interventions to prevent transmission.

Análisis de la variabilidad del resultado del cultivo para «Streptococcus agalactiae» entre la semana 35-37 de gestación y el ingreso en sala de partos / Analysis of the variability of the culture outcome for «Streptococcus agalactiae» between week 35-37 of gestation and admission to delivery

Objetivo: Analizar la variabilidad del resultado del cultivo para Streptococcus agalactiae entre la semana 35-37 de gestación y el ingreso en sala de partos, así como las posibles variables influyentes en este cambio. Metodología: Estudio observacional, descriptivo y transversal. Se realizó un análisis descriptivo e inferencial, uni y bivariante. Técnica de muestreo no probabilística accidental. Resultados: Participaron 304 mujeres gestantes (608 muestras). La prevalencia de S. agalactiae se situó en el 15,1 % (preingreso) y el 15,6 % (ingreso). El 7,2 % de las mujeres (22) presentaron variabilidad de resultado entre el primer y el segundo cultivos. El 4,2 % (8) positivizó y un 3 % (14) negativizó. El 22,9 % (29) de los casos positivos presentaron cepas resistentes a clindamicina.Un antecedente de cultivo positivo aumentó la probabilidad de positividad cuatro veces durante la gestación actual. Los principales factores que influyeron en el cambio del resultado del cultivo aumentando su probabilidad fueron: la etnia (6,155 veces), el primer cultivo positivo (15,203 veces), la presencia de infecciones de transmisión sexual (3,8 veces), la edad (x2 0,005) y el peso (x2 0,044) con resultados estadísticamente relevantes. (AU)

Purpose: To investigate the variability of the culture result for Streptococcus agalactiae between weeks 35-37 of gestation and admissions to the delivery room and the possible variables influencing this change. Material and methods: An observational, descriptive, cross-sectional study of a series of cases was conducted with 304 (608 cultures) pregnant women. An accidental non-probabilistic sampling technique was used. Results: The results’ variability occurred in 7.2% (22) of the sample, where 4% (9) changed from positive to negative, and 26% (14) changed from negative to positive. The prevalence of pregnant women with positive Streptococcus agalactiae was 50 positives in the first culture (15.6%) and 46 (15.1%) in a second time. 4.2% (8) were positive and 3% (14) were negative. 22.9% (29) of the positive cases presented strains resistant to clindamycin.Presenting a history of positive culture in another pregnancy increased the probability of positivity four times during the current pregnancy. Likewise, obtaining a positive result in the first culture registered the probability of continuing to be positive in subsequent determinations in 9.5 times. The presence of a history of sexually transmitted infections increased the probability of suffering a change in result by 3.8 times. (AU)

An alternative index to the global competitiveness index.

This paper reviews the methodology used by the World Economic Forum (WEF) to create the Global Competitiveness Index (WEF-GCI). We propose an alternative competitiveness index that only includes the objective data (hard data) from the WEF-GCI and is created by applying a multivariate statistical procedure (Exploratory Factor Analysis) that allows us to determine the weights from the implicit data structure. The rankings obtained from this index have a high degree of association with those provided by the WEF. The main benefit of this index over the WEF index is that it does not include valuations from opinion surveys given to business executives and/or entrepreneurs of the countries included in the index (soft data). Consequently, the rankings from this alternative index are not affected by political biases or individual interests as it is elaborated only including officially published objective data.

Infecciones de transmisión sexual e influencia en la positividad y/o modificación del resultado del cultivo para Streptococcus agalactiae durante la gestación / Sexually transmitted infections and influence on positivity and/or modification of culture results for Streptococcus agalactiae during gestation

Objetivo: Analizar la relación entre las infecciones de transmisión sexual (ITS) y la positividad para Streptococcus agalactiae (SGB) y/o la modificación del resultado del cultivo para SGB durante el tercer trimestre de gestación. Metodología: Estudio observacional, descriptivo y transversal de serie de casos en gestantes durante el periodo 2016-2018. Muestreo no probabilístico, accidental consecutivo, con un análisis descriptivo e inferencial y una recogida de datos ambispectiva. Resultados: La muestra del estudio fue de 304 gestantes (608 cultivos). La prevalencia de SGB en gestantes fue de 48 (15,3%). Existió una variabilidad de resultados entre los cultivos de 22 (7,2%). Un total de 25 gestantes (8,2%) presentaron antecedentes de ITS, lo que multiplicó el riesgo en 3,8 veces (p= 0,01) para la modificación y/o positividad del cultivo. No se halló asociación entre el tipo de ITS y el cultivo positivo para SGB y/o modificación de éste. Conclusiones: El estudio actualiza la prevalencia de SGB en nuestro medio en el 15,1-15,6%, y muestra una variabilidad del resultado del cultivo para SGB durante el tercer trimestre de gestación del 7,2%.El antecedente de ITS se asoció con una mayor probabilidad de modificación del cultivo para SGB (p= 0,01), así como de positividad del cultivo para SGB (p= 0,01) durante el tercer trimestre de gestación.Se debería considerar el antecedente de ITS, dada su influencia en el resultado final y/o positividad del cultivo rectovaginal. Se precisarían estudios de mayor amplitud y prospectivos para optimizar el cribado para SGB durante la gestación. (AU)

Objective: To analyze the relationship between sexually transmitted infections (STIs) and positivity for Streptococcus agalactiae (GBS) and/or the modification of the culture result during third trimester of pregnancy.Methodology: Observational, descriptive, cross-sectional study of a series of cases in pregnancy women during the years 2016-2018. Non probabilistic, accidental and consecutive sampling with a descriptive and inferential analysis.Results: The study sample was 304 pregnant women (608 cultures). The prevalence of GBS was 48 (15.3%). There was a variability of results between the cultures of 22 (7.2%). 25(8.2%) of the pregnant women had a history of STIs, multiplying the risk by 3.8 times (p= 0.01) for the modification and/or positivity of the culture. There was no association between the type of STIs and the positive culture for GBS and/or its modification.Conclusions: The study updates the prevalence of GBS in our environment and shows a variability of between 15.1-15.6% and variability for the result of the culture during the third trimester of pregnancy of 7.2%.The history of STI was also associated with a greater probability of modification (p= 0.01) and positivity (p= 0.01) of the culture for GBS during the third trimester of gestation.A history of STI should be considered given its influence on the result and positivity of the vaginal-rectal culture. A larger study is required to optimize screening for GBS in pregnancy. (AU)

El sujetador mamario como herramienta de salud en la mujer / The breast bra as a health tool for women

Objetivo: Estudiar la literatura existente sobre el sujetador mamario como herramienta de bienestar y/o salud en la mujer.Metodología: Revisión bibliográfica en las bases de datos Turning Research Into Practice, Biblioteca Cochrane Plus, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), BMJ Best Practice, Cuiden, Cuidatge y UpToDate en inglés y español de los últimos 10 años. Ultima búsqueda en septiembre de 2021.Resultados: De las 150 referencias bibliográficas halladas, 130 cumplían los criterios de selección. Se seleccionaron 12 artículos: 8 originales, 2 guías de actuación y 2 revisiones sistemáticas. Los principales resultados hacían referencia al dolor de mama y sus causas, procesos dolorosos relacionados con el sujetador y su uso (talla, copa...), situaciones especiales (gestación, lactancia, deportes de impacto o cirugías en la mama), alteraciones biomecánicas e influencia en la calidad de vida relacionada con la depresión y la ansiedad.Conclusiones: No se halló evidencia de que la flacidez de los senos esté causada por no usar sujetador mamario. Tampoco se halló relación entre el uso de sostén y un mayor riesgo de cáncer de mama. Se relacionó el correcto uso del sujetador mamario con mejoras en la mastalgia, alteraciones locales o irradiadas, osteomusculares y nerviosas, alteraciones biomecánicas y del estado de ánimo. Parece que el uso del sujetador es beneficioso en determinadas situaciones, como la gestación y la lactancia, las intervenciones quirúrgicas de la mama y la práctica de deportes de impacto. Se evalúa la prenda del sujetador mamario como una herramienta más de salud en la mujer. (AU)

Objective: To study the existing literature on the bra as a tool for well-being in women.Methodology: Review of the Turning Research into Practice, Cochrane Library Plus, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), BMJ Best Practice and UpToDate databases in English and Spanish for the last 10 years. Last search in September 2021.Results: Of the 150 bibliographic references, 130 met the selection criteria. 12 articles were selected: 8 originals, 2 guidelines for action and 2 systematic review. The main results found were breast pain and causes, painful processes related to the bra, special situations such as pregnancy, lactation or breast surgeries, biomechanical alterations and the influence on quality of life related to depression and anxiety.Conclusions: There is no evidence that sagging breasts are caused by not wearing a bra. Nor is it between wearing a bra and an increased risk of breast cancer. Correct use of the bra was related to improvements in breast pain, biomechanical alterations and mood, breastfeeding, breast surgery and practice of impact sports. The bra garment is evaluated as a health tool in women. (AU)

Intra Vitam Diagnosis of Neglected Gurltia paralysans Infections in Domestic Cats (Felis catus) by a Commercial Serology Test for Canine Angiostrongylosis and Insights into Clinical and Histopathological Findings-Four-Case Report.

Gurltia paralysans is a metastrongyloid nematode which belongs to the Angiostrongylidae family and presents tropism for veins of the subarachnoid space in vivo of domestic and wild felids causing a progressive and chronic clinical manifestation of paraparesis/paraplegia. The geographic distribution of G. paralysans includes rural and periurban areas of South America and was recently reported in Europe. To date, a definitive diagnosis of feline gurltiosis is still conducted by post-mortem examination of the spinal cord in affected animals. A presumptive diagnosis of feline gurltiosis can also be achieved based on data of compatible clinical signs and associated epidemiological risk factors. The aim of this preliminary study was to evaluate the commercial serological test Angio Detect TM® (IDEXX Laboratories) as a possible diagnostic method of feline gurltiosis in vivo. For the study, 10 domestic felines (Felis catus) which originated from a high endemic area of Southern Chile, were analyzed. All felines presented chronic paraparesis or severe paraplegia. Subsequently, commercial Angio Detect TM® serological tests for the detection of closely related Angiostrongylus vasorum in canids were performed according to manufacturer's instructions. Conducted serological tests were positive in seven of ten felines showing paraplegia/paraparesis and presumably infected with G. paralysans, and four of them were additionally necropsied, and presented macroscopic findings compatible with feline gurltiosis. Furthermore, the presence of adult female and male G. paralysans specimens at the level of the subarachnoid vasculature in affected spinal cord segments were observed during necropsy. Histopathology demonstrated severe eosinophilic meningomyelitis, coagulopathies with thrombosis in G. paralysans-parasitized leptomeningeal veins. Results of this preliminary study suggest a cross-reaction between A. vasorum-specific antigens, which also parasitize blood vessels in vivo, and G. paralysans when using an Angio Detect TM® test, which suggests its helpful use as a new diagnostic method for feline gurltiosis in live domestic felines. Additional specific antigen research will be required in order to better understand the sensitivity and specificity of A. vasorum antigens used in this test and for existing cross-reactivity with G. paralysans-derived antigens for future a suitable intra vitam immunodiagnosis of neglected feline gurltiosis.

Neuronal Glutamatergic Network Electrically Wired with Silent But Activatable Gap Junctions.

It is widely assumed that electrical synapses in the mammalian brain, especially between interneurons, underlie neuronal synchrony. In the hippocampus, principal cells also establish electrical synapses with each other and have also been implicated in network oscillations, whereby the origin of fast electrical activity has been attributed to ectopic spikelets and dendro-dendritic or axo-axonal gap junctions. However, if electrical synapses were in axo-dendritic connections, where chemical synapses occur, the synaptic events would be mixed, having an electrical component preceding the chemical one. This type of communication is less well studied, mainly because it is not easily detected. Moreover, a possible scenario could be that an electrical synapse coexisted with a chemical one, but in a nonconductive state; hence, it would be considered inexistent. Could chemical synapses have a quiescent electrical component? If so, can silent electrical synapses be activated to be detected? We addressed this possibility, and we here report that, indeed, the connexin-36-containing glutamatergic mossy fiber synapses of the rat hippocampus express previously unrecognized electrical synapses, which are normally silent. We reveal that these synapses are pH sensitive, actuate in vitro and in vivo, and that the electrical signaling is bidirectional. With the simultaneous recording of hundreds of cells, we could reveal the existence of an electrical circuit in the hippocampus of adult rats of either sex consisting of principal cells where the nodes are interregional glutamatergic synapses containing silent but ready-to-use gap junctions.SIGNIFICANCE STATEMENT In this work, we present a series of experiments, both in vitro and in vivo, that reveal previously unrecognized silent pH-sensitive electrical synapses coexisting in one of the best studied glutamatergic synapses of the brain, the mossy fiber synapse of the hippocampus. This type of connectivity underlies an "electrical circuit" between two substructures of the adult rat hippocampus consisting of principal cells where the nodes are glutamatergic synapses containing silent but ready-to-use gap junctions. Its identification will allow us to explore the participation of such a circuit in physiological and pathophysiological functions and will provide valuable conceptual tools to understanding computational and regulatory mechanisms that may underlie network activity.

An Evidence-Based Guideline Supporting Restricted Opioid Prescription after Pediatric Appendectomy.

BACKGROUND/PURPOSE: Surgeon overprescription of opioids is a modifiable contributor to the opioid epidemic. No clear guidelines exist for prescribing opioids to younger patients after surgery. We sought to determine postoperative opioid needs in pediatric/young adult patients after laparoscopic appendectomy. METHODS: Patients 5-20 years old who underwent laparoscopic appendectomy were included for study. All consented patients underwent chart review and were additionally called for an attempted interview. Caregivers were queried on analgesic use and adequacy of pain relief. The main outcome measures were: quantity of opioid used, desire for an opioid, presence of pain ≥4/10, and need for follow-up/call owing to pain. All opioids were converted into morphine milligram equivalents (MME). RESULTS: Seventy-three patients qualified for the study, 49 of whom completed a postoperative telephone interview. Of the interviewees, 83% did not use or desire an opioid and reported pain <4/10 after discharge. Five patients used an opioid upon discharge, and the average MME consumed was 23 (equivalent to 3 pills of 5 mg oxycodone). No zero-opioid patients had unanticipated follow-up for pain concerns. CONCLUSIONS: After hospital discharge following laparoscopic appendectomy, most patients have adequate analgesia without opioids. Opioid prescriptions should be offered sparingly and for no more than 25 MME. LEVEL OF EVIDENCE: Level II. TYPE OF STUDY: Prognosis study.

La vitamina D durante la gestación / Vitamin D during gestation

OBJETIVO: Describir la relevancia del déficit de vitamina D durante la gestación, así como sus consecuencias y sus factores de riesgo, y evaluar la necesidad de administración de suplementos para su tratamiento. METODOLOGÍA: Revisión bibliográfica de las bases de datos Turning Research Into Practice, Evidence-Based Nursing, Joanna Briggs Institute, Biblioteca Cochrane Plus, guías de la National Institute of Health and Care Excellence, PubMed, Índice Médico Español (IME), Cumulative Index to Nursing and Allied Health Literature (CINAHL), en inglés y español, y de la disponibilidad en la biblioteca desde la cual se hacía la consulta. La última búsqueda se efectuó en diciembre de 2017. RESULTADOS: Se obtuvo un total de 127 referencias bibliográficas, de las que 30 cumplían los criterios de selección. Se seleccionaron 26 artículos: 15 artículos originales, 5 revisiones bibliográficas y 6 guías de práctica clínica y protocolos de actuación. CONCLUSIONES: La vitamina D es fundamental en todas las etapas de la vida de la mujer. El déficit de vitamina D en las gestantes es un hecho constatado en los estudios internacionales actuales. Se describe la necesidad de optimizar los niveles de vitamina D durante la gestación, dado que su déficit está relacionado con complicaciones importantes que pueden afectar tanto a la madre como al recién nacido, e incluso a la vida futura de ambos. No obstante, la necesidad, la seguridad y la eficacia de los suplementos de vitamina D administrados de manera sistemática y preventiva durante el embarazo es un tema no exento de controversia entre los profesionales, dado su potencial efecto tóxico. No se dispone de estudios que demuestren el beneficio de los suplementos de vitamina D a corto y largo plazo. Cabe destacar que no parecen tener un efecto teratogénico ni ser potencialmente nocivos para la gestante

AIM: To describe the relevance of vitamin D deficiency during pregnancy, as well as its consequences and risk factors, and to evaluate the need for supplementation for its treatment. METHODOLOGY: Bibliographic review of Turning Research Into Practice databases, Evidence-Based Nursing, Joanna Briggs Institute, Cochrane Plus Library, guides of the National Institute of Health and Care Excellence, PubMed, Spanish Medical Index (IME), Cumulative Index to Nursing and Allied Health Literature (CINAHL) in English and Spanish and availability in the library from which the consultation was made. Last search December of 2017. RESULTS: A total of 127 bibliographical references were obtained, of which 30 met the selection criteria. After reading the abstracts and checking if there was documentary duplication from the different databases, a total of 26 articles were selected. Of these, 15 are original articles, 5 are a bibliographic review and 6 are action guides. CONCLUSIONS: Vitamin D is essential in all stages of a woman's life. The deficit of Vitamin D in pregnant women is a fact described in the current studies worldwide. The need to optimize vitamin D levels during pregnancy is described, because its deficit is related to important complications that can affect the mother and the newborn and even the future life of both. However, the need, safety and efficacy of vitamin D supplements administered routinely and preventively during pregnancy is a controversial issue among professionals, given its potential toxic effect. There are no studies that demonstrate its short and long-term benefit. It should be noted that it does not seem to have a teratogenic effect nor does it seem to be potentially harmful for the pregnant woman

[Incidence and consequences of acute kidney injury among patients admitted to critical care units]. / Incidencia de la injuria renal aguda en unidad de paciente crítico y su mortalidad a 30 días y un año.

BACKGROUND: Acute Kidney Injury (AKI) increases morbidity, mortality and hospital stay in critical patients units (CPU). AIM: To determine the incidence and mortality of AKI in CPU. MATERIAL AND METHODS: Review of electronic medical records of 1,769 patients aged 61 ± 20 years (47% males) discharged from a CPU during one year. Acute Kidney Injury diagnosis and severity was established using the Acute Kidney Injury Network (AKIN) criteria. RESULTS: A history of hypertension and Diabetes Mellitus was present in 44 and 22% of patients, respectively. APACHE II and SOFA scores were 14.6 ± 6.8 and 3.6 ± 2.1 respectively. AKI incidence was 28.9% (stage I, 16.7%, stage II, 5.3% and stage III, 6.9%). Mortality during the first 30 days and during the first year was 8.1 and 20.0% respectively. Patients with stage III AKI had the highest mortality (23.8 and 40.2% at 30 days and one year respectively). Compared with patients without AKI, the Odds ratio for mortality at 30 days and one year of patients with AKI stage III was 3.7 and 2.5, respectively. CONCLUSIONS: Thirty percent of patients admitted to UPC develop an AKI, which influences 30 days and one year mortality.

Incidencia de la injuria renal aguda en unidad de paciente crítico y su mortalidad a 30 días y un año / Incidence and consequences of acute kidney injury among patients admitted to critical care units

Background: Acute Kidney Injury (AKI) increases morbidity, mortality and hospital stay in critical patients units (CPU). Aim: To determine the incidence and mortality of AKI in CPU. Material and Methods: Review of electronic medical records of 1,769 patients aged 61 ± 20 years (47% males) discharged from a CPU during one year. Acute Kidney Injury diagnosis and severity was established using the Acute Kidney Injury Network (AKIN) criteria. Results: A history of hypertension and Diabetes Mellitus was present in 44 and 22% of patients, respectively. APACHE II and SOFA scores were 14.6 ± 6.8 and 3.6 ± 2.1 respectively. AKI incidence was 28.9% (stage I, 16.7%, stage II, 5.3% and stage III, 6.9%). Mortality during the first 30 days and during the first year was 8.1 and 20.0% respectively. Patients with stage III AKI had the highest mortality (23.8 and 40.2% at 30 days and one year respectively). Compared with patients without AKI, the Odds ratio for mortality at 30 days and one year of patients with AKI stage III was 3.7 and 2.5, respectively. Conclusions: Thirty percent of patients admitted to UPC develop an AKI, which influences 30 days and one year mortality.

Configuración del Pentacam en el tamizaje de cirugía refractiva / Pentacam configuration in refractive surgery screening

Objetivo: determinar la consistencia de la configuración manual del Pentacam en el tamizaje de cirugía refractiva. Métodos: se realizó un estudio observacional, descriptivo en el Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el 2012. La muestra quedó conformada por 104 imágenes correspondiente a ojos examinados por el Pentacam que cumplieron los criterios de selección. Se analizaron variables tales como: diámetro para al cálculo de la esfera de mejor ajuste, elevación anterior, elevación posterior y se utilizó la clasificación de ectasias corneales según elevación anterior y posterior para agrupar la muestra. Resultados: del total de la muestra el 45,2 por ciento y el 54,8 por ciento utilizó un diámetro menor de 8 mm, y mayor de 8 mm para el cálculo de la esfera de mejor ajuste, respectivamente. La comparación de media de los dos grupos fue estadísticamente significativa. Según la clasificación de ectasia por elevación anterior y posterior, con un diámetro mayor de 8 mm se duplican en por ciento los exámenes normales y disminuyen los patológicos en un 25 porciento respectivamente. Existen diferencias entre las medias y la desviación estándar de los exámenes evolutivos a un mismo ojo según la configuración automática y manual. Conclusiones: la configuración manual del Pentacam permite tener una consistencia en el tamizaje de cirugía refractiva

Objective: to determine the consistency of manual Pentacam configuration in refractive surgery screening. Methods: observational and descriptive study performed at Ramon Pando Ferrer Cuban Institute of Ophthalmology during 2012. The sample was made up of 104 images of eyes examined by Pentacam equipment, which had met the selection criteria. The analyzed variables were diameter for best fit sphere calculation, anterior elevation, posterior elevation and the classification of corneal ectasias based on anterior and posterior elevations was used in order to group the sample. Results: in the sample, 45.2 percent and 54.8 percent used a diameter lower than 8mm and over 8mm for the calculation of the best fit sphere, respectively. The mean comparison between the two groups was statistically significant. According to the ectasia classification based on anterior and posterior elevations, with the over 8mm diameter, the normal exams doubled in some percentage and the pathological ones decreased by 25 percent, respectively. There are differences between the means and the standard deviations in evolutional exams performed in the same eye, considering the automatic and the manual configurations. Conclusions: manual configuration of Pentacam allows attaining consistency in the refractive surgery screening

Configuración del Pentacam en el tamizaje de cirugía refractiva / Pentacam configuration in refractive surgery screening

Objetivo: determinar la consistencia de la configuración manual del Pentacam en el tamizaje de cirugía refractiva. Métodos: se realizó un estudio observacional, descriptivo en el Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el 2012. La muestra quedó conformada por 104 imágenes correspondiente a ojos examinados por el Pentacam que cumplieron los criterios de selección. Se analizaron variables tales como: diámetro para al cálculo de la esfera de mejor ajuste, elevación anterior, elevación posterior y se utilizó la clasificación de ectasias corneales según elevación anterior y posterior para agrupar la muestra. Resultados: del total de la muestra el 45,2 por ciento y el 54,8 por ciento utilizó un diámetro menor de 8 mm, y mayor de 8 mm para el cálculo de la esfera de mejor ajuste, respectivamente. La comparación de media de los dos grupos fue estadísticamente significativa. Según la clasificación de ectasia por elevación anterior y posterior, con un diámetro mayor de 8 mm se duplican en por ciento los exámenes normales y disminuyen los patológicos en un 25 porciento respectivamente. Existen diferencias entre las medias y la desviación estándar de los exámenes evolutivos a un mismo ojo según la configuración automática y manual. Conclusiones: la configuración manual del Pentacam permite tener una consistencia en el tamizaje de cirugía refractiva(AU)

Objective: to determine the consistency of manual Pentacam configuration in refractive surgery screening. Methods: observational and descriptive study performed at Ramon Pando Ferrer Cuban Institute of Ophthalmology during 2012. The sample was made up of 104 images of eyes examined by Pentacam equipment, which had met the selection criteria. The analyzed variables were diameter for best fit sphere calculation, anterior elevation, posterior elevation and the classification of corneal ectasias based on anterior and posterior elevations was used in order to group the sample. Results: in the sample, 45.2 percent and 54.8 percent used a diameter lower than 8mm and over 8mm for the calculation of the best fit sphere, respectively. The mean comparison between the two groups was statistically significant. According to the ectasia classification based on anterior and posterior elevations, with the over 8mm diameter, the normal exams doubled in some percentage and the pathological ones decreased by 25 percent, respectively. There are differences between the means and the standard deviations in evolutional exams performed in the same eye, considering the automatic and the manual configurations. Conclusions: manual configuration of Pentacam allows attaining consistency in the refractive surgery screening(AU)

Densidad de queratocitos en córneas de pacientes miopes / Density of keratocytes in corneas of myopic patients

Introducción: el análisis de las variables histológicas en pacientes miopes se ha convertido en los últimos años en elemento primordial para asegurar la óptima calidad de indicación y seguimiento en pacientes con defectos refractivos sometidos a tratamiento quirúrgico con láser de excímeros. Objetivo: determinar la densidad de queratocitos en pacientes miopes. Método: se realizó un estudio observacional, descriptivo, transversal con una muestra de 30 ojos 15 pacientes miopes que cumplieron con los criterios establecidos en las Normas y Procedimientos de Oftalmología para el tratamiento con láser de excímeros, de enero a marzo de 2011 en el Centro Oftalmológico de Pinar del Río. Se utilizó el microscopio confocal ConfoScan 4 de NIDEK para la obtención y estudio de las imágenes in vivo de tejido corneal. Los pacientes otorgaron su consentimiento para la participación en el estudio. Resultados: se obtuvo densidad de queratocitos de 21,33 cel/mm3 en estroma anterior; 20,12 cel/mm3 en estroma medio y 18,46 cel/mm3 en estroma posterior. No se obtuvieron diferencias significativas según la magnitud de la ametropía.Conclusiones: la densidad de queratocitos fue mayor en estroma anterior y menor en estroma posterior. La densidad de queratocitos se mantuvo en valores muy similares independientemente de la magnitud de la ametropía (AU)

Introduction: the analysis of histological variables in myopic patients has become in recent years into an essential element to ensure the optimal indication quality and monitoring in patients with refractive defects undergoing surgical treatment with excimer laser.Objective: to determine the density of keratocytes in myopic patients.Methods: it was conducted an observational, descriptive and transversal study with a sample of 30 myopic eyes 15 patients that met the criteria established in the Regulations and Procedures of Ophthalmology for excimer laser treatment from January to March 2011 at Pinar del Rio Ophthalmological Center. Nidek ConfoScan 4 confocal microscope was used to obtain and study the in vivo imaging of corneal tissue. Patients gave their consent for the participation in the study.Results: it was obtained 21,33 cel/mm3 keratocyte density in the anterior stroma; 20,12 cel/mm3 in mid-stroma and 18,46 cel/mm3 in posterior stroma. There were no significant differences according to the magnitude of ametropia.Conclusions: the density of keratocytes was higher in anterior stroma and lower in posterior stroma. Keratocyte density remained very similar values irrespectively of the magnitude of ametropia (AU)

Densidad de queratocitos en córneas de pacientes miopes / Density of keratocytes in corneas of myopic patients

Introducción: el análisis de las variables histológicas en pacientes miopes se ha convertido en los últimos años en elemento primordial para asegurar la óptima calidad de indicación y seguimiento en pacientes con defectos refractivos sometidos a tratamiento quirúrgico con láser de excímeros. Objetivo: determinar la densidad de queratocitos en pacientes miopes. Método: se realizó un estudio observacional, descriptivo, transversal con una muestra de 30 ojos 15 pacientes miopes que cumplieron con los criterios establecidos en las Normas y Procedimientos de Oftalmología para el tratamiento con láser de excímeros, de enero a marzo de 2011 en el Centro Oftalmológico de Pinar del Río. Se utilizó el microscopio confocal ConfoScan 4 de NIDEK para la obtención y estudio de las imágenes in vivo de tejido corneal. Los pacientes otorgaron su consentimiento para la participación en el estudio. Resultados: se obtuvo densidad de queratocitos de 21,33 cel/mm3 en estroma anterior; 20,12 cel/mm3 en estroma medio y 18,46 cel/mm3 en estroma posterior. No se obtuvieron diferencias significativas según la magnitud de la ametropía.Conclusiones: la densidad de queratocitos fue mayor en estroma anterior y menor en estroma posterior. La densidad de queratocitos se mantuvo en valores muy similares independientemente de la magnitud de la ametropía

Introduction: the analysis of histological variables in myopic patients has become in recent years into an essential element to ensure the optimal indication quality and monitoring in patients with refractive defects undergoing surgical treatment with excimer laser.Objective: to determine the density of keratocytes in myopic patients.Methods: it was conducted an observational, descriptive and transversal study with a sample of 30 myopic eyes 15 patients that met the criteria established in the Regulations and Procedures of Ophthalmology for excimer laser treatment from January to March 2011 at Pinar del Rio Ophthalmological Center. Nidek ConfoScan 4 confocal microscope was used to obtain and study the in vivo imaging of corneal tissue. Patients gave their consent for the participation in the study.Results: it was obtained 21,33 cel/mm3 keratocyte density in the anterior stroma; 20,12 cel/mm3 in mid-stroma and 18,46 cel/mm3 in posterior stroma. There were no significant differences according to the magnitude of ametropia.Conclusions: the density of keratocytes was higher in anterior stroma and lower in posterior stroma. Keratocyte density remained very similar values irrespectively of the magnitude of ametropia

Resultados del LASIK miópico en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" / Results of myopic LASIK obtained at “Ramón Pando Ferrer” Cuban Institute of Ophthalmology

Objetivos: Evaluar los resultados y la estabilidad del LASIK miópico realizado en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Métodos: Se realizó un estudio descriptivo, prospectivo y comparativo. El universo estuvo compuesto por los pacientes operados mediante LASIK (4 011 ojos) desde el inicio en nuestro centro (2005) de la cirugía refractiva corneal con láser de excímeros. Se seleccionaron los pacientes con estudios realizados un año después de la cirugía. Las variables estudiadas fueron queratometría, mejor agudeza visual sin corrección, mejor agudeza visual con corrección, equivalente esférico, paquimetría y topografía. Se compararon las variables antes de la cirugía y al año de esta. Los resultados se analizaron mediante la prueba t de Student para datos pareados con significación estadística cuando p< 0,05. Resultados: Se produjeron cambios significativos en la queratometría y el equivalente esférico que causaron incremento de la mejor agudeza visual sin corrección para lejos. La mejor agudeza visual con corrección se mantuvo igual antes y después de la cirugía. La paquimetría se mantuvo dentro de límites de seguridad. No apareció patrón topográfico con evidencia de complicación. Conclusiones: Todas las variables mostraron cambios significativos y como resultado, tendencia a la emetropización. Los patrones topográficos corresponden a ablaciones centrales (miopías).

Objective: To evaluate the results and the stability of the myopic Lasik carried out in “Ramón Pando Ferrer” Cuban Institute of Ophthalmology. Methods: A prospective, descriptive and comparative study was conducted. The universe of study was made up of the patients operated on by LASIK (4011 eyes) from the beginning of the corneal refractive surgery with excimer laser in our center in 2005. The patients were selected from those that had been studied for ametropy correction one year after the surgery. The studied variables were keratometry, better visual acuity without correction, better visual acuity with correction, spherical equivalent, pachymetry and topography, and the obtained results were compared before and at one year of the surgery. The paired T test served to analyze the results with statistical significance of p < 0.05. Results: Significant changes took place in keratometry and spherical equivalent that brought about improved visual acuity without correction for distance vision. The best visual acuity with correction remained the same before and after the surgery. Pachymetry remained within safe limits. There was no topographical pattern with evidences of complications. Conclusion: All the variables underwent significant changes and showed a tendency to emmetropia. The topographical patterns correspond to central ablations (myopias). The pachimetry values were within safe limits.