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The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
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COVID-19 , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva , Pandemias , SARS-CoV-2RESUMO
The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
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In this work, a Monte Carlo ray-tracing model for the simulation and optimization of a fiber Luminescent Solar Concentrator (LSC) based on stacked layers of fiber arrays is developed and validated. The fiber LSC efficiency improvements are compared against a conventional planar LSC. We developed a new model to analyze the performance of different configurations of bulk-doped fibers and fibers constituted by a doped coating and a passive core. These configurations are analyzed also varying fiber packing geometry diameters, and length. Due to the exceptionally low absorption coefficient of the silica fibers (αwg ≈ 10-4 cm-1), concentration factors of up to 1.9 are predicted when dimensions are scaled over 1 m2, which improve more than twice the maximum concentration factor ever reported. These results serve as a preliminary theoretical study for the future development of a new LSC design based on flexible silica micro-fibers coated with Si-QDs doped poly(lauryl methacrylate) (PLMA) layers.
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Risk factors associated with severity and mortality attributable to COVID-19 have been reported in different cohorts, highlighting the occurrence of acute kidney injury (AKI) in 25% of them. Among other, SARS-CoV-2 targets renal tubular cells and can cause acute renal damage. The aim of the present study was to evaluate the usefulness of urinary parameters in predicting intensive care unit (ICU) admission, mortality and development of AKI in hospitalized patients with COVID-19. Retrospective observational study, in a tertiary care hospital, between March 1st and April 19th, 2020. We recruited adult patients admitted consecutively and positive for SARS-CoV-2. Urinary and serum biomarkers were correlated with clinical outcomes (AKI, ICU admission, hospital discharge and in-hospital mortality) and evaluated using a logistic regression model and ROC curves. A total of 199 COVID-19 hospitalized patients were included. In AKI, the logistic regression model with a highest area under the curve (AUC) was reached by the combination of urine blood and previous chronic kidney disease, with an AUC of 0.676 (95%CI 0.512-0.840; p = 0.023); urine specific weight, sodium and albumin in serum, with an AUC of 0.837 (95% CI 0.766-0.909; p < 0.001) for ICU admission; and age, urine blood and lactate dehydrogenase levels in serum, with an AUC of 0.923 (95%CI 0.866-0.979; p < 0.001) for mortality prediction. For hospitalized patients with COVID-19, renal involvement and early alterations of urinary and serum parameters are useful as prognostic factors of AKI, the need for ICU admission and death.
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Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/urina , COVID-19/mortalidade , COVID-19/urina , Injúria Renal Aguda/complicações , Injúria Renal Aguda/fisiopatologia , Adulto , Idoso , Área Sob a Curva , Biomarcadores/urina , COVID-19/complicações , COVID-19/fisiopatologia , Cuidados Críticos , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Urina/químicaRESUMO
A kinetic model has been developed for the formation of selected congeners of PCDD/Fs during the thermal decomposition of different wastes in a horizontal reactor. Previously published data on the decomposition of wastes have been correlated using a kinetic model that only considers process parameters, such as the presence of different amounts of oxygen in the atmosphere of reaction, chlorine and metals in the waste. The effect of both chlorine and metals is modelled through an equation assuming a "saturation effect", i.e., that a certain amount of each substance produces the maximum rate, and that higher amounts do not increase the rate. The presence of oxygen is modelled by a destruction reaction over part of the PCDD/Fs produced. The model, which uses data from more than 64 experiments, correlated the emissions of three selected congeners: 1,2,3,6,7,8-HxCDD, OCDF and 2,3,7,8-TCDF, which are enough to estimate the total amount and toxicity of an emission.
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Poluentes Atmosféricos , Benzofuranos , Dibenzodioxinas Policloradas , Poluentes Atmosféricos/análise , Benzofuranos/análise , Dibenzofuranos , Dibenzofuranos Policlorados , Incineração , Cinética , Laboratórios , Dibenzodioxinas Policloradas/análiseRESUMO
The proximity of the "post-antibiotic era", where infections and minor injuries could be a cause of death, there are urges to seek an alternative for the cure of infectious diseases. Copper nanoparticles and their huge potential as a bactericidal agent could be a solution. In this work, Cu and Cu oxide nanoparticles were synthesized by laser ablation in open air and in argon atmosphere using 532 and 1064 nm radiation generated by nanosecond and picosecond Nd:YVO4 lasers, respectively, to be directly deposited onto Ti substrates. Size, morphology, composition and the crystalline structure of the produced nanoparticles have been studied by the means of field emission scanning electron microscopy (FESEM), high resolution transmission electron microscopy (HRTEM), the energy dispersive spectroscopy of X-rays (EDS), selected area electron diffraction (SAED) and X-ray diffraction (XRD). The UV-VIS absorbance of the thin layer of nanoparticles was also measured, and the antibacterial capacity of the obtained deposits tested against Staphylococcus aureus. The obtained deposits consisted of porous coatings composed of copper and copper oxide nanoparticles interconnected to form chain-like aggregates. The use of the argon atmosphere contributed to reduce significantly the formation of Cu oxide species. The synthesized and deposited nanoparticles exhibited an inhibitory effect upon S. aureus.
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The development of nanofibers is expected to foster the creation of outstanding lightweight nanocomposites and flexible and transparent composites for applications such as optoelectronics. However, the reduced length of existing nanofibers and nanotubes limits mechanical strengthening and effective manufacturing. Here, we present an innovative method that produces glass nanofibers with lengths that are, effectively, unlimited by the process. The method uses a combination of a high-power laser with a supersonic gas jet. We describe the experimental setup and the physical processes involved, and, with the aid of a mathematical simulation, identify and discuss the key parameters which determine its distinctive features and feasibility. This method enabled the production of virtually unlimited long, solid, and nonporous glass nanofibers that display outstanding flexibility and could be separately arranged and weaved.
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OBJECTIVE: To analyze outcomes and factors related to mortality among very elderly trauma patients admitted to intensive care units (ICUs) participating in the Spanish trauma ICU registry. DESIGN: A multicenter nationwide registry. Retrospective analysis. November 2012-May 2017. SETTING: Participating ICUs. PATIENTS: Trauma patients aged ≥80 years. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: The outcomes and influence of limitation of life sustaining therapy (LLST) were analyzed. Comparisons were established using the Wilcoxon test, Chi-squared test or Fisher's exact test as appropriate. Multiple logistic regression analysis was performed to analyze variables related to mortality. A p-value <0.05 was considered statistically significant. RESULTS: The mean patient age was 83.4±3.3 years; 281 males (60.4%). Low-energy falls were the mechanisms of injury in 256 patients (55.1%). The mean ISS was 20.5±11.1, with a mean ICU stay of 7.45±9.9 days. The probability of survival based on the TRISS methodology was 69.8±29.7%. The ICU mortality rate was 15.5%, with an in-hospital mortality rate of 19.2%. The main cause of mortality was intracranial hypertension (42.7%). The ISS, the need for first- and second-tier measures to control intracranial pressure, and being admitted to the ICU for organ donation were independent mortality predictors. LLST was applied in 128 patients (27.9%). Patients who received LLST were older, with more severe trauma, and with more severe brain injury. CONCLUSIONS: Very elderly trauma ICU patients presented mortality rates lower than predicted on the basis of the severity of injury.
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Unidades de Terapia Intensiva , Pressão Intracraniana , Idoso , Idoso de 80 Anos ou mais , Mortalidade Hospitalar , Humanos , Masculino , Sistema de Registros , Estudos RetrospectivosRESUMO
Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient.
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Hiponatremia/diagnóstico , Hiponatremia/terapia , Algoritmos , Estado Terminal , Humanos , Guias de Prática Clínica como AssuntoAssuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Fatores Etários , Idoso , Anticoagulantes/administração & dosagem , Comorbidade , Cuidados Críticos , Fragilidade/diagnóstico , Escala de Coma de Glasgow , Humanos , Estudos Multicêntricos como Assunto , Seleção de Pacientes , TriagemAssuntos
Filtros de Veia Cava , Veia Cava Inferior , Trombose Venosa/prevenção & controle , Ferimentos e Lesões/complicações , Anticoagulantes/efeitos adversos , Contraindicações de Medicamentos , Humanos , Guias de Prática Clínica como Assunto , Filtros de Veia Cava/efeitos adversos , Trombose Venosa/etiologiaRESUMO
BACKGROUND: Nail psoriasis disease is associated with an increased probability of psoriatic arthritis, and its clinical signs may have different correlates with the pathogenesis of adjacent bone destruction and have different prognostic value. Recent publications about psoriasis and nail psoriatic disease describe different ultrasonographic findings but the relationship between these ungueal alterations measured by ultrasonography and the presence of enthesopathy of the extensor digitorum has yet to be discovered. OBJECTIVE: To describe which ultrasonographic characteristics of nail psoriasis are associated with the presence of subclinical enthesopathy in patients with PsO and asymptomatic PsA. METHODS: Patients with psoriasis and asymptomatic psoriatic arthritis were included in the prospective study. Demographic, clinical data and PASI and NAPSI indexes were recorded of all the patients in the assessment visit. The US assessment included Achilles tendon, extensor digitorum tendon and US scan of the nail plate, nail matrix, nail bed and adjacent skin over nail matrix of the five nails of each hand. RESULTS: Forty-eight patients were included in the study; 33 of them presented ultrasound evidence of extensor digitorum tendon enthesopathy. Nails of the patients with subclinical enthesopathy had a higher NAPSI and skin thickness than the nails of the patients without subclinical enthesopathy (P = 0.047). Patients with asymptomatic enthesopathy had significantly thicker proximal nail folds (1.44 ± 0.312 vs. 1.23 ± 0.27, P = 0.023). Nail beds and matrices were also thicker but the differences were not statistically significant (1.77 ± 0.27 vs. 1.74 ± 0.21, P = 0.66, and 1.79 ± 0.28 vs. 1.67 ± 0.19, P = 0.10, respectively). No statistically significant differences in the trilaminar structure were found between both groups. Patients with and without asymptomatic enthesopathy of extensor digitorum tendons did not statistically differ as regards ultrasonographic alterations of the Achilles tendons (60.6% vs. 46.4%, P 0.368). CONCLUSION: Enthesopathy abnormalities can be detected by US in patients with psoriasis without musculoskeletal complaints frequently. There is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations. Further studies are required to research what implications have the presence of these ungual alterations measured by US, and how it affects later development of a PsA.
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Entesopatia/diagnóstico por imagem , Doenças da Unha/diagnóstico por imagem , Unhas/diagnóstico por imagem , Psoríase/diagnóstico por imagem , Tendão do Calcâneo/diagnóstico por imagem , Adulto , Idoso , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico por imagem , Doenças Assintomáticas , Entesopatia/complicações , Feminino , Dedos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/complicações , Estudos Prospectivos , Psoríase/complicações , Índice de Gravidade de Doença , UltrassonografiaRESUMO
The formation of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F) is governed by complex chemical reactions with complex kinetic models. The simulation of Municipal Solid Waste incinerators, or other industrial thermal processes, is a powerful tool that can be used to optimize and control them, and reducing the number of components to simulate is mandatory for a proper use. In this study it has been determined that only the formation of 3 of the 17 main PCDD/F congeners can be considered as linearly independent. This fact has been used to establish linear regression models that are able to estimate properly the total amount and toxicity of a sample considering only the amount of 1,2,3,6,7,8-HxCDD, OCDF and 2,3,7,8-TCDF. All models have been validated using new samples performing a close approach to the real values provided by complete analytical studies. The average relative error is 3.5% and the maximum relative error is below 9% for these new testing samples. The main goal of our investigation is to build a dynamic simulation process of a MSW facility and include the dioxins formation on it using these models.
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Poluentes Atmosféricos/toxicidade , Dioxinas/toxicidade , Dibenzofuranos Policlorados/toxicidade , Monitoramento Ambiental , Incineração , Modelos Lineares , Dibenzodioxinas Policloradas/toxicidadeRESUMO
PURPOSE: Our purpose was to assess the amino acids' (AAs) profile in trauma patients and to assess the effect of the route of nutrition and the exogenous ALA-GLN dipeptide supplementation on plasma AAs' concentration. METHODS: This is a secondary analysis of a previous randomized controlled trial. On day 1 and day 6 after trauma, plasma concentration of 25 AAs was measured using reverse phase high-performance liquid chromatography. Results were analyzed in relation to the route of nutrition and supplementation of ALA-GLN dipeptide. Differences between plasma AAs' concentrations at day 1 and day 6 were evaluated using the Student's t test or Mann-Whitney-Wilcoxon test. One-way ANOVA and the Kruskal-Wallis test were used to compare groups. A two-sided p value less than 0.05 was considered statistically significant. RESULTS: Ninety-eight patients were analyzed. Mean plasma concentrations at day 1 were close to the lower normal level for most AAs. At day 6 we found an increase in the eight essential AAs' concentrations and in 9 out of 17 measured non-essential AAs. At day 6 we found no differences in plasma concentrations for the sum of all AAs (p = .72), glutamine (p = .31) and arginine (p = .23) distributed by the route of nutrition. Administration of ALA-GLN dipeptide increased the plasma concentration of alanine (p = .004), glutamine (p < .001) and citrulline (p = .006). CONCLUSIONS: We found an early depletion of plasma AAs' concentration which partially recovered at day 6, which was unaffected by the route of nutrition. ALA-GLN dipeptide supplementation produced a small increase in plasma levels of glutamine and citrulline.
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Aminoácidos/metabolismo , Suplementos Nutricionais , Dipeptídeos/administração & dosagem , Ferimentos e Lesões/metabolismo , Adolescente , Adulto , Idoso , Aminoácidos/sangue , Dipeptídeos/farmacocinética , Nutrição Enteral , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Nutrição Parenteral , Resultado do Tratamento , Ferimentos e Lesões/sangue , Adulto JovemRESUMO
The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients.