Consistent Effects of Early Remdesivir on Symptoms and Disease Progression Across At-Risk Outpatient Subgroups: Treatment Effect Heterogeneity in PINETREE Study.

INTRODUCTION: In the PINETREE study, early remdesivir treatment reduced risk of coronavirus disease 2019 (COVID-19)-related hospitalizations or all-cause death versus placebo by 87% by day 28 in high-risk, non-hospitalized patients. Here we report results of assessment of heterogeneity of treatment effect (HTE) of early outpatient remdesivir, focusing on time from symptom onset and number of baseline risk factors (RFs). METHODS: PINETREE was a double-blind, placebo-controlled trial of non-hospitalized patients with COVID-19 who were randomized within 7 days of symptom onset and had ≥ 1 RF for disease progression (age ≥ 60 years, obesity [body mass index ≥ 30], or certain coexisting medical conditions). Patients received remdesivir intravenously (200 mg on day 1 and 100 mg on days 2 and 3) or placebo. RESULTS: In this subgroup analysis, HTE of remdesivir by time from symptom onset at treatment initiation and number of baseline RFs was not detected. Treatment with remdesivir reduced COVID-19-related hospitalizations independent of stratification by time from symptom onset to randomization. Of patients enrolled ≤ 5 days from symptom onset, 1/201 (0.5%) receiving remdesivir and 9/194 (4.6%) receiving placebo were hospitalized (hazard ratio [HR] 0.10; 95% confidence interval [CI] 0.01-0.82). Of those enrolled at > 5 days from symptom onset, 1/78 (1.3%) receiving remdesivir and 6/89 (6.7%) receiving placebo were hospitalized (HR 0.19; 95% CI 0.02-1.61). Remdesivir was also effective in reducing COVID-19-related hospitalizations when stratified by number of baseline RFs for severe disease. Of patients with ≤ 2 RFs, 0/159 (0.0%) receiving remdesivir and 4/164 (2.4%) receiving placebo were hospitalized; of those with ≥ 3 RFs, 2/120 (1.7%) receiving remdesivir and 11/119 (9.2%) receiving placebo were hospitalized (HR 0.16; 95% CI 0.04-0.73). CONCLUSIONS: In the outpatient setting, benefit of remdesivir initiated within 7 days of symptoms appeared to be consistent across patients with RFs. Therefore, it may be reasonable to broadly treat patients with remdesivir regardless of comorbidities. TRIAL REGISTRATION: ClinicalTrials.gov number NCT04501952.

Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients.

BACKGROUND: Remdesivir improves clinical outcomes in patients hospitalized with moderate-to-severe coronavirus disease 2019 (Covid-19). Whether the use of remdesivir in symptomatic, nonhospitalized patients with Covid-19 who are at high risk for disease progression prevents hospitalization is uncertain. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving nonhospitalized patients with Covid-19 who had symptom onset within the previous 7 days and who had at least one risk factor for disease progression (age ≥60 years, obesity, or certain coexisting medical conditions). Patients were randomly assigned to receive intravenous remdesivir (200 mg on day 1 and 100 mg on days 2 and 3) or placebo. The primary efficacy end point was a composite of Covid-19-related hospitalization or death from any cause by day 28. The primary safety end point was any adverse event. A secondary end point was a composite of a Covid-19-related medically attended visit or death from any cause by day 28. RESULTS: A total of 562 patients who underwent randomization and received at least one dose of remdesivir or placebo were included in the analyses: 279 patients in the remdesivir group and 283 in the placebo group. The mean age was 50 years, 47.9% of the patients were women, and 41.8% were Hispanic or Latinx. The most common coexisting conditions were diabetes mellitus (61.6%), obesity (55.2%), and hypertension (47.7%). Covid-19-related hospitalization or death from any cause occurred in 2 patients (0.7%) in the remdesivir group and in 15 (5.3%) in the placebo group (hazard ratio, 0.13; 95% confidence interval [CI], 0.03 to 0.59; P = 0.008). A total of 4 of 246 patients (1.6%) in the remdesivir group and 21 of 252 (8.3%) in the placebo group had a Covid-19-related medically attended visit by day 28 (hazard ratio, 0.19; 95% CI, 0.07 to 0.56). No patients had died by day 28. Adverse events occurred in 42.3% of the patients in the remdesivir group and in 46.3% of those in the placebo group. CONCLUSIONS: Among nonhospitalized patients who were at high risk for Covid-19 progression, a 3-day course of remdesivir had an acceptable safety profile and resulted in an 87% lower risk of hospitalization or death than placebo. (Funded by Gilead Sciences; PINETREE ClinicalTrials.gov number, NCT04501952; EudraCT number, 2020-003510-12.).

Regeneración de árboles en ecosistemas naturales y plantaciones de Pinus patula (Pinaceae) dentro de un gradiente altitudinal andino (Azuay, Ecuador) / Regeneration of trees in natural ecosystems and plantations of Pinus patula (Pinaceae), in an Andean altitudinal gradient (Azuay, Ecuador)

Resumen Los bosques y páramos andinos poseen alta riqueza de especies, pero están amenazados constantemente por deforestación. La regeneración natural arbórea de estos ecosistemas condiciona su estructura y funcionalidad en el futuro, pero ha sido escasamente evaluada. En Los Andes del sur del Ecuador, también existen plantaciones forestales de Pinus patula (pino) abandonadas, que podrían ser escenarios para promover la regeneración natural. En un gradiente altitudinal andino, se evaluó florísticamente parámetros de la regeneración arbórea en dos escenarios de estudio: ecosistemas naturales (páramos herbáceos y bosques naturales) y plantaciones de pino. Para ello la diversidad de la regeneración fue descrita mediante la riqueza de especies, índice de Shannon y composición florística. La abundancia a través del número de individuos; estos parámetros fueron comparados en ambos escenarios. También se determinó qué variables ambientales o predictoras de: cobertura de dosel, edáficas, estructura arbórea, distancia horizontal y fisiográficas, explicaron con mayor magnitud la variación en los parámetros de la regeneración. Para ello se realizó un análisis de partición de la variación. La riqueza y diversidad de especies fueron mayores en los ecosistemas naturales, la composición florística fue diferente y su abundancia fue similar. En los ecosistemas naturales, el área basal y la densidad arbórea explicaron mayormente la variación en la riqueza, diversidad y abundancia. No así en las plantaciones de pino en donde la distancia horizontal hacia los bosques nativos fue la predictora que mayormente las explicó. La mayor diversidad de regeneración en los ecosistemas naturales (bosques) está asociada con la existencia de biotipos arbóreos, arbustivos y disponibilidad de semillas, adicionando a la eficiencia en los procesos de dispersión a nivel de micro-hábitat, aspectos que son limitantes en las plantaciones de pino, en los cuales la dispersión o disponibilidad de semillas depende de la cercanía a los ecosistemas naturales.

Abstract Andean forests and paramo have high species richness, but constantly they are threatened by deforestation. Natural arboreal regeneration of these ecosystems will condition their structure and functionality in the future, but now it has been poorly evaluated. In the Andes of Southern Ecuador, there are also abandoned Pinus patula (pine) forest plantations, which could be scenarios to promote natural regeneration. In an Andean altitudinal gradient, we evaluated floristically parameters of tree regeneration between two study scenarios: natural ecosystems (herbaceous paramos and natural forests) and pine plantations. For this, the diversity of regeneration was described by species richness, Shannon index and floristic composition. Abundance with the number of individuals; these parameters were compared between two scenarios. We determined also that environmental variables or predictors of: canopy cover, soil, tree structure, horizontal distance and physiographic explained the variation in the parameters of regeneration with greater magnitude. For this, a partition analysis of the variation was carried out. Richness and diversity of species were greater in natural ecosystems, whereas floristic composition was different and its abundance was similar. In natural ecosystems, basal area and tree density explained mainly the variation in wealth, diversity and abundance. Not so in pine plantations where horizontal distance to the native forests was the predictor that mostly explained. The greatest diversity of regeneration in natural ecosystems (forests) is associated with the existence of arboreal, shrub and seed biotypes. It is adding to this, efficiency in dispersion processes at the micro-habitat level. These aspects are limiting in plantations of pine, in which the dispersion or availability of seeds depends on the proximity to natural ecosystems.

Rendimiento masticatorio y nivel de satisfacción en adultos ecuatorianos rehabilitados con prótesis parcial y total removible / Desempenho mastigatório e nível de satisfação em adultos equatorianos reabilitados com prótese removível parcial e total / Masticatory performance and satisfaction level in rehabilitated ecuadorian adults with partial and total removable prosthesis

Las prótesis dentales permiten rehabilitar la condición del edentulismo parcial y total, para recuperar la función, estética y bienestar de los portadores, pudiendo repercutir en el estado de salud y calidad de vida de los mismos. Objetivo: Determinar la asociación del rendimiento masticatorio con el nivel de satisfacción y el tipo de prótesis parcial o total removible en pacientes rehabilitados de clínica de posgrado de rehabilitación oral de la Facultad de Odontología ­ Universidad Central del Ecuador (FO ­ UCE). Materiales y Métodos: Estudio transversal para determinar la asociación del rendimiento masticatorio con el nivel de satisfacción, género, biotipo facial, relaciones excéntricas, índice de masa corporal y tipo de prótesis. El tamaño de muestra se obtuvo con fórmula para poblaciones finitas y se seleccionó de manera no aleatoria a 40 participantes con Prótesis (P) divididos en 4 grupos de 10 individuos: G1: P. Total Bimaxilar, G2: P. Total Unimaxilar Superior, G3: P. Parcial Maxilar clase III de Kennedy y G4: P. Parcial Mandibular clase III de Kennedy. Para medir el rendimiento masticatorio se empleó el Test de Manly y para el nivel de satisfacción se aplicó la encuesta GOHAI. Los datos fueron analizados mediante las pruebas de Chi Cuadrado y Kruskal Wallis con un nivel de significancia del 5%. Resultados: Se encontró asociación entre rendimiento masticatorio con el tipo de prótesis (p=0,001) y la desoclusión balanceada bilateral (p=0,003) siendo mayor en los portadores de P. parciales maxilar, en el nivel de satisfacción la dimensión psicosocial mostró valor de media más alto. Conclusiones: De acuerdo a los resultados del estudio el rendimiento masticatorio en general fue alto, se presentó asociación con el tipo de prótesis y relaciones de desoclusiones, en cuanto al nivel de satisfacción la mayoría presento bajo nivel, correspondiendo el valor más alto al dominio psicosocial.

Dental prostheses allow to rehabilitate the condition of partial and total edentulism, to recover the esthetics and well being funtion of the carriers, being able to pass on their health status and quality of life. Objective: To determine the masticatory performance association with the level of satisfaction and the type of partial or total removable prosthesis in rehabilitated patients of the oral rehabilitation postgraduate clinic of the Faculty of Dentistry - Central University of Ecuador (FD - CUE). Materials and Methods: Cross-sectional study to determine the masticatory performance association with the level of satisfaction, gender, facial biotype, eccentric relations, body mass index and type of prosthesis. The sample size was obtained with formula for finite populations and 40 participants with prosthesis (P) divided into 4 groups of 10 individuals were randomly selected: G1: P. Total Bimaxillary, G2: P. Total Unimaxillary higher, G3: P. Maxilar Part III of Kennedy and G4: P. Partial Mandibular class III of Kennedy. The Manly Test was used to measure masticatory performance and the GOHAI survey was applied to the level of satisfaction. The data were analyzed by Chi Square and Kruskal Wallis tests with a level of significance of 5%. Results: An association was found between masticatory performance with the type of prosthesis (p = 0.001) and bilateral balanced deocclusion (p = 0.003), being higher in the carriers of partial maxillary P., in the level of satisfaction the psychosocial dimension showed value of average higher. Conclusions: According to the results of the study, the masticatory performance was high in general, there was an association with the type of prosthesis and the relationship of the disocclusions. In terms of the level of satisfaction, the majority presented low level, with the highest value corresponding to the psychosocial domain.

Dentaduras permitir reabilitar a condição do total e parcial desdentado, para recuperar a função, estética e bem-estar dos portadores, pode afetar a saúde e qualidade de vida para eles. Objetivo: determinar a associação da performance mastigatória com satisfação e tipo de prótese parcial removível ou total em pacientes reabilitados reabilitação oral pós-graduação clínica da Faculdade de Odontologia - Universidade Central do Equador (FO - UCE). Materiais e Métodos: De estudo da secção transversal para determinar a associação de desempenho mastigatória com os níveis de satisfação, sexo, biótipo facial, relações excêntricos, índice de massa corporal e tipo de prótese. O tamanho da amostra foi obtida uma população finita fórmula seleccionada e as próteses não aleatoriamente 40 participantes (P) dividido em 4 grupos de 10 indivíduos: G1: P. total bimaxilares, G2: P. total Unimaxilar Superior, G3 : P. Maxilar Parte III de Kennedy e G4: P. Classe Mandibular Parcial III de Kennedy. O Teste de Manly foi usado para medir o desempenho mastigatório e a pesquisa GOHAI foi aplicada ao ní-vel de satisfação. Os dados foram analisados pelos testes de Chi Square e Kruskal Wallis, com nível de significância de 5%. Resultados: A associação entre o desempenho mastigatória foi encontrado com o tipo de prótese (p = 0,001) e desoclusão equilibrada bilateral (p = 0,003) foi maior nas portadoras de P. mandíbula parcial em satisfação mostrou valor dimensão psicossocial maior média. Conclusões: De acordo com o estudo os resultados de desempenho mastigatória foi geralmente elevada, a associação com o tipo de prótese e relações desoclusiones foi apresentada, em relação ao nível de satisfação mais actual nível baixo, o que corresponde ao maior valor para o domínio psicossocial.

Hipertension arterial pulmonar en la altitud / Hypertension arteryal pulmonary in the altitude

Trabajo de deteccion clinica de la Hipertension Arterial Pulmonar en ninos que nacen y viven a 4.000 metros de altitud. Con una metodologia simple, corroborada por el electrocardiograma se detectan casos de hipertension arterial pulmonar por la hipertrofia del ventriculo derecho. Los casos de evidencia clinica y E.C.G. pueden ser comprobados con cateterismo cardiaco y secundariamente los factores concurrentes.

Resultados del uso de la pinza soviética UKL-60 y UKL-25 en resecciones pulmonares en los Hospitales Provincial de Holguín, Antituberculoso "Amalia Simoni", de Camagüey y Antituberculoso "Ambrosio Grillo", de Santiago de Cuba

Exponemos el resultado de la pinza soviética UKL-60 y UKL-25 en resecciones pulmonares lo que constituye una innovación porque: 1.-Disminuye el tiempo quirúrgico liberando al cirujano de la disección del hilio. 2.-Elimina el riesgo de complicaciones hemorrágicas. 3.-Elimina la posibilidad del abandono del acto quirúrgico como inoperable por adherencias cicatriciales entre vasos y bronquios. 4.-Elimina el shock producido en la disección del hilio. 5.-Produce una sutura más firme y deja al bronquio en mejores condiciones de cicatrización. 6.-Ha disminuído el porciento de fístulas y mortalidad (AU)

Obtencion de los parametros optimos para la extraccion de aceite esencial de naranja por el metodo de prensado en frio

El objetivo principal del presente estudio es la aplicacion de ingenieria basica para determinar el grado de aprovechamiento y las condiciones mas favorables para la obtencion del aceite esencial de la cascara de naranja mediante el metodo de extraccion por prensado en frio. Objetivos especificos: recolectar informacion estadistica, para reconocer y dar a conocer las caracteristicas productivas de la naranja a escala mundial como nacional. Recolectar informacion basica sobre las variedades de naranja cultivadas en nuestro pais y algunas de sus mas importantes caracteristicas basicas. Recopilar y analizar datos referidos a los distintos procesos de extraccion de aceite esencial de frutos citricos.