Factors associated with extubation failure in an intensive care unit: a case-control study / Fatores associados à falha de extubação em unidade de terapia intensiva: estudo de caso-controle / Factores asociados al fracaso de la extubación en unidad de cuidados intensivos: estudio de caso y control

Abstract Objective: to investigate the factors associated with extubation failure of patients in the intensive care unit. Method: unpaired, longitudinal, retrospective and quantitative case-control with the participation of 480 patients through clinical parameters for ventilator weaning. Data were analyzed by: Fisher's exact test or the chi-square test; unpaired two-tailed Student's t test; and Mann-Whitney test. Significant P values lower than or equal to 0.05 were admitted. Results: of the patients, 415 (86.5%) were successful and 65 (13.5%) failed. Success group: the most negative fluid balance, APACHE II in 20 (14-25), weak cough in 58 (13.9%). Failure group: the most positive fluid balance, APACHE II in 23 (19-29), weak cough in 31 (47.7%), abundant amount of pulmonary secretions in 47.7%. Conclusion: positive fluid balance and the presence of inefficient cough or inability to clear the airway were predictors of extubation failure.

Resumo Objetivo: investigar os fatores associados à falha de extubação de pacientes na unidade de terapia intensiva. Método: caso-controle não pareado, longitudinal, retrospectivo e quantitativo com a participação de 480 pacientes por meio de parâmetros clínicos para desmame ventilatório. Dados analisados por: Teste Exato de Fisher ou o teste Qui-quadrado; teste t de Student bicaudal não pareado; e teste de Mann-Whitney. Admitiram-se significantes valores de P menores ou iguais a 0,05. Resultados: dos pacientes, 415 (86,5%) tiveram sucesso e 65 (13,5%) falharam. Grupo sucesso: balanço hídrico mais negativo, APACHE II em 20 (14-25), tosse fraca em 58 (13,9%). Grupo falha: balanço hídrico mais positivo, APACHE II em 23 (19-29), tosse fraca em 31 (47,7 %), quantidade abundante de secreção pulmonar em 47,7 %. Conclusão: o balanço hídrico positivo e a presença de tosse ineficiente ou incapacidade de higienizar a via aérea foram preditores de falhas de extubação.

Resumen Objetivo: investigar los factores asociados al fracaso de la extubación de pacientes en la unidad de cuidados intensivos. Método: caso y control no apareado, longitudinal, retrospectivo y cuantitativo con la participación de 480 pacientes mediante parámetros clínicos para el destete de la ventilación. Datos analizados por: Prueba Exacta de Fisher o prueba de Chi-cuadrado; prueba t de Student de dos colas para datos no apareados; y prueba de Mann-Whitney. Se admitieron valores de P significativos menores o iguales a 0,05. Resultados: de los pacientes, 415 (86,5%) tuvieron éxito y 65 (13,5%) fracasaron. Grupo de éxito: balance hídrico más negativo, APACHE II en 20 (14-25), tos débil en 58 (13,9%). Grupo de fracaso: balance de líquidos más positivo, APACHE II en 23 (19-29), tos débil en 31 (47,7%), abundante cantidad de secreciones pulmonares en 47,7%. Conclusión: el balance hídrico positivo y la presencia de tos ineficaz o incapacidad para higienizar la vía aérea fueron predictores de fracaso de la extubación.

Prevalence and factors associated with bacterial vaginosis in women in Brazil: a systematic review / Prevalência e fatores associados à vaginose bacteriana em mulheres no Brasil: uma revisão sistemática

Introduction: Bacterial vaginosis is characterized by the imbalance of the vaginal flora, with decrease in Lactobacillus and increase in other bacteria. Objective: To investigate the prevalence and factors associated with bacterial vaginosis. Methods: Systematic review based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, filed in the International Prospective Register of Systematic Reviews. The research was conducted in the PubMed and Scopus databases in September 2021. After reading the titles and abstracts of 84 articles and the full text of 20 articles, 10 of them were included in the review. The articles were considered eligible if they investigated the prevalence of bacterial vaginosis and used Amsel's diagnostic criteria or Gram-stained bacterioscopy in women of reproductive age without comorbidities. The studies were evaluated by two investigators to establish reliability. The risk of bias and the quality of the selected studies were evaluated using the Joanna Briggs Institute tool. Results: The mean prevalence of bacterial vaginosis in the included studies was 25.4% (95%CI 24.0­26.8). In three population-based studies, the mean prevalence was 18.1% (95%CI 16.0­20.5); and in seven clinic-based studies, it was 27.2% (95%CI 24.6­29.9). The factors associated with bacterial vaginosis were the use of sex accessories (OR 2.4; 95%CI 1.1­4.9), marital status "single" (OR 1.4; 95%CI 1.1­1.8), partner infidelity (OR 1.5; 95%CI 1.2­1.9), abnormal vaginal secretion (OR 1.5; 95%CI 1.2­2.0), and the presence of trichomoniasis (OR 4.1; 95%CI 1.5­11.5). Conclusion: The prevalence of bacterial vaginosis was high, and the associated factors are linked to sexual behavior.

Introdução: A vaginose bacteriana caracteriza-se pelo desequilíbrio da flora vaginal, com diminuição dos Lactobacillus e aumento de outras bactérias. Objetivo: Investigar a prevalência e os fatores associados à vaginose bacteriana. Métodos: Revisão sistemática baseada nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses, protocolado no International Prospective Register of Systematic Reviews. A pesquisa foi realizada nas bases de dados da PubMed e da Scopus, em setembro de 2021. Após a leitura dos títulos e dos resumos de 84 artigos e do texto completo de 20 artigos, dez foram incluídos na revisão. Os trabalhos foram considerados elegíveis quando investigaram a prevalência de vaginose bacteriana e utilizaram os critérios diagnósticos de Amsel ou a bacterioscopia corada pelo Gram em mulheres em idade reprodutiva e sem comorbidades. Os estudos foram avaliados por duas pesquisadoras para estabelecer a confiabilidade. O risco de viés e a qualidade das pesquisas selecionadas foram avaliados pela ferramenta do Joanna Briggs Institute. Resultados: A prevalência média de vaginose bacteriana nos trabalhos incluídos foi de 25,4% (intervalo de confiança ­ IC95% 24,0­26,8). Em três estudos de base populacional, a prevalência média foi de 18,1% (IC95% 16,0­20,5); e, em sete estudos de base clínica, a prevalência média foi de 27,2% (IC95% 24,6­29,9). Os fatores associados à vaginose bacteriana foram o uso de acessórios sexuais (odds ratio ­OR 2,4; IC95% 1,1­4,9), estado civil "solteira" (OR 1,4; IC95% 1,1­1,8), infidelidade do parceiro (OR 1,5; IC95% 1,2­1,9), secreção vaginal anormal (OR 1,5; IC95% 1,2­2,0) e presença de tricomoníase (OR 4,1; IC95% 1,5­11,5). Conclusão: A prevalência de vaginose bacteriana foi elevada e os fatores associados estão ligados ao comportamento sexual.

Perforación cecal por angiostrongiliasis en un adulto mayor / Cecal perforation due to angiostrongyliasis in an elderly patient

La angiostrongiliasis abdominal es una enfermedad parasitaria causada por el género Angiostrongylus costaricensis, un nematodo que infecta a los humanos a través de las secreciones de caracoles o babosas, sus huéspedes definitivos. Costa Rica es el país que se considera más endémico, se ha evidenciado en distintas revisiones que la mayoría de los casos se presentan en niños y personas del sexo masculino. Presentación del caso. Se trata de una mujer de 74 años, que consultó por dolor abdominal agudo, de cuatro días de evolución, acompañado de náuseas, vómitos e hiporexia. Los exámenes de laboratorio reportaron leucocitosis leve y examen general de orina negativo. La ultrasonografía abdominal reportó una masa sólida, heterogénea, mal circunscrita en flanco derecho, esto llevó a la sospecha de una apendicitis aguda. Intervención terapéutica. Se realizó una laparotomía exploradora, con la extirpación de una tumoración de colon perforado que abarcaba desde el ciego hasta el tercio proximal de colon ascendente, además, se realizó una anastomosis de íleo transversa, sin mayor complicación. Evolución clínica. Se manejó con antibióticos y analgésicos, fue dada de alta a los nueve días posteriores al procedimiento, sin complicaciones menores. La biopsia reportó huevos de parásitos consistentes con Angiostrongylus sp

bdominal angiostrongyliasis is a parasitic disease caused by the genus Angiostrongylus costaricensis, a nematode that infects humans through the secretions of snails or slugs, its definitive hosts. Costa Rica is considered the most endemic country, and it has been shown in different reviews that most cases occur in children and males. Case presentation. The patient was a 74-year-old woman who consulted for acute abdominal pain, with four days of evolution, accompanied by nausea, vomiting, and hyporexia. Laboratory tests reported mild leukocytosis and a negative general urine test. Abdominal ultrasonography reported a solid heterogeneous mass, poorly circumscribed in the right lateral abdomen, which led to the suspicion of acute appendicitis. Treatment. An exploratory laparotomy was performed, with the removal of a perforated colon tumor that spanned from the cecum to the proximal third of the ascending colon, in addition, a transverse ileum anastomosis was performed, without further complication. Outcome. She was managed with antibiotics and analgesics and was discharged nine days after the procedure, without complications. The biopsy showed parasite eggs consistent with Angiostrongylus sp

Aspectos epidemiológicos de las infecciones de transmisión sexual en mujeres de la provincia de Santiago de Cuba / Epidemiologic aspects of sexually transmitted infections in women from the province of Santiago de Cuba

Introducción: Las infecciones de transmisión sexual constituyen un relevante problema de salud a nivel mundial; particularmente afectan la salud sexual de las mujeres ocasionando dolencias y efectos muy negativos, como la infertilidad, los embarazos ectópicos y el cáncer cervicouterino. Objetivo: Describir las características epidemiológicas de las infecciones de transmisión sexual relevantes en mujeres de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo en la provincia de Santiago de Cuba de la población femenina que presentó infecciones de transmisión sexual durante el período 2007-2017, detallando cada afección según año, municipio, edad, entre otras variables de interés. Asimismo, se analizaron la frecuencia, las tasas de incidencia, las tendencias y las variaciones temporales. Resultados: Las entidades clínicas predominantes fueron el síndrome de dolor pélvico y la secreción vaginal, en tanto, las menos frecuentes resultaron ser el herpes genital y la blenorragia. En el análisis por cada tipo de infección se observó una mayor afectación en féminas de edades jóvenes. Conclusiones: Las infecciones de transmisión sexual constituyen un serio problema de salud en mujeres de la provincia de Santiago de Cuba, que deviene causa importante de embarazos ectópicos y esterilidad. Sin embargo, se debe mejorar la vigilancia epidemiológica de estas enfermedades, pues existe un marcado subregistro de algunas y, por ende, una inadecuada atención, sobre todo en el sexo femenino.

Introduction: Sexually transmitted infections constitute an outstanding health problem worldwide; they particularly affect the sexual health of women causing ailments and very negative effects as infertility, ectopic pregnancies and cervical uterine cancer. Objective: To describe the epidemiologic characteristics of the outstanding sexually transmitted infections in women from Santiago de Cuba. Methods: A descriptive and retrospective study was carried out in the province of Santiago de Cuba in the female population that presented sexually transmitted infections during 2007-2017, with details of each affection according to year, municipality, age, among other variables of interest. Also, frequency, rates of incidence, tendencies and temporary variations were analyzed. Results: The predominant clinical entities were the pelvic pain syndrome and vaginal secretion, as long as, the less frequent were genital herpes and blennorrhagia. In the analysis for each type of infection a higher affectation was observed in young females. Conclusions: Sexually transmitted infections constitute a serious health problem in women from the province of Santiago de Cuba that becomes important cause of ectopic pregnancies and sterility. However, the epidemiologic surveillance of these diseases should be improved, because there is a marked subrecord of some of them and, therefore, an inadequate care, mainly in the female sex.

Screening complications in the postoperative period of orthopedic surgeries by video arthroscopy

To analyze the prevalence and characteristics of late postoperative complications of orthopedic surgeries by video arthroscopy.This was a descriptive cross-sectional study that evaluated, through its own instrument, local and systemic postoperative complications of patients undergoing orthopedic surgeries by video arthroscopy. The study included 270 patients, who were evaluated on days 30(without prosthesis) and 90(with prosthesis placement) of the postoperative period, by telephone service. The selection of participants occurred sequentially and population-based, within the data collection period, from February to July 2020, in a large hospital for medium and high complexity surgeries. Of the 270 procedures performed in the period, 4.4% (n = 12) presented late postoperative infection. The most frequent complications were erythema (83%), edema (75%) and secretion (67%) in the surgical wound. Most used antibiotic therapy (92%) and anti-inflammatory drugs (67%). Hospital readmission was not necessary concerning the complications. Only 50% required medical evaluation before the scheduled time.The need for practices that ensure the quality of perioperative care and improve the active search to assess surgical outcomes is reinforced.

Establishment and comparison of two methods to produce a rat model of mammary gland hyperplasia with hyperprolactinemia

Abstract This study aimed to establish and compare models of mammary gland hyperplasia (MGH) with hyperprolactinemia (HPRL) using two different methods. The models provide information on the relationship between mammary gland hyperplasia and associated hormones. Model A was constructed using intramuscular injections of estradiol benzoate injection (EBI), followed by progesterone (P), and then metoclopramide dihydrochloride (MDI). Model B was designed by administering MDI, follow by EBI, and then P intramuscularly. Model B showed higher MGH progression compared with model A. Notably, increase in estradiol (E2) was negatively correlated with prolactin (PRL) secretion. However, PRL levels in model B were significantly higher compared with the levels in model A. Estrogen (ER), prolactin receptor (PRLR), and progesterone receptor (PR) mRNA and protein expression levels in model B rats were positively correlated with changes in the corresponding hormone levels. However, E2, P, and PRL levels in model A showed no direct relationship with levels of the mRNAs of related hormones and protein expression levels. Our results suggest that model B is an appropriate model of MGH with HPRL that can be used to perform further studies about the interactions of the E2, P, and PRL hormones in this disorder.

Atividade antimicrobiana in vitro de extratos metanólicos de secreções cutâneas de anfíbios amazônicos sobre fitopatógenos de interesse agrícola / n vitro antimicrobial activity of methanolic extracts from cutaneous secretions of Amazonian amphibians against phytopathogens of agricultural interest

Os mecanismos de defesa bioquímica dos anfíbios envolvem secreções cutâneas de moléculas bioativas com atividade antimicrobiana. Este estudo avaliou a atividade in vitro de extratos metanólicos da secreção cutânea de duas espécies de anfíbios da família Bufonidae, Rhaebo guttatus e Rhinella marina, no controle dos patógenos Fusarium udum, Fusarium solani, Colletotrichum truncatum, Aspergillus flavus, Rhizoctonia solani, Macrophomina phaseolina e Calonectria pseudometrosideri. O extrato de R. guttatus inibiu o crescimento micelial de F. udum, F. solani, A. flavus e M. phaseolina em algumas concentrações testadas. O extrato de R. marina inibiu o crescimento micelial de C. truncatum na concentração de 0,5 mg mL- ¹, e inibiu o crescimento micelial de A. flavus nas concentrações de 0,1 e 0,5 mg mL- ¹, que foi semelhante à inibição pelo controle positivo. O extrato de R. marina também diminuiu a produção de microescleródios de R. solani nas concentrações de 0,2 e 0,3 mg mL- ¹. Além disso, os extratos inibiram a esporulação e germinação de conídios em graus variados. A inibição da formação de apressórios em C. truncatum pelos extratos de R. guttatus e R. marina foi de 85%­99% e 63%­100%, respectivamente. Nossos resultados demonstraram que o tratamento com extratos da secreção cutânea de R. guttatus e R. marina apresentou atividade antifúngica sobre os fitopatógenos estudados.(AU)

Infección por COVID-19 y accidente cerebrovascular / COVID-19 Infection and Stroke

La actual pandemia de COVID-19 causada por el virus SARS-CoV-2, se caracteriza por una alta morbilidad y mortalidad. Algunos estudios han reportado que la frecuencia de ictus en pacientes infectados con el virus oscila entre un 5-20 por ciento. A pesar de estas cifras alarmantes, las vías por las cuales el virus llega al sistema nervioso central y los mecanismos fisiopatológicos por los que puede ocurrir un ictus en estos pacientes no han sido totalmente esclarecidos. Numerosos estudios han demostrado que la infección por SARS-CoV-2 está asociada a un estado protrombótico, capaz de causar un tromboembolismo arterial y venoso. Además, se ha reportado una respuesta inflamatoria exacerbada, con reclutamiento de células sanguíneas y una secreción desproporcionada de citoquinas proinflamatorias. También la hipoxia y fenómenos cardioembólicos han sido propuestos como posibles mecanismos. Es esencial definir con exactitud los mecanismos fisiopatológicos que vincula la infección por SARS-CoV-2 con la ocurrencia del ictus, con la finalidad de aplicar tratamientos más específicos y evitar futuras complicaciones(AU)

The actual Coronavirus Disease 2019 (COVID-19) infection is an ongoing pandemic, characterized by high morbidity and mortality produced by SARS-CoV-2 virus. Studies reported a stroke frequency around 5-20 percent in infected patients; however, SNC invasion and pathophysiological mechanisms related to stroke in COVID-19 patients are still unknown. Several studies have demonstrated that SARS-CoV-2 infection is linked to a prothrombotic state causing venous and arterial thromboembolism. Also, an overstated inflammatory response with recruitment of blood cells and disproportioned secretion of proinflammatory cytokines has been reported. Finally, cardioembolism and hypoxia have been proposed as surrogate mechanisms. It is essential to define the pathophysiological mechanisms of stroke during the infection in order to apply more specific treatments to avoid further stroke complications(AU)

Quantity - but not diversity - of secreted peptides and proteins increases with age in the tree frog Pithecopus nordestinus

Amphibians inhabit the terrestrial environment, a conquest achieved after several evolutionary steps, which were still insufficient to make them completely independent of the aquatic environment. These processes gave rise to many morphological and physiological changes, making their skin (and cutaneous secretion) rich in bioactive molecules. Among the tree frogs, the secretion is composed mainly of peptides; but alkaloids, proteins and steroids can also be found depending on the species. The most known class of biologically active molecules is the antimicrobial peptides (AMPs) that act against bacteria, fungi and protozoans. Although these molecules are well-studied among the hylids, AMPs ontogeny remains unknown. Therefore, we performed peptidomic and proteomic analyses of Pithecopus nordestinus (formerly Phyllomedusa nordestina) in order to evaluate the peptide content in post-metamorphosed juveniles and adult individuals. Methods: Cutaneous secretion of both life stages of individuals was obtained and analyzed by LC-MS/MS after reduction and alkylation of disulfide bonds or reduction, alkylation and hydrolysis by trypsin. Results: Differences in the TIC profile of juveniles and adults in both treatments were observed. Moreover, the proteomic data revealed known proteins and peptides, with slight differences in the composition, according to the life stage and the treatment. AMPs were identified, and bradykinin-potentiating peptides were observed in trypsin-treated samples, which suggests a protein source of such peptide (cryptide). Conclusion: In general, skin secretion contents were similar between juveniles and adults, varying in quantity, indicating that the different stages of life are reflected in the number of molecules and not on their diversity.(AU)

COVID-19 y fertilidad masculina / COVID-19 and male fertility

Introducción: Hasta el momento se han encontrado 27 virus que pueden provocar viremia en el semen humano. Para muchos de estos, faltan datos sobre la transmisión sexual y su repercusión sobre la fertilidad masculina; lo cual resalta las lagunas de conocimiento sobre la persistencia de los virus en los fluidos genitales, especialmente el semen. Objetivo: Realizar una revisión bibliográfica sobre la potencialidad del nuevo coronavirus de persistir en el semen, afectar las células reproductoras masculinas y por ende su fertilidad. Métodos: Se realizó una búsqueda bibliográfica en la base de datos PubMed utilizando los siguientes términos: virus and fertility; coronavirus and semen; coronavirus and testi y coronavirus and angiotensin. Se consultaron un total de 30 artículos originales, de los cuales 24 eran de los últimos 5 años. Conclusiones: La presencia de virus en el semen puede ser más común de lo que se entiende actualmente como potencialidad de daño reproductivo, y no se debe suponer que los virus tradicionales de transmisión no sexual están totalmente ausentes en las secreciones genitales. Los estudios sobre detección viral y persistencia del semen son beneficiosos para la práctica clínica y la salud pública, además de la trascendencia de dichos estudios en el desarrollo fetal, como es el SARS-CoV-2(AU)

Introduction: Twenty-seven viruses have so far been found which may cause viremia in human semen. In many of them, more data are required about sexual transmission and its impact on male fertility, pointing to knowledge gaps about the persistence of the virus in genital fluids, particularly in semen. Objective: Carry out a bibliographic review about the potential of the novel coronavirus to persist in semen, affecting male reproductive cells and hence their fertility. Methods: A bibliographic search was conducted in the database PubMed using the search terms virus and fertility", coronavirus and semen, coronavirus and testis and "coronavirus and angiotensin". A total 30 original papers were consulted, of which 24 were from the last five years. Conclusions: Emergence of the novel coronavirus poses the question of its existence in semen and its capacity to affect reproduction. Presence of the virus in semen may be more common than what is currently understood as reproductive damage potential, and it should not be supposed that traditional non-sexually transmitted viruses are totally absent from genital secretions. Studies about virus detection and semen persistence are useful to medical practice and public health, as well as in relation to their impact on fetal development, as is the case with SARS-CoV-2(AU)

Utilidad de los criterios de Murray para el procesamiento de esputo en pacientes con fibrosis quística. Laboratorio de Infectados de la Universidad de Antioquia (Medellín/Colombia) / Utility of the Murray criteria for sputum processing in patients with cystic fibrosis. Laboratory of Infected of the University of Antioquia (Medellín/Colombia)

Resumen Introducción: la fibrosis quística (FQ) es una enfermedad autosómica recesiva que aumenta la viscosidad de las secreciones, en especial las del árbol respiratorio; genera inflamación crónica y colonización/infección por microorganismos, conduciendo a deterioro de la función pulmonar y muerte. Nuestro estudio evaluó la calidad del esputo de pacientes con FQ que ingresaron al Laboratorio de Infectados de la UdeA con base a los criterios de Murray. Metodología: estudio descriptivo con información retrospectiva, incluyendo todos los esputos de pacientes con FQ, recolectados entre enero de 2015 a diciembre de 2018. Resultados: se analizaron 686 muestras de 85 pacientes, de las cuáles se obtuvo cultivo positivo en 501 (73 %) y el 21 % no cumplían los criterios de calidad según Murray. De 908 aislamientos identificados, 823 (90.6 %) corresponden a microorganismos considerados como patógenos en la vía aérea de los pacientes con FQ donde se incluyen S aureus, Pseudomonas spp, H influenzae, Burkhordelia spp, A. xylosoxidans, S maltophilia, A fumigatus, entre otras. Conclusiones: los criterios de Murray no se deben utilizar para definir el procesamiento o no del esputo en pacientes con FQ.

Abstract Introduction: Cystic fibrosis (CF) is an autosomal recessive disease that affects the production and viscosity of secretions, especially the origin of the respiratory airways; generating chronic inflammation and colonization / infection by microorganisms, leading to functional deterioration and death. Our study evaluated the quality of sputum samples from patients with CF who enter the Infected Laboratory of the UDEA based on the Murray criteria. Methodology: A descriptive study with retrospective information was carried out. All sputum from patients with CF were included, collected between January 2015 and December 2018 in the Infected Laboratory of the University of Antioquia. Results: We analyzed 686 samples from 85 patients with CF, positive culture was obtained in 501 (73 %), considering that 21 % of the respiratory samples did not meet the quality criteria according to Murray criteria. Of 908 isolates identified, 823 (90.6 %) correspond to microorganisms considered as pathogens in the airway of CF patients including S aureus, Pseudomonas spp, H influenzae, Burkhordelia spp, A. xylosoxidans, S maltophilia, A fumigatus, among others. Conclusions: The Murray criteria should not be used to define the processing or not of the sputum in patients with CF, all should be processed.

Factores predisponentes que conllevan a los pacientes a una neumonía asociada ventilación mecánica de la unidad de cuidados intensivos del hospital Teodoro Maldonado Carbo. Periodo 2018 ­ 2019 / Predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado carbo hospital's intensive care unit. period 2018 ­ 2019

Hay varios factores de riesgo que pueden conllevar a una neumonía asociada a ventilación mecánica, tanto intrínseco como extrínseco, y el porcentaje de la neumonía asociada a ventilación mecánica va en aumento, por lo que el personal médico tiene una dura lucha para tratar de disminuir esta problemática. Objetivo: Determinar los factores predisponentes que conllevan a los pacientes a una neumonía asociada a la ventilación mecánica en la Unidad de Cuidados Intensivos del Hospital Teodoro Maldonado Carbo durante el periodo 2018 ­ 2019. Materiales y Métodos: paradigma positivista, enfoque cuantitativo; de modalidad de campo, no experimental. De tipo descriptivo y transversal. La población fue 285 pacientes y la muestra de 60, seleccionado de manera probabilística y sistemático. La técnica fue la encuesta y el instrumento el cuestionario con 15 ítems, revisados y validados por juicios de expertos en el tema, que dieron una confiabilidad de 95%. Resultados: Se evidenció que los factores predominantes, que aumentan los riesgos de padecer una NAVM son elementos de tipo Extrínseco, entre ellos los más comunes son: intubación prolongada, re intubaciones, aspiraciones de secreciones y el traslado del paciente. Mientras que los del factor intrínseco son: desnutrición, edad y etnia. Conclusión: se evidenció la importancia de un diagnóstico oportuno y seguir las normas de bioseguridad establecidas antes, durante y después del proceso de entubación como mecanismo de disminución de probabilidad de que el paciente desarrolle un NAVM(au)

There are several risk factors can lead to pneumonia associated with mechanical ventilation both, intrinsic and extrinsic, and the percentage of pneumonia associated with mechanical ventilation is increasing, which is why medical personnel have a tough fight to try to reduce this problem. Objective: To determine the predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado Carbo Hospital's Intensive Care Unit during the period 2018 - 2019. Materials and Methods: positivist paradigm, quantitative approach; field modality, not experimental. Descriptive and transversal. The population was 285 patients and the sample of 60, selected in a probabilistic and systematic way. The technique was the survey and the instrument was the questionnaire with 15 items, reviewed and validated by expert judgments on the subject, which gave a reliability of 95%. Results: It was evident that the predominant factors that increase the risks of suffering from AVM are extrinsic elements, among them the most common are prolonged intubation, re-intubations, aspiration of secretions and the transfer of the patient. While those of the intrinsic factor are malnutrition, age and ethnicity. Conclusion: the importance of a timely diagnosis and following the biosafety standards established before, during and after the intubation process was evidenced as a mechanism to decrease the probability that the patient develops a VAP(AU)

Pandemia por el SARS-CoV-2: aspectos biológicos, epidemiológicos y clínicos / SARS-CoV-2 Pandemic. Biological, epidemiological, clinical aspects

El objetivo principal de este trabajo es describir los principales aspectos biológicos, epidemiológicos y clínicos,con especial énfasis en la fisiopatología, ocasionado por el SARS-CoV-2.El Coronavirus 2 del Síndrome Agudo Respiratorio Severo,es un orthocoronavirinae, del grupoI V, pertenecientes al género betacoronavirus,que causa la actual enfermedad pandémica definida por la Organización Mundial de la Salud (OMS)(2020), como COVID-19.Esta es considerada por los expertos mundiales como una infección viral emergente. Su origenes veterinario y su transmisión zoonótica, a partir de virus que tienen como reservorios a murciélagos y como hospedador intermediario al pangolín, desde el cual se infiere que pudo adaptarse al ser humano, para transmitirse de persona a persona,mediante gotitas respiratorias y secreciones nasales contaminadas con partículas altamente infecciosas. No se descarta la transmisión fecal-oral. La enfermedad posee un periodo de incubación de 2 a 14 días (promedio:5,2 días) y hasta ahora las medidas de prevención y control más eficientes son la cuarentena social obligatoria, el uso de tapabocas, lavado de manos con agua y jabón por al menos 20 segundos,o con productos en gel con alcohol al 70%, mantener una distancia mínima entre las personas de 2 metros. Lo aprendido de los otros dos betacoronavirus humanos relacionados, causantes de las epidemias previas: SARS-CoVen 2002-2003 y el MERSen 2012 ,permiten encarar de mejor forma la actual pandemia(AU)

The main objective of this work is to describe the main biological, epidemiological and clinical aspects, with special emphasis on pathophysiology, caused by SARS-CoV-2. Coronavirus 2 of Severe Acute Respiratory Syndrome is a member of group IV orthocoronavirinae, belonging to the betacoronavirus genus, which causes the current pandemic disease defined by the World Health Organization as COVID-19. This is considered by world experts as an emerging viral infection. Its origin is veterinary and its zoonotic transmission, from viruses that have bats as reservoirs to pangolin an as an intermediate host, from which it is inferred that it could have adapted to the human being, transmitted from person to person by means of respiratory droplets, and highly infectious contaminated nasal secretions Fecal-oral transmission is not ruled out. The disease has an incubation period of 2 to 14 days (5.2 days in mean), and until now the most efficient prevention and control measures are the obligatory social quarantine, the use of face masks, hand washing with soap and water for at least 20 seconds, or with products in gel with 70 alcohol, keeping a minimum distance between people of 2 meters. What has been learned from the other two related human betacoronaviruses that caused the previous epidemics: SARS-CoV in 2002-2003 and MERS in 2012, allow us to better face the current pandemic(AU)

Nota Técnica nº 008/2020 - SAMU/DAPM/SUE/SES ASSUNTO: Realização de aspiração de secreções de vias aéreas através de sistema fechado de aspiração traqueal e utilização de filtro hepa durante pandemia do novo Coronavírus / Technical Note No. 008/2020 - SAMU / DAPM / SUE / SES SUBJECT: Performing aspiration of airway secretions through a closed tracheal aspiration system and using a hepa filter during a new Coronavirus pandemic

Apresenta recomendações da ANVISA, para manipulação de vias aéreas de pacientes sob intubação oro traqueal e ventilação mecânica, disponibiliza para as Unidades de Suporte Avançado de Vida ­ USA do SAMU.

Aislamientos de Acinetobacter spp. en infecciones asociadas a la asistencia sanitaria / Isolation of Acinetobacter spp. in infections associated with health care

Introducción: El Acinetobacter spp. se ha convertido en un germen de gran relevancia clínica, resulta un verdadero paradigma de las infecciones nosocomiales multirresistentes. Objetivo: Caracterizar los aislamientos microbiológicos de Acinetobacter spp. en infecciones asociadas a la asistencia sanitaria. Métodos: Estudio descriptivo que incluyó 280 aislamientos de Acinetobacter spp. de las muestras provenientes de pacientes hospitalizados, en el periodo de tres años (del 2016 al 2018) en el Hospital Comandante "Manuel Fajardo Rivero". Las variables del estudio fueron: salas de procedencia del aislamiento, tipo de muestra, factor predictivo, diagnóstico infectológico, susceptibilidad antimicrobiana in vitro y multidrogorresistencia, Resultados: El mayor número de aislamientos de Acinetobacter spp. se obtuvo en la unidad de cuidados intensivos (78,9 por ciento), las secreciones respiratorias fueron las muestras con más aislamientos (58,9 por ciento), la ventilación mecánica resultó el factor predictivo más frecuente (67,9 por ciento) y como diagnóstico infectológico, la neumonía asociada al ventilador (66,8 por ciento). Se encontró un porcentaje elevado de cepas con multidrogorresistencia (73,6 por ciento). Conclusiones: El Acinetobacter spp. se encuentra vinculado a las infecciones asociadas a los servicios de salud, fundamentalmente en los cuidados intensivos. Los antimicrobianos probados evidenciaron altos porcentajes de resistencia, con predominio de las cepas multidrogorresistentes(AU)

Introduction: Acinetobacter spp. has become a germ of great clinical relevance, it is a true paradigm of multiresistant nosocomial infections. Objective: To characterize the microbiological isolates of Acinetobacter spp. in infections associated with health care. Methods: Descriptive study that included 280 isolates of Acinetobacter spp. from the samples of hospitalized patients, in the period of three years (from 2016 to 2018) in the Hospital Comandante "Manuel Fajardo Rivero". The variables of the study were: wards of origin of the isolation, type of sample, predictive factor, infectious diagnosis, antimicrobial susceptibility in vitro and multidrug resistance. Results: The highest number of isolates of Acinetobacter spp. was obtained in the intensive care unit (78.9 percent), the respiratory secretions were the samples with the most isolations (58.9 percent), mechanical ventilation was the most frequent predictor (67.9 percent) and as an infectious diagnosis, ventilator-associated pneumonia (66.8 percent). A high percentage of strains with multidrug resistance (73.6 percent) was found. Conclusions: Acinetobacter spp. is linked to infections associated with health services, mainly in intensive care. The antimicrobials tested showed high percentages of resistance, with a predominance of multidrug resistant strains(AU)

Kinesiología respiratoria en niños con disquinesia ciliar primaria / Respiratory phisioterapy in children with primary ciliary dyskinesia

Primary ciliary dyskinesia is a rare autosomal recessive disease with compromised mucociliary drainage. Among the most commonly recommended non-pharmacological therapeutic strategies are secretion drainage techniques. However, the evidence for the use and effectiveness of these techniques is low, and they are generally based on extrapolated evidence of cystic fibrosis. This article reviews the recommendations and available evidence of chest physiotherapy, mainly manual and instrumental techniques of bronchial drainage and physical exercise in children with primary ciliary dyskinesia.

La disquinesia ciliar primaria es una enfermedad autosómica recesiva rara con compromiso del drenaje mucociliar. Entre las estrategias terapéuticas no farmacológicas más comúnmente recomendadas se encuentra las técnicas de drenaje de secreciones. Sin embargo, la evidencia del uso y efectividad de estas técnicas es reducida y generalmente se basan en evidencia extrapolada de la fibrosis quística. Este artículo revisa las recomendaciones y la evidencia disponible de la kinesiología respiratoria, principalmente las técnicas manuales e instrumentales de drenaje bronquial y el ejercicio físico en niños con disquinesia ciliar primaria.

Antibacterial activity of the skin secretion of Phyllomedusa azurea (Anura: Hylidae) from the Central Brazil Cerrado / Actividad antibacterial de secreciones de la piel de Phyllomedusa azurea (Anura: Hylidae) en Cerrado, Brasil centro

Abstract Phyllomedusa azurea is a frog species well distributed geographically in South America, including Brazilian biomes as Pantanal and Cerrado. Compared with other anurans from the Phyllomedusinae family, there are few reports on the bioactive potential of skin-derived molecules from this species. In this perspective, the aim of the present study was to evaluate the in vitro antibacterial activity of skin secretion of P. azurea by detection of Minimum Inhibitory Concentration (MIC) of the growth of bacterial indicator strains and to determine if occurs a changing in the bacterial cell envelope permeability. The MIC determination was carried out by the microdilution plate method. The absorbance was measured and analyzed statistically using the t-test to compare two groups (0.05 % of significance). The impact of the crude extract on cell envelope permeability of Staphylococcus aureus ATCC 25923 was conducted by the crystal violet assay, and the absorbance was measured spectrophotometry followed by the calculation of the crystal violet uptake percentage. The specific MIC for S. aureus ATCC 25923 and Escherichia coli ATCC 25922 was 31.25 µg/mL, while for Bacillus subtilis ATCC 6633 was 125 µg/mL and Pseudomonas aeruginosa ATCC 27853 was 250 µg/mL. The treatment with crescent concentrations of frog skin secretion increased the crystal violet uptake by S. aureus ATCC 25923 cells, suggesting an action on the cell plasma membrane. The results demonstrated that the skin secretion of P. azurea presents antibacterial activity and merit further investigations to characterize the bioactive molecules.(AU)

Resumen P. azurea es una especie de rana bien distribuida geográficamente en América del Sur, que incluye biomas brasileños como Pantanal y Cerrado. En comparación con otros anuros de Phyllomedusinae, existen pocos informes sobre el potencial bioactivo de las moléculas derivadas de la piel de esta especie. En esta perspectiva, el objetivo del presente estudio fue evaluar la actividad antibacteriana in vitro de la secreción de la piel de P. azurea mediante la detección de la Concentración Inhibitoria Mínima (CIM) del crecimiento de cepas indicadoras bacterianas y determinar si ocurre un cambio en la permeabilidad de la envoltura celular bacteriana. La determinación de MIC se llevó a cabo mediante el método de la placa de microdilución. La absorbancia se midió y se analizó estadísticamente mediante la prueba t para comparar dos grupos (0.05 de significancia). El impacto del extracto crudo sobre la permeabilidad de la envoltura celular de Staphylococcus aureus ATCC 25923 se realizó mediante el ensayo de cristal violeta, y se midió la absorbancia mediante espectrofotometría seguida del cálculo del porcentaje de absorción de violeta cristal. La CIM específica para S. aureus ATCC 25923 y Escherichia coli ATCC 25922 fue 31.25 μg / ml, mientras que para Bacillus subtilis ATCC 6633 de 125 μg / ml y Pseudomonas aeruginosa ATCC 27853 de 250 μg / ml. El tratamiento con concentraciones crecientes de secreción de piel de rana aumentó la absorción de violeta cristal por las células de S. aureus ATCC 25923, sugiriendo una acción sobre la membrana plasmática de la célula. Los resultados demostraron que la secreción de la piel de P. azurea presenta actividad antibacteriana y amerita más investigaciones para caracterizar las moléculas bioactivas.(AU)

Effects of manual chest compression on expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure maneuver in patients on mechanical ventilation / Efeitos da compressão torácica manual sobre o flow bias expiratório durante a manobra positive end-expiratory pressure-zero end-expiratory pressure em pacientes sob ventilação mecânica invasiva

ABSTRACT Objective: To investigate the effects of manual chest compression (MCC) on the expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) airway clearance maneuver applied in patients on mechanical ventilation. The flow bias, which influences pulmonary secretion removal, is evaluated by the ratio and difference between the peak expiratory flow (PEF) and the peak inspiratory flow (PIF). Methods: This was a crossover randomized study involving 10 patients. The PEEP-ZEEP maneuver was applied at four time points, one without MCC and the other three with MCC, which were performed by three different respiratory therapists. Respiratory mechanics data were obtained with a specific monitor. Results: The PEEP-ZEEP maneuver without MCC was enough to exceed the threshold that is considered necessary to move secretion toward the glottis (PEF − PIF difference > 33 L/min): a mean PEF − PIF difference of 49.1 ± 9.4 L/min was achieved. The mean PEF/PIF ratio achieved was 3.3 ± 0.7. Using MCC with PEEP-ZEEP increased the mean PEF − PIF difference by 6.7 ± 3.4 L/min. We found a moderate correlation between respiratory therapist hand grip strength and the flow bias generated with MCC. No adverse hemodynamic or respiratory effects were found. Conclusions: The PEEP-ZEEP maneuver, without MCC, resulted in an expiratory flow bias superior to that necessary to facilitate pulmonary secretion removal. Combining MCC with the PEEP-ZEEP maneuver increased the expiratory flow bias, which increases the potential of the maneuver to remove secretions.

RESUMO Objetivo: Avaliar os efeitos da compressão torácica manual (CTM) sobre o flow bias expiratório durante a manobra positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) para a remoção de secreção em pacientes sob ventilação mecânica invasiva. O flow bias, que influencia na remoção de secreção pulmonar, foi avaliado pela razão e diferença entre pico de fluxo expiratório (PFE) e pico de fluxo inspiratório (PFI). Métodos: Estudo cruzado e randomizado no qual participaram 10 pacientes. A manobra PEEP-ZEEP foi aplicada em quatro momentos, sendo um sem CTM e os outros três em associação com a CTM, que foram aplicadas por três fisioterapeutas distintos. Um monitor específico foi utilizado para o registro dos dados de mecânica respiratória. Resultados: A manobra PEEP-ZEEP sem a CTM foi suficiente para ultrapassar o limiar do flow bias expiratório (diferença PFE − PFI > 33 l/min), considerado necessário para deslocar a secreção em direção à glote; a média da diferença PFE − PFI encontrada foi de 49,1 ± 9,4 l/min. A média da razão PFE/PFI alcançada foi de 3,3 ± 0,7. A associação da CTM à PEEP-ZEEP aumentou a média da diferença PFE − PFI em 6,7 ± 3,4 l/min. Foi observada correlação moderada entre a força de preensão manual dos fisioterapeutas e o flow bias gerado durante a CTM. Não foram encontradas alterações hemodinâmicas ou respiratórias adversas ao longo do estudo. Conclusões: A manobra PEEP-ZEEP sem a CTM resultou em um flow bias expiratório superior ao considerado efetivo para auxiliar na remoção de secreção pulmonar. A associação com a CTM aumentou o flow bias expiratório, o que aumenta o potencial da manobra para remover secreções.