[Epidemiological profile of allergic respiratory disease in Mexican children]. / Perfil epidemiológico de la enfermedad respiratoria alérgica en niños mexicanos.

OBJECTIVE: Report the prevalence and severity of the most common allergic diseases in children living in Monterrey, México. METHODS: Cross-sectional multi-center survey on the most common allergic diseases, completed by parents of 6-7-year-old children and by 13-14- year-old adolescents in the Monterrey metropolitan area, between January 2018 and December 2019. RESULTS: A total of 3,044 questionnaires were eligible for the analysis. Among children between 6-7 years old, 30.2% (n = 143/473) presented wheezing at any time in their life; with a higher prevalence in the male population. In the adolescent group, 26.4% reported having experienced wheezing at some point in their life, with a slight predominance in the female group (54.9%). CONCLUSIONS: Knowing the prevalence of allergic diseases in our population gives us tools to generate strategies that allow us to provide the best quality healthcare to our patients.

OBJETIVO: Reportar la prevalencia y gravedad de las enfermedades alérgicas más comunes en niños residentes en Monterrey, México. MÉTODOS: Encuesta multicéntrica transversal, acerca de las enfermedades alérgicas más comunes, completada por padres de niños de 6 aa 7 años y por adolescentes de 13 a 14 años del área metropolitana de Monterrey, entre enero de 2018 y diciembre de 2019. RESULTADOS: Un total de 3044 cuestionarios fueron elegibles para el análisis. Entre los niños de 6-7 años, 30.2% (n = 143/473) manifestaron sibilancias en algún momento de su vida; con mayor prevalencia en la población masculina. En el grupo de adolescentes el 26.4% refirió haber tenido sibilancias alguna vez en su vida, con un ligero predominio en el grupo femenino (54.9%). CONCLUSIONES: Conocer la prevalencia de las enfermedades alérgicas en la población brinda herramientas para generar estrategias para la mejor calidad asistencial en los pacientes.

Academic motivation and contextual influences in well-being for students with disabilities in higher education.

Objective: The purpose of this study was to utilize self-determination theory (SDT) incorporating the person-environment contextual factors as a framework to examine how the SDT factors may interact with functional disability and contextual factors to influence well-being for students with disabilities in higher education. Methods and participants: A quantitative descriptive design utilizing a convenience sample of 210 students with disabilities in higher education was used. Results: The final regression model accounted for 64% of the variance in well-being. When controlling for all other predictor variables in the model, functional disability, autonomy, learning competence, and relatedness were found to be predictive of well-being, with autonomy being the strongest predictor of well-being, followed by relatedness, learning competence, and functional disability. Conclusion: This study offers critical insights for higher education institutions, emphasizing the need for fostering environments that prioritize autonomy, competence, and relatedness to promote the well-being of students with disabilities.

Glycogen synthase kinase 3 inhibition controls Mycobacterium tuberculosis infection.

Compounds targeting host control of infectious diseases provide an attractive alternative to antimicrobials. A phenotypic screen of a kinase library identified compounds targeting glycogen synthase kinase 3 as potent inhibitors of Mycobacterium tuberculosis (Mtb) intracellular growth in the human THP-1 cell line and primary human monocytes-derived macrophages (hMDM). CRISPR knockouts and siRNA silencing showed that GSK3 isoforms are needed for the growth of Mtb and that a selected compound, P-4423632 targets GSK3ß. GSK3 inhibition was associated with macrophage apoptosis governed by the Mtb secreted protein tyrosine phosphatase A (PtpA). Phospho-proteome analysis of macrophages response to infection revealed a wide array of host signaling and apoptosis pathways controlled by GSK3 and targeted by P-4423632. P-4423632 was additionally found to be active against other intracellular pathogens. Our findings strengthen the notion that targeting host signaling to promote the infected cell's innate antimicrobial capacity is a feasible and attractive host-directed therapy approach.

TracrRNA reprogramming enables direct PAM-independent detection of RNA with diverse DNA-targeting Cas12 nucleases.

Many CRISPR-Cas immune systems generate guide (g)RNAs using trans-activating CRISPR RNAs (tracrRNAs). Recent work revealed that Cas9 tracrRNAs could be reprogrammed to convert any RNA-of-interest into a gRNA, linking the RNA's presence to Cas9-mediated cleavage of double-stranded (ds)DNA. Here, we reprogram tracrRNAs from diverse Cas12 nucleases, linking the presence of an RNA-of-interest to dsDNA cleavage and subsequent collateral single-stranded DNA cleavage-all without the RNA necessarily encoding a protospacer-adjacent motif (PAM). After elucidating nuclease-specific design rules, we demonstrate PAM-independent RNA detection with Cas12b, Cas12e, and Cas12f nucleases. Furthermore, rationally truncating the dsDNA target boosts collateral cleavage activity, while the absence of a gRNA reduces background collateral activity and enhances sensitivity. Finally, we apply this platform to detect 16 S rRNA sequences from five different bacterial pathogens using a universal reprogrammed tracrRNA. These findings extend tracrRNA reprogramming to diverse dsDNA-targeting Cas12 nucleases, expanding the flexibility and versatility of CRISPR-based RNA detection.

Sick building syndrome: do outdoor pollutants and pollen affect it?

Introduction: Sick building syndrome (SBS) refers to non-specific complaints, including upper-respiratory irritative symptoms, headaches, fatigue, and rash, which are usually associated with a particular building by their temporal pattern of occurrence and clustering among inhabitants or colleagues. The aim of the study was to determine the association between the clinical manifestations of sick building syndrome with outdoor pollutants and airborne pollen. Methods: It was a descriptive and prospective observational study conducted from November 2021 to April 2022. It included subjects over 18 years old who completed an online survey on sick building syndrome (general symptoms, nasal, ocular, oropharyngeal, and skin symptoms) presented at home, housing information and personal history. The APS-330 from Pollen Sense ® was used to obtain data on pollen in the air and the local pollution monitoring system (SIMA) to obtain information regarding pollutants. For statistical analysis, SPSS version 16 was used. Results: A total of 402 surveys were included; 91% of the subjects reported having at least 1 symptom. Females presented more general symptoms (fatigue and headache) than males. Subjects with a personal history of atopy showed a higher prevalence of practically all symptoms. Airborne pollen exposure was positively associated with mucosal symptoms in eyes and nose. Outdoor fungi spore exposure was positively associated with oculo-nasal and cutaneous symptoms in the scalp. Conclusion: This study found significant associations with female gender and a history of atopy, which suggests a higher risk for these subjects. Despite the limitations of the study, we can conclude that there is an association between the clinical manifestations of sick building syndrome with indoor and outdoor pollution.

Pistachio (Pistacia vera L.) consumption improves cognitive performance and mood in overweight young adults: A pilot study.

This pilot study evaluated the impact of pistachio consumption on cognitive performance and mood in overweight young adults. Pistachios were characterized (chemical and nutraceutical), and a baseline-final, uncontrolled nutritional intervention was performed (28 g of pistachio/28 days). Psychometric tests were applied to estimate cognitive performance and mood; anthropometric evaluation, biochemical analysis, and plasma antioxidant activity were included. The main component of nuts was lipids (48.1%). Pistachios consumption significantly (p ≤ 0.05) reduced waist circumference (-1.47 cm), total cholesterol (-10.21 mg/dL), LDL (-6.57 mg/dL), and triglycerides (-21.07 mg/dL), and increased plasma antioxidant activity. Pistachio supplementation improved risk tolerance (p ≤ 0.006) and decision-making strategy (p ≤ 0.002; BART-task), executive functions (BCST-task; p ≤ 0.006), and selective and sustained attention (Go/No-Go-test; p ≤ 0.016). The mood state was positively modulated (p ≤ 0.05) for anxiety, anger-hostility, and sadness-depression. These results show for the first time the benefits of pistachio consumption on cognitive performance and mood in overweight young adults.

Effect of the Healthy Dish Method to Reduce Waist Circumference in Teachers with Abdominal Obesity of a Peruvian University.

Introduction: Obesity has increased steadily in recent decades, becoming a worldwide pandemic. Objective: To determine the effect of the "Healthy Dish" method to reduce waist circumference in teachers with abdominal obesity in a Peruvian University. Methods: Quasi-experimental, prospective study in 43 teachers, divided into 21 in the control group and 22 in the experimental group, who received a two-session workshop on abdominal obesity and the "Healthy Dish" method. The latter was applied for 2 months, monitored 5 days a week, the waist circumference of both groups was measured at one month and at two months and compared. For the statistical analysis, descriptive and inferential statistics or nonparametric statistics were applied (Mann-Whitney U-test, according to the assumption of normality). Results: The predominant age range was 40 to 49 years, women, married, overweight, with a family history of hypertension, cancer and diabetes mellitus. After the intervention, 40.9% of teachers in the experimental group decreased their waist circumference and 54.5% normalized it, while the control group decreased it by 23.8% and 47.6% normalized it. Only 4.54% of teachers in the experimental group showed no change in their waist circumference, compared to 19.0% in the control group, and 9.52% of teachers in the control group increased their waist circumference. Conclusion: The healthy dish method has a positive effect on decreasing waist circumference in teachers with abdominal obesity.

Hypersensitivity reaction to Abiraterone, successful desensitization protocol in prostate cancer patient.

INTRODUCTION: In prostate cancer, androgens are key in the growth of both normal prostate and cancer cells. Abiraterone acetate inhibits CYP17, an important target in prostate cancer given its central role in the production of adrenal and tumor-derived androgens. Although abiraterone is generally well tolerated, common adverse effects such as hypertension, hypokalemia, and hepatotoxicity have been reported. CLINICAL CASE: We present the case of an 83-year-old Mexican man with high-volume EC IV prostate cancer resistant to castration, orchiectomy, and bone, liver, and lung metastases. First-line treatment with the CHAARTED scheme was indicated, by patient decision refuse chemotherapy treatment. On the fourth day of starting treatment, he developed pruritic erythematous macular skin lesions and urticaria on the posterior chest that resolved spontaneously. A generalized erythematous and pruritic maculopapular rash appeared 12 days after starting abiraterone, for which she was referred to allergies. MANAGEMENT AND RESULTS: An oral provocation test was performed for two days, presenting localized macular lesions eight hours after the administration of abiraterone. An oral desensitization protocol was carried out for ten days in which no hypersensitivity reactions were observed, thus achieving the successful administration of abiraterone.

The association of air pollution in respiratory allergy: Its impact in an industrial city.

Background: Asthma and allergic diseases have increased in recent decades and are more common in industrialized countries. Industrial areas with a considerably high number of inhabitants and vehicles can favor the presence of serious air pollution and therefore the appearance and exacerbation of respiratory allergy symptoms. The objective of this study was to determine the relationship between exposure to environmental pollutants with exacerbation of respiratory allergy. Methods: A total of 240 subjects above 6 years old who lived in the metropolitan area of Monterrey, Nuevo León, Mexico, with diagnosis of allergic rhinitis and/or asthma, were included. The subject's address was registered in the database and the rhinitis control assessment test (RCAT) and the asthma control test (ACT) were applied. Environmental data were obtained from the Environmental Monitoring System (SIMA) of Nuevo León. Geolocation of industries and avenues in proximity of subject's addresses and SIMA stations were obtained through geographic information systems using ArcGis software. Results: The relation between pollutants and subjects' RCAT, ACT, and spirometry results in the 14 stations was established. PM10 and forced vital capacity (FVC) had an r = 0.074 with p = 0.005, PM10 and absolute FEV1/FVC ratio presented an r = -0.102 with a p = 0.000; The distance found to be associated with a worsening of respiratory symptoms was living 165 m from a main road or 241 m from an industrial establishment. Conclusions: Exposure to pollutants present in the environment are factors associated with increased symptoms in subjects with respiratory allergies.

Efficacy of therapeutic plasma exchange in a case of severe, generalised canine pemphigus foliaceus.

Successful treatment of pemphigus foliaceus (PF) often requires a multimodal therapeutic approach. The dog described herein underwent four therapeutic plasma exchange treatments for severe, refractory PF, resulting in a 50% reduction of lesional body surface area. This treatment option should be considered for the management of canine PF.

O tratamento bem-sucedido do pênfigo foliáceo (PF) geralmente requer uma abordagem terapêutica multimodal. O cão aqui descrito foi submetido a quatro tratamentos de troca de plasma terapêutica (TPE) para PF grave e refratário, resultando em uma redução de 50% da área corpórea lesional. Esta opção de tratamento deve ser considerada para o manejo do PF canino.

El tratamiento exitoso del pénfigo foliáceo (PF) a menudo requiere un enfoque terapéutico multimodal. El perro aquí descrito se sometió a cuatro tratamientos terapéuticos de intercambio plasmático (TPE) para un PF refractario grave, lo que resultó en una reducción del 50% de la superficie corporal lesionada. Esta opción de tratamiento debe considerarse para el control de PF canino.

Traiter efficacement le pemphigus foliacé (PF) nécessite souvent une approche thérapeutique multimodale. Dans ce rapport clinique, un chie a reçu quatre traitements de plasmaphérèse thérapeutique (EPT) pour le traitement d'un PF sévère et réfractaire, ce qui a permis de réduire de 50 % la surface corporelle lésionnelle. Cette option thérapeutique devrait être envisagée pour la prise en charge du PF canin.

Towards richer knowledge partnerships between ecology and ethnoecology.

Indigenous and traditional practices based on ethnoecological knowledge are fundamental to biodiversity stewardship and sustainable use. Knowledge partnerships between Indigenous Peoples, traditional local communities, and ecologists can produce richer and fairer understandings of nature. We identify key topical areas where such collaborations can positively transform science, policy, and practice.

Doxofylline as a steroid-sparing treatment in Mexican children with asthma.

OBJECTIVE: The aim of this pilot study was to assess the efficacy of doxofylline as an ICS-sparing agent in the treatment of Mexican children with asthma. METHODS: 10-week, open-label, crossover, pilot study, we examined the steroid-sparing effect of doxofylline in Mexican children with asthma. Patients aged 6-16 years treated with inhaled corticosteroids (ICS) for at least 8 wk before enrollment were divided randomly into two groups at the baseline visit. Group A (n = 31) received doxofylline (18 mg/kg/day) plus standard-dose budesonide (D + SDB) for the first 4-week period followed by doxofylline plus reduced-dose budesonide (D + RDB) for the second 4-week period. Group B (n = 30) received D + RDB followed by D + SDB. Clinical outcomes assessed included lung function (forced expiratory volume; in 1 s, FEV1), fractional exhaled nitric oxide (FeNO), asthma control, number of exacerbations and use of rescue medication (salbutamol). RESULTS: It was shown that combined use of doxofylline and ICS may allow children with asthma to reduce their daily dose of ICS while maintaining lung function and improving asthma control (p = 0.008). There were few asthma exacerbations and only one patient required treatment with systemic corticosteroids. Rescue medication use decreased significantly in patients receiving D + SDB during the first 4-week period. CONCLUSIONS: Our results suggest that doxofylline may be a steroid-sparing treatment in asthma, but longer-term, controlled studies are needed to confirm these observations.

Self-assembly of cyclic peptide monolayers by hydrophobic supramolecular hinges.

Supramolecular polymerisation of two-dimensional (2D) materials requires monomers with non-covalent binding motifs that can control the directionality of both dimensions of growth. A tug of war between these propagation forces can bias polymerisation in either direction, ultimately determining the structure and properties of the final 2D ensemble. Deconvolution of the assembly dynamics of 2D supramolecular systems has been widely overlooked, making monomer design largely empirical. It is thus key to define new design principles for suitable monomers that allow the control of the direction and the dynamics of two-dimensional self-assembled architectures. Here, we investigate the sequential assembly mechanism of new monolayer architectures of cyclic peptide nanotubes by computational simulations and synthesised peptide sequences with selected mutations. Rationally designed cyclic peptide scaffolds are shown to undergo hierarchical self-assembly and afford monolayers of supramolecular nanotubes. The particular geometry, the rigidity and the planar conformation of cyclic peptides of alternating chirality allow the orthogonal orientation of hydrophobic domains that define lateral supramolecular contacts, and ultimately direct the propagation of the monolayers of peptide nanotubes. A flexible 'tryptophan hinge' at the hydrophobic interface was found to allow lateral dynamic interactions between cyclic peptides and thus maintain the stability of the tubular monolayer structure. These results unfold the potential of cyclic peptide scaffolds for the rational design of supramolecular polymerisation processes and hierarchical self-assembly across the different dimensions of space.

[Asociación de exposición a humo de camiones en adolescentes con asma de un centro de referencia del noreste de México].

Objective: To compare whether adolescents who are exposed to truck smoke have a higher prevalence of asthma symptomatology versus those who are not exposed. Methods: A cross-sectional, descriptive, and comparative study. Adolescents aged 13 and 14 years were included and completed a self-report questionnaire. Subjects were selected following the same methodology as in ISAAC phase III. They underwent an epidemiological survey for the presence of symptoms. Ex- posure to truck smoke was defined as passing trucks most of the day as perceived by the patient. The distribution was assessed with the Kolmogorov-Smirnov test. Comparisons with Chi-square or Student's t-test, as appropriate. A value of p³0.05 was considered statistically significant. Results: A total of 492 patients were included. The demographic variables can be seen in Table 1. When performing the association between the groups of ad- olescents with asthma exposed to truck smoke, a significant difference was found in the prevalence of respiratory symptomatology and asthma (26.0% vs 9.6%, p=0.000) (Table 1). Conclusions: Adolescent patients with asthma who are exposed to truck smoke demonstrated a significant difference in the presence of respiratory symptom- atology and asthma compared to patients without exposure.

Objetivo: Comparar si los adolescentes que están expuestos a humo de camiones tienen mayor prevalencia de sintomatología de asma contra quienes no están expuestos. Métodos: Estudio transversal, descriptivo y comparativo. Se incluyeron adolescentes de 13 y 14 años de edad quienes completaron un cuestionario autoinfor- mado. Los sujetos se seleccionaron siguiendo la misma metodología que en la fase III de ISAAC. Se les realizó una encuesta epidemiológica para la presencia de síntomas. Exposición al humo de camiones se definió como el paso de camiones la mayoría del día a percepción del paciente. La distribución fue evaluada con la prueba de Kolmogórov-Smirnov. Comparaciones con prueba de Chi-cuadrada o T de Student, según corresponda. Un valor de p £ 0.05 fue considerado estadísticamente significativo. Resultados: Se incluyeron un total de 492 pacientes. Las variables demográficas se pueden observar en la Tabla 1. Al realizar la asociación entre los grupos de adolescentes con asma que se encuentran expuestos a humo de camiones se encontró una diferencia significativa en la prevalencia de sintomatología respira- toria y asma (26.0% vs 9.6%, p = 0.000). Conclusiones: Los pacientes adolescentes con asma que se encuentran expuestos al humo de camiones demostraron tener diferencia significativa en la presencia de sintomatología respiratoria y asma en comparación con los pacientes sin exposición.

Interleukin-6 as a biomarker of hypersensitivity reactions in chemotherapeutics and monoclonal antibodies.

BACKGROUND: In recent years, a new type of immediate hypersensitivity reaction known as cytokine release began to emerge, and within this phenotype of reactions, interleukin-6 is the most frequently associated with the presence during drug administration. Chemotherapeutic agents (QT) and monoclonal antibodies. OBJECTIVE: Determine interleukin-6 levels in hypersensitivity reactions to QT and monoclonal antibodies. METHODS: Observational and prospective study that was carried out from March 1, 2021 to March 1, 2022 in a university hospital in northeastern Mexico. Symptoms, severity, interleukin-6 levels, and skin tests of hypersensitivity reaction were evaluated at QT and monoclonal antibodies. RESULTS: A total of 41 patients with oncological disease were included, the most frequent being ovarian cancer. Symptoms as initial hypersensitivity reaction were neuromuscular in taxanes and cutaneous in Platinums.41.5% presented elevation of interleukin-6, and it was found more frequently in presence of metastases. Positive skin tests were found more frequently in the carboplatin and doxorubicin groups. The most frequently presented phenotype was type I in paclitaxel, carboplatin, and doxorubicin, and mixed-reaction (type I and cytokine release) in oxaliplatin. CONCLUSION: With the increasing prevalence of hypersensitivity reactions to biologic and antineoplastic therapies, interleukin-6 should be recognized as a biomarker in immediate hypersensitivity reactions to QT and monoclonal antibodies.

Hypersensitivity Reactions to Taxanes: A Comprehensive and Systematic Review of the Efficacy and Safety of Desensitization.

Taxanes in the treatment of cancer are associated with a significant incidence of hypersensitivity reactions, which may preclude their use in patients in need of first line therapy. Drug desensitization induces transient immunological tolerance and has allowed the reintroduction of taxanes in highly allergic patients. Increase the knowledge of hypersensitivity reactions (HSR) during the administration of taxanes. A systematic review regarding the safety and efficacy of rapid drug desensitization (RDD) for taxanes HSR. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was registered in PROSPERO(CRD42021242324) and a comprehensive search was conducted in Medline, Embase, Web of Science and Scopus databases. 25 studies encompassing 10 countries were identified and 976 patients with initial HSR to paclitaxel (n = 707) and docetaxel (n = 284), that underwent a total of 2,396 desensitizations. The most common symptoms were cutaneous (74.6%) with paclitaxel and respiratory (72.6%) with docetaxel. Severe initial hypersensitivity reactions including anaphylaxis occurred in 39.6% and 13% of paclitaxel and docetaxel cases respectively and during the first (87.4%) or second exposure (81.5%). Patients tolerated well RDD and breakthrough reactions (BTR) occurred in 32.2% of paclitaxel-treated patients and in 20.6% of docetaxel treated patients. Premedications included corticosteroids, antihistamines and leukotriene receptor antagonists. The most commonly used protocol was the BWH 3 bags 12 steps, all protocols showed a success rate between 95-100%, with no reported deaths. RDD is a safe and effective procedure in patients with HSR to taxanes and protocols should be standardized for wide range implementation.

Assembly of functional diversity in an oceanic island flora.

Oceanic island floras are well known for their morphological peculiarities and exhibit striking examples of trait evolution1-3. These morphological shifts are commonly attributed to insularity and are thought to be shaped by the biogeographical processes and evolutionary histories of oceanic islands2,4. However, the mechanisms through which biogeography and evolution have shaped the distribution and diversity of plant functional traits remain unclear5. Here we describe the functional trait space of the native flora of an oceanic island (Tenerife, Canary Islands, Spain) using extensive field and laboratory measurements, and relate it to global trade-offs in ecological strategies. We find that the island trait space exhibits a remarkable functional richness but that most plants are concentrated around a functional hotspot dominated by shrubs with a conservative life-history strategy. By dividing the island flora into species groups associated with distinct biogeographical distributions and diversification histories, our results also suggest that colonization via long-distance dispersal and the interplay between inter-island dispersal and archipelago-level speciation processes drive functional divergence and trait space expansion. Contrary to our expectations, speciation via cladogenesis has led to functional convergence, and therefore only contributes marginally to functional diversity by densely packing trait space around shrubs. By combining biogeography, ecology and evolution, our approach opens new avenues for trait-based insights into how dispersal, speciation and persistence shape the assembly of entire native island floras.

Hypersensitivity reactions to anticancer chemotherapy and monoclonal antibodies: Safety and efficacy of desensitization.

BACKGROUND: Hypersensitivity reactions to anticancer chemotherapy and monoclonal antibodies may lead to discontinuation of first-line treatment options. Identification of these reactions can provide specific diagnosis and treatment by rapid drug desensitizations. OBJECTIVE: To determine the hypersensitivity reactions involved in anticancer chemotherapy and monoclonal antibodies, and the safety and efficacy of rapid drug desensitization. METHODS: We conducted an observational study of hypersensitivity reaction presented after the administration of anticancer chemotherapy and monoclonal antibodies in Mexico. We documented the symptoms of initial reaction and their severity, and the results of skin tests. We also report our experience of the administration of 12-step (mild-moderate reactions) and 16-step (severe reactions) desensitization protocols in these patients. RESULTS: Overall, 93 patients received 336 rapid drug desensitization; 105 to taxanes, 115 to platinum drugs, 101 to monoclonal antibodies, and 15 other anticancer chemotherapy. Hypersensitivity reaction to taxanes occurred in the first or second administration, platinum drugs after the sixth cycle, and rituximab in the first cycle. The most common symptom in carboplatin was urticaria, paclitaxel back pain, oxaliplatin and docetaxel dyspnea, and in the monoclonal antibodies cardiovascular symptoms. Skin tests were positive in 75% of the carboplatin group, and only 16.7% in docetaxel. There was a rapid drug desensitization success rate of 99.4% and 85.7% did not present any related hypersensitivity reaction. CONCLUSION: The diagnosis of hypersensitivity reaction to anticancer chemotherapy and monoclonal antibodies offers a panorama in the management of oncological diseases. Our standardized desensitization protocol is safe and effective and can be reproduced in other centers to treat patients who need to maintain first-line treatment.

Clinical factors associated with extubation failure and post-extubation laryngeal stridor in adult patients on invasive mechanical ventilation / Factores clínicos asociados a extubación fallida y a estridor laríngeo post-extubación en pacientes adultos con ventilación mecánica invasiva

Abstract Introduction: Orotracheal intubation is a procedure that implies risks such as extubation failure and laryngeal stridor, which increase the risk of morbidity. Objective: To identify factors associated with early extubation failure (≤24 hours) and the development of post-extubation laryngeal stridor in adult patients on invasive mechanical ventilation (IMV). Materials and methods: Case-control study conducted in the intensive care unit (ICU) of a quaternary care hospital in Bogotá, Colombia, between April 2019 and February 2020, in which information was collected prospectively. A total of 180 patients with IMV ≥24 hours and at least >1 extubation attempt were included: 30 cases defined as patients with early extubation failure (≤24 hours to extubation), and 150 controls. Differences between cases and controls regarding the variables considered were determined using the Student's t test and the Chi-squared or Fisher's exact tests. In addition, a multivariate analysis (unconditional logistic regression model) was performed to establish the factors associated with extubation failure and post-extubation laryngeal stridor, calculating the odds ratio (OR) and the respective 95% confidence intervals (95%CI). A significance level of p<0.05 was considered. Results: Early extubation failure and laryngeal stridor had a prevalence of 16.66% (n=30) and 3.89% (n=7), respectively. In the multivariate analysis, having a history of intubation (OR=4.27, 95%CI: 1.44-12.66), the presence of active cancer (OR=2.92, 95%CI: 1.08-7.90), and being diagnosed with pneumonia (OR=2.84, 95%CI: 1.15-6.99) were significantly associated with extubation failure, while the duration of IMV (OR=1.53, 95%CI: 1.18-1.99) and history of intubation (OR=37.99, 95%CI: 2.22-650.8) were significantly associated with post-extubation laryngeal stridor. Conclusions: Based on the results reported here, it is suggested to consider factors such as history of intubation, comorbidity with cancer, and diagnosis of pneumonia in the stratification of critically ill patients to increase the likelihood of successful extubation.

Resumen Introducción. La intubación orotraqueal es un procedimiento que conlleva riesgos como la extubación fallida y el estridor laríngeo, los cuales aumentan el riesgo de morbilidad. Objetivo. Identificar los factores asociados a extubación fallida temprana (≤24 horas) y al desarrollo de estridor laríngeo post-extubación en pacientes adultos con ventilación mecánica invasiva (VMI). Materiales y métodos. Estudio de casos y controles con recolección prospectiva de información realizado en la unidad de cuidados intensivos (UCI) de un hospital de IV nivel de Bogotá, Colombia, entre abril de 2019 y febrero de 2020. Se incluyeron 180 pacientes con VMI ≥24 horas y al menos 1 intento de extubación: 30 casos definidos como pacientes con extubación fallida temprana (≤24 horas a la extubación) y 150 controles. Las diferencias en las variables consideradas entre casos y controles se determinaron mediante las pruebas t de Student y Chi-cuadrado o exacta de Fisher. Además, se realizó un análisis multivariado (modelo de regresión logística no condicional) para determinar los factores asociados con extubación fallida y estridor laríngeo post-extubación, calculando los Odds ratio (OR) con sus respectivos intervalos de confianza al 95% (IC95%). Se consideró un nivel de significancia de p<0.05. Resultados. La extubación fallida temprana y el estridor laríngeo tuvieron una prevalencia de 16.66% (n=30) y 3.89% (n=7), respectivamente. En el análisis multivariado, el antecedente de intubación (OR=4.27, IC95%: 1.44-12.66), la presencia de cáncer activo (OR=2.92, IC95%: 1.08-7.90) y ser diagnosticado con neumonía (OR=2.84, IC95%: 1.15-6.99) se asociaron significativamente con extubación fallida, mientras que la duración de la VMI (OR=1.53, IC95%: 1.18-1.99) y el antecedente de intubación (OR=37.99, IC95%: 2.22-650.8), con estridor laríngeo post-extubación. Conclusiones. Con base en los resultados aquí obtenidos, se sugiere considerar factores como antecedente de intubación, comorbilidad con cáncer y diagnóstico de neumonía en la estratificación de los pacientes críticamente enfermos para aumentar la probabilidad de una extubación exitosa.