A medicalized hotel as a public health resource for the containment of Covid-19: more than a place for quarantining.

BACKGROUND: To describe the implementation of a medicalized hotel in the community of Madrid as a public health resource for the containment of coronavirus disease (COVID-19) and to describe the characteristics of population benefitted. METHODS: A descriptive study of the implementation of the Via Castellana Medicalised Hotel (VCMH) was conducted. The average monthly household income, educational level and occupational social class of the subjects admitted were obtained through a survey conducted during their stay. RESULTS: There was no guidance for launching; however the hotel was coordinated by a tertiary referral hospital and attended the preventive medicine regulations and the decrees of legal regimes and authorization of health services in Madrid. Between 19 March and the 9 May 2020, 399 patients were admitted; 59% (235) were migrant; the main reason for referral (58%) was a lack of house conditions for quarantining, including overcrowding, which when compared with the migrant status a positive correlation was found. Some other reasons for referral were homelessness and eviction. Most of the survey participants had low monthly household income, educational level and social class. CONCLUSIONS: This medicalized hotel provided medical care and offered housing to a subgroup of vulnerable population who could not afford a safe quarantine.

SALIVARY CORTISOL LEVELS AND RESPONSE TO THE REMISSION INDUCTION TREATMENT IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA.

Cancer in children, and mainly the acute lymphoblastic leukemia (ALL), is considered as one of the leading public health problems in Mexico. Glucocorticoids used to treat ALL may cause suppression of the hypothalamic-pituitary-adrenal axis. The aim of the present study was to determine whether cortisol levels in saliva of the patients with ALL are related to the response to the remission induction therapy. The authors have conducted a clinical, prospective and comparative study. The Mann-Whitney U test was used to compare the variables values by gender or type of evolution. According to the patients' evolution, ROC curves were made for salivary cortisol levels and uric acid. An absolute value of 1000 blasts in peripheral blood count after a week of prednisone regimen was defined as a satisfactory response to the treatment. Review of the data has shown that area under the salivary cortisol levels' curve (AUC) was greater than that under the uric acid levels', as a predictor of a poor response to the remission induction. There were no statistically significant gender-associated differences in any variables except in erythrocytes. High levels of cortisol in saliva at the time of diagnosis of ALL seem to be of bad prognosis of the response to the remission induction therapy.

Identifying drivers of forest resilience in long-term records from the Neotropics.

Here, we use 30 long-term, high-resolution palaeoecological records from Mexico, Central and South America to address two hypotheses regarding possible drivers of resilience in tropical forests as measured in terms of recovery rates from previous disturbances. First, we hypothesize that faster recovery rates are associated with regions of higher biodiversity, as suggested by the insurance hypothesis. And second, that resilience is due to intrinsic abiotic factors that are location specific, thus regions presently displaying resilience in terms of persistence to current climatic disturbances should also show higher recovery rates in the past. To test these hypotheses, we applied a threshold approach to identify past disturbances to forests within each sequence. We then compared the recovery rates to these events with pollen richness before the event. We also compared recovery rates of each site with a measure of present resilience in the region as demonstrated by measuring global vegetation persistence to climatic perturbations using satellite imagery. Preliminary results indeed show a positive relationship between pre-disturbance taxonomic richness and faster recovery rates. However, there is less evidence to support the concept that resilience is intrinsic to a region; patterns of resilience apparent in ecosystems presently are not necessarily conservative through time.

Incidencia de cáncer infantil en una ciudad colombiana / Incidence of Pediatric Cancer in a Colombian City / Incidência de cancro infantil em uma cidade colombiana

Introducción: el cáncer infantil es poco frecuente y solo representa entre el 0,5% y el 3% de las neoplasias malignas en el mundo. El objetivo de este estudio fue describir el comportamiento del número de casos de cáncer infantil en las comunas de Santiago de Cali entre el periodo 2009 al 2013. Materiales y métodos: se presentan los mapas con la distribución de las tasas de incidencia estandarizadas por edad para cada comuna y se propone una metodología estadística alternativa para obtener probabilidades predictivas de observar cantidades iguales o mayores de casos de cáncer infantil en un periodo igual al del estudio, utilizando técnicas propias de la Estadística Bayesiana. Resultados: en el periodo bajo estudio se observaron 350 casos de cáncer infantil en la ciudad (37% de leucemias), lo que corresponde a una incidencia estandarizada media de 121 casos nuevos por millón de individuos con edades menores de 15 años. Conclusión: las tasas de incidencia de cáncer infantil observadas para la ciudad fueron menores a muchas de las reportadas en la literatura, sin embargo, debe considerarse el hecho de que todos los estudios no comparten las mismas condiciones para la recolección de los datos en términos de tiempo y la definición de población infantil.

Introduction: Pediatric cancer is a rare disease and only represents between 0.5% and 3% of malignant neoplasms in the world. The main goal of this study was to describe the behavior of incidence of pediatric cancer in the administrative units of the urban area of Santiago de Cali in the period 2009 to 2013. Materials and methods: Maps with the distribution of standardized incidence rates by age for each administrative unit are presented. We propose a methodology to obtain the predictive statistical probabilities of observing equal or greater amounts of pediatric cancer cases in a time period equal to the study, using Bayesian statistical techniques. Results: During the period of study, were observed 350 cases of pediatric cancer in the city (37% of leukemia), corresponding to standardized incidence of new 121 cases per million of individuals aged under 15 years. Conclusion: Incidence rates of pediatric cancer observed for the city were lower than many of those reported in the literature, however, should be considered the fact that all studies do not share the same conditions for data collection in terms of periods time and the definition of child population.

Introdução: O cancro infantil é pouco frequente e só representa entre o 0,5% e o 3% das neoplasias malignas no mundo. O objetivo deste estudo foi descobrir o comportamento de número de casos de cancro infantil nas comunas de Santiago de Cali entre o período 2009 ao 2013. Materiais e métodos: apresentam-se os mapas com a distribuição das taxas de incidência estandardizadas por idade para cada comuna e se propõe uma metodologia estatística alternativa para obter probabilidades preditivas de observar quantidades iguais ou maiores de casos de cancro infantil em um período de tempo igual ao do estudo, utilizando técnicas próprias da Estatística Bayesiana. Resultados: no período sob estudo se observaram 350 casos de cancro infantil na cidade (37% de leucemias), o que corresponde a uma incidência estandardizada média de 121 casos novos por milhão de indivíduos com idades menores de 15 anos. Conclusão: as taxas de incidência de cancro infantil observadas para a cidade foram menores a muitas das reportadas na literatura, no entanto, deve considerar-se o fato de que todos os estudos não partilham as mesmas condições para a recoleção dos dados em termos dos períodos de tempo e a definição de população infantil.

Beyond the wing planform: morphological differentiation between migratory and nonmigratory dragonfly species.

Migration is a significant trait of the animal kingdom that can impose a strong selective pressure on several structures to overcome the amount of energy that the organism invests in this particular behaviour. Wing linear dimensions and planform have been a traditional focus in the study of flying migratory species; however, other traits could also influence aerodynamic performance. We studied the differences in several flight-related traits of migratory and nonmigratory Libellulid species in a phylogenetic context to assess their response to migratory behaviour. Wings were compared by linear measurements, shape, surface corrugations and microtrichia number. Thorax size and pilosity were also compared. Migratory species have larger and smoother wings, a larger anal lobe that is reached through an expansion of the discoidal region, and longer and denser thoracic pilosity. These differences might favour gliding as an energy-saving displacement strategy. Most of the changes were identified in the hind wings. No differences were observed for the thorax linear dimensions, wetted aspect ratio, some wing corrugations or the wing microtrichiae number. Similar changes in the hind wing are present in clades where migration evolved. Our results emphasize that adaptations to migration through flight may extend to characteristics beyond the wing planform and that some wing characteristics in libellulids converge in response to migratory habits, whereas other closely related structures remain virtually unchanged. Additionally, we concluded that despite a close functional association and similar selective pressures on a structure, significant differences in the magnitude of the response may be present in its components.

Topological data analysis for discovery in preclinical spinal cord injury and traumatic brain injury.

Data-driven discovery in complex neurological disorders has potential to extract meaningful syndromic knowledge from large, heterogeneous data sets to enhance potential for precision medicine. Here we describe the application of topological data analysis (TDA) for data-driven discovery in preclinical traumatic brain injury (TBI) and spinal cord injury (SCI) data sets mined from the Visualized Syndromic Information and Outcomes for Neurotrauma-SCI (VISION-SCI) repository. Through direct visualization of inter-related histopathological, functional and health outcomes, TDA detected novel patterns across the syndromic network, uncovering interactions between SCI and co-occurring TBI, as well as detrimental drug effects in unpublished multicentre preclinical drug trial data in SCI. TDA also revealed that perioperative hypertension predicted long-term recovery better than any tested drug after thoracic SCI in rats. TDA-based data-driven discovery has great potential application for decision-support for basic research and clinical problems such as outcome assessment, neurocritical care, treatment planning and rapid, precision-diagnosis.

Stress exacerbates neuron loss and microglia proliferation in a rat model of excitotoxic lower motor neuron injury.

All individuals experience stress and hormones (e.g., glucocorticoids/GCs) released during stressful events can affect the structure and function of neurons. These effects of stress are best characterized for brain neurons; however, the mechanisms controlling the expression and binding affinity of glucocorticoid receptors in the spinal cord are different than those in the brain. Accordingly, whether stress exerts unique effects on spinal cord neurons, especially in the context of pathology, is unknown. Using a controlled model of focal excitotoxic lower motor neuron injury in rats, we examined the effects of acute or chronic variable stress on spinal cord motor neuron survival and glial activation. New data indicate that stress exacerbates excitotoxic spinal cord motor neuron loss and associated activation of microglia. In contrast, hypertrophy and hyperplasia of astrocytes and NG2+ glia were unaffected or were modestly suppressed by stress. Although excitotoxic lesions cause significant motor neuron loss and stress exacerbates this pathology, overt functional impairment did not develop in the relevant forelimb up to one week post-lesion. These data indicate that stress is a disease-modifying factor capable of altering neuron and glial responses to pathological challenges in the spinal cord.

Efecto del ejercicio y reposo postintervención sobre variables de riesgo cardiovascular en grupo de escolares / Effect of exercise and a post-intervention rest in cardiovacular risk variables in schoolars / Efeitos de exercicios e do repouso pos-operatorio sobre variaveis de risco cardiovascular em grupo de escolares

Objetivo: determinar el efecto de un programa de ejercicio seguido de un periodo de reposo post-intervención en marcadores de riesgo cardiovascular de un grupo de escolares de un Colegio de Cali-Colombia. Materiales y métodos: estudio experimental en el que se incluyeron 26 escolares con edades entre 10 y 13 años. Estos se sometieron a un período (4 meses) de intervención con ejercicio seguido de un periodo de reposo. Cambios en: glucosa y perfil lipídico; variables antropométricas; y parámetros de capacidad física, fueron evaluados. Resultados: los niños mostraron mayores valores de porcentaje (%) grasa corporal, cHDL, VO2max, carga y lactato al finalizar la intervención con ejercicio, e incremento significante en el valor de glicemia, IMC y % grasa corporal respecto al final del periodo de reposo post-intervención. En las niñas solo se observó incremento en la mediana de la carga luego de intervención con ejercicio. En el periodo de reposo post-intervención el IMC, porcentaje de grasa corporal y glicemia fueron más altos, y el valor de carga menor en comparación con el final de la intervención con ejercicio. Conclusiones: los niños presentaron mejor respuesta al ejercicio en variables relacionadas con riesgo cardiovascular, y este hallazgo podría estar influenciado por actividad física espontanea en los varones. En la mayoría de variables se observaron cambios negativos tras el periodo de reposo post-intervención. Para el conocimiento de los autores, este ensayo representa una primera exploración del efecto de un periodo sedentario tras un programa de ejercicio en el perfil cardiovascular de un grupo de escolares.

Objective: to determine the effect of an exercise program followed by a rest period post-intervention on cardiovascular risk markers in a group of children of Cali-Colombia school. Materials: experimental study which included 26 children aged 10-13 years old. These were subjected to a exercise intervention period (4 months) followed by a rest period. Changes in: glucose and lipid profile, anthropometric variables, and parameters of physical capacity, were evaluated. Results:boys showed higher values of body fat percentage, cHDL, VO2max, load and lactate at the end of the exercise intervention, and significant increase in the value of blood glucose, BMI and body fat percentage at the end of the post-intervention rest period. In girls only was observed an increase in load median after exercise intervention. In the post-intervention rest period BMI, body fat percentage and blood glucose were higher and the load value was lower compared to the end of the exercise intervention. Conclusions: boys had a better response to exercise in variables related to cardiovascular risk, and this finding could be influenced by spontaneous physical activity in men. In most of the variables, negative changes were observed after the post-intervention rest period. To the author’s knowledge, this paper represents a first exploration of the effect of a sedentary period after an exercise program on the cardiovascular profile of a schoolchildren group.

Objetivo: determinar o efeito de um programa de exercícios seguidos por um período de pós-intervenção nos marcadores de risco cardiovascular em um grupo de resto escolares de Cali Colombia.Materiais: estudo experimental em que 26 alunos foram incluídos com idades entre 10 e 13 anos. Estes foram submetidos a um período (4 meses ), seguido intervenção de exercício com um período de descanso. Mudanças: glicose e do perfil lipídico; variáveis antropométricas ; e foram avaliados parâmetros de capacidade física Resultado: as crianças apresentaram maior percentagem (%) de gordura corporal, o cHDL, VO2max, de carga e de lactato no final da intervenção de exercício, e aumento significativo na quantidade de glicose, imce % de gordura corporal em comparação com o fim de período de descanso pós-intervenção. Em raparigas foi observado aumento apenas no meio de carga, após a intervenção do exercício. No período de descanso pós-intervenção imc, percentual de gordura e de glicose no sangue foram maiores e menor valor de carga em relação ao final da intervenção de exercícios.Conclusões: as crianças apresentaram melhor resposta ao exercício em variáveis relacionadas ao risco cardiovascular, e este achado poderia ser influenciada pela atividade física espontânea em homens. Na maioria das variáveis foram observadas variações negativas depois do período de descanso pós-intervenção. Para o conhecimento dos autores , este estudo representa a primeira análise do efeito de um período sedentário após um programa de exercício no perfil cardiovascular de um grupo de crianças em idade escolar

Evidence for induction of humoral and cytotoxic immune responses against devil facial tumor disease cells in Tasmanian devils (Sarcophilus harrisii) immunized with killed cell preparations.

Tasmanian devils (Sarcophilus harrisii) risk extinction from a contagious cancer, devil facial tumour disease (DFTD) in which the infectious agent is the tumor cell itself. Because devils are unable to produce an immune response against the tumor cells no devil has survived 'infection'. To promote an immune response we immunized healthy devils with killed DFTD tumor cells in the presence of adjuvants. Immune responses, including cytotoxicity and antibody production, were detected in five of the six devils. The incorporation of adjuvants that act via toll like receptors may provide additional signals to break 'immunological ignorance'. One of these devils was protected against a challenge with viable DFTD cells. This was a short-term protection as re-challenge one year later resulted in tumor growth. These results suggest that Tasmanian devils can generate immune responses against DFTD cells. With further optimization of immune stimulation it should be possible to protect Tasmanian devils against DFTD with an injectable vaccine.

Independent evaluation of the anatomical and behavioral effects of Taxol in rat models of spinal cord injury.

The goal of the current manuscript was to replicate published data that show intrathecal infusions of Taxol® (paclitaxel), an anti-neoplastic microtubule stabilizing agent, reduce fibrogliotic scarring caused by a dorsal spinal hemisection (DHx) injury and increase functional recovery and growth of serotonergic axons after moderate spinal contusion injury. These experiments were completed as part of an NIH-NINDS contract entitled "Facilities of Research Excellence in Spinal Cord Injury (FORE-SCI) - Replication". Here, data are presented that confirm the anti-scarring effects of Taxol after DHx injury; however, Taxol did not confer neuroprotection or promote serotonergic axon growth nor did it improve functional recovery in a model of moderate spinal contusion injury. Thus, only partial replication was achieved. Possible explanations for disparate results in our studies and published data are discussed.

The adiponectin/leptin ratio is a useful tool to evaluate the metabolic status in an obstetrical intensive care unit.

INTRODUCTION: Critically ill patients, including obstetrical patients, face undernutrition but a reliable and cost effective study to assess their nutritional state is still missing. Our main objective was to analyze serum leptin and adiponectin concentrations in puerperal women attended in an Obstetrical Intensive Care Unit (OICU) in order to evaluate their potential role as nutritional metabolic parameter. METHODS: This was a descriptive, clinical, longitudinal and comparative study. We evaluated the anthropometric variables, clinical laboratories, daily calories and adiponectin and leptin serum levels of 16 puerperal women attended at the OICU of the Materno Perinatal Hospital "Mónica Pretelini" (HMPMP). RESULTS: For all women there was a negative correlation with Spearman test between leptin the day of discharge from the obstetrical intensive care unit and the days of stay -0.632 (p = 0.011). Considering an adiponectin/leptin ratio, the media in the first day was of 0.3 (0.07-13.6) and in the day of discharge it was of 2.4 (0.1-24.6) in overweight women. The same values for obese women were of 0.3 (0.2-0.4) and 0.5 (0.3-1.2). CONCLUSION: After an average of six days of hospitalization, leptin showed a decrement in women attended at the OICU. As expected, adiponectin increased in both groups. The adiponectin/ leptin ratio could be a useful metabolic parameter.

Caracterización de los pacientes con hemorragia de vías digestivas altas no varicosa en un hospital de tercer nivel de Cundinamarca, Colombia / Characterization of patients with non-varicose upper GI bleeding at a Level 3 Hospital in Cundinamarca, Colombia

La hemorragia de vías digestivas altas (HVDA) es una emergencia habitual; su etiología más común es laúlcera péptica. La restauración del volumen intravascular y la presión arterial son la prioridad del manejo previo al identificar la causa del sangrado. La esofagogastroduodenoscopia (EGD) debe realizarse luego de lareanimación inicial, así como lograrse la estabilización hemodinámica, para identifi car la causa del sangradoy dar el tratamiento necesario. Se realiza un estudio sobre el evento en un hospital de referencia de tercernivel, en Cundinamarca, Colombia.Materiales y métodos: Estudio descriptivo retrospectivo; datos obtenidos de la historia clínica electrónica de pacientes adultos que consultaron por urgencias en el Hospital Universitario de la Samaritana (HUS) por HVDA, diagnosticada por hematemesis, melenas, rectorragia o anemia, y a quienes se les realizó EGDdurante el periodo abril de 2010-abril de 2011. Resultados: Se atendió a 385 pacientes a lo largo del período de estudio; se excluyó a 100 de ellos,debido a hemorragia secundaria a várices esofágicas, historia clínica incompleta y hemorragia digestivabaja, para un total de 285 pacientes analizados. Conclusiones: La mayoría de la población atendida en el Hospital Universitario de La Samaritana (HUS)por HVDA son adultos mayores de 60 años. La úlcera péptica sigue siendo el diagnóstico más común asociadoal uso de AINE y ASA. La mortalidad es comparable a la de las regencias internacionales.

Upper gastrointestinal tract bleeding is a common emergency whose most common etiology is a peptic ulcer.Restoration of intravascular volume and blood pressure management are priorities before identifyingthe cause of bleeding. After initial resuscitation and after hemodynamic stabilization has been achieved, anesophagogastroduodenoscopy (EGD) should be performed to identify the cause of bleeding and determinethe treatment needed. This is a study performed at a third level referral hospital in Cundinamarca, Colombia.Materials and Methods: This is a retrospective study of data from electronic medical records of adult patients admitted to the emergency room of the Hospital Universitario de la Samaritana (HUS) because of uppergastrointestinal tract bleeding which ahd been diagnosed because of hematemesis, melena, rectal bleedingand/or anemia. Patients all underwent EGD between April 2010 and April 2011.Results: 385 patients with upper gastrointestinal tract bleeding were seen during the study period, but 100were excluded because of bleeding secondary esophageal varices, incomplete clinical histories and lowergastrointestinal bleeding. A total of 285 patients were included. 69.1 % were older than 60 years, 73.3 % hadhypertension, 55.1 % reported use of infl ammatory drugs (NSAIDs) and aspirin (ASA), 19.6 % reported previous bleeding episodes, and 17.9 % had hemodynamic instability. 63 patients (22.1 %) required endoscopichemostasis, and 32 (11.2 %) experienced rebleeding. Overall mortality reported was 13.1 % of which 55.3 %were men. Mortality attributable to gastrointestinal bleeding was 3.1 %.Conclusions: The majority of patients served by the HUS with upper GI bleeding are adults over 60 years.Peptic ulcers remain the most common diagnosis associated with the use of NSAIDs and ASA. The mortalityrate is comparable to international standards.

Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo / Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients

Introducción: El óptimo manejo de la sedación, analgesia y delirium ofrece al paciente crítico comodidad y seguridad, facilita el buen desarrollo de medidas de soporte y manejo integral y disminuye complicaciones, impactando en un mejor desenlace. Objetivo: Actualizar la Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo publicada en Medicina Intensiva en el 2007 y dar recomendaciones para el manejo de la sedación, analgesia y delirium. Metodología: Se reunió un grupo de 21 intensivistas procedentes de 9 países de la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 de ellos además especialistas en epidemiología clínica y metodología para elaboración de guías. Se acogió la propuesta del Grading of Recommendations Assessment, Development and Evaluation Working Group para emitir el grado de recomendación y evaluar la calidad de la evidencia. La fuerza de las recomendaciones fue calificada como 1=fuerte, o 2=débil, y la calidad de la evidencia como A=alta, B=moderada, o C=baja. Expertos en búsqueda de literatura apoyaron con esta estrategia de búsqueda: MEDLINE a través de PUBMED, bases de datos de la biblioteca Cochrane a través de The Cochrane Library y la base de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud. Los miembros asignados a las 11 secciones de la guía, basándose en la revisión de la literatura, presentaron las recomendaciones, sustentadas y discutidas en sesiones plenarias, aprobando aquellas que superaron el 80% del consenso. La elaboración de las guías contó con el soporte de la Asociación Colombiana de Medicina Crítica y Cuidado Intensivo. Resultados: Para la elaboración de la guía fueron finalmente seleccionadas 467 referencias, observándose un importante aumento en el número y calidad de los estudios, permitiendo realizar 64 fuertes recomendaciones con evidencia alta y moderada, contrastando con las 28 de la edición anterior. Conclusiones: Esta guía contiene recomendaciones y sugerencias basadas en la mejor evidencia para el manejo de la sedación, analgesia y delirium del paciente crítico, incluyendo un paquete de medidas (bundle). Se destacan: evaluación del dolor y la agitación/sedación mediante escalas; usar inicialmente opioides para el control de la analgesia, adicionando técnicas multimodales para disminuir consumo de opioides; promover el menor nivel de sedación necesario, evitando la sobresedación; en caso de requerir medicamentos sedantes, escoger el más apropiado, evitando el uso rutinario de benzodiazepinas; por último, identificar factores de riesgo para delirium, prevenirlo, diagnosticarlo y manejarlo, con el medicamento más conveniente, ya sea haloperidol, antipsicóticos atípicos o dexmedetomidina, evitando el uso de benzodiazepinas y disminuyendo el uso de opioides

Introduction: Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes. Objective: To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium. Methodology: A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1=strong, or 2=weak, and quality of evidence as A=high, B=moderate, or C=low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations, that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of this guidelines. Results: Four hundred sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition. Conclusions: This Guidelines contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to apropiate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropiate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids

Low-dose amphotericin B and murine dialyzable spleen extracts protect against systemic candida infection in mice.

Candida albicans causes opportunistic systemic infections with high mortality (30%-50%). Despite significant nephrotoxicity, amphotericin (AmB) is still used for the treatment of this serious fungal infection. Therefore, alternative treatments are urgently needed. Dialyzable leukocyte extracts have been used successfully to treat patients with mucocutaneous candidiasis, but their effectiveness in systemic candidiasis has not been evaluated. In this study, low-dose AmB (0.1 mg/kg) plus 10 pg of murine dialyzable spleen extracts (mDSE) were tested in a systemic candidiasis mouse model. Survival, tissue fungal burden, kidney damage, kidney cytokines, and serum levels of IL-6 and hepcidin were evaluated. Our results showed that the combined treatment of low-dose AmB plus mDSE improved survival and reduced kidney fungal burden and histopathology; these effects correlated with increased kidney concentration of IFN- γ and TGF- ß 1, decreased levels of TNF- α , IL-6, and IL-10, as well as high levels of systemic IL-6 and hepcidin. Low-dose AmB and mDSE synergized to clear the infectious agent and reduced tissue damage, confirming the efficacy of a low dose of AmB, which might decrease the risk of drug toxicity. Further studies are necessary to explore these findings and its implications in future therapeutic approaches.

Efecto de ajuste del flujo dializante (Qd) sobre la eficacia en hemodiálisis a pacientes de bajo peso / Effect of flow adjustment dialysate (Qd) hemodialysis on effectiveness of underweight patients / Efeito do ajuste do fluxo dialisante (Qd) sobre a eficácia em hemodiálise realizada em pacientes com baixo peso

Las guías KDOQI del año 2006 utilizan como estándar de adecuación para la diálisis el parámetro Kt/V, donde V es el volumen de distribución de urea. Los pacientes con bajo peso tienen menor cantidad total de agua corporal total (menor V), de modo que es posible reducir la cantidad de Qd sin alterar la eficacia de la diálisis. Objetivo: evaluar el efecto de la reducción del Qd sobre la adecuación de la diálisis en pacientes con pesos menores o iguales a 60 kg sometidos a hemodiálisis. Metodología: estudio observacional con alcance comparativo realizado en la unidad de diálisis de una clínica especializada de Bogotá. Se evaluaron dos valores de Qd (400 ml/min y 500 ml/min) dentro del proceso de diálisis de individuos con peso menor o igual a 60 kg. Se hizo un seguimiento de tres meses para cada forma de diálisis y al final de cada mes se midieron los niveles de Kt/V, hemoglobina y fósforo. Resultados: fueron incluidos 61 pacientes, 60,7% de sexo femenino. La edad media fue de 55,9 años (DE 14,8) para las mujeres y 60,1 años (DE 13,9) para los hombres. No se observaron diferencias estadísticamente significativas entre los niveles medios de las variables evaluadas, en los momentos de seguimiento ni al final del estudio. Conclusiones: es posible tener una adecuada terapia de diálisis utilizando un valor menor al establecido por los estándares tradicionales cuando se tienen pacientes con bajo peso, siempre y cuando se mantengan los demás parámetros de suplencia renal.

KDOQI guidelines in 2006 using standard dialysis adequacy Kt/V, where V is volume of distribution of urea, underweight patients have lower total body water, lower V, which could reduce the requirement without affecting Qd the efficiency of dialysis. Objective: to evaluate the effect on the adequacy of dialysis Qd reduction occurs in patients weighing less than or equal to 60 kg who are on hemodialysis. Methodology: patients with chronic kidney disease on hemodialysis regularly with weight less than or equal to 60 kg of a renal clinic to evaluate two periods I and II, were continued therapy parameters with decrease of Qd for the second period. The variables were collected directly by the researchers of the history. The values thus obtained would be compared using t test or paired variables, and statistical significance of the test below 0,05. Results: we included 61 patients, 60.7% female, mean age 57,3 years (SD 14,8). Average age of men 60.1 (SD 13,9) and women was 55,9 (SD 15,4). There were no statistically significant differences for the variables Kt/V, Hemoglobin and there was a significant reduction in the phosphorus levels. Conclusions: this study demonstrates that adequate therapy is achieved with less than Qd traditional standards, with 400 ml/min in patients with low weight as long as you keep the other parameters of renal substitution.

As guias KDOQI do ano 2006 utilizam como padrão de adequação da diálise o Kt/V, onde V é o volume de distribuição da ureia. Pacientes com baixo peso têm menor quantidade total de água no corpo total, (menor V), de modo que seria possível reduzir a quantidade de Qd sem afetar a eficiência da diálise. Objetivo: avaliar o efeito que tem a redução do Qd sobre a adequação da diálise em pacientes com hemodiálise que têm peso menor ou igual a 60 kg. Metodologia: estudo descritivo realizado na unidade de diálise de uma clínica especializada de Bogotá. Foram avaliados dois valores de Qd (400 ml/min e 500 ml/min) dentro do processo de diálise realizado em indivíduos com peso menor ou igual a 60 Kg. Realizou-se um seguimento de três meses para cada uma das formas de diálise aplicada e ao final de cada mês realizaram-se medições dos níveis de Kt/V, hemoglobina e fósforo. Resultados: o estudo observacional incluiu 61 pacientes, 60,7% do gênero feminino. A idade média foi de 55,9 anos (DE 14,8) para as mulheres e 60,1 anos (DE 13,9) para os homens. Não foram observadas diferenças estatisticamente significantes entre os níveis médios das variáveis nas medições de seguimento nem ao final do estudo. Conclusões: conclui-se que é possível obter uma terapia adequada de diálise com um valor de Qd inferior ao estabelecido sob os padrões tradicionais em pacientes como baixo peso, sempre e quando sejam mantidos os demais parâmetros de suplência renal.

Medición del potencial evocado cognitivo, P300, en un grupo de individuos colombianos sanos / Cognitive Evoked Potential Measurement, P300, in a group of healthy Colombian individuals / Medição do potencial evocado cognitivo P300 em um grupo de indivíduos colombianos sadios

Los potenciales evocados cognitivos son mediciones electrofisiológicas relacionadas con procesos que tienen que ver con ciertas funciones cognitivas. El potencial cognitivo P300 está específicamente relacionado con procesos de atención. Objetivo: identificar valores para la latencia y amplitud de onda P300 en una muestra de individuos colombianos y describir su comportamiento con respecto a edad, género y escolaridad de los sujetos. Método: se estudiaron 122 sujetos sanos entre los 6 y 80 años, se practicó medición del potencial según la metodología odd-ball, en las derivaciones Cz y Pz. Resultados: se identificaron valores medianos, mínimos y máximos para diferentes grupos etarios y se estableció que la latencia de la onda P300 aumenta con la edad de los individuos y que, por el contrario, la amplitud de la misma tiende a disminuir. De igual forma, al correlacionar latencia y amplitud, se evidenció una relación inversa. Conclusiones: no se encontraron diferencias para latencia y amplitud de onda relacionadas con el género ni la escolaridad de los sujetos, así como tampoco se halló diferencia al realizar la medición en la derivación Pz comparada con la onda obtenida en la derivación Cz.

Cognitive evoked potentials are electrophysiological measurements of cognitive functions. Cognitive potential P300 is specifically related to attention processes. Objetive: the aim of this study was to establish reference values for latency and amplitude of P300 wave in the Colombian population and determine their variability with age, gender and education of the subjects. Methods: we studied 122 healthy subjects between 6 and 80 years, are practical potential measurement methodology as odd-ball, in leads Cz and Pz. Results: we were able to establish reference values for different age groups, and statistical significance was found with which the latency of P300 wave increases with the age of individuals, and instead thereof the amplitude tends to decrease. Similarly to correlate latency and amplitude was shown an inverse relationship between them. Conclusions: no differences were found for latency and wave amplitude, gender-related or school subjects as well as no difference was found when measuring the Pz derivation obtained compared with the wave in lead Cz.

Os potenciais evocados cognitivos são medições eletrofisiológicas das funções cognitivas. O Potencial Cognitivo P300 está relacionado com processos de atenção. Objetivo: estabelecer valores de referência para a latência e a amplitude de onda P300 na população colombiana e determinar sua variabilidade na presença de variáveis como a idade, o gênero e a escolaridade dos indivíduos. Método: em uma amostra de 122 indivíduos sãos, com idades entre os 6 e os 80 anos, mensurou-se o potencial segundo a metodologia odd-ball nas derivações Cz e Pz. Resultados: estabeleceram-se valores de referência para diferentes grupos de idade e verificou-se que a latência da onda P300 aumenta com a idade dos indivíduos, enquanto que a amplitude da onda tende a diminuir. Conclusões: um estudo de correlação entre a latência e a amplitude permitiu evidenciar que existe uma relação inversa entre as duas características. Quanto ao gênero e a escolaridade, não foram observadas diferenças para a latência e a amplitude da onda, tanto na derivação Pz quanto na derivação Cz.

Determining the response of African biota to climate change: using the past to model the future.

Prediction of biotic responses to future climate change in tropical Africa tends to be based on two modelling approaches: bioclimatic species envelope models and dynamic vegetation models. Another complementary but underused approach is to examine biotic responses to similar climatic changes in the past as evidenced in fossil and historical records. This paper reviews these records and highlights the information that they provide in terms of understanding the local- and regional-scale responses of African vegetation to future climate change. A key point that emerges is that a move to warmer and wetter conditions in the past resulted in a large increase in biomass and a range distribution of woody plants up to 400-500 km north of its present location, the so-called greening of the Sahara. By contrast, a transition to warmer and drier conditions resulted in a reduction in woody vegetation in many regions and an increase in grass/savanna-dominated landscapes. The rapid rate of climate warming coming into the current interglacial resulted in a dramatic increase in community turnover, but there is little evidence for widespread extinctions. However, huge variation in biotic response in both space and time is apparent with, in some cases, totally different responses to the same climatic driver. This highlights the importance of local features such as soils, topography and also internal biotic factors in determining responses and resilience of the African biota to climate change, information that is difficult to obtain from modelling but is abundant in palaeoecological records.

Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients.

INTRODUCTION: Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes. OBJECTIVE: To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium. METHODOLOGY: A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1=strong, or 2=weak, and quality of evidence as A=high, B=moderate, or C=low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations, that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of this guidelines. RESULTS: Four hundred sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition. CONCLUSIONS: This Guidelines contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to apropiate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropiate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids.