Effect of the modified snorkel mask as noninvasive ventilatory support in patients with acute hypoxemic respiratory failure due to COVID-19.

Background: The shortage of mechanical ventilators during the COVID-19 pandemic led doctors to use alternative noninvasive ventilation systems, including a modified snorkel mask. Data on the use of the modified snorkel mask is limited. Purpose: The study aims to describe the effect and clinical characteristics of patients with COVID-19 treated with a snorkel mask and to investigate the factors associated with the failure to use noninvasive ventilation with a snorkel mask. Methods: In this retrospective observational study, adult patients with COVID-19 who were treated with a snorkel mask at Daniel Alcides Carrion Hospital of Huancayo-Perú were selected. Results: Of the 390 patients included, 158 (20.5%) received noninvasive ventilation with a snorkel, 84 (53.2%) patients were discharged alive without intubation, and the mortality rate was 22%. In the control group that received standard treatment, 129 patients (55.6%) failed (i.e., deceased or admitted to a mechanical ventilator). The mortality rate was 33.2%. ROX index < 4.8, consolidation-type tomographic pattern, and the presence of complications, such as bacterial pneumonia or thromboembolism, were independently associated with a higher risk of noninvasive ventilation failure with snorkels. Conclusions: Using the snorkel system resulted in an absolute mortality reduction of 11%, and recovery increased by 15% compared to the standard treatment system. Therefore, this device can be used as an acceptable alternative in the absence of mechanical ventilators.

Flora microbiana en el conducto auditivo externo en estudiantes de medicina de la Universidad de San Martín de Porres, en la ciudad de Lima - Perú, durante el período de agosto a octubre 2012 / Microbial flora in the ear canal in medical students at the University of San Martin de Porres in Lima - Peru, during the period from August to October 2012

Objetivo: Identificar a los microorganismos que conforman la flora normal del conducto auditivo externo. Material y Métodos: se analizaron 100 muestras tomadas del conducto auditivo externo de estudiantes de primer, segundo y tercer año de la Facultad de Medicina Humana de la Universidad de San Martín de Porres. Resultados: en el 97 % de las muestras obtenidas del conducto auditivo externo se observó crecimiento bacteriano, en el 92,8 % de las muestras se aisló una bacteria y en 7,2 % se aislaron dos bacterias. En 49 muestras se aisló Staphylococcus aureus, en 48 muestras Staphylococcus epidermidis, en cuatro muestras Klebsiella y en tres muestras Escherichia coli. Conclusiones: en las muestras obtenidas del conducto auditivo externo la bacteria Gram positiva más frecuente fue Staphylococcus aureus y la bacteria Gram negativa más frecuente fue Klebsiella.

Objective: to identify the organisms that conform the normal flora of the external auditory canal. Material and Methods: We have analyzed 100 samples of the ear canal of students from first, second and third year of the Faculty of Human Medicine at the University of San Martin de Porres. Results: In 97% of samples taken from the external auditory canal, bacterial growth was observed; in 92,8% of the samples a bacterium was isolated and in 7,2% two bacteria were isolated. In 49 samples Staphylococcus aureus was isolated; in 48 samples, Staphylococcus epidermidis; in four samples, Klebsiella and three samples, Escherichia coli. Conclusions: in the samples obtained from the external auditory canal the most common Gram-positive bacterium was Staphylococcus aureus and Gram negative bacteria was Klebsiella.

Molecular characterisation of Mycobacterium tuberculosis isolates in the First National Survey of Anti-tuberculosis Drug Resistance from Venezuela.

BACKGROUND: Molecular typing of Mycobacterium tuberculosis strains has become a valuable tool in the epidemiology of tuberculosis (TB) by allowing detection of outbreaks, tracking of epidemics, identification of genotypes and transmission events among patients who would have remained undetected by conventional contact investigation. This is the first genetic biodiversity study of M. tuberculosis in Venezuela. Thus, we investigated the genetic patterns of strains isolated in the first survey of anti-tuberculosis drug-resistance realised as part of the Global Project of Anti-tuberculosis Drug Resistance Surveillance (WHO/IUATLD). RESULTS: Clinical isolates (670/873) were genotyped by spoligotyping. The results were compared with the international spoligotyping database (SpolDB4). Multidrug resistant (MDR) strains (14/18) were also analysed by IS6110-RFLP assays, and resistance to isoniazid and rifampicin was characterised. Spoligotyping grouped 82% (548/670) of the strains into 59 clusters. Twenty new spoligotypes (SITs) specific to Venezuela were identified. Eight new inter-regional clusters were created. The Beijing genotype was not found. The genetic network shows that the Latin American and Mediterranean family constitutes the backbone of the genetic TB population-structure in Venezuela, responsible of >60% of total TB cases studied. MDR was 0.5% in never treated patients and 13.5% in previously treated patients. Mutations in rpoB gene and katG genes were detected in 64% and 43% of the MDR strains, respectively. Two clusters were found to be identical by the four different analysis methods, presumably representing cases of recent transmission of MDR tuberculosis. CONCLUSION: This study gives a first overview of the M. tuberculosis strains circulating in Venezuela during the first survey of anti-tuberculosis drug-resistance. It may aid in the creation of a national database that will be a valuable support for further studies.