Sepsis death risk factor score based on systemic inflammatory response syndrome, quick sequential organ failure assessment, and comorbidities / Puntuación de factores de riesgo de mortalidad por sepsis basada en el síndrome de respuesta inflamatoria sistémica, el índice rápido secuencial de fallo orgánico y comorbilidades

Objective In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score. Design This retrospective cohort study was conducted between 2016 and 2021. Setting Two university hospitals in Brazil. Participants Patients with sepsis. Interventions Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities. Main variable of interest In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis. Results A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38 °C (odds ratio [OR] = 0.65), previous sepsis (OR = 1.42), qSOFA ≥ 2 (OR = 1.43), leukocytes >12,000 or <4,000 cells/mm3 (OR = 1.61), encephalic vascular accident (OR = 1.88), age >60 years (OR = 1.93), cancer (OR = 2.2), length of hospital stay before sepsis >7 days (OR = 2.22,), dialysis (OR = 2.51), and cirrhosis (OR = 3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction. Conclusions Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low. (AU)

Objetivo En este estudio, nuestro objetivo fue evaluar los factores de riesgo de muerte de los pacientes incluidos en el protocolo de sepsis, utilizando datos clínicos de qSOFA, SIRS y comorbilidades, así como el desarrollo de un puntaje de riesgo de mortalidad. Diseño Este estudio de cohorte retrospectivo se llevó a cabo entre 2016 y 2021. Ámbito Dos hospitales universitarios en Brasil. Participantes Pacientes con sepsis. Intervenciones Se recopilaron varios datos clínicos y de laboratorio centrados en SIRS, qSOFA y comorbilidades. Variable de interésprincipales La mortalidad intrahospitalaria fue la variable de resultado primaria. Se desarrolló un puntaje de riesgo de mortalidad después del análisis de regresión logística. Resultados Se incluyeron un total de 1,808 pacientes con una tasa de mortalidad del 36%. Diez variables permanecieron como factores independientes relacionados con la muerte en el análisis multivariado: temperatura ≥38 °C (odds ratio [OR] = 0.65), sepsis previa (OR = 1.42), qSOFA≥2 (OR = 1.43), leucocitos >12,000 o <4,000 células/mm3 (OR = 1.61), accidente cerebrovascular encefálico (OR = 1.88), edad >60 años (OR = 1.93), cáncer (OR = 2.2), duración de la estancia hospitalaria antes de la sepsis >7 días (OR = 2.22), diálisis (OR = 2.51) y cirrosis (OR = 3.97). Considerando la ecuación del análisis de regresión logística binaria, el puntaje presentó un área bajo la curva de 0.668, un modelo débil para la predicción de la muerte. Conclusiones Varios factores de riesgo se asocian de forma independiente con la mortalidad, lo que permite el desarrollo de una puntuación de predicción basada en datos de qSOFA, SIRS y comorbilidades; sin embargo, el rendimiento de esta puntuación es bajo. (AU)

Sepsis death risk factor score based on systemic inflammatory response syndrome, quick sequential organ failure assessment, and comorbidities.

OBJECTIVE: In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score. DESIGN: This retrospective cohort study was conducted between 2016 and 2021. SETTING: Two university hospitals in Brazil. PARTICIPANTS: Patients with sepsis. INTERVENTIONS: Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities. MAIN VARIABLE OF INTEREST: In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis. RESULTS: A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38 °C (odds ratio [OR] = 0.65), previous sepsis (OR = 1.42), qSOFA ≥ 2 (OR = 1.43), leukocytes >12,000 or <4,000 cells/mm3 (OR = 1.61), encephalic vascular accident (OR = 1.88), age >60 years (OR = 1.93), cancer (OR = 2.2), length of hospital stay before sepsis >7 days (OR = 2.22,), dialysis (OR = 2.51), and cirrhosis (OR = 3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction. CONCLUSIONS: Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low.

Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients.

OBJECTIVE: To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS: IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS: At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS: In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.

Cardiovascular health and target end-organ damage and comorbidities in hypertensive patients from a Spanish primary care urban population / Salud cardiovascular y daño a órganos diana y comorbilidades en pacientes hipertensos procedentes de una población urbana de atención primaria en España

We hypothesized that a poorer cardiovascular health status is related to a higher risk of hypertension-mediated organ-damage (HMOD) or hypertension-related comorbidities (HRC). We assessed the relationship between cardiovascular health metrics (CVHM) and HMOD-HRC in 243 hypertensive patients from primary care center followed for two years. We recorded the baseline CVHM score (Life's Simple 7) plus clinical data, including prevalent and incident HMOD-HRC, hospitalization and mortality. The prevalence of ideal CVHM scores was very low in both men and women. The patients with healthier CVHM scores were younger, and had a lower prevalence of diabetes, cardiovascular disease and chronic kidney disease. We recorded 264 cases of HMOD-HRC (225 at baseline and 39 during follow-up). Nine patients died and 64 had any-cause hospitalization during follow-up. A lower prevalence of HMOD-HRC and unfavorable outcomes was observed as the number of ideal CVHM increased (P<0.05). Multivariate logistic regression adjusted for confounders showed a lower CVHM score (0–1) was associated with increased odds of HMOD-HRC (4.04, 95% CI 1.26–12.94; P=0.019) and composite endpoint (HMOD-HRC, death or all-cause hospitalization) (3.43, 95% CI 1.19–9.92; P=0.023). Individual components were less predictive than the cumulative CVHM score. Few hypertensive patients in this urban population had ideal CVHM scores. An inverse relationship between scores and outcomes (HMOD-HRC, death or hospitalizations) was observed. Interventions to increase this score may improve prognosis among community-based hypertensive patients (AU)

Nuestra hipótesis fue que un estado de peor salud cardiovascular está relacionado con un mayor riesgo de daño orgánico provocado por la hipertensión (DOP HTA) o de comorbilidades relacionadas con la hipertensión (CRHTA). Evaluamos la relación entre las métricas de la salud cardiovascular (MSCV) y el DOP HTA-CRHTA en 243 pacientes hipertensos procedentes de un centro de atención primaria, a quienes se realizó un seguimiento durante 2 años. Registramos la puntuación basal de MSCV (Life's Simple 7) y los datos clínicos, incluyendo DOP HTA-CRHTA prevalente e incidental, hospitalización y mortalidad. La prevalencia de puntuaciones MSCV ideales fue muy baja tanto en hombres como en mujeres. Los pacientes con puntuaciones MSCV más saludables fueron más jóvenes y tuvieron una menor prevalencia de diabetes, cardiopatías y enfermedad renal crónica. Registramos 264 casos de DOP HTA-CRHTA (225 al inicio y 39 durante el seguimiento). Nueve pacientes fallecieron y 64 fueron hospitalizados por cualquier causa durante el seguimiento. Se observó una menor prevalencia de DOP HTA-CRHTA y resultados no favorables a medida que aumentaba el MSCV ideal (p<0,05). La regresión logística multivariante ajustada a los factores de confusión reflejó una menor puntuación MSCV (0-1) asociada a un incremento de la odds ratio de DOP HTA-CRHTA (4,04, IC 95% 1,26-12,94; p=0,019) y un resultado compuesto (DOP HTA-CRHTA, muerte u hospitalización por cualquier causa) (3,43, IC 95% 1,19-9,92; p=0,023). Los componentes individuales fueron menos predictivos que la puntuación MSCV acumulada. Pocos pacientes hipertensos de esta población urbana tuvieron puntuaciones MSCV ideales. Se observó una relación inversa entre las puntuaciones y los resultados (DOP HTA-CRHTA, muerte u hospitalizaciones). Las intervenciones para incrementar esta puntuación pueden mejorar el pronóstico entre los pacientes hipertensos con base comunitaria (AU)

Cardiovascular health and target end-organ damage and comorbidities in hypertensive patients from a Spanish primary care urban population.

We hypothesized that a poorer cardiovascular health status is related to a higher risk of hypertension-mediated organ-damage (HMOD) or hypertension-related comorbidities (HRC). We assessed the relationship between cardiovascular health metrics (CVHM) and HMOD-HRC in 243 hypertensive patients from primary care center followed for two years. We recorded the baseline CVHM score (Life's Simple 7) plus clinical data, including prevalent and incident HMOD-HRC, hospitalization and mortality. The prevalence of ideal CVHM scores was very low in both men and women. The patients with healthier CVHM scores were younger, and had a lower prevalence of diabetes, cardiovascular disease and chronic kidney disease. We recorded 264 cases of HMOD-HRC (225 at baseline and 39 during follow-up). Nine patients died and 64 had any-cause hospitalization during follow-up. A lower prevalence of HMOD-HRC and unfavorable outcomes was observed as the number of ideal CVHM increased (P<0.05). Multivariate logistic regression adjusted for confounders showed a lower CVHM score (0-1) was associated with increased odds of HMOD-HRC (4.04, 95% CI 1.26-12.94; P=0.019) and composite endpoint (HMOD-HRC, death or all-cause hospitalization) (3.43, 95% CI 1.19-9.92; P=0.023). Individual components were less predictive than the cumulative CVHM score. Few hypertensive patients in this urban population had ideal CVHM scores. An inverse relationship between scores and outcomes (HMOD-HRC, death or hospitalizations) was observed. Interventions to increase this score may improve prognosis among community-based hypertensive patients.

Influence of enlarged waist circumference and hypertriglyceridemia in the severity of acute pancreatitis: A retrospective study / Influencia del aumento de la circunferencia de la cintura y la hipertrigliceridemia en la gravedad de la pancreatitis aguda: un estudio retrospectivo

Introduction: Acute pancreatitis is a frequent inflammatory gastrointestinal disorder with high mortality rates in severe forms. An early evaluation of its severity is key to identify high-risk patients. This study assessed the influence of waist circumference together with hypertriglyceridemia on the severity of acute pancreatitis. Methods: A retrospective study was performed, which included patients admitted with acute pancreatitis from March 2014 to March 2021. Patients were classified into four phenotype groups according to their waist circumference and triglyceride levels: normal waist circumference and normal triglycerides; normal waist circumference and elevated triglycerides; enlarged waist circumference and normal triglycerides; and enlarged waist circumference and triglycerides, namely hypertriglyceridemic waist (HTGW) phenotype. Clinical outcomes were compared among the groups. Results: 407 patients were included. Systemic inflammatory response syndrome (SIRS) and intensive care unit admission were most frequent among patients in the HTGW phenotype group, at 44.9% and 8.2%, respectively. The incidence of local complications was higher in the normal waist circumference with elevated triglycerides group (27%). On multivariable analysis, an enlarged waist circumference was related to an increase of 4% and 2% in the likelihood of developing organ failure and SIRS, respectively. Hypertriglyceridemia was an independent risk factor for both organ failure and local complications. Conclusions: HTGW phenotype was significant related to developing of SIRS. It seems that an enlarged waist circumference has a greater role than hypertriglyceridemia in the development of SIRS. Obesity and hypertriglyceridemia were both independent risk factors for organ failure. Patients with hypertriglyceridemia were more likely to develop local complications. (AU)

Introducción: La pancreatitis aguda es una patología frecuente con altas tasas de mortalidad en sus formas graves. Este estudio evaluó la influencia de la circunferencia de la cintura (CC) junto con la hipertrigliceridemia en la gravedad de la pancreatitis aguda. Métodos: Se realizó un estudio retrospectivo que incluyó pacientes con pancreatitis aguda desde 2014 hasta 2021. Los pacientes se clasificaron en cuatro grupos fenotípicos según su CC y los niveles de triglicéridos: CC normal y triglicéridos normales, CC normal y triglicéridos elevados, CC aumentada y triglicéridos normales, y CC aumentada y triglicéridos elevados, es decir, el fenotipo cintura hipertrigliceridémica (HTGW). Resultados: Se incluyeron 407 pacientes. El síndrome de respuesta inflamatoria sistémica (SIRS) y la admisión a la unidad de cuidados intensivos fueron más frecuentes entre los pacientes con fenotipo HTGW, en 44,9 y 8,2%, respectivamente. La incidencia de complicaciones locales fue mayor en el grupo de CC normal con triglicéridos elevados (27%). En el análisis multivariable, una CC aumentada se relacionó con un aumento de 4 y 2% en la probabilidad de desarrollar fallo orgánico y SIRS, respectivamente. La hipertrigliceridemia fue un factor de riesgo tanto para el fallo orgánico como para las complicaciones locales. Conclusiones: El fenotipo HTGW se relacionó con el desarrollo de SIRS. Parece que una CC aumentada tiene un papel más importante que la hipertrigliceridemia en el desarrollo de SIRS. La obesidad y la hipertrigliceridemia fueron factores de riesgo independientes para el fallo orgánico. Los pacientes con hipertrigliceridemia tenían más probabilidades de desarrollar complicaciones locales. (AU)

Influence of enlarged waist circumference and hypertriglyceridemia in the severity of acute pancreatitis: A retrospective study.

INTRODUCTION: Acute pancreatitis is a frequent inflammatory gastrointestinal disorder with high mortality rates in severe forms. An early evaluation of its severity is key to identify high-risk patients. This study assessed the influence of waist circumference together with hypertriglyceridemia on the severity of acute pancreatitis. METHODS: A retrospective study was performed, which included patients admitted with acute pancreatitis from March 2014 to March 2021. Patients were classified into four phenotype groups according to their waist circumference and triglyceride levels: normal waist circumference and normal triglycerides; normal waist circumference and elevated triglycerides; enlarged waist circumference and normal triglycerides; and enlarged waist circumference and triglycerides, namely hypertriglyceridemic waist (HTGW) phenotype. Clinical outcomes were compared among the groups. RESULTS: 407 patients were included. Systemic inflammatory response syndrome (SIRS) and intensive care unit admission were most frequent among patients in the HTGW phenotype group, at 44.9% and 8.2%, respectively. The incidence of local complications was higher in the normal waist circumference with elevated triglycerides group (27%). On multivariable analysis, an enlarged waist circumference was related to an increase of 4% and 2% in the likelihood of developing organ failure and SIRS, respectively. Hypertriglyceridemia was an independent risk factor for both organ failure and local complications. CONCLUSIONS: HTGW phenotype was significant related to developing of SIRS. It seems that an enlarged waist circumference has a greater role than hypertriglyceridemia in the development of SIRS. Obesity and hypertriglyceridemia were both independent risk factors for organ failure. Patients with hypertriglyceridemia were more likely to develop local complications.

Seguimiento de la actividad clínica y del daño orgánico acumulado en una cohorte de pacientes con lupus eritematoso sistémico de la península de Yucatán, México (1995-2016) / Follow-up of clinical activity and accumulated organic damage in a cohort of patients with Systemic Lupus Erythematosus from the Yucatán peninsula, México (1995-2016)

Introducción: El lupus eritematoso sistémico (LES) es una enfermedad autoinmune con severidad variable, frecuente en individuos hispanos y afroamericanos. Objetivo: Conocer la actividad clínica y el daño acumulado, así como la prevalencia e incidencia, en una cohorte dinámica de pacientes con LES de la península de Yucatán (1995 a 2016). Pacientes y métodos: Se analizaron 200 pacientes con LES, beneficiarios del servicio médico del Hospital Regional ISSSTE de Mérida, Yucatán, durante 22 años. Se evaluó la actividad de la enfermedad y el daño acumulado mediante la escala MEX-SLEDAI y SLICC-ACR-DI, respectivamente, y su correlación con variables clínicas y demográficas. Resultados: Se analizaron 185 pacientes mujeres y 15 hombres. Los índices promedio de actividad y daño acumulado durante el seguimiento fueron de 4,63 y 1,10, respectivamente. El índice de actividad se observó significativamente menor en las mujeres respecto de los hombres (4,36 vs. 7,43), y el daño acumulado no presentó diferencia por sexo. Las manifestaciones asociadas con mayor actividad fueron las mucocutáneas y articulares, y los órganos con mayor daño acumulado el musculoesquelético, el neurológico y el gonadal. Se encontró relación de los índices con el tiempo de evolución, las remisiones/reactivaciones y la actividad persistente. La mortalidad se relacionó con actividad persistente por complicaciones vasculares sistémicas e insuficiencia renal y hepática. La incidencia y prevalencia anual del LES calculada fue de 2,86% y 48,43% en la península de Yucatán. Conclusiones: Los pacientes presentaron actividad persistente, con reactivaciones leves a moderadas y daño acumulado más agresivo en hombres. La actividad clínica disminuye e incrementa el daño acumulado a mayor tiempo de evolución, con menor afección renal y mayor sobrevida, lo que sugiere un curso más benigno en la población de la península de Yucatán.(AU)

IntroductionSystemic lupus erythematosus (SLE) is an autoimmune with variable severity, common in Hispanic and African-American individuals.Objective: To know the clinical activity and the accumulated damage, as well as the prevalence and incidence, in a dynamic cohort of patients with SLE from the Yucatan Peninsula (1995-2016). Patients and methods: A cohort of 200 patients with SLE, medical service beneficiaries of the ISSSTE Regional Hospital of Mérida, Yucatán, was analyzed for 22 years. Disease activity and accumulated damage were evaluated using the MEX-SLEDAI scale and the SLICC-ACR-DI, respectively, and its correlation with clinical and demographic variables. Results: 185 female and 15 male patients were analyzed. Average accumulated damage and activity indices during follow-up were 4.63 and 1.10, respectively. The activity index was significantly lower in females compared to males (4.36 vs 7.43), and the accumulated damage did not present a difference by sex. The manifestations associated with greater activity were the mucocutaneous and articular ones, and the organs with the greatest accumulated damage were the musculoskeletal, neurological and gonadal. A relationship between the indices was found with the evolution time, remissions / reactivations, and persistent activity. Mortality was related to persistent activity due to systemic vascular complications and kidney and liver failure. The annual incidence and prevalence of SLE calculated was 2.86% and 48.43% in Yucatán Peninsula. Conclusions: The patients presented persistent activity, with mild to moderate reactivations, and accumulated damage more aggressive in men. The clinical activity decreases and increases the accumulated damage at a longer evolution time, with less kidney disease and greater survival, which suggests a more benign course in the population of the Yucatan Peninsula.(AU)

Follow-up of clinical activity and accumulated organic damage in a cohort of patients with systemic lupus erythematosus from the Yucatán Peninsula, Mexico (1995-2016).

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune with variable severity, common in Hispanic and African-American individuals. OBJECTIVE: To know the clinical activity and the accumulated damage, as well as the prevalence and incidence, in a dynamic cohort of patients with SLE from the Yucatan Peninsula (1995-2016). PATIENTS AND METHODS: A cohort of 200 patients with SLE, medical service beneficiaries of the ISSSTE Regional Hospital of Mérida, Yucatán, was analysed for 22 years. Disease activity and accumulated damage were evaluated using the MEX-SLEDAI scale and the SLICC-ACR-DI, respectively, and its correlation with clinical and demographic variables. RESULTS: 185 female and 15 male patients were analysed. Average accumulated damage and activity indices during follow-up were 4.63 and 1.10, respectively. The activity index was significantly lower in females compared to males (4.36 vs 7.43), and the accumulated damage did not present a difference by sex. The manifestations associated with greater activity were the mucocutaneous and articular ones, and the organs with the greatest accumulated damage were the musculoskeletal, neurological and gonadal. A relationship between the indices was found with the evolution time, remissions/reactivations, and persistent activity. Mortality was related to persistent activity due to systemic vascular complications and kidney and liver failure. The annual incidence and prevalence of SLE calculated was 2.86% and 48.43% in Yucatán Peninsula. CONCLUSIONS: The patients presented persistent activity, with mild to moderate reactivations, and accumulated damage more aggressive in men. The clinical activity decreases and increases the accumulated damage at a longer evolution time, with less kidney disease and greater survival, which suggests a more benign course in the population of the Yucatan Peninsula.

Influencia del cambio de uso del suelo sobre las reservas de carbono orgánico en el Parque Natural Regional Cortadera, Boyacá (Colombia)

Los páramos almacenan grandes reservas de carbono orgánico en el suelo (COS), influenciados por las condiciones climáticas y biogeoquímicas, propias del ecosistema; sin embargo, su progresiva conversión hacia cultivos, ganadería o minería incide directamente en las reservas de COS. Con el fin de determinar el efecto que ejerce el cambio de uso de suelo sobre la variabilidad de las reservas de COS, se realizó un monitoreo de COS entre 2013, 2018 y 2020, en el Parque Natural Regional Cortadera. Se estudiaron parcelas permanentes de muestreo (PPM), ubicadas bajo tres diferentes usos del suelo: conservado, en recuperación e intervenido. Se analizaron muestras de carbono orgánico y densidad aparente, a dos profundidades (0-15 cm y 15-30 cm). Se encontró que la PPM en escenario conservado presentó los contenidos más altos de COS, con valores de 290,37; 199,22 y 257,5 tC ha-1, para cada uno de los años en estudio; seguido por la PPM en recuperación, que evidenció valores de COS 215,3 tC ha-1, en el 2020, en contraste con la PPM intervenida, que presentó contenidos mínimos de 15,50; 34,01 y 88,06 tC ha-1. Se observó que los mayores contenidos de COS se encuentran a la profundidad de 15 a 30 cm. Dichos aspectos, resaltan la importancia de avanzar en acciones enfocadas a la protección de ecosistemas estratégicos, considerando las constantes amenazas relacionadas con la transformación del paisaje y, con ello, la posibilidad de proveer funciones y servicios asociados a la captura de carbono y la regulación climática.

The paramos accumulate high stocks of soil organic carbon (SOC), influenced by the climatic and biogeochemical conditions of the ecosystem. However, their progressive conversion to crops, livestock, or mining has a direct impact on the SOC stocks. To determine the effect of land use change on the variability of SOC stocks, monitoring of SOC content was conducted between the years 2013, 2018, and 2020 in the Parque Natural Regional Cortadera. Permanent sampling plots (PPS) located under three different land uses were studied: conserved, recovering, and intervened. To do so, samples of soil organic carbon and bulk density at two depths were analyzed (0-15 cm and 15-30 cm). The conserved PPS showed the highest SOC contents, with maximum values of 290.37; 199.22, and 257.5 tC ha-1 for each of the years under study; follow by the recovery PPM that presented COS values of 215.3 tC ha-1 in 2020, in contrast to the intervened PSP that showed minimum contents of 15.50; 34.01 and 88.06 tC ha-1. Furthermore, the highest SOC contents were found at 15-30 cm depth. These factors emphasize the importance of carrying out actions focused on protecting strategic ecosystems such as paramos, taking into account the continuous threats related to the transformation of the landscape and, consequently, the possibility of providing ecosystem functions and services related to carbon capture and climate regulation.

Patología orgánica asociada al tabaquismo / Organic pathology associated with smoking

Introducción: El tabaquismo es un problema de salud de dimensiones epidémicas con un importante impacto sobre la salud de la población. Según la OMS, esta epidemia mata a más de 8 millones de personas. Además, es uno de los desencadenantes más importantes de enfermedades pulmonares crónicas, cardiovasculares y neoplásicas, por lo que es considerado el factor de riesgo de enfermedad y de muerte prematura evitable más importante a nivel mundial.Objetivo: En esta revisión bibliográfica se discutirá la evidencia actual del daño orgánico producido por el tabaco, los mecanismos fisiopatológicos mediante los cuales se produce y la relevancia en la prevención mediante el cese del consumo. Resultados: El hábito tabáquico es uno de los desencadenantes más importantes de cáncer, siendo actualmente el responsable del 30 % de los cánceres a nivel mundial. Por otro lado, el aparato respiratorio es uno de los que más sufre el impacto de su consumo, relacionándose de forma estrecha con el desarrollo de enfermedad pulmonar obstructiva crónica, asma e infecciones respiratorias. Además, tiene un rol muy importante en la patogenia de las enfermedades cardiovasculares; hay evidencia clara de que el tabaquismo constituye un factor de riesgo cardiovascular, estando muy relacionado con el desarrollo de cardiopatía coronaria, enfermedad arterial periférica y accidentes cerebrovasculares.Conclusiones: El humo del cigarrillo contiene partículas potencialmente peligrosas para la salud de quien está expuesto a ellas. De este modo, fumar cigarrillo se convierte en un factor etiológico común a muchos tipos de cáncer, de enfermedad cardiovascular y enfermedad pulmonar obstructiva crónica. La nicotina, uno de sus componentes, es un potente agente adictivo. Todo esto en suconjunto hace del cigarrillo un importante problema de salud pública.(AU)

Introduction: Smoking is a health problem of epidemic dimensions with a significant impact on the health of the population. According to the WHO, this epidemic kills more than 8 million people. In addition, it is one of the most important triggers of chronic pulmonary, cardiovascular and neoplastic diseases, which is why it is considered the most important risk factor for disease and premature death worldwide. Objective: This bibliographic review will discuss the current evidence of organic damage caused by tobacco, the pathophysiological mechanisms through which it is produced and the relevance in prevention through the cessation of consumption. Results: Smoking is one of the most important triggers of cancer, currently being responsible for 30% of cancers worldwide. On the other hand, the respiratory system is one of those that suffers the most from the impact of its consumption, being closely related to the development of chronic obstructive pulmonary disease, asthma and respiratory infections. In addition, it has a very important role in the pathogenesis of cardiovascular diseases, there is clear evidence that smoking is a cardiovascular risk factor, being closely related to the development of coronary heart disease, peripheral arterial disease and cerebrovascular accidents. Conclusions: Cigarette smoke contains particles that are potentially dangerous to the health of those who are exposed to them. In this way, cigarette smoking becomes an aetiological factor common to many types of cancer, cardiovascular disease and chronic obstructive pulmonary disease. Nicotine, one of its components, is a powerful addictive agent. All this together makes cigarettes a major public health problem.(AU)

Biodisponibilidad de fósforo en alimentos y su efecto en la enfermedad renal crónica / Bioavailability of phosphorus in food and its effect in chronic kidney disease

Resumen Introducción: el objetivo del presente trabajo se centra en reconocer la importancia de las investigaciones que relacionan la biodisponibilidad de fósforo en diferentes grupos de alimentos de origen animal, vegetal e industrial y su efecto en la progresión de la enfermedad renal crónica (ERC). Metodología: la revisión se sustentó en la búsqueda literaria en páginas web como PUBMED, Redalyc, SciELO, SCIHUB y Google Academic. Se seleccionó cada estudio, descartando aquellos que no fueran cuantitativos u originales, estuvieran incompletos, sin metodología clara, realizados en mamíferos o si los resultados no se especificaban en porcentajes. La lectura puso especial énfasis en el índice de biodisponibilidad de fósforo derivado del consumo de distintos productos alimenticios. Se elaboraron tres matrices de acuerdo con el origen del comestible y la biodisponibilidad de fósforo que absorbe el organismo. Resultados: se encontró que los alimentos industrializados y los aditivos muestran una biodisponibilidad de fósforo del 90 % al 100 %, los de origen animal del 40 % al 80 % y los de origen vegetal del 30 %. Conclusiones: los aditivos de los alimentos industrializados promueven la hiperfosfatemia y, con ello, aceleran la progresión de la enfermedad renal crónica, a diferencia de los de origen animal y vegetal, menos perjudiciales para la salud. Esto da pauta a la formación del sector salud para ampliar su conocimiento sobre el tratamiento nutricional del paciente.

Abstract Introduction: to know the importance of the investigations that relate the bioavailability of phosphorus in different groups of foods of animal, vegetable and industrialized origin and its effect on the progression in patients with Chronic Kidney Disease (CKD). Methodology: the review is based on a literary search that was carried out on web pages such as: PUBMED, Redalyc, SciELO, SCIHUB and Google Academic. Each of the studies was selected discarding those that were not quantitative, original, complete, with clear methodology, carried out in mammals, and that in their results specified the bioavailability of phosphorus in percentages. All the studies were read, placing main emphasis and interest on the percentage of phosphorus bioavailability when consuming different food groups. Three matrices were made according to the origin of the food and the bioavailability of phosphorus that is absorbed in the body; grouping them into foods of animal, vegetable and industrialized origin and additives. Results: it was found that industrialized foods and additives show a phosphorus bioavailability of 90-100%, those of animal origin 40-80%, those of plant origin 30%. Conclusions: The additives used in industrialized foods promote hyperphosphatemia and thus accelerate the progression of chronic kidney disease, unlike foods of animal and vegetable origin that are less harmful to health. This guides the training of the health sector, expanding its knowledge in the nutritional treatment of the patient.

COVID-19 and essential workers: Healthcare delays among organic farmers.

INTRODUCTION AND OBJECTIVE: While the overall impact of COVID-19 is still being assessed, there is strong evidence that the pandemic has greatly aggravated traditional flaws of healthcare systems around the globe. Understanding the healthcare impact of the COVID-19 pandemic is essential for emergency preparedness and the prevention of collateral damage. The food and agriculture sector is an essential service and critical to food availability and access. However, literature on the healthcare impact of COVID-19 in farmers is scarce. This study aimed to explore healthcare delays caused by the COVID-19 pandemic in certified organic producers. METHODS: An observational Cross-sectional study based on answers of an electronic self-reported survey. Participants included were United States certified organic producers listed in the Organic Integrity Database. RESULTS: Respondents represented 40 states; response rate was estimated at 11%. Analyses were conducted on 344 records. A high majority were non-Hispanic Whites with a four-year college education or more. More than 90% had health insurance. More than one-third (36.5%) of respondents reported healthcare delays. Female producers were nearly twice as likely to report non-COVID-19 related healthcare delays as their male counterparts (OR 1.95, 95% CI: 1.10-3.44). CONCLUSION: This study provides national data on healthcare delays among organic producers and their households and identifies sex differences in non-COVID-19 related healthcare delays. This study is the first to collect data on organic producers and can serve as a baseline for future studies; it may inform practice, research and policy on emergency preparedness, protection of essential workers, and healthcare services and quality.

Obtención y caracterización físico química de un sustrato nutritivo hecho a partir de los desechos del cacao para la producción de plántulas de hortalizas: en asocio con empresa Chukwa Chocolates / Obtaining and physicochemical characterization of a nutritive substrate made from cacao waste for the production of vegetable seedlings: in association with Chukwa Chocolates

En el beneficiado del cacao se producen una gran cantidad de residuos, las mazorcas generalmente son desechadas dentro de los mismos cultivos y genera problemáticas como la proliferación de insectos y microorganismos patógenos. De estos desechos las cáscaras son las de mayor relevancia. La Escuela de Ingeniería Química de ITCA-FEPADE evaluó añadirle valor a este subproducto, incorporando desechos de cáscara de cacao en la formulación de un sustrato para el cultivo de plántulas de hortalizas. El objetivo de esta investigación fue obtener un sustrato orgánico que sirva de soporte material y nutritivo a partir de cáscaras de cacao criollo. La biomasa vegetal se caracterizó teniendo en cuenta parámetros como el porcentaje de humedad, pH, porcentaje de cenizas, contenido de potasio, nitrógeno y fósforo. Se ejecutaron pruebas comparativas de formulación del sustrato, siembra, cultivo y crecimiento de las plántulas de hortalizas de tomate y pepino, obteniendo como resultado la fórmula óptima de un sustrato y abono orgánico y el mejor medio de desarrollo. De los resultados obtenidos se concluye que, a partir de un adecuado procesamiento y aprovechamiento de las cáscaras de cacao, se puede transformar este desecho en un producto biomaterial alternativo que genera una opción de bioprospección agroindustrial.

In the cacao beneficiation, a large amount of waste is produced, generally, the cacao pods are discarded within the same crops and generate problems such as the proliferation of insects and pathogenic microorganisms. The shell are the most relevant this waste. In Escuela de Ingeniería Química of ITCA-FEPADE the incorporation of cacao shell waste in the formulation of a substrate for growing vegetables was evaluated because the giving benefit to these by-products. The objective of this research was to obtain a substrate that serves as material and nutritional support for vegetable seedlings, from creole cacao shells. The vegetal biomass was characterized taking into account parameters such as moisture percentage, pH, ash percentage, potassium, nitrogen and phosphorus content. Subsequently, comparative tests of formulation, planting and growth of vegetable tomato and cucumber seedlings were carry out, obtaining as result, the optimal formula for the substrate and the best development environment. It concludes that, through an adequate processing and use of the cacao shell, it is possible to transform a waste into an alternative biomaterial product that generates an agro industrial bioprospecting option.

Remoção de carbono orgânico dissolvido de águas filtradas com tratamento complementar por pré-oxidação com ozônio e adsorção em carvão ativado / Removal of dissolved organic carbon in filtered water complemented with treatment by pre-oxidation with ozone and adsorption on activated carbon

Resumo Este trabalho teve como objetivo avaliar as remoções de carbono orgânico dissolvido presente em águas filtradas de estação de tratamento de água com tratamento complementar por pré-oxidação com ozônio e adsorção em carvão ativado granular. Para o estudo de adsorção foi utilizado o método de ensaio rápido em coluna de escala reduzida, com carvão ativado produzido de cascas de coco. Realizou-se a comparação entre as curvas de ruptura para os ensaios com e sem aplicação de ozônio. Os resultados mostraram reduções nas concentrações de carbono orgânico dissolvido no início dos ensaios e após a passagem da água com e sem pré-ozonização pelas colunas ensaio rápido em coluna de escala reduzida seguida de incrementos progressivos das concentrações à medida que se aumentou o volume de leitos tratados. Na fase final dos ensaios, os aumentos de volume de leitos tratados não causaram mudanças significativas nas concentrações efluentes de carbono orgânico dissolvido. O mesmo comportamento foi observado com relação à absorção em radiação ultravioleta a 254 nm. O uso de ozônio previamente à adsorção em carvão ativado granular, usando o método ensaio rápido em coluna de escala reduzida, resultou em maiores reduções na absorbância da luz ultravioleta em 254 nm do que nas concentrações de carbono orgânico dissolvido. As absorbâncias específicas à radiação ultravioleta das amostras ozonizadas foram menores do que as que não receberam ozônio.

Abstract The objective of this study was to evaluate the removal of dissolved organic carbon in filtered water followed by pre-oxidation with ozone and adsorption on granular activated carbon. The rapid small-scale column test was used for the adsorption essays with activated carbon produced from coconut shells. A comparison was made between the breakthrough curves for tests performed with and without pre-oxidation with ozone. The results showed reductions in dissolved organic carbon concentrations after initial passage of water with and without ozone through the rapid small-scale column test column, followed by progressive increases in concentrations along with the number of the bed volumes. In the final phase of the tests, increases in bed volumes did not cause significative changes in effluent dissolved organic carbon concentrations. The same behavior was also observed with respect to ultra-violet absorbance at 254 nm. The use of ozone prior to adsorption on GAC, using the ERCER method, caused greater reductions on UV254 absorbance than in concentrations of dissolved organic carbon. The specific ultraviolet absorbance values of samples that received ozone were lower than those that were not ozonized.

C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain.

OBJECTIVE: To identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia. MATERIAL AND METHODS: An approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score. MEASUREMENTS AND MAIN RESULTS: Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P = 0.0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P < 0.0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P < 0.05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P > 0.05 vs AUC-ROC development). CONCLUSION: Patients COVID-19 presenting at admission SOFA score ≥ 2 combined with CRP ≥ 9.1 mg/mL could be at high risk to require critical care.

Consumo incidental de plástico y otros materiales antropogénicos por parte de Coragyps atratus (Bechstein, 1793) en un vertedero de basura de Ecuador / Incidental consumption of plastic and other anthropogenic materials by Coragyps atratus (Bechstein, 1793) in a garbage dump in Ecuador

Resumen En este estudio se analiza y discute la ingesta de plástico y otros materiales antropogénicos por parte de Coragyps atratus en un vertedero de residuos suburbano de Calceta, Provincia de Manabí, Ecuador. De un total de 112 egagrópilas analizadas, el 100% contenía materiales antropogénicos siendo los más conspicuos, diferentes tipos de plásticos y microplásticos, además de metales, vidrio, suelo y otros. Se discute y contrasta con la bibliografía la importancia relativa de los materiales antropogénicos encontrados, así como su potencial impacto en la especie y para el ser humano.

Abstract This study analyzes and discusses the ingestion of plastic and other anthropogenic materials by Coragyps atratus in a suburban waste dump in Calceta, Manabí Province, Ecuador. Of a total of 112 pellets analyzed, 100% contained anthropogenic materials, the most conspicuous being different types of plastics and microplastics, as well as metals, glass, soil, and others. The relative importance of the anthropogenic materials found is discussed and analyzed, same as their potential impact on the species and humanity.

Preparation and process optimization of microbial organic copper as a feed additive / Preparação e otimização do processo de cobre orgânico microbiano como aditivo alimentar

As an essential trace element for animals, copper significantly contributes to the growth and health of animals. Compared to inorganic trace elements, organic trace elements are better supplements; notably, they are acquired through microbial transformation. Therefore, we screened for copper-enriched microorganisms from high copper content soil to obtain organic copper. Sodium diethyldithio carbamate trihydrate was applied as a chromogenic agent for determining micro amounts of intracellular copper through spectrophotometry. In total, 50 fungi were isolated after the successful application of the screening platform for copper-rich microbes. Following morphological and molecular biology analyses, the N-2 strain, identified as Aspergillus niger sp. demonstrated showed better copper enrichment potential than others. Notably, the strain tolerance to copper was nearly thrice that of Saccharomyces cerevisiae, up to 1600mg/L. The content of the organic bound copper was 22.84mg Cu/g dry cell. Using the Central Composite Design (CCD) response surface method, we optimized the fermentation condition (inoculation amount, 13%; temperature, 28(C; pH, 5.0). Compared to the original strain results under the single factor fermentation condition, we reported an increase by 24.18% under the optimized conditions. Collectively, these findings provide a reference for uncovering new and low-cost organic copper additives.(AU)

Como elemento traço essencial para os animais, o cobre contribui significativamente para o crescimento e saúde dos animais. Comparado aos oligoelementos inorgânicos, os oligoelementos orgânicos são melhores suplementos; notavelmente, eles são adquiridos através de transformação microbiana. Portanto, nós selecionamos microorganismos enriquecidos com cobre de solos com alto teor de cobre para obter cobre orgânico. O carbamato de sódio diethyldithio trihidratado foi aplicado como agente cromogênico para a determinação de micro quantidades de cobre intracelular através da espectrofotometria. No total, 50 fungos foram isolados após a aplicação bem sucedida da plataforma de triagem para micróbios ricos em cobre. Após análises morfológicas e de biologia molecular, a cepa N-2, identificada como Aspergillus niger sp. demonstrou um melhor potencial de enriquecimento de cobre do que outras. Notavelmente, a tolerância da estirpe ao cobre foi quase três vezes maior que a da Saccharomyces cerevisiae, até 1600mg/L. O conteúdo de cobre ligado orgânico era de 22,84mg Cu/g de célula seca. Usando o método de superfície de resposta Central Composite Design (CCD), nós otimizamos a condição de fermentação (quantidade de inoculação, 13%; temperatura, 28C; pH, 5,0). Em comparação com os resultados da deformação original sob a condição de fermentação de fator único, relatamos um aumento de 24,18% sob as condições otimizadas. Coletivamente, estas descobertas fornecem uma referência para descobrir novos aditivos de cobre orgânico de baixo custo.(AU)

Assessment of weight gain and control of parasitism by Rhipicephalus microplus in dairy cattle in the field using organosynthetic parasiticide, phytotherapics and homeopathy / Avaliação do ganho de peso e controle do parasitismo por Rhipicephalus microplus em bovinos leiteiros a campo usando parasiticida organosintético, fitoterápicos e homeopatia

The goal of this research was to compare the effect of the following products on dairy cattle, parasitized by Rhipicephalus microplus: organosynthetics - Clorfenvinfós and Ivermectina (OG); phytotherapics - Eucalyptus oil (EG) and Neem cake (NG); Homeopathy (HG); The control group (CG) received no treatment. Infestation was by R. microplus (MIC) and weight gain (GP) were evaluated. The study included 60 animals (5 groups) from ­ Dutch / Zebu, aged between 25-44 months and initial weight between 211-477kg. EG and NG showed MIC 84.9% and 14.0% greater than CG, respectively (P <0.05; P = 0). HG and OG had MIC less than CG 24.4% and 16.9%, respectively (P<0.05; P <0.05). EG, NG and OG obtained GP lower than CG in 7.9%, 8.9% and 8.06% (P <0.05) respectively. The HG GP was 4.9% higher (P <0.05) than CG. This was the first research to prove parasitism control by R. microplus in a field test, using homeopathy. The methodology for choosing Homeopathy for the control of enzooties, developed and tested for the first time in this study, proved to be adequate and efficient, opening the possibility for establishing a new methodology for strategic control of parasitism by R. microplus.(AU)

O objetivo desta pesquisa foi comparar o efeito dos seguintes produtos sobre bovinos leiteiros, parasitados por Rhipicephalus microplus: organossintéticos - clorfenvinfós e ivermectina (OG); fitoterápicos - óleo de eucalipto (EG) e torta de Neem (NG) e homeopatia (HG). O grupo controle (CG) não recebeu tratamento. Foram avaliados infestação por R. microplus (MIC) e ganho de peso/grupo (GP) em 60 animais (5 grupos), a partir de ­ holandês/zebu, com idade entre 25 e 44 meses e peso inicial entre 211 e 477kg. EG e NG apresentaram MIC 84,9% e 14,0% maior que CG, respectivamente (P<0,05; P=0). HG e OG apresentaram MIC menor que CG 24,4% e 16,9%, respectivamente (P<0,05; P<0,05). EG, NG e OG obtiveram GP menor que CG em 7,9%, 8,9% e 8,06% (P<0,05), respectivamente. O GP do HG foi 4,9% maior (P<0,05) que o CG. Esta foi a primeira pesquisa a comprovar controle do parasitismo por R. microplus em teste a campo, usando homeopatia. A metodologia para escolha de medicamentos homeopáticos para controle de enzootias, desenvolvida e testada pela primeira vez neste estudo, mostrou-se adequada e eficiente, abrindo a possibilidade para estabelecimento de nova metodologia para controle estratégico do parasitismo por R. microplus.(AU)

C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain. / Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España.

OBJECTIVE: To identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia. MATERIAL AND METHODS: An approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score. MEASUREMENTS AND MAIN RESULTS: Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P=.0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P<.0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P<.05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P>0.05 vs AUC-ROC development). CONCLUSION: Patients COVID-19 presenting at admission SOFA score ≥2 combined with CRP ≥9,1mg/mL could be at high risk to require critical care.