Características y resultados de pacientes COVID-19 tratados con ventilación mecánica invasiva en Hospital San Juan de Dios. Marzo-junio 2020

Background: The overall mortality of patients with COVID-19 admitted to intensive care units is approximately 40%. Aim: To describe the characteristics of a cohort of patients with COVID-19 who required invasive mechanical ventilation due to severe hypoxemic acute respiratory failure at a general hospital in Santiago, Chile. Material and Methods: Review of medical records and follow up for 28 days of patients with COVID-19 confirmed by polymerase chain reaction who required invasive mechanical ventilation and who were admitted to the intensive care unit from March 24 to June 7, 2020. Results: Data from 152 patients aged 58 (interquartile range (IQR) 47-65 years (66% men) was analyzed. As of July 5, 36 (24%) had died, 75 (49%) were discharged, 10 (7%) were still on invasive mechanical ventilation, 11 (7%) remained with tracheostomy but without invasive mechanical ventilation, and 20 (13%) were hospitalized in a basic unit. The median time on invasive mechanical ventilation among extubated patients was 14 days (IQR 10-21) and 121 (80%) were in the prone position. Patients who died were older, had a higher frequency of diabetes mellitus and a higher driving pressure at 7 days than those discharged alive from the intensive care unit. Conclusions: In this study mortality was lower than that reported in the first international studies, probably due to the selection of younger patients and greater knowledge of the disease.

[Features and evolution of patients with COVID-19 who required mechanical ventilation]. / Características y resultados de pacientes COVID-19 tratados con ventilación mecánica invasiva en Hospital San Juan de Dios. Marzo-junio 2020.

BACKGROUND: The overall mortality of patients with COVID-19 admitted to intensive care units is approximately 40%. AIM: To describe the characteristics of a cohort of patients with COVID-19 who required invasive mechanical ventilation due to severe hypoxemic acute respiratory failure at a general hospital in Santiago, Chile. MATERIAL AND METHODS: Review of medical records and follow up for 28 days of patients with COVID-19 confirmed by polymerase chain reaction who required invasive mechanical ventilation and who were admitted to the intensive care unit from March 24 to June 7, 2020. RESULTS: Data from 152 patients aged 58 (interquartile range (IQR) 47-65 years (66% men) was analyzed. As of July 5, 36 (24%) had died, 75 (49%) were discharged, 10 (7%) were still on invasive mechanical ventilation, 11 (7%) remained with tracheostomy but without invasive mechanical ventilation, and 20 (13%) were hospitalized in a basic unit. The median time on invasive mechanical ventilation among extubated patients was 14 days (IQR 10-21) and 121 (80%) were in the prone position. Patients who died were older, had a higher frequency of diabetes mellitus and a higher driving pressure at 7 days than those discharged alive from the intensive care unit. CONCLUSIONS: In this study mortality was lower than that reported in the first international studies, probably due to the selection of younger patients and greater knowledge of the disease.

Ecotoxicity screening of novel phosphorus adsorbents used for lake restoration.

Short-term standardized laboratory tests were carried out for evaluating acute and chronic toxicological effects of novel phosphorus (P) adsorbents on Raphidocelis subcapitata (algal growth rate inhibition) and on Daphnia magna (immobilization, with direct and indirect exposure to adsorbents, and uptake-depuration tests). Four P adsorbents were tested: two magnetic (HQ and Fe3O4) and two non magnetic (CFH-12® and Phoslock®). For the case of the algal growth inhibition test, the EC50 was 1.5 and 0.42 g L-1 for HQ and CFH-12®, respectively, and no inhibition patterns were observed neither for Fe3O4 nor for Phoslock®. When organisms were exposed to a direct contact, in the D. magna immobilization test, no statistically significant differences were found in the EC50 values among the four studied adsorbents. The huge difference between direct and indirect contact experiments suggests that toxicity is mainly physically mediated. The uptake-depuration test evidenced a much faster uptake and depuration rates for Phoslock®, which was precisely the adsorbent with the highest particle size. In a realistic worst-case scenario using data from Honda lake (Almería, Spain), where lake restoration is carried out by a adding a single large dose to bind surplus P in the lake, the predicted environmental concentrations for all adsorbents were lower than EC50 for all adsorbents and they were found to exceed a provisional limit value for ecotoxicity after a short-term exposure. All in all, since neither accumulation nor longer term effects of P adsorbents in the pelagic phase is expected, this risk may however, on a case-to-case basis, be acceptable.

Do magnetic phosphorus adsorbents used for lake restoration impact on zooplankton community?

Magnetic microparticles (MPs) have been recently proposed as innovative and promising dissolved inorganic phosphorus (DIP) adsorbents. However, before using them in a whole-lake restoration project, it is essential to assess their toxicological effects (direct and indirect) on aquatic biota. In the present study we hypothesized that zooplankton community is affected by MPs used for lake restoration. To test our hypothesis we designed a microcosms experiment (n = 15) containing lake water and surface sediment from a hypertrophic lake. Temporal changes (70 days) on physico-chemical conditions and on zooplankton structure (rotifers, copepods and branchiopods) were monitored under different scenarios. In particular, three different treatments were considered: no addition of MPs (control) and MPs addition (1.4 g MPs L-1) on the surface water layer (T-W) and on the sediment (T-S). After 24 h of contact time, MPs were removed with a magnetic rake. A total of 15 zooplankton species (12 rotifers, 1 branchiopod and 2 copepods) were recorded and a high abundance of zooplankton was registered during the experiment for all treatments. No significant differences (RM-ANOVA test; p > 0.05) in total abundance, species richness and species diversity among treatments were found. The absence of any effect of MPs on zooplankton can be explained because MPs did not significantly alter any of its physico-chemical (e.g. temperature, pH, O2) or biological (e.g. food quantity and quality) drivers. These results confirm the suitability of MPs as a promising tool for removing DIP in eutrophic aquatic ecosystems.

SlPRA1A/RAB attenuate EIX immune responses via degradation of LeEIX2 pattern recognition receptor.

Pattern recognition receptors (PRR) are plasma membrane (PM) proteins that recognize microbe-associated molecular patterns (MAMPs), triggering an immune response. PRR are classified as receptor like kinases (RLKs) or receptor like proteins (RLPs). The PM localization of PRRs, which is crucial for their availability to sense MAMPs, depends on their appropriate trafficking through the endomembrane system. Recently, we have identified SlPRA1A, a prenylated RAB acceptor type-1 (PRA1) from S. lycopersicum, as a regulator of RLP-PRR localization and protein levels. SlPRA1A overexpression strongly decreases RLP-PRR protein levels, particularly those of LeEIX2, redirecting it to the vacuole for degradation. Interestingly, SlPRA1A does not affect RLK-PRRs, indicating its activity to be specific to RLP-PRR systems. As PRA1 proteins stabilize RABs on membranes, promoting RABs activity, we aimed to identify a RAB target of SlPRA1A. Screening of a set of A. thaliana RABs revealed that AtRABA1e is able to mimic SlPRA1A activity. Through live cell imaging, we observed that SlPRA1A enhances AtRABA1e localization on SlPRA1A positive punctuated structures. These results indicate that AtRABA1e is a putative target of SlPRA1, and a co-regulator of LeEIX2 trafficking and degradation.

Automated detection of fluorescent cells in in-resin fluorescence sections for integrated light and electron microscopy.

Integrated array tomography combines fluorescence and electron imaging of ultrathin sections in one microscope, and enables accurate high-resolution correlation of fluorescent proteins to cell organelles and membranes. Large numbers of serial sections can be imaged sequentially to produce aligned volumes from both imaging modalities, thus producing enormous amounts of data that must be handled and processed using novel techniques. Here, we present a scheme for automated detection of fluorescent cells within thin resin sections, which could then be used to drive automated electron image acquisition from target regions via 'smart tracking'. The aim of this work is to aid in optimization of the data acquisition process through automation, freeing the operator to work on other tasks and speeding up the process, while reducing data rates by only acquiring images from regions of interest. This new method is shown to be robust against noise and able to deal with regions of low fluorescence.

Defining functional interactions during biogenesis of epithelial junctions.

In spite of extensive recent progress, a comprehensive understanding of how actin cytoskeleton remodelling supports stable junctions remains to be established. Here we design a platform that integrates actin functions with optimized phenotypic clustering and identify new cytoskeletal proteins, their functional hierarchy and pathways that modulate E-cadherin adhesion. Depletion of EEF1A, an actin bundling protein, increases E-cadherin levels at junctions without a corresponding reinforcement of cell-cell contacts. This unexpected result reflects a more dynamic and mobile junctional actin in EEF1A-depleted cells. A partner for EEF1A in cadherin contact maintenance is the formin DIAPH2, which interacts with EEF1A. In contrast, depletion of either the endocytic regulator TRIP10 or the Rho GTPase activator VAV2 reduces E-cadherin levels at junctions. TRIP10 binds to and requires VAV2 function for its junctional localization. Overall, we present new conceptual insights on junction stabilization, which integrate known and novel pathways with impact for epithelial morphogenesis, homeostasis and diseases.

Magnetic microparticles as a new tool for lake restoration: A microcosm experiment for evaluating the impact on phosphorus fluxes and sedimentary phosphorus pools.

In the last decades, magnetic particles (MPs) as adsorbents have gained special attention due to their high adsorption capacity and the possibility of recovering them by applying a magnetic separation gradient. For the first time MPs have been tested as P adsorbents in a microcosm experiment in a context of lake restoration. MPs were added to sediment cores from a hypertrophic lake, at Fe:PMobile molar ratio of 285:1 and 560:1 under both, oxic and anoxic conditions. We have found that, under anoxic conditions (anoxic), MPs are able to reduce P release rate from the sediment to the overlying water and to reduce sedimentary PMobile concentration (a 22-25% reduction within 0-4 cm depth compared to controls). Under oxic conditions, the addition of MPs do not affect P fluxes across the sediment and water interface since the lake sediment is naturally rich in iron oxides. However a measured reduction in sedimentary PMobile concentration (12-16% reduction in 0-10 cm depth) contributes to a potential reduction in long-term P efflux.

The influence of pH on manganese removal by magnetic microparticles in solution.

An extensive experimental work is reported that aims to assess the efficiency in manganese (Mn) removal from aqueous solution by carbonyl iron microparticles using magnetic separation techniques. A set of batch experiments are performed to explore the effect of pH, adsorbent concentration, surface coating and contact time for achieving the highest Mn removal efficiency. Mn removal efficiency is extremely high (>98%) for pH values larger than 9 as a result of the chemisorption of Mn oxides onto magnetic microparticles. In contrast, Mn removal efficiency for pH < 9 was significantly reduced as Mn remains as a soluble cation. In this manuscript we demonstrate that the efficiency clearly increases when increasing the adsorbent concentration and when using MnOx(s) coated magnetic particles instead of bare particles. Desorption rates from Mn-loaded magnetic particles at different pHs were always lower than 15%. Furthermore, Mn removal efficiency remained at a very high value (>95%) when reused particles were employed in the adsorption process.

Efecto del plasma seminal sobre el estado redox del semen equino criopreservado / Effect of seminal plasma on the redox state of cryopreserved stallion semen

Objetivo. Determinar el efecto del plasma seminal sobre la generación de especies reactivas de oxígeno (ERO) y la peroxidación lipídica de semen equino criopreservado y su asociación con parámetros de calidad seminal. Materiales y métodos. El semen de cinco caballos de la raza criollo colombiano (dos eyaculados cada uno), fue criopreservado mediante un protocolo de congelación rápida, empleando un diluyente leche-yema de huevo, suplementado con 0%, 10% y 20% de plasma seminal equino. En muestras de semen fresco y criopreservado se evaluó la generación de ERO y la peroxidación lipídica por espectrofluorimetría, y los parámetros de calidad seminal de movilidad progresiva, vitalidad e integridad de membrana, mediante microscopia de contraste de fase. Para el análisis estadístico se ajustaron modelos mixtos y se realizaron análisis de regresión y correlación. Resultados. Se hallaron promedios post-descongelación de movilidad progresiva, vitalidad e integridad de membrana de 37.8%±20.2, 50.6% ± 14.6 y 37.8% ± 15.5, respectivamente. Para el semen fresco y criopreservado suplementado con 0%, 10% y 20% de plasma seminal, los promedios de producción de ERO (URF) fueron de 13.34±10.7, 16.15 ± 13.5, 17.32 ± 16 y 22.98 ± 19.4, respectivamente; mostrando un incremento estadísticamente significativo (p≤0.05) en la producción de ERO por efecto de la criopreservación y la suplementación con plasma seminal. Los promedios de peroxidación lipídica (nmolMDA/ml) para estos mismos tratamientos, fueron de 0.41 ± 0.25, 0.72±0.37, 0.51 ± 0.29 y 0.47±0.26, respectivamente; mostrando una reducción significativa (p≤0.05) de la peroxidación lipídica del semen suplementado con 10% y 20% de plasma seminal, respecto al semen no suplementado (0%). Conclusiones. El plasma seminal reduce la peroxidación lipídica del semen equino criopreservado.

Objective. Determine the effect of seminal plasma on the generation of reactive oxygen species (ROS) and lipid peroxidation of cryopreserved stallion semen, and its association with semen quality parameters. Materials and methods. The semen of five stallions of Colombian creole breed (two ejaculates each) was cryopreserved by a rapid freezing protocol, using a milk-egg yolk extender supplemented with 0%, 10% and 20% of equine seminal plasma. The samples of fresh and cryopreserved semen were evaluated for ROS generation and lipid peroxidation by spectrofluorimetry, and semen quality parameters of progressive motility, vitality and membrane integrity using phase contrast microscopy. Mixed models were adjusted for statistical, regression, and correlation analysis. Results. Post-thaw averages of progressive motility, vitality and integrity of membrane of 37.8% ± 20.2, 50.6% ± 14.6 and 37.8 ± 15.5%, respectively were found. For fresh and cryopreserved semen supplemented with 0%, 10% and 20% of seminal plasma, the averages of ROS production (RFU) were 13.34 ± 10.7, 16.15 ± 13.5, 17.32 ± 16 and 22.98 ± 19.4, respectively; showing a statistically significant increase (p≤0.05) of ROS production by effect of cryopreservation and seminal plasma supplementation. The averages of lipid peroxidation (nmolMDA / ml) for these same treatments were 0.41 ± 0.25, 0.72 ± 0.37, 0.51 ± 0.29 and 0.47 ± 0.26, respectively; showing a significant decrease (p≤0.05) of lipid peroxidation of semen supplemented with 10% and 20% of seminal plasma compared to unsupplemented semen (0%). Conclusions. Seminal plasma reduces lipid peroxidation of stallion cryopreserved semen.

Setting up High Gradient Magnetic Separation for combating eutrophication of inland waters.

To find new approaches to devise technologies for handling with eutrophication of inland waters is a global challenge. Separation of the P from water under conditions of continuous flow is proposed as an alternative and effective method. This work is based on using highly magnetic particles as the seeding adsorbent material and their later removal from solution by High Gradient Magnetic Separation (HGMS). Contrast to other methods based on batch conditions, large volumes of water can be easily handled by HGMS because of decreasing retention times. This study identifies the best working conditions for removing P from solution by investigating the effects of a set of four different experimental variables: sonication time, flow rate (as it determines the retention time of particles in the magnetic field), magnetic field strength and the iron (Fe) particles/P concentration ratio. Additionally, the change of P removal efficiency with time (build up effect) and the possibility of reusing magnetic particles were also studied. Our results evidenced that while flow rate does not significantly affect P removal efficiency in the range 0.08-0.36 mL s(-1), sonication time, magnetic field strength and the Fe particles/P concentration ratio are the main factors controlling magnetic separation process.

Valoración de la Atención Continuada en un Centro de Salud Rural de la Comarca de la Vera en la provincia de Cáceres / Assessment of continuing care in a rural health centre in the Vera area of Caceres province, Spain

El objetivo fue determinar las características de la demanda asistencial en la atención continuada en una zona de salud rural de la Comarca de la Vera. Material y métodos. Estudio epidemiológico descriptivo y transversal, basado en la recogida de los datos que figuran en los libros de registro de cada una de las urgencias atendidas en el Centro de Salud de Villanueva de la Vera, desde el 1 de Enero de 2005 al 1 de Enero de 2006. Material y métodos. Se recogieron las siguientes variables: sexo, edad, hora, fecha, motivo de consulta, tipo de asistencia y derivación hospitalaria. Resultados. Se atendieron un total de 5.677 pacientes con una media de 473,08/mes y 15,6/día sin diferencia entre ambos sexos. Resultados. Un 93,1% se resolvieron en el centro de salud, mientras que un 6,8%, se derivaron al hospital de referencia siendo el primer motivo de traslado los problemas relacionados con el aparato locomotor. Resultados. La mayoría de la demanda corresponde a patologías no graves, por lo que nuestra labor asistencial, en los centros de atención primaria, debería estar enfocada hacia la educación para la salud influyendo positivamente en conocimientos, actitudes y conductas de la población. Conclusiones. El perfil de usuario que demanda atención continuada es el de una persona joven, trabajador activo que consulta por traumatismos y problemas respiratorios a la salida de sus centros de trabajo (AU)

The objective is to determine the characteristics of emergency care demand in the rural health area of Vera. Material and methods. A descriptive epidemiological, cross-sectional study, based on collecting the data contained in the records of each of the emergencies seen in the Villanueva Health Centre,Vera, from 1st January 2005 to 1st January 2006. We collected the following variables: gender, age, time, date, reason for consultation, and type of assistance and hospital referral. Results. A total of 5677 patients were seen, with an average of 15.6 per day (or 473/month) with no sex differences. Most, 93.1%, were resolved at the Health Centre, while 6.8%, were referred to Hospital, as the main cause was problems associated with musculoskeletal system movement. Results. Most of the demand is dealing with non-serious diseases, therefore care work in Primary Care Health Centres should be focused on health education impacting positively on knowledge, attitudes and behaviour of the population. Conclusions. The user profile that demand continuing care is that of a young person, active employee who complains of injuries and respiratory problems on leaving their workplaces (AU)

Assessing the psychosocial and academic needs of Latino youth to inform the development of school-based programs.

A survey was made of the leaders in the Latino community from four East coast cities on the mental health, academic, and behavioral needs of Latino youth, services available to them, and recommendations to better address their needs. Of the 112 Latino leaders recruited, 46 responded to the survey, expressing their views that Latino youth experience significant stress in the United States, present behavioral and academic adjustment problems, and generally have difficulty accessing appropriate services and resources. Programs for these youth were presented as limited in number and lacking in cultural sensitivity. Community leaders endorsed the development of comprehensive and culturally sensitive programs for Latino youth in schools that address their psychosocial and academic needs.

Characterization of airborne transducers by optical tomography

This paper describes the application of an acousto-optic method to the measurement of airborne ultrasound. The method consists of a heterodyne interferometric probing of the pressure emitted by the transducer combined with a tomographic algorithm. The heterodyne interferometer measures the optical phase shift of the probe laser beam, proportional to the acoustic pressure integrated along the light path. A number of projections of the sound field, e.g. a set of ray integrals obtained along parallel paths, are made in moving the transducer to be tested. The main advantage of the method is its very high sensitivity in air (2 x 10(-4) Pa Hz-1/2), combined with a large bandwidth. Using the same principle as X-ray tomography the ultrasonic pressure in a plane perpendicular to the transducer axis can be reconstructed. Several ultrasonic fields emitted by wide-band home made electrostatic transducers, with operating frequencies between 200 and 700 kHz, have been measured. The sensitivities compared favorably with those of commercial airborne transducers.

Family involvement in expanded school mental health.

Expanded school mental health (ESMH) programs address the limitations of traditional mental health agencies in meeting the needs of youth by providing a full range of services in a familiar and nonstigmatizing setting. Because of the central role families play in the lives of children, their involvement in ESMH can enhance the effectiveness of treatments and ensure that services are responsive to the needs of the larger community. Increasing family involvement, however, is a complex and resource-intensive endeavor, and requires consideration of the goals of the ESMH program and potential obstacles to meeting those goals. The challenges of involving family members in ESMH, guidelines for determining the program's goals with respect to family involvement, and strategies for achieving these goals are described. Underlying the strategies is the need to be flexible, creative, and respectful of the beliefs and concerns of the families served by the ESMH program.

[The function of the group tutorial in training human resources in public health]. / La función de la tutoría grupal en la formación de recursos humanos en salud pública.

Within the educational system, the method of group tutor was developed as a teaching strategy: the tutor goes along with a group of students to field training and works with them on the systematization and analysis of the study to obtain the final report. The purpose of this paper is to recuperate the work experience of the Department of Didactics of the School of Public Health of Mexico during 1991. A relevant conclusion is that this form of work needs to be studied and developed, since it demands a greater amount of independence from the students and requires a different participation from the teacher, both as coordinator and advisor.

[An alternative to perinatal care: traditional midwives in the state of Morelos]. / Una alternativa para la atención perinatal: las parteras tradicionales en el Estado de Morelos.

In Morelos, it is estimated that about 40 percent of the births are attended by traditional birth attendants or parteras. This indicates a considerable contribution made by these health care workers. The objective of this study is to present a profile of the parteras in the state of Morelos: their concepts, resources, practices, age groups, geographic concentration, and the degree of training they possess. At the National Institute of Public Health (INSP), a census was created from three sources: data on the rural areas obtained by researchers at INSP; censuses of the parteras made by the Secretary of Health; and those made by the Mexican Social Security System. The total number of parteras found was six hundred and thirty. They are distributed in 33 municipalities throughout the state with the majority lying in the border zones of the urban centers. Most of the parteras are between the ages of 51 and 70 years, however, there exists a small number who are less than 30 years old. Approximately 60 percent knew how to read and write, and half had received training on health services. Besides this information and other studies based on this theme, the parteras have been classified as traditional, trained, and untrained. Due to secondary sources, the data has inevitable limitations in quality. However, the integration of the three sources of information and its relation to qualitative variables constitutes the beginning point for elaboration on plans and programs with this therapeutic sector.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of cigarette smoking in women]. / Algunos efectos del tabaquismo en la mujer.

The relation between cigarette smoking and obstetrical history, characteristics of skin and voice, presence of hirsutism and newborn weight/height index was studied in 100 hospitalized women. 45 had never smoked, 36 were present and 19 former smokers. No differences were found in the average age of menarche, number of live births or stillborns. Abortions were twice as frequent in women smoking more than 10 cigarettes a day. Menopause occurred an average of 5 years earlier among smokers. A significant increase in hoarseness and face hirsutism was detected, the relative risk for heavy smokers (more than 10 cigarettes per day) being 14.2 for hoarseness, 5.6 for facial hirsutism and 2.8 for other locations of hirsutism. Obesity was twice as common among smokers. These findings, related to hormonal disturbance, should be used in education efforts in the anti-smoking campaign among Chilean women.