COVID-19-Induced Myopathy and Diaphragmatic Weakness: A Case Report.

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that can induce myopathy, which can evolve into potentially life-threatening muscle weakness, including diaphragmatic paralysis. We present a case report of a 57-year-old female treated in the medical ICU for acute respiratory distress syndrome (ARDS) triggered by active COVID-19 infection, who subsequently developed worsening respiratory weakness from underlying COVID-19 myopathy manifesting as respiratory muscle weakness. Our patient's muscle biopsy highlights the development of muscle atrophy without evidence of inflammatory myopathy, making the presence of pre-existing autoimmune myopathy unlikely. While literature cites different biochemical etiologies for the development of myopathy, the exact mechanism behind this phenomenon is not yet defined.

Clindamycin Efficacy in Patients With Methicillin-Sensitive Staphylococcus aureus in a Fourth-Level Hospital in the City of Medellín.

BACKGROUND:  The antibiotic of choice for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is antistaphylococcal penicillins, such as oxacillin, but cefazolin has also risen as an equally effective alternative. Murine models have suggested that clindamycin is a therapeutic alternative for Staphylococcus aureus bacteremia (SAB). METHODS:  In this retrospective cohort study, patients from the Hospital Universitario San Vicente Fundación (HUSVF) in Medellín, Colombia, were recruited from January 2013 and December 2019. Patients with positive blood culture for MSSA, with at least one follow-up blood culture, and those with more than 72 hours of parenteral antibiotic therapy for SAB were selected. The main objective was to determine the efficacy of clindamycin compared to other antibiotics to achieve a microbiologic cure. Secondary results included in-hospital mortality and hospital stay. RESULTS:  A total of 486 patients were included (clindamycin = 50 and other anti-MSSA = 436). The patients in the clindamycin group had a lower rate of microbiological cure (n = 41 [84%]) compared to other antibiotics (n = 367 [84%]) (OR 1.08 IC 95% 0.74-1.58). In secondary outcomes, no statistically significant differences were observed in the in-hospital mortality. The main source of SAB was a central or peripheral catheter (58%). CONCLUSIONS:  Our study found no differences in the rate of microbiological cure, in-hospital mortality, and hospital stay on the clindamycin group compared to other anti-MSSA antibiotics. However, in patients with metastatic complications, the rate of microbiological cure is reduced, and the in-hospital mortality is higher in patients with more severe disease.

Ensayo controlado aleatorizado de un programa multicomponente para cuidadores informales de pacientes con Alzheimer / Randomized controlled trial of a multicomponent program for informal caregivers of Alzheimer's patients / Ensaio controlado randomizado de um programa multicomponente para cuidadores informais de pacientes com Alzheimer

Resumen Objetivo Evaluar la eficacia del programa multicomponente más respiro en la sobrecarga y el apoyo social de cuidadores informales de pacientes con Trastorno Neurocognitivo Mayor tipo Alzheimer. Materiales y Método Ensayo controlado aleatorizado en paralelo en 58 cuidadores aleatorizados a uno de los tres grupos de comparación: Grupo de intervención multicomponente más respiro (n=19), grupo de sólo respiro (n=19) y grupo control (n=20), se evaluaron la sobrecarga y el apoyo social mediante las escalas de Zarit y Medical Outcomes Study, en línea de base, post intervención a 5 meses y un seguimiento a 10 meses. La evaluación del efecto se realizó mediante un modelo de efectos mixtos de covarianza no estructurada. Resultados Los cuidadores fueron en su mayoría los hijos de los pacientes (72%), mujeres (76%) con una edad media de 55.1(12) años y con educación inferior a secundaria (58%). Se encontró una reducción significativa de la sobrecarga de 13.1 (IC95% -19.3:6.9) puntos en el grupo multicomponente más respiro, con un sostenimiento del efecto a 10 meses (p<0.001). Se encontró un incremento, aunque no significativa del apoyo social post intervención de 10.8 (-1,7; 23,4) para el grupo multicomponente y respiro, sin embargo, el efecto se incrementó en el tiempo logrando un aumento a 13,2 puntos (p=0.039) a los 10 meses de seguimiento. No se observó un efecto significativo en la sobrecarga ni apoyo social para el grupo que solo recibió respiro. Conclusiones El programa multicomponente más respiro mostró tener un efecto benéfico en la sobrecarga y apoyo social de cuidadores de Alzheimer.

Abstract Objective To evaluate the efficiency of a multicomponent plus respite care program on care burden and social support for informal caregivers of patients with major neurocognitive disorders associated with Alzheimer's disease. Materials and Methods A parallel randomized controlled trial was conducted with 58 caregivers who were randomly allocated to one of the following three comparison groups: a multicomponent plus respite care group (n=19), a respite care group (n=19), and a control group (n=20). Burden and social support were assessed by using the Zarit Scale and Medical Outcomes Study at baseline with a post-intervention at 5 months and follow-up at 10 months. The assessment of effects was measured by using a mixed-effects model with an unstructured covariance matrix. Results Caregivers were mostly patients' children (72%), female (76%) having a mean age of 55.1 years (12) and less than secondary education (58%). A significant reduction of 13.1% (95%CI -19.3:6.9) in caregiver burden was found in the multicomponent plus respite care group, showing a sustained effect at 10 months (p<0.001). A non-significant increase of 10.8% (-1.7;23.4) in post-intervention social support was found in the multicomponent plus respite care group. However, the effects increased over time achieving an increase at 13.2% (p=0.039) at the 10-month follow-up. No significant effects on caregiver burden or social support were reported for the respite care group. Conclusions The multicomponent plus respite care group demonstrated beneficial effects on care burden and social support for Alzheimer's caregivers.

Resumo Objetivo Avaliar a eficácia do programa multicomponente mais alívio na sobrecarga e suporte social de cuidadores informais de pacientes com Transtorno Neurocognitivo Maior do tipo Alzheimer. Método Ensaio controlado randomizado em paralelo em 58 cuidadores randomizados para um dos três grupos de comparação: Grupo de intervenção multicomponente mais alívio (n=19), grupo apenas alívio (n=19) e grupo de controle (n=20), foram avaliados a sobrecarga e suporte social usando as escalas de Zarit e Medical Outcomes Study, linha de base, pós-intervenção em 5 meses e um acompanhamento de 10 meses. A avaliação do efeito foi realizada usando um modelo de efeitos mistos de covariância não estruturada. Resultados Os cuidadores eram, em sua maioria, filhos dos pacientes (72%), mulheres (76%) com uma de idade de média de 55,1 (12) anos e com escolaridade inferior ao ensino médio (58%). Foi encontrada uma redução significativa na sobrecarga de 13,1 (IC95% -19,3:6,9) pontos no grupo multicomponente mais alívio, com uma sustentação de efeito em 10 meses (p<0,001). Foi encontrado um aumento, embora não significativo, no suporte social pós-intervenção de 10,8 (-1,7; 23,4) para o grupo multicomponente e alívio, no entanto, o efeito aumentou ao longo do tempo, alcançando um aumento para 13,2 pontos (p=0,039) aos 10 meses de acompanhamento. Nenhum efeito significativo na sobrecarga ou suporte social foi observado para o grupo que apenas recebeu alívio. Conclusões O programa de multicomponente mais alívio mostrou ter um efeito benéfico na sobrecarga e no suporte social dos cuidadores de Alzheimer.

Ensayo controlado aleatorizado de un programa multicomponente para cuidadores informales de pacientes con Alzheimer / Randomized controlled trial of a multicomponent program for informal caregivers of Alzheimer's patients

Objetivo: Evaluar la eficacia del programa multicomponente más respiro en la sobrecarga y el apoyo social de cuidadores informales de pacientes con Trastorno Neurocognitivo Mayor tipo Alzheimer. Materiales y Método: Ensayo controlado aleatorizado en paralelo en 58 cuidadores aleatorizados a uno de los tres grupos de comparación: Grupo de intervención multicomponente más respiro (n=19), grupo de sólo respiro (n=19) y grupo control (n=20), se evaluaron la sobrecarga y el apoyo social mediante las escalas de Zarit y Medical Outcomes Study, en línea de base, post intervención a 5 meses y un seguimiento a 10 meses. La evaluación del efecto se realizó mediante un modelo de efectos mixtos de covarianza no estructurada. Resultados: Los cuidadores fueron en su mayoría los hijos de los pacientes (72%), mujeres (76%) con una edad media de 55.1(12) años y con educación inferior a secundaria (58%). Se encontró una reducción significativa de la sobrecarga de 13.1 (IC95% -19.3:6.9) puntos en el grupo multicomponente más respiro, con un sostenimiento del efecto a 10 meses (p<0.001). Se encontró un incremento, aunque no significativa del apoyo social post intervención de 10.8 (-1.7; 23.4) para el grupo multicomponente y respiro, sin embargo, el efecto se incrementó en el tiempo logrando un aumento a 13.2 puntos (p=0.039) a los 10 meses de seguimiento. No se observó un efecto significativo en la sobrecarga ni apoyo social para el grupo que solo recibió respiro. Conclusiones: El programa multicomponente más respiro mostró tener un efecto benéfico en la sobrecarga y apoyo social de cuidadores de Alzheimer.

Objective: To evaluate the efficiency of a multicomponent plus respite care program on care burden and social support for informal caregivers of patients with major neurocognitive disorders associated with Alzheimer's disease. Materials and Methods: A parallel randomized controlled trial was conducted with 58 caregivers who were randomly allocated to one of the following three comparison groups: a multicomponent plus respite care group (n=19), a respite care group (n=19), and a control group (n=20). Burden and social support were assessed by using the Zarit Scale and Medical Outcomes Study at baseline with a post-intervention at 5 months and follow-up at 10 months. The assessment of effects was measured by using a mixed-effects model with an unstructured covariance matrix. Results: Caregivers were mostly patients' children (72%), female (76%) having a mean age of 55.1 years (12) and less than secondary education (58%). A significant reduction of 13.1% (95%CI -19.3:6.9) in caregiver burden was found in the multicomponent plus respite care group, showing a sustained effect at 10 months (p<0.001). A non-significant increase of 10.8% (-1.7;23.4) in post-intervention social support was found in the multicomponent plus respite care group. However, the effects increased over time achieving an increase at 13.2% (p=0.039) at the 10-month follow-up. No significant effects on caregiver burden or social support were reported for the respite care group. Conclusions: The multicomponent plus respite care group demonstrated beneficial effects on care burden and social support for Alzheimer's caregivers.

Objetivo: Avaliar a eficácia do programa multicomponente mais alívio na sobrecarga e suporte social de cuidadores informais de pacientes com Transtorno Neurocognitivo Maior do tipo Alzheimer. Método: Ensaio controlado randomizado em paralelo em 58 cuidadores randomizados para um dos três grupos de comparação: Grupo de intervenção multicomponente mais alívio (n=19), grupo apenas alívio (n=19) e grupo de controle (n=20), foram avaliados a sobrecarga e suporte social usando as escalas de Zarit e Medical Outcomes Study, linha de base, pós-intervenção em 5 meses e um acompanhamento de 10 meses. A avaliação do efeito foi realizada usando um modelo de efeitos mistos de covariância não estruturada. Resultados: Os cuidadores eram, em sua maioria, filhos dos pacientes (72%), mulheres (76%) com uma de idade de média de 55.1 (12) anos e com escolaridade inferior ao ensino médio (58%). Foi encontrada uma redução significativa na sobrecarga de 13.1 (IC95% -19.3:6.9) pontos no grupo multicomponente mais alívio, com uma sustentação de efeito em 10 meses (p<0,001). Foi encontrado um aumento, embora não significativo, no suporte social pós-intervenção de 10,8 (-1.7; 23.4) para o grupo multicomponente e alívio, no entanto, o efeito aumentou ao longo do tempo, alcançando um aumento para 13,2 pontos (p=0.039) aos 10 meses de acompanhamento. Nenhum efeito significativo na sobrecarga ou suporte social foi observado para o grupo que apenas recebeu alívio. Conclusões: O programa de multicomponente mais alívio mostrou ter um efeito benéfico na sobrecarga e no suporte social dos cuidadores de Alzheimer.

Calidad de vida en cuidadores informales de pacientes con Alzheimer tras implementación de programa multicomponente / Quality of life in informal caregivers of Alzheimer's patients after implementation of a multi-component program

INTRODUCCIÓN: el cuidado de un paciente dependiente tiene mayores implicaciones si el diagnóstico es la enfermedad de Alzheimer, su calidad de vida se ve afectada de manera considerable en los aspectos relacionados con la salud. OBJETIVO: evaluar el efecto de una intervención multicomponente y transdisciplinar en la calidad de vida relacionada con la salud en cuidadores informales de pacientes con Trastorno Neurocognitivo Mayor (TNC) tipo Alzheimer. MÉTODOS: participaron 50 cuidadores informales de pacientes con Alzheimer, empleando el cuestionario SF-36, mediante un ensayo aleatorizado con tres grupos de comparación y con evaluación de la calidad al inicio, y a los 5 y 10 meses. Para encontrar el tamaño del efecto de las intervenciones en la calidad de vida, según los grupos estudiados, se usó un modelo de efectos mixtos con covarianza no estructurada. RESULTADOS: se encontró que quienes recibieron la intervención multicomponente más respiro obtuvieron un mejoramiento de la calidad de vida en todas las dimensiones y componentes excepto en la función física, con efectos sostenidos en seguimiento. CONCLUSIÓN: las intervenciones no farmacológicas multicomponente acompañadas de un relevo del cuidado tienen un efecto positivo en la percepción de calidad de vida en cuidadores.

INTRODUCTION: The care of a dependent patient has greater implication if the diagnostic is the disease of Alzheimer's, their quality of life is affected considerably in the aspects related to health. OBJECTIVE: to evaluate the effect of a multicomponent and transdisciplinary intervention on health-related quality of life in informal caregivers of patients with Alzheimer-type Major Neurocognitive Disorder (TNC). METHODS: 50 informal caregivers of Alzheimer's patients participated, using the SF-36 questionnaire, through a randomized trial with three comparison groups and quality assessment at baseline, and at 5 and 10 months. To find the effect size of the quality of life interventions, according to the groups studied, a mixed effects model with unstructured covariance was used. RESULTS: it was found that those who received the multicomponent intervention plus respite obtained an improvement in the quality of life in all dimensions and components except physical function, with sustained effects in follow-up. CONCLUSION: multicomponent non-pharmacological interventions accompanied by a change of care have a positive effect on the perception of quality of life in caregivers.

Combining Lean and Applied Research methods to improve rigor and efficiency in acute care outcomes research: A case study.

Hospital care is the single, largest contributor to health spending, yet evidence to guide value transformation is lacking. The large, real-world studies required to fill this void are challenging to conduct in the complex and fast-paced acute care environment. To address these challenges, we created a framework that combines Lean manufacturing methodology and Applied Research principles. We deployed this framework to design, pilot, and iteratively improve a study protocol testing the effectiveness of an innovative care pathway for patients hospitalized with acute exacerbations of Chronic Obstructive Pulmonary Disease. Over a three month period, the protocol was successfully piloted and refined at a single site, subsequently becoming the basis for a large system-wide randomized controlled trial. This framework combining Lean and Applied Research methods resulted in synergies that neither method could accomplish alone and may serve as a template for learning healthcare systems to efficiently generate real-world evidence in the acute care setting.

Chemical and histological comparisons between Brevoortia sp. (menhaden) collected in fall 2010 from Barataria Bay, LA and Delaware Bay, NJ following the DeepWater Horizon (DWH) oil spill.

Body burdens of PAHs were compared to histological effects in menhaden (Family: Clupeidae, Genus: Brevoortia) collected in fall 2010 from Barataria Bay, LA (BBLA) and Delaware Bay, NJ (DBNJ). Barataria Bay was heavily oiled during the DeepWater Horizon (DWH) oil spill, while Delaware Bay although urbanized had no reported recent oil spills. GCMS analyses of pre-spill 2009, BBLA and DBNJ fish found predominantly C2/C3 phenanthrene (1.28-6.52 ng/mg). However, BBLA also contained five higher molecular weight PAHs (0.06-0.34 ng/mg DW). Fluorescent aromatic compound spectroscopy (FACS) of gastrointestinal (GI) tract tissue showed statistically higher levels of hydroxypyrene-like PAHs in DBNJ than BBLA fish. Histopathologic lesions were more prevalent in BBLA than DBNJ fish. The lesion prevalence (gill, trunk kidney, epidermis, stomach) in the BBLA menhaden were significantly higher and more severe than observed in the DBNJ menhaden. Reversible lesions included gill lamellar hyperplasia, adhesions, edema, and epidermal hyperplasia. The increased pigmented macrophage centers were indicative of activated macrophages responding to connective tissue damage or other antigens. The liver hepatic necrosis and renal tissue mineralization may well have undergone repair, but damage to the kidney nephrons and hepatic/biliary regions of the liver would be slower to resolve and apparently remained after elimination of PAHs. Therefore, a direct cause and effect between DWH oil spill and increased lesion prevalence in BBLA menhaden could not be established.

Detection of polycyclic aromatic hydrocarbons (PAHs) in raw menhaden fish oil using fluorescence spectroscopy: Method development.

Raw menhaden fish oil was developed for biomonitoring polycyclic aromatic hydrocarbons (PAHs) using fluorescence spectroscopy. Menhaden (Genus Brevoortia) were collected in 2010 and/or 2011 from Delaware Bay, New Jersey, USA; James River, Virginia, USA; Vermillion Bay, Louisiana, USA (VBLA); and Barataria Bay, Louisiana, USA (BBLA). Barataria Bay, Louisiana received heavy oiling from the Deepwater Horizon oil spill. Method development included determining optimal wavelengths for PAH detection, fish oil matrix interferences, and influence of solvent concentration on extraction. Results showed that some fish oils contained high molecular weight PAH-like compounds in addition to other fluorescent compounds such as albumin and vitamin A and vitamin E. None of these naturally occurring compounds interfered with detection of high molecular weight PAHs. However, data suggested that the lipid component of fish oil was altering fluorescence spectra by supporting the formation of PAH excimers. For example, the most intense excitation wavelength for hydroxypyrene shifted from Ex285/Em430 to Ex340/Em430. Comparison of Deepwater Horizon crude oil and fish oil spectra indicated that some fish oils contained crude oil-like PAHs. Using wavelengths of Ex360/Em430, fish oil concentrations were calculated as 3.92 µg/g, 0.61 µg/g, and 0.14 µg/g for a Delaware Bay sample, BBLA 2011, and VBLA 2011, respectively. Overall, these results supported using menhaden fish oil to track PAH exposures spatially and temporally.

Presencia de depresión asociada al consumo de sustancias psicoactivas en adolescentes entre trece y diecisiete años en tres Instituciones Educativas de la ciudad de Chiclayo / Presence of depression associated to consumed of psychoactive substance among teenagers between thirteen and seventeen years in 3 Educative Institutions of the city of Chiclayo

Determinar la asociación entre la depresión y el consumo de sustancias psicoactivas en adolescentes. El estudio: Descriptivo, Transversal. Lugar: Chiclayo, Perú 2010. Muestra: trescientos setenta adolescentes, de ellos 110 mujeres y 260 varones. Intervenciones: Se encuestó a adolescentes, usando test auto aplicado de Zung y ENA. Para el análisis se utilizaron los programas: EPIDAT y SPSS. Hallazgos: El 99,73% de nuestra población presenta depresión. Manifestándose depresión leve en un 30,27 %, depresión modera 65,95 % y depresión grave 3,51%. Dentro del principal motivo para iniciar el consumo de drogas ilícitas es la curiosidad y del consumo de drogas lícitas es el placer. La principal droga consumida por adolescentes es el alcohol arrojando un porcentaje de 69,19%, el tabaco con un 33,24% y drogas ilícitas con un 8%. Conclusiones: No se encontró asociación entre los niveles de depresión y el consumo de sustancias psicoactivas. La principal droga consumida por adolescentes es el alcohol. El 8% de nuestra población está en riesgo de consumir drogas.(AU)

Objective: Establish the situation between the depression and the psychoactive substances consume as well known as drugs. The study: Transverse. City/Place: Chiclayo, Peru. 2010 Sample: Three hundred seventy teenagers, 110 female and 260 male. Interventions: We make a poll for the teenagers using the applied auto test from Zung and Zena. For the analysis we used programs: EPIDAT and SPSS. Findings: The 99.73% of our sample presents depression. Showing low grade of depression in a 30.27 %, mid grade of depression in a 65.95 % and high grade of depression in a 3.51%.The most common reason for consuming drugs is the pleasure and the curiosity of the nowaday's teenagers. The principal drug taken by teenagers is the alcohol with a 69.19%, the tobacco with a 33.24% and other kinds of illegal drugs with an 8%. Conclusions: We couldn't get an association between the depression levels and the psychoactive substances consuming. The most consumed drug for the teenagers is the alcohol. The 8% of our simple is in a consuming drug risk.(AU)