Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Prospective, Multicenter Cohort Study From Colombia, 2018-2022.

OBJECTIVES: High driving pressure (DP, ratio of tidal volume (Vt) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality. DESIGN: Multicenter, prospective study conducted between February 2018 and December 2022. SETTING: Twelve tertiary care PICUs in Colombia. PATIENTS: One hundred eighty-four intubated children with moderate to severe PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H2O, p < 0.01). Of note, children with a Vt less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H2O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H2O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02). CONCLUSIONS: In children with moderate to severe PARDS, a DP greater than 15 cm H2O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.

Differences in SARS-CoV-2 Clinical Manifestations and Disease Severity in Children and Adolescents by Infecting Variant.

Since the COVID-19 pandemic began, different SARS-CoV-2 variants have been identified and associated with higher transmissibility than the ancestral nonvariant strain. During January 1, 2021-January 15, 2022, we assessed differences in clinical and viral parameters in a convenience sample of COVID-19 outpatients and inpatients 0-21 years of age in Columbus, Ohio, USA, according to the infecting variant, identified using a mutation-specific reverse transcription PCR assay. Of the 676 patients in the study, 17.75% were infected with nonvariant strains, 18.49% with the Alpha variant, 41.72% with Delta, and 16.42% with Omicron. Rates of SARS-COV-2/viral co-infections were 15.66%-29.41% and were comparable across infecting variants. Inpatients with acute Delta and Omicron infections had lower SARS-CoV-2 cycle threshold values and more frequent fever and respiratory symptoms than those with nonvariant strain infections. In addition, SARS-COV-2/viral co-infections and the presence of underlying conditions were independently associated with worse clinical outcomes, irrespective of the infecting variant.

Effects of inhalation of low-dose nitrite or carbon monoxide on post-reperfusion mitochondrial function and tissue injury in hemorrhagic shock swine.

INTRODUCTION: Tissue reperfusion following hemorrhagic shock may paradoxically cause tissue injury and organ dysfunction by mitochondrial free radical expression. Both nitrite and carbon monoxide (CO) may protect from this reperfusion injury by limiting mitochondrial free radial production. We explored the effects of very small doses of inhaled nitrite and CO on tissue injury in a porcine model of hemorrhagic shock. METHODS: Twenty pigs (mean wt. 30.6 kg, range 27.2 to 36.4 kg) had microdialysis catheters inserted in muscle, peritoneum, and liver to measure lactate, pyruvate, glucose, glycerol, and nitrite. Nineteen of the pigs were bled at a rate of 20 ml/min to a mean arterial pressure of 30 mmHg and kept between 30 and 40 mmHg for 90 minutes and then resuscitated. One pig was instrumented but not bled (sham). Hemorrhaged animals were randomized to inhale nothing (control, n = 7), 11 mg nitrite (nitrite, n = 7) or 250 ppm CO (CO, n = 5) over 30 minutes before fluid resuscitation. Mitochondrial respiratory control ratio was measured in muscle biopsies. Repeated measures from microdialysis catheters were analyzed in a random effects mixed model. RESULTS: Neither nitrite nor CO had any effects on the measured hemodynamic variables. Following inhalation of nitrite, plasma, but not tissue, nitrite increased. Following reperfusion, plasma nitrite only increased in the control and CO groups. Thereafter, nitrite decreased only in the nitrite group. Inhalation of nitrite was associated with decreases in blood lactate, whereas both nitrite and CO were associated with decreases in glycerol release into peritoneal fluid. Following resuscitation, the muscular mitochondrial respiratory control ratio was reduced in the control group but preserved in the nitrite and CO groups. CONCLUSIONS: We conclude that small doses of nebulized sodium nitrite or inhaled CO may be associated with intestinal protection during resuscitation from severe hemorrhagic shock.

Use of multiplex PCR in pleural effusion: is it necessary to change the paradigm of culture-based methods?

The microbiological diagnosis of pleural effusion is based largely on classical microbiology methods, but these methods have a high rate of false negative results. Some previous studies have shown improved diagnostic performance for pathogens such as Streptococcus pneumoniae using molecular biology methods. We present the use of a multiplex PCR platform (BIOFIRE FILMARRAY Pneumonia Panel) for the aetiological diagnosis of pleural effusion in paediatric pneumonia. We present a case series of 17 pleural fluid samples that were processed by culture-based microbiology and molecular biology methods. Microbiological isolation was successful in four cases (25 %) through traditional culture methods. In contrast, the molecular biology panels allowed for detection in 16 out of 17 cases (94 %). The results from these panels led to a change in management for nine out of the 17 cases (52 %). This study found an increase in aetiological diagnosis in complicated pneumonia in children by using molecular biology methods, which led to a significant change in patient management.

[Depression and its relationship with mild cognitive impairment and Alzheimer disease: A review study]. / La depresión y su relación con el deterioro cognitivo leve y la enfermedad de Alzheimer. Un estudio de revisión sistemática.

The objective of the present study was to determine whether depression precedes Mild cognitive impairment (MCI) as a risk factor or as a predictor in Alzheimer's disease (AD). A systematic review of observational studies (cross-sectional and cohort or follow-up) was carried out using the PRISMA search algorithm, for clinical markers in MCI and AD, in the Science Direct, Springer, Scopus and Proquest databases. The study eligibility criteria included inclusion criteria: of types of documents, articles of primary studies, type of source scientific journals, published in the English language, from January 2010 to April 2020, in patients with MCI and AD and in the group of age included in people with a minimum age range of 45years. Exclusion criteria were: publications older than 10years because the aim of the article was to explore recent studies, secondary research studies, type of report document, languages other than English. 3385 articles were identified, of which 30 articles were finally selected. It was found that there is an association between depression and AD, but properly as a risk factor but not, as a predictor or clinical marker of the development of AD. The degree of association is greater when they present depressive symptoms and simultaneously report subjective memory complaints or the presence of MCI.

Association of Cancer Diagnosis and Therapeutic Stage With Mortality in Pediatric Patients With COVID-19, Prospective Multicenter Cohort Study From Latin America.

Background: Children with cancer are at risk of critical disease and mortality from COVID-19 infection. In this study, we describe the clinical characteristics of pediatric patients with cancer and COVID-19 from multiple Latin American centers and risk factors associated with mortality in this population. Methods: This study is a multicenter, prospective cohort study conducted at 12 hospitals from 6 Latin American countries (Argentina, Bolivia, Colombia, Ecuador, Honduras and Peru) from April to November 2021. Patients younger than 14 years of age that had an oncological diagnosis and COVID-19 or multisystemic inflammatory syndrome in children (MIS-C) who were treated in the inpatient setting were included. The primary exposure was the diagnosis and treatment status, and the primary outcome was mortality. We defined "new diagnosis" as patients with no previous diagnosis of cancer, "established diagnosis" as patients with cancer and ongoing treatment and "relapse" as patients with cancer and ongoing treatment that had a prior cancer-free period. A frequentist analysis was performed including a multivariate logistic regression for mortality. Results: Two hundred and ten patients were included in the study; 30 (14%) died during the study period and 67% of patients who died were admitted to critical care. Demographics were similar in survivors and non-survivors. Patients with low weight for age (<-2SD) had higher mortality (28 vs. 3%, p = 0.019). There was statistically significant difference of mortality between patients with new diagnosis (36.7%), established diagnosis (1.4%) and relapse (60%), (p <0.001). Most patients had hematological cancers (69%) and they had higher mortality (18%) compared to solid tumors (6%, p= 0.032). Patients with concomitant bacterial infections had higher mortality (40%, p = 0.001). MIS-C, respiratory distress, cardiovascular symptoms, altered mental status and acute kidney injury on admission were associated with higher mortality. Acidosis, hypoxemia, lymphocytosis, severe neutropenia, anemia and thrombocytopenia on admission were also associated with mortality. A multivariate logistic regression showed risk factors associated with mortality: concomitant bacterial infection OR 3 95%CI (1.1-8.5), respiratory symptoms OR 5.7 95%CI (1.7-19.4), cardiovascular OR 5.2 95%CI (1.2-14.2), new cancer diagnosis OR 12 95%CI (1.3-102) and relapse OR 25 95%CI (2.9-214). Conclusion: Our study shows that pediatric patients with new onset diagnosis of cancer and patients with relapse have higher odds of all-cause mortality in the setting of COVID-19. This information would help develop an early identification of patients with cancer and COVID-19 with higher risk of mortality.

La depresión y su relación con el deterioro cognitivo leve y la enfermedad de Alzheimer. Un estudio de revisión sistemática / Depression and its relationship with mild cognitive impairment and Alzheimer disease: A review study

El objetivo del presente estudio fue determinar si la depresión antecede al deterioro cognitivo leve (DCL) como factor de riesgo o como predictor en la enfermedad de Alzheimer (EA). Se realizó una revisión sistemática de estudios observacionales (transversales y de cohorte o seguimiento) mediante el algoritmo de búsqueda PRISMA, de los marcadores clínicos en DCL y EA, en las bases de datos Science Direct, Springer, Scopus y Proquest. Los criterios de elegibilidad del estudio incluyeron como criterios inclusión: tipos de documentos, artículos de estudios primarios; tipo de fuente, revistas científicas, en idioma inglés, desde enero de 2010 hasta abril de 2020, en pacientes con DCL y EA y en el grupo de edad comprendido en personas con un rango de edad mínimo de 45años. Los criterios de exclusión fueron: las publicaciones de más de 10años (el objetivo del artículo era explorar estudios recientes), estudios de investigación secundaria, tipo de documento de informe, otros idiomas diferentes al inglés. Se identificaron 3.385 artículos, de los que finalmente se seleccionaron 30 artículos. Se encontró que existe una asociación entre la depresión y la EA, pero propiamente como un factor de riesgo, mas no como un predictor o marcador clínico del desarrollo de la EA. El grado de asociación es mayor cuando presentan sintomatología depresiva y simultáneamente reportan quejas de memoria subjetiva o la presencia de DCL. (AU)

The objective of the present study was to determine whether depression precedes Mild cognitive impairment (MCI) as a risk factor or as a predictor in Alzheimer's disease (AD). A systematic review of observational studies (cross-sectional and cohort or follow-up) was carried out using the PRISMA search algorithm, for clinical markers in MCI and AD, in the Science Direct, Springer, Scopus and Proquest databases. The study eligibility criteria included inclusion criteria: of types of documents, articles of primary studies, type of source scientific journals, published in the English language, from January 2010 to April 2020, in patients with MCI and AD and in the group of age included in people with a minimum age range of 45years. Exclusion criteria were: publications older than 10years because the aim of the article was to explore recent studies, secondary research studies, type of report document, languages other than English. 3385 articles were identified, of which 30 articles were finally selected. It was found that there is an association between depression and AD, but properly as a risk factor but not, as a predictor or clinical marker of the development of AD. The degree of association is greater when they present depressive symptoms and simultaneously report subjective memory complaints or the presence of MCI. (AU)

Intervention for Smokers through New Communication Technologies: What Perceptions Do Patients and Healthcare Professionals Have? A Qualitative Study.

BACKGROUND: The use of information and communication technologies (ICTs) in the health service is increasing. In spite of limitations, such as lack of time and experience, the deployment of ICTs in the healthcare system has advantages which include patient satisfaction with secure messaging, and time saving benefits and utility for patients and health professionals. ICTs may be helpful as either interventions on their own or as complementary tools to help patients stop smoking. OBJECTIVES: To gather opinions from both medical professionals and smokers about an email-based application that had been designed by our research group to help smoking cessation, and identify the advantages and disadvantages associated with interventions based on the utilization of ICTs for this purpose. METHODS: A qualitative, descriptive-interpretative study with a phenomenological perspective was performed to identify and interpret the discourses of the participating smokers and primary healthcare professionals. Data were obtained through two techniques: semi-structured individual interviews and discussion groups, which were recorded and later systematically and literally transcribed together with the interviewer's notes. Data were analyzed with the ATLAS TI 6.0 programme. RESULTS: Seven individual interviews and four focal groups were conducted. The advantages of the application based on the email intervention designed by our research group were said to be the saving of time in consultations and ease of access for patients who found work timetables and following a programme for smoking cessation incompatible. The disadvantages were thought to be a lack of personal contact with the healthcare professional, and the possibility of cheating/ self-deception, and a greater probability of relapse on the part of the smokers. CONCLUSIONS: Both patients and healthcare professionals viewed the email-based application to help patients stop smoking as a complementary aid to face-to-face consultations. Nevertheless, ICTs could not substitute personal contact in the smoking cessation programme.

Vasculitis primaria del sistema nervioso central, un reto diagnóstico. Reporte de caso / Primary vasculitis of the central nervous system, a diagnostic challenge. Case report

RESUMEN La angeítis primaria del sistema es una rara entidad, en la cual hay destrucción y compromiso inflamatorio de los vasos del sistema nervioso central. Con frecuencia, es subdiagnosticada por sus múltiples formas de presentación clínica y por los hallazgos en neuroimágenes que pueden simular otras patologías, lo que retrasa el diagnóstico y el manejo oportuno. Este tipo de vasculitis es muy poco comprendida y no existen suficientes estudios en la actualidad respecto a su fisiopatología y manejo. Los marcadores inflamatorios suelen ser normales, con alteración del LCR en un 80-90 % de los casos y la arteriografía cerebral puede mostrar un patrón típico descrito como áreas alternantes de dilatación y estenosis; sin embargo, con muy baja sensibilidad. Ante una alta sospecha clínica y ausencia de pruebas diagnósticas no invasivas, el diagnóstico se realiza a través de biopsia de las lesiones cerebrales y meninges. Finalmente, el tratamiento se basa en combinación de corticoides y ciclofosfamida, aunque se carece de estudios controlados que lo soporten.

SUMMARY Primary angiitis of the central nervous system is a rare condition in which there is destruction and inflammatory involvement of the vessels of the central nervous system. It is often underdiagnosed given its multiple forms of clinical presentation and neuroimaging findings that can mimic other pathologies delaying diagnosis and management. This type of vasculitis is very poorly understood and there are not enough studies at present regarding the pathophysiology and management. Inflammatory markers are usually normal with abnormal CSF in 80-90 %% of cases and cerebral arteriography may show a typical pattern described as in "Rosario" however with very low sensitivity. Given the persistence of high clinical and absence of non-invasive diagnostic tests suspect the final diagnosis is made by biopsy of brain lesions and meninges. Finally, treatment is based on a combination of corticosteroids and cyclophosphamide however has not controlled studies support it.

Evolución de la ergonomía participativa: conceptos y aproximaciones metodologicas / Evolution of participatory ergonomics: concepts and methodological approaches

Se realizó una revisión descriptiva de la evolución de la ergonomía participativa como estrategia de intervención, su progreso conceptual y metodológico desde sus inicios de aplicación a la ac- tualidad. La revisión se realizó a partir de estrategias de consulta que incluyeron las siguientes: 1) consulta de seis bases de datos, 2) seis principales revistas científicas y 3) selección de cuatro libros especializados. Se seleccionaron 70 artículos potenciales clasificados como bibliografía exploratoria. Se establecieron como criterios de selección los siguientes: artículos científicos o libros especializados y tema central ergonomía participativa aplicada. De acuerdo con estos cri- terios se determinó como bibliografía pertinente y relevante 37 publicaciones, las cuales fueron analizadas a la luz de la evolución de la ergonomía participativa. Como conclusión se determinó que la ergonomía participativa puede ubicarse como una subárea de la Macroergonomía en cons- tante evolución que llega a considerarse por distintos autores como filosofía, modelo, enfoque, estrategia o metodología. Es necesario revisar la evidencia científica para desarrollar un concepto más acertado, que le permita a la ergonomía participativa ser parte integral en cada una de las dimensiones de la ergonomía.

This article is a descriptive review about the evolution of participatory ergonomics intervention strategy, its conceptual and methodological progress since its formation to its present applica- tion. The research was done throughout consultation strategies which included the following: 1) six databases, 2) six major scientific journals and 3) four specialized books. 70 potential articles were selected as exploratory literature. The selection criteria were focused on scientific articles or specialized books whose principal subject was participatory applied ergonomics. According to these criteria, 37 publications were chosen and analyzed focusing on the evolution of participa- tory ergonomics. In conclusion it was determined that participatory ergonomics can be classified as a subarea of Macroergonomics which is evolving continuously and is considered by different authors as philosophy, model, approach, strategy or methodology. It is necessary to review the scientific evidence to develop a most accurate concept that allows the participatory ergonomics to be an integral part in each of the dimensions of ergonomics.

Aceptabilidad, percepción y permisividad de los padres a las diferentes técnicas de manejo del comportamiento utilizadas en los pacientes pediátricos de la Clínica CES / Parental acceptability, perception and permissiveness of different behavior management techniques of patients treated at The CES University Dental Clinics

El propósito de este estudio fue medir el grado de aceptabilidad, permisividad y percepción por parte de los padres hacia las diferentes técnicas de manejo de comportamiento utilizadas en los pacientes atendidos en la Clínica Odontopediatría CES Sabaneta. Se seleccionó una muestra de 81 padres de familia, escogidos por conveniencia, sin distingo de edad, sexo raza, estado socioeconómico o escolaridad. Con el fin de evaluar el grado de aceptación, permisividad y percepción de las distintas técnicas, los padres fueron subdivididos en grupos de 10, a quienes se proyecto un video, de aproximadamente siete minutos, sobre el tratamiento y la utilización de las técnicas decir, mostrar y hacer, refuerzo positivo, refuerzo negativo, distracción contingente, restricción física y tabla de restrictiva. A continuación se procedió a recolectar información, mediante un cuestionario técnicamente diseñado y previamente válido por los investigadores con una prueba piloto. Los resultados en cuanto a aceptación, percepción y permisividad, fueron superiores y estadísticamente significativos a favor de las técnicas comunicativas – decir, mostrar y hacer, refuerzo positivo y distracción contingente – sobre las técnicas restrictivas – restricción física o tabla restrictiva -. Sin embargo, se observó que, a pesar de los bajos niveles de aceptación y percepción, el grado de permisividad (autorización) para las técnicas restrictivas aumentaba a medida que se daba una explicación previa y el tipo de procedimiento lo justificaba.

Niveles de colesterol sanguineo en poblaciones infantiles entre 6 y 10 años de dos estratos socioeconómicos diferentes / Serum cholesterol levels in children

Teniendo en cuenta que los niveles de colesterol sérico constituyen un factor predisponente para la aparición de enfermedades cardiovasculares y siendo un factor prevenible y detectable desde la infancia, se realizó un estudio clínico epidemiológico donde se determinaron las concentraciones de colesterol total sérico empleando el método enzimático (REFLOTRON), en 288 niños bogotanos con edades comprendidas entre los 6 y los 10 años de edad, de ambos sexos y pertenecientes a dos estratos socioeconómicos diferentes, con el fin de determinar los valores promedio y las posibles diferencias entre los dos sexos, grupos de edad y estrato socioeconómico. Dentro de los resultados, se obtuvieron valores promedio de colesterol total de 167,271 +/- 28,173 mg/dl, con diferencias significativas entre los promedios de la población de nivel socioeconómico medio alto y los de medio bajo (t<0,05). No se encontraron diferencias significativas en cuanto a la edad ni al sexo