Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system / Análisis de adherencia a un protocolo de movilización precoz en una unidad de cuidados intensivos: datos recopilados prospectivamente durante un periodo de tres años por el sistema de información clínica

Objective To determinate the adherence and barriers of our early mobilization protocol in patients who had received mechanical ventilation >48h in routine daily practice through clinical information system during all Intensive Care Unit (ICU) stay. Design Observational and prospective cohort study. Setting Polyvalent ICU over a three-year period (2017–2019). Patients Adult patients on mechanical ventilation >48h who met the inclusion criteria for the early mobilization protocol. Interventions None. Main variables of interest Demographics, adherence to the protocol and putative hidden adherence, total number of mobilizations, barriers, artificial airway/ventilatory support at each mobilization level and adverse events. Results We analyzed 3269 stay-days from 388 patients with median age of 63 (51–72) years, median APACHE II 23 (18–29) and median ICU stay of 10.1 (6.2–16.5) days. Adherence to the protocol was 56.6% (1850 stay-days), but patients were mobilized in only 32.2% (1472) of all stay-days. The putative hidden adherence was 15.6% (509 stay-days) which would increase adherence to 72.2%. The most common reasons for not mobilizing patients were failure to meeting the criteria for clinical stability in 241 (42%) stay-days and unavailability of physiotherapists in 190 (33%) stay-days. Adverse events occurred in only 6 (0.4%) stay-days. Conclusions Data form Clinical Information System showed although adherence was high, patients were mobilized in only one-third of all stay-days. Knowing the specific reason why patient were not mobilized in each stay-day allow to develop concrete decisions to increase the number of mobilizations (AU)

Objetivo Determinar la adherencia y barreras del protocolo de movilización precoz en pacientes que recibieron ventilación mecánica >48 horas en la práctica diaria habitual a través del sistema de información clínica durante toda su estancia en Unidad de Cuidados Intensivos (UCI). Diseño Estudio observacional y prospectivo. Ámbito UCI polivalente durante un periodo de tres años (2017-2019). Pacientes Se incluyeron pacientes adultos en ventilación mecánica > 48 horas que cumplieron los criterios de inclusión del protocolo. Intervenciones Ninguna. Variables principales Se aplicaron variables demográficas, adherencia y adherencia oculta, número total de movilizaciones, barreras, tipo vía aérea artificial/soporte ventilatorio en cada nivel de movilización y eventos adversos. Resultados Analizamos 3.269 días de estancia de 388 pacientes con una mediana de edad de 63 (51-72) años, mediana de APACHE-II 23(18-29) y estancia en UCI mediana de 10,1 (6,2-16,5) días. La adherencia al protocolo fue del 56,6% (1.850 días de estancia), pero los pacientes se movilizaron solo el 32,2% (1.472) de todos los días de estancia. La adherencia oculta fue del 15,6% (509 días de estancia), aumentando la adherencia al 72,2%. Las causas más comunes para la no movilización fueron el incumplimiento de los criterios de estabilidad clínica en 241 (42%) días de estancia y la falta de disponibilidad de fisioterapeutas en 190 (33%) días de estancia. Los eventos adversos ocurrieron en solo 6 (0,4%) días de estancia. Conclusiones Aunque la adherencia fue alta, los pacientes se movilizaron en solo un tercio de todos los días de estancia. Conocer el motivo específico por el cual los pacientes no fueron movilizados permite desarrollar decisiones concretas para incrementar el número de movilizaciones (AU)

Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system.

OBJECTIVE: To determinate the adherence and barriers of our early mobilization protocol in patients who had received mechanical ventilation >48h in routine daily practice through clinical information system during all Intensive Care Unit (ICU) stay. DESIGN: Observational and prospective cohort study. SETTING: Polyvalent ICU over a three-year period (2017-2019). PATIENTS: Adult patients on mechanical ventilation >48h who met the inclusion criteria for the early mobilization protocol. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographics, adherence to the protocol and putative hidden adherence, total number of mobilizations, barriers, artificial airway/ventilatory support at each mobilization level and adverse events. RESULTS: We analyzed 3269 stay-days from 388 patients with median age of 63 (51-72) years, median APACHE II 23 (18-29) and median ICU stay of 10.1 (6.2-16.5) days. Adherence to the protocol was 56.6% (1850 stay-days), but patients were mobilized in only 32.2% (1472) of all stay-days. The putative hidden adherence was 15.6% (509 stay-days) which would increase adherence to 72.2%. The most common reasons for not mobilizing patients were failure to meeting the criteria for clinical stability in 241 (42%) stay-days and unavailability of physiotherapists in 190 (33%) stay-days. Adverse events occurred in only 6 (0.4%) stay-days. CONCLUSIONS: Data form Clinical Information System showed although adherence was high, patients were mobilized in only one-third of all stay-days. Knowing the specific reason why patient were not mobilized in each stay-day allow to develop concrete decisions to increase the number of mobilizations.

Evaluation of the flora of Puerto Rico for in vitro antiplasmodial and antimycobacterial activities.

The emergence of resistant strains of Plasmodium falciparum and Mycobacterium tuberculosis underscores the need for novel drugs that are effective against these microorganisms. As part of our screening programme of the flora of Puerto Rico, we tested a number of ethanol extracts of higher plants for antiplasmodial and antimycobacterial activities. A total of 40 extracts belonging to 23 plant families and 37 species were tested for antiplasmodial activity. Five extracts demonstrated activity against Plasmodium falciparum in vitro (50%-100% parasite suppression at 5 microg/mL). Another 63 extracts belonging to 30 plant families and 50 species were tested in vitro against Mycobacterium tuberculosis. Two extracts were found to be active, Ficus citrifolia and Pisonia borinquena (85% or more inhibition of microbial growth at 100 microg/mL of extract).

Duplication 11q and deletion 5p syndromes due to a reciprocal translocation segregating in four generations.

We report on 2 relatives with duplication 11q and deletion 5p, resulting from an adjacent-1 segregation of a balanced reciprocal translocation 5p15;11q23, segregating in 4 generations of this family. Twelve out of 16 at-risk relatives of inheriting the translocation were shown to be carriers, giving a significant (p less than .05) 3:1 ratio of carriers/noncarriers. The breakpoint on chromosome 11 at q23 is a folate sensitive fragile site into where the proto-oncogene c-ets has been mapped.

Deficiencia de lactasa y el sindrome de colon irritable. / Lactase deficiency and irritable colon syndrome

Se ivestigo la posible relacion entre el sindrome de colon iritable y la deficiencia de lactasa intestinal.Cincuenta y cinco (66%) de 83 pacientes con colon irritable tuvieron hipolactasia, proporcion similar a la de otros pacientes sin colon irritable en nuestra Institucion. Por otro lado, cuando menos el 56% de los sujetos deficientes que se sometieron a una dieta sin lactosa, mostraron clara mejoria clinica. Este estudio piloto plantea la necesidad de realizar una investigacion doble ciego para esclarecer el papel de la hipolactasia en el sindrome de colon irritabl

Falta de asociacion entre los grupos sanguineos del sistema ABO y la colelitiasis. / Lack of association between the ABO blood groups system and cholelithiasis

Se estudio la distribucion de grupos sanguineos del sistema ABO en 973 pacientes con colelitiasis, comparandose los resultados con los obtenidos por otros investigadores en dos grupos de mestizos del D.F., no encontrandose diferencias significativas. Se analizaron ademas, los resultados del presente estudio en conjunto con los de otros 22 trabajos similares descritos en la literatura, encontrandose que aun cuando en algunas investigaciones si hay diferencias significativas para algunas de las comparaciones, los resultados son sumamente heterogeneos, por lo que no se puede concluir que existe asociacion entre los fenotipos del sistema ABO y la colelitiasis