Clinical outcomes in patients with diabetes and stress hyperglycemia that developed SARS-CoV-2 infection / Desenlaces clínicos de los pacientes con diabetes e hiperglucemia de estrés que presentaron infección por SARS-CoV-2

INTRODUCTION: Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease. OBJECTIVE: To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection. MATERIALS AND METHODS: A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed. RESULTS: A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia). CONCLUSIONS: Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.

Introducción. La diabetes y la hiperglucemia de estrés se han relacionado con peores desenlaces clínicos en pacientes infectados por SARS-CoV-2 y con riesgo de enfermedad grave. Objetivo. Evaluar los resultados clínicos en tres grupos de pacientes (con diabetes, sin diabetes o con hiperglucemia de estrés) con infección por SARS-CoV-2. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de cohorte en Cali (Colombia). Se incluyeron pacientes de 18 años o más, con diagnóstico de infección por SARS-CoV-2 atendidos en urgencias, hospitalización o unidad de cuidados intensivos entre marzo de 2020 y diciembre de 2021. Se excluyeron los pacientes inmunocomprometidos y las mujeres embarazadas. Los pacientes fueron clasificados en tres grupos: sin diabetes, con diabetes y con hiperglucemia de estrés. Se realizó una comparación entre los grupos. Resultados. Se incluyeron 945 pacientes (59,6 % sin diabetes, 27 % con diabetes y 13,4 % con hiperglucemia de estrés). El 55,3 % requirió manejo en la unidad de cuidados intensivos, con mayor necesidad por parte de los pacientes con hiperglucemia de estrés (89,8 %) y diabetes (67,1%), sin diferencia entre estos grupos (p = 0,249). Se observó una mayor probabilidad de muerte en el grupo con hiperglucemia de estrés versus sin diabetes (OR ajustado = 8,12; IC95%: 5,12-12,88; p < 0,01). La frecuencia de síndrome de distrés respiratorio agudo, necesidad de ventilación mecánica invasiva, uso de vasopresores e inotrópicos, necesidad de terapia de reemplazo renal de novo y mortalidad fue mayor en pacientes con alteraciones metabólicas (diabetes e hiperglucemia de estrés). Conclusiones. La diabetes y la hiperglucemia de estrés se asociaron a peores resultados clínicos y mortalidad en pacientes con COVID-19. Estos pacientes deben ser identificados tempranamente y considerados de alto riesgo al momento del diagnóstico de COVID-19 para mitigar los desenlaces adversos.

Structural, Thermal, and Release Properties of Hybrid Materials Based on Layered Zinc Hydroxide and Caffeic Acid.

Caffeic acid (CA) molecules were immobilized in a layered inorganic host matrix based on zinc hydroxide structures with different starting interlayer anions, nitrate, and acetate. The chemical composition, structure, thermal stability, morphology, and surface of the host matrices and hybrid compounds were analyzed by X-ray diffraction (XRD), themogravimetric/differencial thermal analysis (TG/DTA), Fourier transform infrarred spectroscopy (FT-IR), scanning electron microscopy (SEM), and X-ray photoelectron spectroscopy (XPS). Additionally, the surface charge of the materials was investigated using zeta potential at pH ~7. The results show an influence of the surface charge on the chemical, interaction, and structure of the resulting hybrid materials as a function of the starting layered structures. An expansion of the basal spacing to 10.20 Å for zinc hydroxide nitrate (ZHN), and a shrinkage to 10.37 Å for zinc hydroxide acetate (ZHA). These results suggest that the CA lies with a tilt angle in the interlayer region of the inorganic host matrix. The immobilization of CA is favored in ZHN, with respect to ZHA, because a single-layered phase was identified. A higher thermal stability at 65 °C was observed for ZHN-CA than for ZHA-CA. The evaluation of the release behavior showed a higher percentage of CA released from ZHN than ZHA, and the release mechanism was described by the Elovich model. The hybrid materials show potential characteristics for use as bioactive delivery systems.

Structural and Electrical Studies for Birnessite-Type Materials Synthesized by Solid-State Reactions.

The focus of this paper is centered on the thermal reduction of KMnO4 at controlled temperatures of 400 and 800 °C. The materials under study were characterized by atomic absorption spectroscopy, thermogravimetric analysis, average oxidation state of manganese, nitrogen adsorption-desorption, and impedance spectroscopy. The structural formulas, found as a result of these analyses, were K 0.29 + ( M n 0.84 4 + M n 0.16 3 + ) O 2.07 · 0.61 H 2 O and K 0.48 + ( M n 0.64 4 + M n 0.36 3 + ) O 2.06 · 0.50 H 2 O . The N2 adsorption-desorption isotherms show the microporous and mesoporous nature of the structure. Structural analysis showed that synthesis temperature affects the crystal size and symmetry, varying their electrical properties. Impedance spectroscopy (IS) was used to measure the electrical properties of these materials. The measurements attained, as a result of IS, show that these materials have both electronic and ionic conductivity. The conductivity values obtained at 10 Hz were 4.1250 × 10-6 and 1.6870 × 10-4 Ω-1cm-1 for Mn4 at 298 and 423 K respectively. For Mn8, the conductivity values at this frequency were 3.7074 × 10-7 (298) and 3.9866 × 10-5 Ω-1cm-1 (423 K). The electrical behavior was associated with electron hopping at high frequencies, and protonic conduction and ionic movement of the K+ species, in the interlayer region at low frequencies.

Electrical Behavior of a Catalyst Composed of Laminar Manganese Oxide Supported on γ-Al2O3.

The electrical characterization of catalysts composed of layered manganese oxide in the form of birnessite supported on γ-Al2O3, which have been successfully used in the combustion of soot, is presented. The results indicate that the electrical conduction and ion conduction processes are influenced by the amount of the active phase. There was also evidence of Grotthuss-type proton conductivity favored by the presence of surface water on the exposed alumina surface. The above is supported by the porous nature of the catalyst in which the surface area varied between 125.2 ± 1.2 and 159.0 ± 1.1 m2/g, evidencing changes in the alumina surface. The conductivity, determined from measurements of impedance spectroscopy, at low frequency showed changes associated with the amount of the active phase. The values ranged from 2.61 × 10-8 ± 2.1 × 10-9 Ω-1·cm-1 (pure alumina) to 7.33 × 10-8 ± 5.9 × 10-9 Ω-1·cm-1, 7.21 × 10-8 ± 5.8 × 10-9 Ω-1·cm-1 and 4.51 × 10-7 ± 3.6 × 10-8 Ω-1·cm-1 at room temperature for catalysts with nominal active phase contents of 5.0, 10.0 and 20.0%, respectively. Such results indicate that it is possible to modulate the electrical properties with variations in the synthesis parameters.

Structural Analysis and Conduction Mechanisms in Polycrystalline Zinc Hydroxide Nitrate.

The conduction and dielectric properties in zinc hydroxide nitrate (Z5HN) were studied in detail as a function of the temperature and relative humidity by impedance spectroscopy, and the structure was investigated by X-ray diffraction (XRD). Elemental analysis indicated a layered material containing carbonate anions [Zn5(OH)8(NO3)1.6(CO3)0.2·1.7H2O] due to the high capability of adsorption of Z5HN, which makes this material appropriate for applications in real conditions. The water content affected the interlayer distance, conductivity, and dielectric response of the layered material. An electrostatic repulsive interaction after reduction of the water content as a function of the temperature causes an increase of the interlayer distance and a decrease in the conductivity response and dielectric behavior. The highest conductivity, 10-7 Ω-1 cm-1, was obtained at a shorter interlayer distance for the sample heat-treated at 25 °C. The Z5HN synthesized was also characterized at different temperatures using thermogravimetric analysis and Fourier transform infrared and Raman spectroscopy. Multipeak analysis of the XRD patterns at various relative humidity levels showed the formation of a most hydrated phase and an increase of the interlayer distance related with the adsorption of water molecules. This layered material presented a conductivity of 10-5 Ω-1 cm-1 at high relative humidity (92%). The dipole-dipole interaction appeared to be the dominant mechanism for the dielectric behavior at the lowest temperatures and highest humidity due to the high water content in the Z5HN structure. Taking into account its crystallization water and high adsorption of water molecules in the interlayer region, a conduction pathway in the Z5HN structure was proposed, which provides the route for proton transport by hydrogen-bonding networks on the basis of a Grotthuss-type mechanism in facilitating the long-range proton hopping at 25 °C. The results for high relative humidity imply that a vehicular conduction mechanism also may contribute to the electrical response.

Relación entre ansiedad, depresión, estrés y sobrecarga en cuidadores familiares de personas con demencia tipo alzheimer por mutación e280a en presenilina 1 / Relation among anxiety, depression, stress and overload on relative caregivers of pacients with alzheimer’s dementia by mutation e280a in presenilin 1

Introducción: El deterioro cognitivo y funcional de la Enfermedad de Alzheimer (EA) produce un impacto significativo en el Cuidador Principal. Trastornos de ansiedad y afectivos son mayores en cuidadores familiares de personas con Alzheimer que en la población general. Objetivo: Describir la relación entre Ansiedad, Depresión, Estrés y Sobrecarga en Cuidadores Familiares de personas con demencia tipo Alzheimer por mutación E280A en Presenilina 1. Sujetos y Método: Seleccionamos 14 cuidadores familiares, a quienes les fueron aplicadas escalas de Ansiedad, Depresión, Estrés y Sobrecarga. Para el análisis se tuvieron en cuenta los puntajes en dichas escalas y variables del cuidador como edad, sexo, estado civil, ocupación, escolaridad, parentesco, tiempo de cuidado y edad del familiar enfermo. Resultados: Se encontraron relaciones moderadamente altas entre Ansiedad Rasgo y Depresión (r=0,757; p=0,001), moderadas entre Ansiedad Estado y Ansiedad Rasgo (r=0,497; p=0,070), Depresión (r=0,451;p=0,105); moderadas entre Ansiedad Rasgo y Edad del Familiar Enfermo (r=0,414; p=0,140), Estrés (r=0,542; p=0,045), Sobrecarga (r=0,573; p=0,031), y moderadamente alta con Depresión (r=0,757; p=0,001); moderada entre Depresión y Sobrecarga(r=0,403; p=0,152); entre Estrés y Sobrecarga (r=493; p=0,072); entre Sobrecarga y Tiempo de Cuidado del Familiar Enfermo (r=-0,523; p=0,054), Depresión (r=0,403; p=0,152) y Edad del Familiar Enfermo (r=0,412; p=0,142). Conclusiones: Se encontraron tres cuidadores con niveles elevados de Estrés, uno con Depresión Leve y otro con Sobrecarga Intensa y Depresión Leve. Ninguno presentó niveles elevados de Ansiedad, pero si una tendencia para la Ansiedad Rasgo en los hijos de los afectados, permitiéndonos pensar en una característica individual en estas personas.

Introduction. Cognitive and functional impairment of Alzheimer’s disease (AD) produces a significant impact on principal caregiver. Anxiety and Affective disorders are seen more often in relative caregivers of AD patients than in general population. Objective. To describe relationships among Anxiety, Depression, Stress and Overload in relative caregivers of people with Alzheimer type dementia presenilin-1 E280A mutation. Subjects and Methods. We selected 14 relative caregivers, to whom Anxiety, Depression, Stress and Overload scales were applied. For analysis, as scores of those scales were considered as caregiver’s variables such as age, gender, civil status, occupation, education, relationship, time of care and patient’s age. Results. Moderately high relations were found between Anxiety Trait and Depression(r=0,757; p=0,001), moderate between Anxiety State and Anxiety Trait (r=0,497;p=0,070), Depression(r=0, 451; p=0,105); moderate between Anxiety Trait and patient’s age (r=0,414; p=0,140), Stress (r=0,542;p=0,045), Overload (r=0,573; p=0,031), and moderately high with Depression (r=0,757; p=0,001); moderate between Depressionand Overload (r=0,403; p=0,152); between Stress and Overload (r=493; p=0,072); between Overload and time of patient’s care (r=-0,523; p=0,054), Depression (r=0,403; p=0,152) and patient’s age (r=0,412; p=0,142). Conclusions. Three caregivers with increased stress levels were found, one with mild depression and other with intense overload and mild depression. None of participants presented increased Anxiety levels, but a trend to Anxiety Trait in patient’s offspring, allowing us to think in an individual character in these people.

Tratamiento integral con prótesis parcial fija y cirugía maxilofacial en paciente con bruxismo / Comprehensive treatment with fixed partial prosthetic restoration and maxillofacial surgery in patients with bruxism

El propósito de este caso clínico es mostrar la relación que se puede generar entre tratamientos protésicos y cirugía maxilofacial sin ortodoncia previa, en un paciente bruxómano severo, con micrognatismo mandibular, desarmonía oclusal, pobre estética, patología articular y desgastes dentarios severos. Un año después de terminada la rehabilitación se encuentra un resultado óptimo, estable y biológicamente aceptable...

New layered double hydroxides containing intercalated manganese oxide species: synthesis and characterization.

Manganese oxide species (MnO(x)) have been intercalated within the gallery spaces of Mg-Al layered double hydroxides (LDHs). Synthesis of these materials was achieved by ion-exchange of the LDH-nitrate precursor with permanganate anion followed by reduction with organic reagents, such as glucose, ethanol, and ascorbic acid. Elemental analysis, X-ray diffraction, FT-IR spectroscopy, Raman spectroscopy, HR-TEM, and N(2) sorption analyses have been used to characterize these materials. TEM micrographs of LDH-MnO(x) materials revealed platelike morphology, characteristic of hydrotalcite-like compounds. Chemical analysis results showed that permanganate anions exchanged with nitrate anions. FT-IR and Raman spectroscopy confirmed the reduction of the permanganate anions after treatment with the organic reagents. The XRD diffraction patterns of LDH-MnO(x) revealed that the layer structure is maintained after all synthetic steps. The observed basal spacings of intercalates varied depending on the reducing agent; the largest expansion was 9.93A, corresponding to the use of ascorbic acid. The specific surface areas were also affected according to the organic reagent used, indicating that the structural modifications in the interlayer domain observed by X-ray diffraction also influence the microtextural properties.

Cirugía ortognática en pacientes en crecimiento / Orthognathic Surgery in growing patients

El manejo de las deformidades dentofaciales en pacientes en crecimiento presenta un único y creciente problema para los ortodoncistas y cirujanos maxilofaciales. Los pacientes en crecimiento pueden presentar deformidades dentofaciales clínicas significativas que requieren corrección quirúrgica. En algunos casos, ciertos factores funcionales, esqueléticos y psicosociales pueden hacer necesaria la intervención quirúrgica temprana. Hay una diferencia de dos años entre el inicio, pico y finalización de crecimiento puberal entre ambos sexos. Aproximadamente el 98 por ciento del crecimiento facial es usualmente alcanzado en las niñas a los 15 años, y en los niños entre los 17 y 18 años. Existe siempre la posibilidad de que procedimientos correctivos secundarios se requieren después de la cirugía correctiva inicial...

Comportamiento de la Mortalidad Violenta Antioquia 1990-2000 / Violent mortality behavior. Antioquia 1990-2000

La violencia representa una enorme carga para la economía de los países, con perdidas de billones de dólares, representado en costo de atención de salud, disminución de la productividad y gastos en la aplicación de la justicia. Por cada persona que muere como resultado de la violencia, muchas con heridas o sufren un amplio rango de problemas de salud, física, sexual o mental, debidos a la exposición a la violencia...

Double-Aging Method for Preparation of Stabilized Na-Buserite and Transformations to Todorokites Incorporated with Various Metals.

A double-aging method has been developed to prepare and stabilize Na-buserite. In the first step, Na-buserite is synthesized by aging a MnO(x)() gel, which is produced from the oxidation of Mn(OH)(2) in NaOH solutions by KMnO(4) in the presence of Mg(2+). Stabilization of Na-buserite is done by further aging the as-synthesized buserite in distilled deionized water. Physical and chemical changes during the second aging (stabilization) have been investigated by using X-ray diffraction (XRD), infrared (IR), scanning electronic microscopy and energy-dispersive X-ray studies (SEM/EDX), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), cyclic voltammetry (CV), and temperature-programmed desorption combined with mass spectrometer (TPD-MS). The amount and type of metals incorporated into buserite and todorokite are greatly increased by the second aging treatment (including many lanthanides, whose incorporation has not been reported before). The metal species introduced in the layers considerably change the interlayer distances and, accordingly, the cell parameters. A criterion is obtained for the transformation of todorokite-type tunnel MnO(x)() materials from buserite-type layered MnO(x)() by hydrothermal treatment: only buserites which are stable at elevated temperatures in aqueous systems can convert to a todorokite structure; unstable buserites form a structure whose main d spacings are at 3.56 and 7.1 Å. Interconversions among several layered MnO(x)() are also discussed.