Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort.

BACKGROUND: Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster. METHODS: Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3. RESULTS: Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3. CONCLUSIONS: During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis.

Food and beverage can coatings: A review on chemical analysis, migration, and risk assessment.

The internal surface of food and beverage cans is generally covered with polymeric coatings to preserve food and protect metal substrate from corrosion. Coating materials are complex formulations that contain different starting substances (e.g., monomers, prepolymers, additives, etc.) and in addition during the manufacture of the material several compounds can be formed (e.g., reaction products, degradation products, etc.). These substances have the potential to migrate into the food. Many of them have not been identified and only some have been toxicologically evaluated. This article aims to provide a comprehensive review on the analytical methods used for the identification of potential migrants in can coatings. The migration and exposure to chemicals migrating from can coatings are also reviewed and discussed so far, which is essential for risk assessment. Moreover, a brief section on the current status of the legislation on varnishes and coatings for food contact in Europe is also presented. Liquid chromatography coupled to diode array and fluorescence detectors and particularly to mass spectrometry and gas chromatography-tandem mass spectrometry seem to be the techniques of choice for the identification of potential migrants in can coatings. Some studies have reported migration levels of BPA (bisphenol A) and BADGE (bisphenol A diglycidyl ether) and derivatives exceeding the specific migration limits set in the European legislation. On the whole, low dietary exposure to migrants from can coatings has been reported. However, it is interesting to highlight that in these studies the combined exposure to multiple chemicals has not been considered.

Cybervictimization and suicidal ideation in adolescents: A prospective view through gratitude and life satisfaction.

Previous research reports that cybervictims are more likely to experience suicidal ideations. Gratitude and life satisfaction have shown to predict suicide risk, but they have rarely been explored in the cyberbullying context. Hence, this study examined the roles of gratitude and life satisfaction in suicide risk in cyberbullying situations. An initial sample of 858 adolescents participated in a prospective study, completing questionnaires assessing gratitude, life satisfaction, cyberbullying experiences and suicidal ideation. Results showed that low levels of gratitude and life satisfaction influence suicidal ideation in cybervictimized adolescents. Limitations and implications of this study are discussed.

Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients.

PURPOSE: Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. METHODS: We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. RESULTS: Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. CONCLUSION: Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.

The Role of Emotional Intelligence, the Teacher-Student Relationship, and Flourishing on Academic Performance in Adolescents: A Moderated Mediation Study.

Educational context has an important influence on adolescents' development and well-being, which also affects their academic performance. Previous empirical studies highlight the importance of levels of emotional intelligence for students' academic performance. Despite several studies having analyzed the association and underlying mechanisms linking emotional intelligence and academic performance, further research, including both personal and contextual dimensions, is necessary to better understand this relation. Therefore, the purpose of this study was to deepen the understanding of the effect of emotional intelligence has on academic performance, examining the possible mediating role of flourishing and the moderating role of the teacher-student relationship. A convenience sample of 283 adolescents (49.8% female), aged 12-18 years (M = 14.42, SD = 1.12), participated in a cross-sectional study by completing self-report questionnaires measuring emotional intelligence (Wong and Law Emotional Intelligence Scale), flourishing (Flourishing Scale), and teacher-student relationship (Inventory of Teacher-Student Relationships) and reported their grades of the previous term on four mandatory subjects in the Spanish education curriculum. Results indicated that flourishing completely mediated the path from emotional intelligence to academic performance and that teacher-student relationship was a significant moderator in this model. Thus, in adolescents with worse teacher-student relationship, the association of emotional intelligence and flourishing was stronger than in adolescents with better teacher-student relationship. In turn, flourishing was positively associated with academic performance. These results suggest that it is crucial to foster better teacher-student relationship, especially in adolescents with low emotional intelligence, and to positively impact their well-being and their academic performance.

Social Responsibility and Misleading Advertising of Health Products on the Radio. The Opinion of the Professionals.

This research studies the opinion of advertising professionals in agencies, on the responsibility in relation to misleading advertising of health-related products, on the medium of radio. Through a closed survey of these professionals with different types of response, dichotomous, multiple choice and Likert scale, relevant results were obtained regarding compliance and application of the law and social responsibility linked to an advertising that directly affect health. The results show that only 10% of them know the legislation, although almost 90% of those surveyed consider it necessary to have legislative knowledge, and for only half of these, is it important. A large majority assure that the health sector should be one of the most protected sectors in the advertising world and, it should be noted, that the vast majority of the professionals surveyed view the legal restrictions on advertising in the health sector as positive. There is no unanimity as to who is responsible for the message, agency or advertiser. For its part, radio is presented as one of the most serious media and less prone to misleading advertising. To conclude, it can be stated that the professionals of the agencies do not perceive the existence of misleading advertising in the health sector, neither do they consider radio as one of the media where this deception can most occur. However, they coincide in stating that the health sector is one of the most dangerous if the damage that advertising deception can cause to consumers is considered.

How Do Cyber Victimization and Low Core Self-Evaluations Interrelate in Predicting Adolescent Problematic Technology Use?

Research has demonstrated that cyber victimization is consistently associated with higher problem behaviors such as problematic technology use. However, little research has examined specific individual dispositions that can serve as a buffer in the link between cyber victimization and higher problematic uses of technology (i.e., problematic Internet, smartphone, and social media), such as core self-evaluations (CSE). A convenience sample of 1211 high school students, 657 females, 554 males, aged 12 to 18 (mean age = 13.74) completed measures of cyber victimization, CSE, and different problematic technology-related behaviors. Results of correlational analysis revealed significant associations between cyber victimization and all problematic uses of technology. Our findings also suggested that high CSE weakened the relationship between cyber victimization and two of the three problematic uses of technology. Consistent with social compensation theory, cyber victimization was concurrently linked to different problematic uses of technology. Low CSE also strengthened the link between cyber victimization and problems use of smartphones and social media and also showed a marginally significant interaction with cyber victimization in predicting problematic Internet use. Implications of these preliminary findings are discussed and avenues for further research are offered.

Gratitude and Emotional Intelligence as Protective Factors against Cyber-Aggression: Analysis of a Mediation Model.

Cyber-bullying is becoming an increasing school and health problem affecting adolescents worldwide. A number of studies have examined risk factors and protective factors in cyber-bullying situations and their consequences on the psychological well-being of adolescents. Gratitude and Emotional Intelligence (EI) are two personal resources that have been shown to have beneficial effects on the health and the social, personal and psychological functioning of young people. Nevertheless, little is known about these two variables in the context of cyber-bullying. The main purpose of this study was to examine the roles of gratitude and EI in cyber-aggression. Specifically, we hypothesised a mediational effect of gratitude in emotional intelligence-cyber-aggression link. A total of 1157 students aged 12-18 years (54.4% females) completed several questionnaires assessing gratitude (Gratitude Questionnaire; GQ-5), EI (Wong and Law's Emotional Intelligence Scale; WLEIS-S) and cyber-bullying (European Cyberbullying Intervention Project Questionnaire; ECIPQ). The results showed expected significant associations between the studied variables. Moreover, the structural equation model analysis confirmed that EI dimensions were indirectly associated with cyber-aggression via gratitude, even when controlling for the effects of socio-demographic variables. These findings provide evidence on why those adolescents high in emotional intelligence are less aggressive in cyber-bullying context and suggest possibilities for gratitude interventions to reduce aggressive actions by electronic means among adolescents. The theoretical and practical implications are discussed.

A Serial Mediation Model of the Relationship between Cybervictimization and Cyberaggression: The Role of Stress and Unforgiveness Motivations.

Cyberaggression is often triggered by cybervictimization. However, little attention has been given to the underlying mechanisms in this relationship. Specifically, this study examined the mediating roles of stress as well as unforgiveness (i.e., revenge and avoidance motivations) in the cybervictimization-cyberbullying aggression link. The main goal is to investigate the direct and indirect effects of cybervictimization on cyberbullying aggression while modeling a process in which cybervictimization causes stress, which in turn causes unforgiveness motivations concluding with cyberbullying aggression as the consequent. A total of 979 adolescents (Mage = 13.72, SD = 1.31) completed the relevant scales at two time points spaced four months apart. The results confirm that stress and revenge motivation at Time 1 act as serial mediators between cybervictimization at Time 1 and cyberbullying behaviors at Time 2. Additionally, the results reveal that avoidance at Time 1 was not a significant mediator in the links between cybervictimization at Time 1 and cyberbullying aggression at Time 2. Our findings provide support for the stress-and-coping model of forgiveness in adolescence and offer original insight into the developmental process of bully-victims in cyberbullying context. These results suggest the importance of efforts addressing motivations and emotion-focused coping strategies in adolescents who have been bullied to prevent and reduce those adolescents' future stress and aggressive behaviors. The contributions and implications of the results are discussed.

Porfiria eritropoyetica congénita o enfermedad de Gunther. 1er caso comprobado en el Hospital J.M. de los Ríos. / Congenital erythropoietic porfhiria or gunther disease. 1th verified case in the Hospital J.M. de los Rios

Los autores presentan un caso de PORFIRIA ERITROPOYETICA CONGENITA, cuadro clínico muy poco frecuente conociéndose apenas referencia de 60 casos publicados en el mundo, siendo el nuestro, el primero demostrado en el Hospital de Niños J.M. de los Ríos de Caracas. Nuestra paciente es hija de padres consanguíneos, con 3 hermanos de igual sexo fallecidos con igual sintomatología, es decir orinas rojas desde el nacimiento, fotosensibilidad de piel, eritrodoncia, uñas rojas, anemia hemolítica, esplenomegalia y que luego de comprobado el diagnóstico con la determinación de copro y uroporfirina en orina, se trató con protector solar (dioxido de titanio), Beta carotenos orales (Solatene) esplenectomía con aplicación prevía de vacuna antineumococcica (NeumoVac) y recientemente el egregado de carbón medicinal por vía oral. Su evolución ha sido favorable hasta el momento