Higher mortality and intubation rate in COVID-19 patients treated with noninvasive ventilation compared with high-flow oxygen or CPAP.

The effectiveness of noninvasive respiratory support in severe COVID-19 patients is still controversial. We aimed to compare the outcome of patients with COVID-19 pneumonia and hypoxemic respiratory failure treated with high-flow oxygen administered via nasal cannula (HFNC), continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), initiated outside the intensive care unit (ICU) in 10 university hospitals in Catalonia, Spain. We recruited 367 consecutive patients aged ≥ 18 years who were treated with HFNC (155, 42.2%), CPAP (133, 36.2%) or NIV (79, 21.5%). The main outcome was intubation or death at 28 days after respiratory support initiation. After adjusting for relevant covariates and taking patients treated with HFNC as reference, treatment with NIV showed a higher risk of intubation or death (hazard ratio 2.01; 95% confidence interval 1.32-3.08), while treatment with CPAP did not show differences (0.97; 0.63-1.50). In the context of the pandemic and outside the intensive care unit setting, noninvasive ventilation for the treatment of moderate to severe hypoxemic acute respiratory failure secondary to COVID-19 resulted in higher mortality or intubation rate at 28 days than high-flow oxygen or CPAP. This finding may help physicians to choose the best noninvasive respiratory support treatment in these patients.Clinicaltrials.gov identifier: NCT04668196.

International Consensus Document on Obstructive Sleep Apnea. / Documento internacional de consenso sobre apnea obstructiva del sueño.

The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).

[Systematic of the fish Petenia splendida (Perciformes: Cichlidae) of Lake Petén Itzá, Guatemala]. / Sistemática del pez Petenia splendida (Perciformes: Cichlidae) en el lago Petén Itzá, Guatemala.

The Lake Petén Itzá is located in the multiple use zone of the Maya Biosphere Reserve. It belongs to the subtropical moist forest (warm) life zone, and has very important flora and fauna diversities. Among the fish species, the white fish (Petenia splendida) is of high commercial value. The main goal of the present work was to clarify the taxonomic position of the two forms of the white fish in Petén (Guatemala), and to compare it with the Usumacinta (Mexico) form, based on the collected material from 1978 and 2006 (Usumacinta), and collections made during 2008 and 2009 in the Lake Petén Itzá. Samples were obtained from 10 different locations in the lake. From the total of 57 fish specimens collected, 50 fish were selected (25 yellow form and 25 silver form); besides, 21 specimens from 10 locations of the Usumacinta river in Mexico, from the Fish Collection, FCB, UANL. A total of 36 morphometric and 16 meristic characteristics, were analyzed, and also coloration, habitat and fishing method. This study reports the P. splendida of the Lake Petén Itzá with the following characteristics: the yellow form at a depth of 0.5-1.5m with dorsal fin XIV-(XV)-XVI/11-(12)-13, the silver form at a depth of 2-3m with dorsal fin XIV-(XV)-XVI/10-(12)-13, and the Usumacinta form with a dorsal fin XIV-(XV)-XV/12-(13)-13. The discrimination analysis demonstrates a differentiation among the three analyzed populations. Some of the characteristics are the ocular diameter, the anal source-pelvic source distance and the dorsal source-anal source distance. The geographic area studied has a high diversity of fish fauna along the watershed, and it is possible to observe the anthropogenic damage, due to the overexploitation based the unapplicability of the existent regulation and the urbanization. If this situation continues it could jeopardize the survival of this emblematic specie.

Previously Undetected Obstructive Sleep Apnea in Patients With New-Onset Atrial Fibrillation.

Obstructive sleep apnea-hypopnea syndrome (OSA) compromises the efficacy of atrial fibrillation (AF) control strategies. Continuous positive airway pressure (CPAP) may ameliorate arrhythmia control especially in early AF stages (new-onset AF). We investigated a practical screening strategy to determine the likelihood of CPAP indication in new-onset AF patients. Seventy-seven consecutive patients with new-onset (<1 month) AF were prospectively evaluated. Of them, 4 were excluded due to previously diagnosed OSA. The remaining 73 (68% persistent AF) fulfilled the Epworth, Berlin and STOP-BANG questionnaires, an ambulatory polysomnography being performed thereafter in all them in order to determine the apnea-hipopnea index (AHI). CPAP was indicated following conventional criteria. The variables associated with the diagnosis of OSA, with the AHI value and with CPAP indication were investigated by means of descriptive, univariate and multivariate analysis. The prevalence of OSA of any degree and CPAP indication was 82% and 37%, respectively. The variables associated (p < 0.05) with a higher AHI were male gender, body mass index, obesity, hypertension, and high-risk scoring at the Berlin and STOP-BANG questionnaires. In the multivariate analysis, the STOP-BANG scoring proved superior to conventional risk factors and became the only variable predicting CPAP indication (odds ratio 4.5 [1.9 to 10.6]; p = 0.01), an optimized cutoff value of ≥4 being newly established (sensitivity/specificity 76/65%). In conclusion, in patients referred with new-onset AF we documented a high risk of OSA and of need for CPAP. A STOP-BANG scoring of ≥4 in our population was a practical screening alternative to direct polysomnography in this setting.

Obstructive sleep apnoea and 24-h blood pressure in patients with resistant hypertension.

Obstructive sleep apnoea (OSA) is common in patients with resistant hypertension, but understanding of the pathogenic mechanisms linking both conditions is limited. This study assessed the prevalence of OSA and the relationships between OSA and 24-h blood pressure (BP) in 62 consecutive patients with resistant hypertension, defined as clinic BP values ≥ 140/90 despite the prescription of at least three drugs at adequate doses, including a diuretic. In order to exclude a 'white coat effect', only patients with ambulatory 24-h BP values ≥ 125/80 were recruited. Patients underwent polysomnography, 24-h ambulatory BP monitoring and completed the Epworth sleepiness scale (ESS). OSA was defined as an apnoea-hypopnoea index (AHI) ≥ 5 and excessive daytime sleepiness (EDS) by an ESS ≥ 10. A multiple linear regression analysis was used to assess the association of anthropometric data, OSA severity measures and ESS with 24-h systolic and diastolic BP. Mean 24-h BP values were 139.14/80.98 mmHg. Ninety per cent of patients had an AHI ≥ 5 and 70% had an AHI ≥ 30. Only the ESS was associated with 24-h diastolic BP [slope 0.775, 95% confidence interval (CI) 0.120-1.390, P < 0.02); age was associated negatively with 24-h diastolic BP (slope -0.64, 95% CI -0.874 to -0.411, P < 0.001). Compared with those without EDS, patients with EDS showed a significantly higher frequency of diastolic non-dipping pattern (69.2% versus 34.7%, P < 0.032). Our results demonstrate a high prevalence of severe OSA in patients with resistant hypertension and suggest that EDS could be a marker of a pathogenetic mechanism linking OSA and hypertension.

Entrenamiento para el desarrollo de competencias en evaluación de impacto social a gestores de proyectos

Introducción: El contexto tecnocientífico cubano actual promueve proyectos de ciencia, tecnología e innovación, que tributan al progreso del modelo de desarrollo económico social socialista que propone el país. Pero, en la práctica, estos proyectos evidencian poca sistematicidad en la evaluación de impacto social, lo que da al traste con la transformación social que se pretende. Debido a esto, se considera necesaria la superación de los profesionales que, desde las universidades cubanas, gestionan proyectos. Objetivo: Proponer un entrenamiento para el desarrollo de competencias en evaluación de impacto social para gestores de proyectos de las universidades cubanas. Materiales y métodos: El diagnóstico realizado con métodos científicos teóricos y con la aplicación de encuestas y entrevistas a gestores de proyectos, y el análisis documental a proyectos en ejecución y a sus resultados, así como a los documentos rectores del posgrado en Cuba, permitieron conformar la propuesta de entrenamiento que se presenta. Resultados: Se identificó un nivel bajo de conocimientos y habilidades en evaluación de impacto social de los proyectos, y una alta disposición hacia la superación profesional en el tema. Esto conduce a la propuesta de un entrenamiento que consta de acciones para el desarrollo de competencias en los gestores de proyecto. Conclusiones: El entrenamiento que se propone resulta una vía esencial para atender demandas y necesidades de superación profesional en torno a conocimientos, habilidades y valores, para la evaluación de impacto social por gestores de proyectos de las universidades cubanas.

Introduction: The current Cuban techno-scientific context promotes projects of science, technology and innovation, which contribute to the progress of the model of socialist social economic development the country proposes. But, in practice, these projects show little systematicity in the social impact assessment, which ruins the social transformation that is pretended. Due to this, it is considered necessary the upgrading of the professionals who manage projects of Cuban universities. Objective: To propose training for the development of skills in social impact assessment for project managers of Cuban universities. Materials and methods: The diagnosis, carried out with scientific-theoretical methods, and with the application of inquiries and interviews to project managers, and the documentary analysis of projects in execution and their results, as well as of leading documents of post-graduate studies in Cuba, allowed to elaborate the training proposal presented. Results: A low level of knowledge and skills in the social impact assessment of the projects and a high disposition towards professional upgrading on the topic were identified. This leads to the proposal of a training that consists on actions for the development of skills in project managers. Conclusions: The training proposed results an essential way to meet demands and needs of professional upgrading regarding knowledge, skills and values, for the assessment of the social impact by project managers of Cuban universities.

Obstructive sleep apnea and metabolic syndrome in spanish population.

UNLABELLED: Obstructive sleep apnea (OSA) is a clinical picture characterized by repeated episodes of obstruction of the upper airway. OSA is associated with cardiovascular risk factors, some of which are components of metabolic syndrome (MS). OBJECTIVES: First, determine the prevalence of MS in patients with OSA visited in sleep clinic. Second, evaluate whether there is an independent association between MS components and the severity of OSA. METHODS: Patients with clinical suspicion of OSA were evaluated by polysomnography. Three groups were defined according to apnea hypoapnea index (AHI): no OSA (AHI <5), mild-moderate (AHI≥ 5 ≤30), and severe (AHI> 30). All patients were determined in fasting blood glucose, total cholesterol, HDL cholesterol, triglycerides and insulin. MS was defined according to criteria of National Cholesterol Education Program (NCEP). RESULTS: A total of 141 patients (mean age 54 ± 11 years) were evaluated. According to AIH, 25 subjects had no OSA and 116 had OSA (41mild-moderate and 75 severe). MS prevalence ranged from 43-81% in OSA group. Also, a significant increase in waist circumference, triglycerides, glucose, blood pressure levels, and a decrease in HDL cholesterol levels was observed in more severe OSA patients. All polysomnographic parameters correlated significantly with metabolic abnormalities. After a multiple regression analysis, abdominal obesity (p <0.02), glucose (p <0.01) and HDL cholesterol (p <0.001) were independently associated with OSA. CONCLUSIONS: Our findings show high prevalence of MS in OSA, especially in severe group. A significant association between OSA and some of the components of MS was found in Spanish population.

Hyperleptinemia is associated with parameters of low-grade systemic inflammation and metabolic dysfunction in obese human beings.

Leptin is an adipose tissue-derived hormone that has been involved in hypothalamic and systemic inflammation, altered food-intake patterns, and metabolic dysfunction in obese mice. However, it remains unclear whether leptin has a relationship with parameters of systemic inflammation and metabolic dysfunction in humans. We thus evaluated in a cross-sectional study the circulating levels of leptin in 40 non-obese and 41 obese Mexican individuals, examining their relationship with tumor necrosis factor alpha (TNF-α), interleukin (IL) 12, IL-10, central obesity, serum glucose and insulin levels, and serum triglyceride and cholesterol concentrations. Circulating levels of leptin, TNF-α, IL-12, IL-10, and insulin were measured by ELISA, while concentrations of glucose, triglyceride, and cholesterol were determined by enzymatic assays. As expected, serum levels of leptin exhibited a significant elevation in obese individuals as compared to non-obese subjects, showing a clear association with increased body mass index (r = 0.4173), central obesity (r = 0.4678), and body fat percentage (r = 0.3583). Furthermore, leptin also showed a strong relationship with serum TNF-α (r = 0.6989), IL-12 (r = 0.3093), and IL-10 (r = -0.5691). Interestingly, leptin was also significantly related with high concentrations of fasting glucose (r = 0.5227) and insulin (r = 0.2229), as well as elevated levels of insulin resistance (r = 0.3611) and circulating triglyceride (r = 0.4135). These results suggest that hyperleptinemia is strongly associated with the occurrence of low-grade systemic inflammation and metabolic alteration in obese subjects. Further clinical research is still needed to determine whether hyperleptinemia may be a potential marker for recognizing the advent of obesity-related metabolic disorders in human beings.

Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial.

OBJECTIVES: This controlled trial assessed the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH). METHODS: We evaluated 96 patients with resistant hypertension, defined as clinic BP at least 140/90 mmHg despite treatment with at least three drugs at adequate doses, including a diuretic. Patients underwent a polysomnography and a 24-h ambulatory BP monitoring (ABPM). They were classified as consulting room or ABPM-confirmed resistant hypertension, according to 24-h BP lower or higher than 125/80 mmHg. Patients with an apnea-hypopnea index at least 15 events/h (n = 75) were randomized to receive either CPAP added to conventional treatment (n = 38) or conventional medical treatment alone (n = 37). ABPM was repeated at 3 months. The main outcome was the change in systolic and diastolic BP. RESULTS: Sixty-four patients completed the follow-up. Patients with ABPM-confirmed resistant hypertension treated with CPAP (n = 20), unlike those treated with conventional treatment (n = 21), showed a decrease in 24-h diastolic BP (-4.9 ± 6.4 vs. 0.1 ± 7.3 mmHg, P = 0.027). Patients who used CPAP > 5.8 h showed a greater reduction in daytime diastolic BP {-6.12 mmHg [confidence interval (CI) -1.45; -10.82], P = 0.004}, 24-h diastolic BP (-6.98 mmHg [CI -1.86; -12.1], P = 0.009) and 24-h systolic BP (-9.71 mmHg [CI -0.20; -19.22], P = 0.046). The number of patients with a dipping pattern significantly increased in the CPAP group (51.7% vs. 24.1%, P = 0.008). CONCLUSION: In patients with resistant hypertension and OSA, CPAP treatment for 3 months achieves reductions in 24-h BP. This effect is seen in patients with ABPM-confirmed resistant hypertension who use CPAP more than 5.8 h.

Sistemática del pez Petenia splendida (Perciformes: Cichlidae) en el lago Petén Itzá, Guatemala

Systematic of the fish Petenia splendida (Perciformes: Cichlidae) of Lake Petén Itzá, Guatemala. The Lake Petén Itzá is located in the multiple use zone of the Maya Biosphere Reserve. It belongs to the subtropical moist forest (warm) life zone, and has very important flora and fauna diversities. Among the fish species, the white fish (Petenia splendida) is of high commercial value. The main goal of the present work was to clarify the taxonomic position of the two forms of the white fish in Petén (Guatemala), and to compare it with the Usumacinta (Mexico) form, based on the collected material from 1978 and 2006 (Usumacinta), and collections made during 2008 and 2009 in the Lake Petén Itzá. Samples were obtained from 10 different locations in the lake. From the total of 57 fish specimens collected, 50 fish were selected (25 yellow form and 25 silver form); besides, 21 specimens from 10 locations of the Usumacinta river in Mexico, from the Fish Collection, FCB, UANL. A total of 36 morphometric and 16 meristic characteristics, were analyzed, and also coloration, habitat and fishing method. This study reports the P. splendida of the Lake Petén Itzá with the following characteristics: the yellow form at a depth of 0.5-1.5m with dorsal fin XIV-(Xv)-XVI/11-(12)-13, the silver form at a depth of 2-3m with dorsal fin XIV-(XV)-XVI/10-(12)-13, and the Usumacinta form with a dorsal fin XIV-(XV)-XV/12-(13)-13. The discrimination analysis demonstrates a differentiation among the three analyzed populations. Some of the characteristics are the ocular diameter, the anal source-pelvic source distance and the dorsal source-anal source distance. The geographic area studied has a high diversity of fish fauna along the watershed, and it is possible to observe the anthropogenic damage, due to the overexploitation based the unapplicability of the existent regulation and the urbanization. If this situation continues it could jeopardize the survival of this emblematic specie. Rev. Biol. Trop. 59 (3): 1205-1216. Epub 2011 September 01.

El Lago Petén Itzá se ubica en la zona de usos múltiples de la Reserva de la Biosfera Maya, entre sus especies ícticas encontramos al pez blanco (Petenia splendida) de alto valor comercial. El propósito del presente trabajo es aclarar la posición taxonómica de las dos formas de pez blanco de Petén y compararlas con la forma del Usumacinta. Entre 2008 y 2009 se recolectaron 25 ejemplares de la forma amarilla y 25 de la plateada en 10 localidades del lago Petén Itzá y 21 en la cuenca del Usumacinta durante 1978 y 2006; se revisaron 36 características morfométricas y 16 merísticas, así como coloración, hábitat y forma de pesca. La P. splendida del Lago presenta las siguientes características: la forma amarilla se encuentra a una profundidad entre 0.5 y 1.5m, tiene aleta dorsal XIV-(XV)-XVI/11-(12)-13; la plateada esta a profundidades entre 2-3m, presenta aleta dorsal XIV-(XV)-XVI/10-(12)-13, mientras que la forma del Usumacinta posee aleta dorsal XIV-(XV)-XV/12-(13)-13. El análisis discriminante muestra una diferenciación entre las tres poblaciones analizadas aunque no es determinante. La fauna de peces de la cuenca del área de estudio presenta alta diversidad, se observa daño antropogénico producto de la sobreexplotación, por la falta de aplicación de la reglamentación existente y la urbanización.