Evaluation of intrinsic and extrinsic factors affecting pregnancy rate in dual-purpose cows under tropical conditions.

Embryo transfer (ET) in bovines was created with the purpose of increasing the pregnancy rate (PR) of animals with high genetic value; however, multiple factors have been found to affect the success of this reproductive biotechnology. These factors are frequently grouped in intrinsic and extrinsic factors. Thus, the objective of the present experiments was to assess the effect of intrinsic and extrinsic factors on the pregnancy rate under tropical conditions. To do this a total of 648 embryo transfer (ET) procedures were performed between January and December 2021. The intrinsic factors were size and location of the corpus luteum, body condition, genetic group, age and parity; while extrinsic factors were location of the farm, environmental comfort, season in which the ET was carried out, prevailing weather conditions, and the preservation, quality, and the development stage of embryos at the time of ET. A χi2 was used for analysis of main effects, and logistic regression analysis to calculate the probability of pregnancy and the association between intrinsic or extrinsic factors; additionally, a multivariate analysis of data clusters was used to find a linkage between the effects. While recipient female age had a negative effect (Odds ratio = 0.345-0.871) on PR (p < 0.05), being higher in younger cows, the rest of the intrinsic factors did not affect the PR. The significant (p < 0.05) extrinsic factors were THI category, season of year and type of embryo preservation, showing that the highest PR (p < 0.05) was obtained in the comfort THI category, during the winter season and using fresh embryos for transfer. The clustering analysis did not show any linkage between PR and intrinsic factors, while a linkage (p < 0.05) was found with season of the year and embryo preservation as extrinsic factors. It is concluded that age of the recipient cow and environmental conditions at the time of the embryo transfer are key factors to be considered for a successful pregnancy rate from in-vitro ET programs using dual-purpose cows under tropical conditions.

Retinal Detachment Associated With Giant Retinal Tears: Surgical Management and Outcomes in the Past 2 Decades.

Purpose: To describe the surgical outcomes of rhegmatogenous retinal detachments (RRDs) associated with giant retinal tears (GRTs) and define factors associated with primary anatomic failure. Methods: This retrospective consecutive study comprised primary GRT-RRD surgeries between 1999 and 2021 at a single institution. Exclusion criteria were a follow-up of less than 3 months and incomplete surgical data. Results: The series included 69 eyes (64 patients). Single-surgery anatomic success (SSAS) was achieved in 75% and final anatomic success (FAS) in 90%. The mean logMAR visual acuity improved from 1.5 ± 1.1 to 0.6 ± 0.9. Preoperative factors significantly associated with redetachment were proliferative vitreoretinopathy (PVR) (odds ratio [OR], 6.2; P < .01), hypotony (OR, 13.6; P < .01), and a 180-degree or larger GRT (OR, 3.3; P = .04). All cases were treated with pars plana vitrectomy (PPV) and perfluoro-N-octane (PFCL). Perfluoropropane (C3F8) was used in 59% and silicone oil in 41%; the redetachment rate was significantly lower in gas cases (15% vs 39%) (P = .02). An encircling band, placed in 84% eyes, had a tendency to reduce redetachment (22% vs 36%) (P = .32). Lensectomy was performed in 61% of phakic eyes, with no effect on redetachment (20% vs 21%) (P = .92). On multivariate analysis, PVR and hypotony were significantly associated with redetachment. Conclusions: PPV with PFCL achieved high SSAS and FAS rates. PVR and hypotony were the main preoperative factors associated with anatomic failure. In cases without PVR, C3F8 tamponade significantly increased SSAS. Encircling scleral buckling showed a nonsignificant tendency toward an increase in SSAS. Lensectomy had no effect on SSAS.

Correction: Burgos-Mansilla et al. Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis. J. Clin. Med. 2021, 10, 4696.

In the original publication [...].

Kinematic and Morphometric Assessment of Fresh Semen, before, during and after Mating Period in Brahman Bulls.

The objective of the present study was to determine the effects that the reproductive season has on the motility, kinematics, morphology, and sperm morphometry of Brahman bulls evaluated with a commercial CASA system. The experiment was carried out at the Costa Rica Institute of Technology from March to August 2021. A total of eight Brahman bulls were used. A total of 28 ejaculates were collected in the pre-mating period (PMP), during it (DMP), and after it (AMP) using an electroejaculator. The sperm concentration was measured with the Accuread photometer. The motility was measured using a Spermtrack® counting chamber. The analyses were performed with the CASA-Mot ISAS®v1 system. The morphology was analyzed using a microscope with a negative phase contrast objective. Morphometry was evaluated with the CASA-Morph. The sperm concentration did not present differences between the PMP and AMP; however, it was significantly higher than DMP (p > 0.05). Regarding the progressiveness variables, linearity on forward progression (LIN), straightness (STR), and wobble (WOB) were higher (p < 0.05) DMP. A kinematic principal component analysis grouped all the variables into three factors and an effect on the reproductive period was found (p < 0.05) in the parameters of the head and middle part of the sperm, such as width and perimeter, which were greater in the PMP. The length of the sperm head in the PMP and DMP did not show differences; however, both were larger (p < 0.05) than AMP. The insertion distance of the middle piece of the sperm was significantly greater than DMP. Finally, the PMP contained cells with a larger insertion angle (p < 0.05) than AMP. These findings are important to understand the implications of reproductive status on sperm quality and to consider them in andrological evaluations.

Prevalence and risk factors of coccidiosis in calves from Veracruz, México.

The objectives of the present study were: (1) to determine the prevalence of Eimeria spp. sporulated oocysts in calves from 26 Municipalities in the Central Zone of the State of Veracruz, Mexico, (2) to identify the Eimeria spp. infecting calves, and (3) to identify the risk factors associated with the presence of Eimeria spp. in tropical cattle. A total of 930 individual fecal samples were analyzed by using the McMaster technique; then, oocysts were maintained in 2.5% potassium dichromate to allow sporulation. The general prevalence of calves with Eimeria spp. oocysts was 39.7% (370/930). Of a total of 10 identified species, Eimeria canadensis was the most observed, followed by Eimeria bovis and Eimeria zuernii. The statistical analysis showed an association between the age of the calves (5 to 9 months), the presence of other animals, the physiographic regions and the restricted type of husbandry with the presence of Eimeria spp. in calves (P<0.05). Protective risk factors, such as: routine coprological analysis was also associated with a decrease in infection. These data demonstrate the presence of coccidia in cattle from the State of Veracruz, additionally to the necessary measures that must be taken to control this parasitosis.

Burnout and Self-Perceived Stress in Workers in Essential Services after the Impact of Hurricanes Irma and Maria.

OBJECTIVE: To examine the levels of burnout and self-perceived stress in workers at the Puerto Rico Electric Power Authority, who experienced major disasters: Hurricanes Irma and Maria. METHODS: A quantitative descriptive cross-sectional study with a non-probabilistic convenience sample was conducted in workers at the Puerto Rico Electric Power Authority. A structured questionnaire was administered to a sample of 163 eligible participants, aged 21 years and older, who participated voluntarily. Using employees of the electric company, the study examined the relationships between burnout and several characteristics (years of employment, existing health conditions, and coping strategies) both before and after Hurricanes Irma and Maria. Burnout was assessed with Gil-Monte's Spanish Burnout Inventory, and self-perceived stress was assessed with the 14-item Perceived Stress Scale. RESULTS: Before the hurricanes, 16.6% of the workers reported high levels of burnout syndrome, while, after the hurricanes, the proportion increased to one-fifth (20.9%). Prior to the 2 hurricanes, more than one-fourth (23.4%) of the sample reported being extremely stressed; after the hurricanes, that proportion increased to 55%. Factors such as years of employment, counseling, and self-perceived stress showed significant statistical associations (P < .05) with burnout. CONCLUSION: From a public health standpoint, priority should be given to this population, thereby preventing burnout and any other negative effects of the aftermath (i.e., the lengthy response, recovery, and reconstruction) of these kinds of major disaster.

Prevalence and risk factors of coccidiosis in calves from Veracruz, México / Prevalência e fatores de risco da coccidiose em bezerros em Veracruz, México

The objectives of the present study were: (1) to determine the prevalence of Eimeria spp. sporulated oocysts in calves from 26 Municipalities in the Central Zone of the State of Veracruz, Mexico, (2) to identify the Eimeria spp. infecting calves, and (3) to identify the risk factors associated with the presence of Eimeria spp. in tropical cattle. A total of 930 individual fecal samples were analyzed by using the McMaster technique; then, oocysts were maintained in 2.5% potassium dichromate to allow sporulation. The general prevalence of calves with Eimeria spp. oocysts was 39.7% (370/930). Of a total of 10 identified species, Eimeria canadensis was the most observed, followed by Eimeria bovis and Eimeria zuernii. The statistical analysis showed an association between the age of the calves (5 to 9 months), the presence of other animals, the physiographic regions and the restricted type of husbandry with the presence of Eimeria spp. in calves (P<0.05). Protective risk factors, such as: routine coprological analysis was also associated with a decrease in infection. These data demonstrate the presence of coccidia in cattle from the State of Veracruz, additionally to the necessary measures that must be taken to control this parasitosis.(AU)

Os objetivos do presente estudo foram: (1) determinar a prevalência de oocistos esporulados de Eimeria spp. em bezerros de 26 municípios na zona central do estado de Veracruz, México; (2) identificar as espécies de Eimeria que infectam bezerros; e (3) identificar os factores de risco associados à presença de Eimeria spp. em bovinos de região tropical. Um total de 930 amostras individuais de fezes foi analisado usando-se a técnica McMaster. Depois oocistos foram mantidos em 2,5% de dicromato de potássio para esporulação. A prevalência geral de animais com oocistos de Eimeria spp. foi de 39,7% (370/930). De um total de 10 espécies identificadas, Eimeria canadensis foi a mais observada, seguida de Eimeria bovis e Eimeria zuernii. A análise estatística indicou uma associação entre a idade dos bezerros (5 a 9 meses), a presença de outros animais, as regiões fisiográficas e o tipo restrito de criação com a presença de Eimeria spp. em bezerros (P<0,05). Os fatores de risco protetores, tais como a análise coprológica de rotina, foram também associados a uma diminuição da infecção. Esses dados indicaram a presença de coccídios em bovinos do estado de Veracruz, além das medidas necessárias que devem ser tomadas para controlar essa parasitose.(AU)

Microalgae as biostimulants: a new approach in agriculture.

This review aims to elucidate the state of the art of microalgae-based biostimulants as a tool in agriculture by summarizing the biologically active compounds factors that influence the use of microalgae biostimulants and their application methods in the field. Additionally, we examined the factors that support the use of microalgal biostimulants to face abiotic and biotic stress in crop plants. The use of microalgae in crop production and the benefits of seed preparation, foliar application, soil drenching, and hydroponic treatments were discussed. Furthermore, the use of these biostimulants in crop plants and their multiple benefits such as, better rooting, higher crop, fruit yields, drought and salinity tolerance, photosynthetic activity and pathogen resistance was thoroughly presented. The present situation of microalgal biostimulants and their difficulties in the market was analyzed, as well as the perspectives of their use. However, data shows that microalgal derived biostimulants can be used as an alternative for the protection of crops and plant growth regulators and play a significant key role in increasing the levels of production, yield and health of crops. Special interest needs to focus on investigating more microalgae species and their biological active compound factors, due to the largely untapped field. Perspectives regarding future research lines and development priorities were included.

Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis.

The objective was to describe the effectiveness of different physical therapy modalities to improve Quality of Life (QoL) in Head and Neck Cancer (HNC) survivors. PubMed, Scopus, Web of Science, CINAHL and Cochrane Library were searched for randomized clinical controlled trials published until 30 April 2020. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 251 records were retrieved, and 10 met the inclusion criteria. Interventions whose parameters focus on a 12-week exercise programs of aerobic activity (walking) or Progressive Resistance Training (PRT) for the whole body are effective and safe modalities improving QoL in HNC survivors. Electrophysical agents did not show significant results between groups. As for the assessment of methodological quality, 4 of the 10 articles included had a high risk of overall bias. Only five articles provided sufficient information to conduct a meta-analysis for exercise program intervention on QoL, showing a tendency in favor of intervention group, even when the global results did not show statistically significant improvements (pooled Cohen's d 0.15; 95% CI: -0.25 to 0.54; I2 45.87%; p heterogeneity = 0.10). The present review and meta-analysis identified meaningful benefits of exercise on QoL of HNC survivors; this has been confirmed in a meta-analysis. This review adds evidence supporting exercise interventions on Head and Neck Cancer population whose opportunities for successful recovery after medical treatment are more limited.

Leptin Chronic Effect on Differentiation, Ion Currents and Protein Expression in N1E-115 Neuroblastoma Cells.

<b>Background and Objective:</b> Arcuate nucleus (ARC), a component of appetite-regulatory factors, contains populations of both orexigenic and anorexigenic neurons and one of the fundamental components of its system is leptin. Studies have evidenced the critical neurotrophic role in the development of ARC. To determine such effects on neuron development, N1E-115 neuroblastoma cells were used as an ARC model. <b>Materials and Methods:</b> N1E-115 neuroblastoma cells were treated with leptin [10 nM] for 24, 48 and 72 hrs. Dimethyl sulfoxide (DMSO) 1.5% was used as a known drug that promotes neurite expression. Cells percentage (%) that developed neurites was evaluated by bright field microscopy. Patch-clamp electrophysiology was used to analyze membrane ion currents, RT-PCR for quantifying changes in mRNA expression of anorexic peptides, proopiomelanocortin (POMC) and cocaine and amphetamine-related transcript (CART), in addition to principal Na_v, Ca_v ion channel subunits. <b>Results:</b> N1E-115 cells treated with leptin show neurite expression after 24 hrs of treatment, similar effects were obtained with DMSO. Leptin (time-dependent) increases the inward current in comparison with the control value at 72 hrs. Outward currents were not affected by leptin. Leptin and DMSO increased Na⁺ and Ca²⁺ current without changes in the kinetic properties. Lastly, leptin promotes an increase in mRNA level expression of transcripts to POMC, CART, Na_v1.2 and Ca_v1.3. <b>Conclusion:</b> Leptin chronic treatment promotes neurite expression, Up-regulation of Na⁺ and Ca²⁺ ion channels determining neuronal excitability, besides increasing the mRNA level expression of anorexic peptides POMC and CART in neuroblastoma N1E-115.

Deep Learning for Gravitational-Wave Data Analysis: A Resampling White-Box Approach.

In this work, we apply Convolutional Neural Networks (CNNs) to detect gravitational wave (GW) signals of compact binary coalescences, using single-interferometer data from real LIGO detectors. Here, we adopted a resampling white-box approach to advance towards a statistical understanding of uncertainties intrinsic to CNNs in GW data analysis. We used Morlet wavelets to convert strain time series to time-frequency images. Moreover, we only worked with data of non-Gaussian noise and hardware injections, removing freedom to set signal-to-noise ratio (SNR) values in GW templates by hand, in order to reproduce more realistic experimental conditions. After hyperparameter adjustments, we found that resampling through repeated k-fold cross-validation smooths the stochasticity of mini-batch stochastic gradient descent present in accuracy perturbations by a factor of 3.6. CNNs are quite precise to detect noise, 0.952 for H1 data and 0.932 for L1 data; but, not sensitive enough to recall GW signals, 0.858 for H1 data and 0.768 for L1 data-although recall values are dependent on expected SNR. Our predictions are transparently understood by exploring tthe distribution of probabilistic scores outputted by the softmax layer, and they are strengthened by a receiving operating characteristic analysis and a paired-sample t-test to compare with a random classifier.

Esteroides en extubación: ¿A quién? ¿Cómo? ¿Cuándo? / Steroids post-extubation: Who? How? When? / Esteróides na extubação: quem? Como e quando?

Resumen: El fracaso en la extubación es una complicación de alto riesgo para los pacientes en las Unidades de Cuidados Intensivos. El edema laríngeo y el estridor laríngeo han sido estudiados como causas que propician el fracaso en la extubación. Parte de las estrategias para la prevención del fracaso en la extubación y el manejo del estridor o edema laríngeo es el uso de esteroides. La discrepancia entre el tiempo, la dosis, el paciente candidato y el tipo de esteroide obligan a crear una propuesta que estandarice su utilización. La presente revisión se enfoca en identificar a aquellos pacientes que se benefician del uso de esteroides, el tipo de esteroide que se debe utilizar, el momento y la dosis correcta.

Abstract: Post-extubation failure is a high risk complication for patients in intensive care unit. Laryngeal edema and laryngeal stridor have been studied as causes of post-extubation failure. Part of the strategies for the prevention of post-extubation failure and management of stridor or laryngeal edema is the use of steroids. The discrepancy between the time, the dos, the patient and the type of steroid forces to create a strategy that standardizes its use. This review focuses on identify patients who benefit from the use of steroids, type of steroid that should be uses, timing and correct dose.

Resumo: O fracasso na extubação é uma complicação de alto risco para pacientes em unidades de terapias intensivas. O edema e o estridor laríngeo foram estudados como causas que propician a falha na extubação. Parte das estratégias para prevenção da falha na extubação e manejo do estridor ou edema laríngeo é o uso de esteróides. A discrepância entre o tempo, a dose, o paciente candidato e o tipo de esteróide nos obriga a criar uma proposta padrão de utilização. A presente revisão se concentra em identificar os pacientes que são beneficiados com o uso de esteróides, o tipo de esteróide que deve ser usado, o momento e a dose correta.

A1­A2 Fenestration Tube Technique for Clipping a Ruptured Anterior Communicating Artery Aneurysm

A fenestration tube is a clipping reconstruction technique that allows the preservation of critical vessels in aneurysm surgery. A patient with a ruptured anterior communicating artery (ACoA) aneurysm with a posterior projection was admitted to our neurosurgery unit. A right dominant A1 with rotation of the A2 fork was observed on preoperative computed tomography angiography (CTA). During surgery, we observed that the recurrent artery of Heubner branched off the A2 just distal to the neck of the aneurysm. Successful clipping was achieved by building an "A1­A2 fenestration tube," with preservation of the recurrent artery and of the ACoA perforators. Surgical nuances and the advantages of fenestration tubes are discussed.

Implicaciones legales de la hemotransfusión en terapia intensiva / Legal implications of blood transfusion in Critical Care Unit / Implicações legais da hemotransfusão na unidade de terapia intensiva

Resumen: Antecedentes: Las hemotransfusiones son un procedimiento común en las unidades de cuidados intensivos a nivel mundial. El personal médico implicado en la hemotransfusión habitualmente no está familiarizado con el marco legal de tal disposición. Caso clínico: Paciente femenino de 17 años de edad ingresada en la UCI con politraumatismo, choque hemorrágico severo, traumatismo craneoencefálico severo meritorio de craneotomía descompresiva urgente, hemoneumotórax y lesión esplénica; tales diagnósticos le generan choque hemorrágico con anemia severa por hemoglobina en 5 g/dL. La madre de la paciente, responsable de la misma, prohíbe que se realice transfusión de hemoderivados por ideas religiosas. Los médicos a cargo solicitan apoyo de expertos en el área legal para saber cuál es la mejor conducta a seguir con efecto de anticipar y prevenir los posibles conflictos legales, quienes explican que la vida no es un bien jurídico disponible y, ante condiciones de gravedad, la hemotransfusión debe realizarse. Conclusiones: Es necesario establecer una política legalmente válida sobre los derechos y obligaciones de transfusiones sanguíneas, que deberá ser conocida por todos los trabajadores de la salud en la institución donde se implemente dicha política, así como el derecho de solicitar asesoría legal en cada caso en que se presente en este tipo de conflictos.

Abstract: Background: Hemotransfusions are a common procedure in intensive care units worldwide. The medical personnel involved in hemotransfusion are usually not familiar with the legal framework of such a provision. Clinical case: A 17-year-old female admitted to the ICU with multiple trauma, severe hemorrhagic shock, severe cranioencephalic traumatism, urgent decompressive craniotomy, hemopneumothorax and splenic lesion, such diagnoses generate hemorrhagic shock with severe anemia due to hemoglobin at 5 g/dL. The mother of the patient, responsible for her, prohibits any transfusion of blood products by religious idea. The doctors in charge request expert support in the legal area to know what is the best behavior to follow, with the effect of anticipating and preventing possible legal conflicts, who explain that life is not a legal right available, and in the face of serious conditions, the hemotransfusion must be done. Conclusions: A legally valid policy should be established on the rights and obligations of blood transfusions, which should be known by all health workers in the institution where said policy is implemented and that of requesting legal advice in each case presented in this type of conflicts.

Resumo: Antecedentes: A hemotransfusão é um procedimento comum em unidades de terapia intensiva em todo o mundo. O pessoal médico envolvido na hemotransfusão geralmente não está familiarizado com a estrutura legal de tal disposição. Caso clínico: Paciente do sexo feminino, 17 anos, admitida na UTI com politraumatismo, choque hemorrágico grave, trauma cranioencefálico grave que necessitou craniotomia descompressiva de urgência, hemopneumotórax e lesão esplênica, tais diagnósticos ocasionaram choque hemorrágico com anemia grave devido à hemoglobina de 5 g/dL. A mãe da paciente, responsável pela mesma, proíbe qualquer transfusão de hemoderivados por crença religiosa. Os médicos responsáveis solicitam apoio especializado na área jurídica para saber qual a melhor conduta a seguir, com a intenção de antecipar e prevenir possíveis conflitos legais, que explicam que a vida não é um direito legal disponível, e diante de condições graves, a hemotransfusão deve ser feita. Conclusões: Deve ser estabelecida uma política legalmente válida sobre os direitos e obrigações das hemotransfusões, que deve ser do conhecimento de todos os profissionais de saúde na instituição onde tal política é implementada e da solicitação de assessoria jurídica em cada caso que se apresente esse tipo de conflitos.

Surgery of a Posterior Communicating Artery Aneurysm with Fetal-Type Circulation

Inadvertent occlusion of a fetal-type posterior communicating artery in aneurysm surgery could result in posterior circulation infarction and neurological morbidity. The case of a patient with an unruptured posterior communicating artery aneurysm with lateral projection and a fetal-type posterior communicating artery is presented. The utility of the carotid-oculomotor window as a surgical corridor to safely find the fetaltype posterior communicating artery is discussed.

A oclusão da artéria comunicante posterior do tipo fetal em cirurgia de aneurisma pode resultar em infarto da circulação posterior e morbidade neurológica. Apresentamos o caso de um paciente com aneurisma não roto da artéria comunicante posterior com projeção lateral e uma artéria comunicante posterior do tipo fetal. Discutimos a utilidade da janela carótida-oculomotora como um corredor cirúrgico para encontrar com segurança a artéria comunicante posterior do tipo fetal.

Síndrome de Lynch: Caracterización genético clínica y epidemiología. Caso clínico / Lynch syndrome: clinical genetic characterization and epidemiology. Clinical case

El cáncer colorrectal hereditario no polipósico (CCHNP), también llamado síndrome de Lynch, es la forma más común de cáncer colorrectal (CCR) hereditario (1). Se trata de un síndrome con gran carga genética y penetrancia, que se presenta en etapas tempranas de la vida, en diversos miembros de la familia (2). Es una enfermedad autosómica dominante debido a la presencia de mutaciones en los genes reparadores de bases desapareadas de ADN, principalmente MSH2 y MLH1, que representan un 90% del total, y con menor frecuencia, MSH6 y PMS2(3). El 80% de los cánceres colorrectales son de aparición esporádica, el 10% son familiares y el restante 5-10%, tienen carácter hereditario. Se presenta el caso de un hombre de 35 años, con múltiples recurrencias y al menos dos generaciones afectados. Se discuten los aspectos más importantes sobre el diagnostico, manejo y consejo genético en estos casos

The obesity is characterized by the higher content of Hereditary non-polyposis colorectal cancer (HNPCC), also called Lynch syndrome, is the most common form of hereditary colorectal cancer (CRC) (1). It is a syndrome with a high genetic load and penetrance, which occurs in the early stages of life, in several family members (2). It is an autosomal dominant disease due to the presence of mutations in DNA repair genes, mainly MSH2 and MLH1, which represent 90% of the total, and with less frequency MSH6 and PMS2 (3). The 80% of colorectal cancers are sporadic, 10% are familiar and the 5-10% is hereditary. We present the case of a man of 35 years, with multiple recurrences and at least two generations affected. The most important aspects about the diagnosis, management and genetic counseling in these cases are discussed.

Impacto del seguimiento farmacoterapéutico para identificar los errores de medicación y disminuir eventos adversos en pacientes de terapia intensiva del Hospital H+ Querétaro / Impact of pharmacotherapeutic follow-up to identify the medication errors and decrease adverse events in patients of intensive care at H+ Querétaro Hospital / Impacto do seguimento farmacoterapêutico para identificar erros de medicação e diminuir eventos adversos em pacientes na Terapia Intensiva do Hospital H+ Querétaro

Resumen: Introducción: El error de medicación es toda desviación en el proceso del uso de medicamentos que son administrados al paciente. Los errores de medicación son una causa frecuente de eventos adversos en el paciente. Objetivo: Identificar la relación del seguimiento farmacoterapéutico en la detección de errores de medicación con el incremento del número de intervenciones para la prevención de eventos adversos en pacientes de la unidad de terapia intensiva (UTI). Material y método: Se determinó la tasa de errores de medicación con el fin de obtener el valor basal (periodo 1), posteriormente se evaluó un segundo periodo (periodo 2), en el cual el seguimiento farmacoterapéutico se incrementó con la búsqueda intencionada de los errores de medicación. La identificación, clasificación y registro se llevó a cabo de acuerdo con la taxonomía de NCC MERP con ayuda del seguimiento farmacoterapéutico en cada uno de los pacientes. Resultados: En el periodo 1 se identificó un total de 107 errores de medicación, mismos que representaron una tasa de errores de 514.42 por 1,000 días/paciente, con una tasa de intervenciones de 52.88 por 1,000 días/paciente. En el periodo 2 se observó una tasa de 950.76 por 1,000 días/paciente, con una tasa de intervenciones de 132.58 por 1,000 días/paciente. En ninguno de los dos periodos se identificaron errores que produjeran daño en los pacientes. Conclusiones: La búsqueda intencionada de errores de medicación e intervenciones farmacéuticas favorecen la seguridad del uso de medicamentos, lo que ayuda a prevenir los eventos adversos asociados en pacientes de la unidad de terapia intensiva.

Abstract: Introduction: Medication error is all deviation in the process of using medications that are administered to the patient; the medication errors are a frequent cause of adverse events in the patient. Objective: To identify the relationship of pharmacotherapeutic monitoring in the detection of medication errors with the increase in the number of interventions for the prevention of adverse events in patients of the Intensive Care Unit. Material and method: The medication error rate was determined in order to obtain the baseline value (period 1), then a second period (period 2) was evaluated in which the pharmacotherapeutic follow-up was increased with the intentional search for medication errors. The identification, classification and registration were carried out according to the NCC MERP taxonomy with the help of the pharmacotherapeutic follow-up to each of the patients. Results: In period 1, a total of 107 medication errors were identified, representing an error rate of 514.42 per 1,000 days/patient, with a rate of interventions of 52.88 per 1,000 days/patient. For period 2 a rate of 950.76 per 1,000 days/patient was found, with a rate of interventions of 132.58 per 1,000 days/patient. In either period, an error was identified that caused damage in the patients. Conclusions: The intentional search for medication errors and pharmaceutical interventions favor the safety in the use of the drugs helping to prevent the adverse events associated with its use in patients of the intensive care unit.

Resumo: Introdução: O erro de medicação é qualquer desvio no processo de utilização de medicamentos que são administrados aos pacientes, os erros de medicação são uma causa comum de eventos adversos no paciente. Objetivo: Identificar a relação do seguimento farmacoterapêutico na detecção de erros de medicação com o aumento do número de intervenções para a prevenção de eventos adversos em pacientes na unidade de terapia intensiva. Material e método: Determinou-se a taxa de erros de medicação a fim de obter a linha de base (período 1), avaliou-se posteriormente um segundo período (período 2) em que o acompanhamento farmacoterapêutico aumentou com a busca deliberada de erros de medicação. A identificação, classificação e registo foram realizados de acordo com a taxonomia do NCC MERP com ajuda do seguimento farmacoterapêutico para cada um dos pacientes. Resultados: No período 1, identificamos um total de 107 erros de medicação, o que representou uma taxa de 514.42 erros por 1,000 dias/paciente, com uma taxa intervenção de 52.88 por 1,000 dias/paciente. Para o período 2 foi encontrada 950.76 para 1,000 dias/paciente, com uma taxa de intervenção de 132.58 por 1,000 dias/pacientes. Não identificamos em nenhum dos dois períodos um erro que produzisse danos aos pacientes. Conclusões: A busca intencional por erros de medicação e intervenções farmacêuticas favorecem a segurança no uso de medicamentos, ajudando a prevenir os eventos adversos associados ao seu uso em pacientes na unidade de terapia intensiva.

Application of water quality index to evaluate groundwater quality (temporal and spatial variation) of an intensively exploited aquifer (Puebla valley, Mexico).

The spatial and temporal variation of water quality in the urban area of the Puebla Valley aquifer was evaluated using historical and present data obtained during this investigation. The current study assessed water quality based on the Water Quality Index developed by the Canadian Council of Ministers of the Environment (CCME-WQI), which provides a mathematical framework to evaluate the quality of water in combination with a set of conditions representing quality criteria, or limits. This index is flexible regarding the type and number of variables used by the evaluation given that the variables of interest are selected according to the characteristics and objectives of development, conservation and compliance with regulations. The CCME-WQI was calculated using several variables that assess the main use of the wells in the urban area that is public supply, according to criteria for human use and consumption established by Mexican law and international standards proposed by the World Health Organization. The assessment of the index shows a gradual deterioration in the quality of the aquifer over time, as the amount of wells with excellent quality have decreased and those with lower index values (poor quality) have increased throughout the urban area of the Puebla Valley aquifer. The parameters affecting groundwater quality are: total dissolved solids, sulfate, calcium, magnesium and total hardness.

Influenza A (H1N1pdm09)-Related Critical Illness and Mortality in Mexico and Canada, 2014.

OBJECTIVES: The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. DESIGN: Observational study and a survey of available healthcare setting resources. SETTING: Twenty-one hospitals, 13 in Mexico and eight in Canada. PATIENTS: Critically ill patients with confirmed H1N1pdm09 during 2013-2014 influenza season. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median PaO2-to-FIO2 ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H2O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting PaO2-to-FIO2 ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80-0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10-2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02-27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. CONCLUSIONS: Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.