Efficacy of the "Start to move" protocol on functionality, ICU-acquired weakness and delirium: A randomized clinical trial.

OBJECTIVE: To evaluate the efficacy of the Start to move protocol compared to conventional treatment in subjects over 15 years of age hospitalized in the ICU on an improvement in functionality, decrease in ICU-acquired weakness (DAUCI), incidence of delirium, days of mechanical ventilation (MV), length of stay in ICU and mortality at 28 days. DESIGN: randomized controlled clinical trial. SETTING: Intensive Care Unit. PARTICIPANTS: Includes adults older than 15 years with invasive mechanical ventilation more than 48h, randomized allocation. INTERVENTIONS: Start to move protocol and conventional treatment. MAIN VARIABLES OF INTEREST: Functionality, incidence of ICU-acquired weakness, incidence of delirium, days on mechanical ventilation, ICU stay and mortality-28 days, ClinicalTrials.gov number, NCT05053724. RESULTS: 69 subjects were admitted to the study, 33 to the Start to move group and 36 to conventional treatment, clinically and sociodemographic comparable. In the "Start to move" group, the incidence of IUCD at ICU discharge was 35.7% vs. 80.7% in the "conventional treatment" group (p=0.001). Functionality (FSS-ICU) at ICU discharge corresponds to 26 vs. 17 points in favor of the "Start to move" group (p=0.001). The difference in Barthel at ICU discharge was 20% in favor of the "Start to move" group (p=0.006). There were no significant differences in the incidence of delirium, days of mechanical ventilation, ICU stay and 28-day mortality. The study did not report adverse events or protocol suspension. CONCLUSIONS: The application of the "Start to move" protocol in ICU showed a reduction in the incidence of IUAD, an increase in functionality and a smaller decrease in Barthel score at discharge.

Intraparenchymal Hematoma With Significant Mass Effect Treated With Factor Eight Inhibitor Bypass Activity.

The authors present the case of an 80-year-old female with myelodysplastic syndrome treated with chemotherapy and apixaban, a direct oral anticoagulant who suffered an intracranial hemorrhage. She presented to the emergency department with altered mental status and was found to have a large intraparenchymal hematoma with a significant mass effect. Our patient was given FEIBA (Factor Eight Inhibitor Bypass Activity) to reverse the hemorrhage. Anticoagulant-related bleeding reversal strategies are discussed.

Snake antivenom production in Ecuador: Poor implementation, and an unplanned cessation leads to a call for a renaissance.

Snakebite envenomation is a global health problem. This health problem asymmetrically affects rural populations in developing countries to such an extent that it recently has been listed as a priority neglected tropical disease (NTD). It is estimated that 5.4 million individuals are bitten by snakes each year, causing at least 2.7 million envenomations and more than 100,000 deaths each year. Ecuador has one of the highest snakebite envenomation incidence rates in Latin America, mostly in the coastal and Amazonian provinces. Envenomations in these regions are the result of bites primarily by species of snakes belonging to the Viperidae family. Ecuador was able to locally produce antivenoms, however serious flaws were revealed in the antivenom production process, leading to the decommissioning of the existing facility. In the interest of public health, we have summarized the political and social setbacks experienced by the antivenom serum production plant in Ecuador, while encouraging resuming local production of snake antivenom to improve the responsiveness of the already overburdened health system.

A Cross-Sectional Survey of the Zika Virus and its Prevention: The Knowledge, Thoughts, and Beliefs of a Community of Residents in Caguas, Puerto Rico.

OBJECTIVE: The objective of this study was to explore the knowledge, thoughts, and beliefs regarding the Zika virus and its prevention in a community of residents in the municipality of Caguas, Puerto Rico, and elicit their concerns and perceptions of risk. METHODS: A quantitative, non experimental, descriptive, cross-sectional correlational study was conducted in a community in Caguas, Puerto Rico. A structured questionnaire was administered to a sample of 158 residents, aged 21 and older, who participated voluntarily. The data were analyzed using SPSS version 17 via univariate and bivariate analysis. RESULTS: Of 158 surveyed, 64.6% were women; with a population average of 53.85 years. Of the respondents who believed that they would be affected in some way if they were infected by the Zika virus, over half (52.3%) felt that the virus represented a significant threat to their emotional stability. Of those who perceived emotional threat, 39.5% (n=32) continued to study after completing high school (X2=9.217, p=0.027), 57.9% (n=55) had private health insurance (X2=6.325; p=0.042), and 67.9% (n=55) reported it was little or unlikely to become infected (X2= 6.783; p=0.034). Out of those concerned, 57.4% (n=54) considered Zika very or extremely severe (X2=22.827, p<0.001) and 98.9% (n=93) clean the house surroundings as a preventive measure (X2 = 4.951, p=0.026). Lack of interest was the most common reason identified for not complying with preventive actions by the residents (89.2%). CONCLUSION: The underestimation both of the risk concerning the Zika virus and of its consequences was evident. This study reaffirms the need to develop a network that effectively and constantly communicates risk estimates, doing so while addressing the specific needs within the communities served by that network. Community interventions aimed at improving the benefits of and reducing the risks associated with and the perceived barriers to preventive behaviors are needed.

Microencapsulación mediante secado por aspersión de aceite de mora (Rubus glaucus) extraído con CO2 supercrítico / Microencapsulation by spray drying of blackberry (Rubus glaucus ) oil extracted with supercritical CO2 / Microencapsulação por secagem por atomização de óleo de amora (Rubus glaucus) extraído com Co2 supercrítico

El aceite de mora es un ingrediente natural con potencial en la industria cosmética y alimentaria, puede experimentar degradación oxidativa en condiciones ambientales. Se extrajo aceite a partir de semillas de mora empleando fluidos supercríticos, se microencapsuló mediante secado por aspersión y se evaluó la influencia de diferentes condiciones de operación en el rendimiento y la eficiencia del proceso. Se emplearon como materiales encapsulantes: masterdry, goma arábiga y maltodextrina. Se comparó el perfil de ácidos grasos antes y después de la microencapsulación y se estudió el tamaño y morfología de las microcápsulas. En el proceso de microencapsulación la temperatura de entrada fue la única variable estadísticamente significativa usando masterdry y goma arábiga. La goma arábiga resultó ser el mejor encapsulante entre los tres estudiados. Se obtuvieron microcápsulas con tamaños entre 8,2 y14 -im, con superficie continua en las paredes y ausencia de poros. Se comprobó que la microencapsulación con los tres encapsulantes permitió proteger el aceite y conservar mayoritariamente su perfil de ácidos grasos.

Blackberry oil is a natural ingredient with potential in cosmetics and food industry, however, it experiences oxidative degradation at ambient conditions. Therefore, oil was obtained from blackberry seeds by supercritical fluid extraction and then was microcapsulated by spray drying. The influence of different operating conditions during spray-drying towards yield and encapsulation was evaluated. Masterdry, gum arabic, and maltodextrin were used as wall materials. Fatty acid profile was compared before and after microencapsulation, the size and morphology of the microcapsules were also studied. Inlet temperature was the only statistically significant variable in process yield and efficiency when gum arabic and masterdry were used. Feed flow rate was statistically significant only for process yield and it was influenced negatively when maltodextrin was used. Gum arabic was the best wall material among the three studied. Microcapsules with sizes between 8.2 and 14 -im were obtained; continuous wall and no apparent cracks were observed. It was also seen that the fatty acid profile was mostly conserved after microencapsulation process carried out with the three wall materials.

O óleo de amora é um ingrediente natural com potencial na indústria cosmética e dos alimentos, é susceptível à degradação por oxidação em condições ambientais. O óleo de sementes de amora foi extraído usando fluidos supercríticos e foi microencapsulado por secagem por pulverização. Foi avaliada a influência de diferentes condições de operação sobre o rendimento e eficiência do processo. Foram utilizados como materiais de encapsulação: masterdry, maltodextrina, e goma arábica. O perfil dos ácidos graxos foi comparado antes e depois de microencapsulação, o tamanho e a morfologia das microcápsulas foi também estudada. Determinou-se que, no processo de microencapsulação a temperatura de entrada era a única variável estatisticamente significativa usando masterdry e goma-arábica. A goma-arábica mostrou ser o melhor encapsulante entre os três estudados. Foram obtidas microcápsulas com tamanhos entre 8,2 e 14 -im, superfície contínua sobre as paredes e ausência de poros. Verificou-se que a microencapsulação permitiu que os três encapsulantes protegessem o óleo e retivessem majoritariamente o seu perfil de ácidos graxos.

Detecting Ni(II) in aqueous solution by 3-(2-pyridyl)-[1,2,3]triazolo[1,5-a]pyridine and dimethyl-ß-cyclodextrin.

A new supramolecular sensitizer for nickel(II) ion in aqueous solution based on a pyridyltriazolopyridine-cyclodextrin inclusion complex is proposed. The inclusion complexation behavior, characterization and binding ability of pyridyltriazolopyridine (PTP) with dimethyl-ß-cyclodextrin (DMßCD) has been investigated both in solution and solid state by means of absorption, fluorescence, (1)H NMR, DSC, and molecular modeling methods. The stoichiometry of the inclusion complex is 1:1, and the thermodynamic studies indicate that the inclusion of PTP is mainly an entropic driven process. The 2D NMR studies revealed that the pyridyl-triazolopyridine is included by both sides of cyclodextrin which are in good agreement with the docking results. The fluorescence changes upon addition of divalent cations to the inclusion complex indicate a high selectivity and sensitivity for Ni(2+) by fluorescence quenching in neutral aqueous solution.