THE ROLE OF IMMUNOMODULATORY THERAPY WITH OXIRIS IN COVID 19 WITH RENAL FAILURE AND IMMUNE DYSFUNCTION.

INTRODUCTION: The main objective of this study is to evaluate the impact of hemoadsorption on the elimination of inflammatory mediators. METHODS: A prospective, bicenter, observational cohort study was conducted between March 2020 and February 2022 to explore the immunomodulatory response, demographic and clinical characteristics of individuals with COVID-19 admitted to the ICU with severe acute respiratory failure and in need of CRRT with Oxiris® with or without AKI. RESULTS: 64 patients were analyzed. Statistically significant differences were observed between exposed and unexposed groups, regarding levels of D-dimer -15614 (24848.9) vs -4136.5(9913.47) (p .031, d:1.59, 95% CI -21830, -1126). An increase in PCT was observed 0.47(2.08) vs -0.75(2.3) (p .044 95% CI 0.03,2.44). No differences were found in a decrease in CRP -4.21(7.29) vs -1.6(9.02) (p .22) nor in the rest of inflammatory parameters fibrinogen, IL-6, ferritin, lymphocytes, and neutrophils. Subgroup analysis in patients exposed to therapy also showed a significant decrease in D-Dimer of 55% from baseline; 6000 (1984.5-277750) pre-therapy vs 2700 (2119.5-6145) (95% CI -23000, -2489) post-therapy with a strong effect size (p .001, d:0.65). CONCLUSION: The hemoadsorptive therapy in COVID 19 was associated with a significant decrease in D-dimer parameters without showing decreases in the rest of the clinical, inflammatory parameters and severity scales analyzed.

Toxicity of commercial atrazine in rattus novergicus organs as a function of concentration: histopathological, ultrastructural and hematological evaluation.

The effect of commercial Atrazine (ATR) on Rattus Novergicus organs was determined for a concentration of cATR of 1, 3, 13, 30, and 50 ppb. ATR was dissolved in drinking water. The rats were allowed to drink from it ad libitum for an uninterrupted period of 28 days as established by the Office of Environmental Protection protocol under the number EPA OPPTS 870.3050. In the 28 days of the test, data on the behavior of the medicated animals was recorded before the extraction of sample tissues (heart, liver, spleen, brain, and testicles) for histological analysis. A direct correlation of cATR and organ damage was found. The study showed that even for the smallest doses (1ppb), commercial ATR produced several lesions in the studied animals. The rats showed hepatic periacinar necrosis with acute coagulation, hepatocyte lipidosis, severe portal lymphocytic inflammation, coronary periarteritis, and lymphocytic meningoencephalitis for high concentrations. In the male reproductive system, testicular degeneration with mild acute tubular necrosis was observed.

A Case Study on Vestibular Sensations in Driving Simulators.

Motion platforms have been used in simulators of all types for several decades. Since it is impossible to reproduce the accelerations of a vehicle without limitations through a physically limited system (platform), it is common to use washout filters and motion cueing algorithms (MCA) to select which accelerations are reproduced and which are not. Despite the time that has passed since their development, most of these algorithms still use the classical washout algorithm. In the use of these MCAs, there is always information that is lost and, if that information is important for the purpose of the simulator (the training simulators), the result obtained by the users of that simulator will not be satisfactory. This paper shows a case study where a BMW 325Xi AUT fitted with a sensor, recorded the accelerations produced in all degrees of freedom (DOF) during several runs, and data have been introduced in mathematical simulation software (washout + kinematics + actuator simulation) of a 6DOF motion platform. The input to the system has been qualitatively compared with the output, observing that most of the simulation adequately reflects the input to the system. Still, there are three events where the accelerations are lost. These events are considered by experts to be of vital importance for the outcome of a learning process in the simulator to be adequate.

Combination of arterial lactate levels and Cv-aCO2/Da-vO2 ratio to predict early allograft dysfunction after liver transplantation.

PURPOSE: We examined the ability of the P(v-a)CO2/Da-vO2 ratio combined with elevated lactate levels to predict early allograft dysfunction (EAD). MATERIALS AND METHODS: Patients were classified into four groups according to lactate levels and P(v-a)CO2/Da-vO2 ratio: Group 1; lactate >2.0 mmol/L and P(v-a)CO2/Da-vO2 ratio >1.0; Group 2; lactate >2.0 mmol/L and P(v-a)CO2/Da-vO2 ratio <1.0; group 3; lactate<2.0 mmol/L and P(v-a)CO2/Da-vO2 ratio >1.0; group 4; lactate<2.0 mmol/L and P(v-a)CO2/Da-vO2 ratio <1.0. We defined EAD according to Olthoff criteria. RESULTS: One-hundred and fifty patients were included. EAD occurred in 41 patients (27.3%), and was associated with worse graft survival at 1 year (92% vs. 73%; P = ,003) as well as a higher re-transplantation rate (4,6% vs. 17,1%; P = ,019). The multivariate analysis revealed that P(v-a)CO2/Da-vO2 ratio at T6 [OR 7.05(CI95% 2.77-19.01, P<.001)] was an independent predictor for EAD. Belonging to group 1 at 6 h was associated with worse clinical outcomes but no association was found with 1-year graft survival or 1-year patient survival. CONCLUSIONS: In this single center, prospective, observational study in patients who received an OLT, we found that elevated lactate levels combined with a high Cv-aCO2/Da-vO2 after 6 h was associated with the development of EAD and worse clinical outcomes in the early postoperative period.

Development of a Hybrid Method to Generate Gravito-Inertial Cues for Motion Platforms in Highly Immersive Environments.

Motion platforms have been widely used in Virtual Reality (VR) systems for decades to simulate motion in virtual environments, and they have several applications in emerging fields such as driving assistance systems, vehicle automation and road risk management. Currently, the development of new VR immersive systems faces unique challenges to respond to the user's requirements, such as introducing high-resolution 360° panoramic images and videos. With this type of visual information, it is much more complicated to apply the traditional methods of generating motion cues, since it is generally not possible to calculate the necessary corresponding motion properties that are needed to feed the motion cueing algorithms. For this reason, this paper aims to present a new method for generating non-real-time gravito-inertial cues with motion platforms using a system fed both with computer-generated-simulation-based-images and video imagery. It is a hybrid method where part of the gravito-inertial cues-those with acceleration information-are generated using a classical approach through the application of physical modeling in a VR scene utilizing washout filters, and part of the gravito-inertial cues-the ones coming from recorded images and video, without acceleration information-were generated ad hoc in a semi-manual way. The resulting motion cues generated were further modified according to the contributions of different experts based on a successive approximation-Wideband Delphi-inspired-method. The subjective evaluation of the proposed method showed that the motion signals refined with this method were significantly better than the original non-refined ones in terms of user perception. The final system, developed as part of an international road safety education campaign, could be useful for developing further VR-based applications for key fields such as driving assistance, vehicle automation and road crash prevention.

Novel Insights into the Multiple Sclerosis Risk Gene ANKRD55.

An intronic variant in ANKRD55, rs6859219, is a genetic risk factor for multiple sclerosis, but the biological reasons underlying this association are unknown. We characterized the expression of ANKRD55 in human PBMCs and cell lines. Three ANKRD55 transcript variants (Ensembl isoforms 001, 005, and 007) could be detected in PBMCs and CD4(+) T cells but were virtually absent in CD8(+), CD14(+), CD19(+), and CD56(+) cells. Rs6859219 was significantly associated with ANKRD55 transcript levels in PBMCs and CD4(+) T cells and, thus, coincides with a cis-expression quantitative trait locus. The processed noncoding transcript 007 was the most highly expressed variant in CD4(+) T cells, followed by 001 and 005, respectively, but it was not detected in Jurkat, U937, and SH-SY5Y cell lines. Homozygotes for the risk allele produced more than four times more transcript copies than did those for the protective allele. ANKRD55 protein isoforms 005 and 001 were predominantly located in the nucleus of CD4(+) T cells and Jurkat and U937 cells. ANKRD55 was produced by primary cultures of murine hippocampal neurons and microglia, as well as by the murine microglial cell line BV2, and it was induced by inflammatory stimuli. ANKRD55 protein was increased in the murine mouse model of experimental autoimmune encephalomyelitis. Flow cytometric analysis of CNS-infiltrating mononuclear cells showed that CD4(+) T cells and monocytes expressed ANKRD55 in experimental autoimmune encephalomyelitis mice, with the higher fluorescence intensity found in CD4(+) cells. A low percentage of microglia also expressed ANKRD55. Together, these data support an important role for ANKRD55 in multiple sclerosis and neuroinflammation.

A nodule on the scalp as the first sign of extranodal disease in medullary thyroid carcinoma.

Medullary carcinoma of the thyroid gland accounts for only 5-10% of thyroid carcinomas. Also, metastases to the skin of malignant tumors are infrequently (2-9% of patients). In the case herein reported in a 64-year old woman, a metastatic nodule on the scalp was the presenting clinical manifestation of a medullary thyroid carcinoma. A comprehensive review of the literature was conducted for similar cases using PubMed. Only 18 cases of cutaneous metastases of medullary thyroid carcinoma have been previously reported in the literature, but skin lesions were the presenting complaint of the thyroid neoplasm in only three.

Vitreous-lens interface changes after cataract surgery using active fluidics and active sentry with high and low infusion pressure settings.

PURPOSE: To determine whether the infusion pressure used during phacoemulsification may have a detrimental effect on the anterior hyaloid membrane barrier (AHMB) in a pressure fluctuation-free environment using diagnostic spectral-domain optical coherence tomography (SD-OCT) postoperatively. SETTING: Tandil Eye Clinic, Tandil, Buenos Aires, Argentina, and Centro Oftalmológico Dr. Charles, CABA, Buenos Aires, Argentina. DESIGN: Prospective, randomized, multicenter, experimental, and double-masked study. METHODS: Phacoemulsification with intraocular lens implantation was performed in all patients with the Centurion Vision System equipment with active fluidics and active sentry. Patients were randomly assigned to configuration 1 or 2. Configuration 1 had intraocular pressure (IOP) 30 mm Hg and configuration 2 IOP 80 mm Hg. Inclusion criteria were axial length >22 mm and <25 mm, age older than 50 and younger than 70 years, and complete adhesion of AHMB. RESULTS: 80 eyes of 80 patients were included. Berger space was identified in 17 cases (42.5%) of group 2 and 3 cases (7.5%) of group 1 postoperatively using SD-OCT. A statistically significant relationship was established using Fisher exact test ( P = .0003). Postoperatively, we observed posterior vitreous detachment changes in only 1 patient (1.25%) during the 3 months of follow-up ( P = .5). According to the Wong-Baker FACES Scale, the patient's subjective perception was better for the low infusion pressure group ( P = .0001, Fisher exact test). CONCLUSIONS: Phacoemulsification with high infusion pressure can change the vitreous-lens interface. Positive Berger space after phacoemulsification is a biomarker of this change and can occur in eyes without risk factors. Incidence is directly related to the infusion pressure used.

Optimal Prone Position Duration in Patients With ARDS Due to COVID-19: The Omelette Pilot Trial.

BACKGROUND: Prone position (PP) has been widely used in the COVID-19 pandemic for ARDS management. However, the optimal length of a PP session is still controversial. This study aimed to evaluate the effects of prolonged versus standard PP duration in subjects with ARDS due to COVID-19. METHODS: This was a single-center, randomized controlled, parallel, and open pilot trial including adult subjects diagnosed with severe ARDS due to COVID-19 receiving invasive mechanical ventilation that met criteria for PP between March-September 2021. Subjects were randomized to the intervention group of prolonged PP (48 h) versus the standard of care PP (∼16 h). The primary outcome variable for the trial was ventilator-free days (VFDs) to day 28. RESULTS: We enrolled 60 subjects. VFDs were not significantly different in the standard PP group (18 [interquartile range [IQR] 0-23] VFDs vs 7.5 [IQR 0-19.0] VFDs; difference, -10.5 (95% CI -3.5 to 19.0, P = .08). Prolonged PP was associated with longer time to successful extubation in survivors (13.00 [IQR 8.75-26.00] d vs 8.00 [IQR 5.00-10.25] d; difference, 5 [95% CI 0-15], P = .001). Prolonged PP was also significantly associated with longer ICU stay (18.5 [IQR 11.8-25.3] d vs 11.50 [IQR 7.75-25.00] d, P = .050) and extended administration of neuromuscular blockers (12.50 [IQR 5.75-20.00] d vs 5.0 [IQR 2.0-14.5] d, P = .005). Prolonged PP was associated with significant muscular impairment according to lower Medical Research Council values (59.6 [IQR 59.1-60.0] vs 56.5 [IQR 54.1-58.9], P = .02). CONCLUSIONS: Among subjects with severe ARDS due to COVID-19, there was no difference in 28-d VFDs between prolonged and standard PP strategy. However, prolonged PP was associated with a longer ICU stay, increased use of neuromuscular blockers, and greater muscular impairment. This suggests that prolonged PP is not superior to the current recommended standard of care.

Health Promoting Universities and the salutogenic theory: contemporary challenges in the Latin American reality.

The objective is to reflect on the existing articulation between Aaron Antonovsky's salutogenic theory and Health Promoting Universities, highlighting the challenges for the operationalization of health promotion actions in the Latin American university scenario in the contemporary world. The visible adherence of the ideas of the salutogenic theory to the guiding components of the Health Promoting Universities movement was identified, which has contributed to successful experiences around the world. Practices in the light of salutogenic theory can be considered effective strategies for improving the quality of life in the university setting; however, it is necessary for those involved to detach themselves so that the logic of acting based on a pathogenic process is broken. Furthermore, regional challenges in the Latin American reality must be understood and overcome with the support of public policies.

Health indicators in Brazil and Spain: strategies for health promoting universities.

AIMS: The study aims to identify and compare health indicators collected by national research in Spain and in Brazil that can generate action strategies for health promoting universities. METHODS: This is an epidemiological, descriptive, cross-sectional study that uses the database of the Secretariat of Health Surveillance of the Brazilian Ministry of Health and the database of the National Statistics Institute of Spain. Based on the National Health Promotion Policy, the analyzer axis prioritizes defined themes; percentage of physical exercise, daily smokers, sedentary lifestyle, obesity and self-perception of health status were evaluated. The data were collected from 2014 to 2020. RESULTS: In Brazil, physical exercise is the highest percentage indicator, whereas in Spain, sedentary lifestyle is the highest. Regarding the age group, Brazil presented the lowest prevalence of daily smokers in the age group from 18 to 24, with little increase in older age groups; in Spain, older age groups presented the highest rates of sedentary lifestyle and obesity. In 2020, 4.5% of Brazilians reported a negative self-perception of health and in Spain 6.6%. CONCLUSION: The indicators 'physical exercise', 'daily smokers' and 'sedentary lifestyle' presented better results in Brazil than in Spain. Brazil presents a better perspective on health when compared with Spain, as the results showed that older ages present higher rates of sedentary lifestyle and obesity. Our study results also show that Brazilians report better self-perception in health, which can be interpreted by health promotion strategies.

Shock Index and Physiological Stress Index for reestratifying patients with intermediate-high risk pulmonary embolism.

OBJECTIVE: Study and Evaluation of Two Scores: Shock Index (SI) and Physiological Stress Index (PSI) as discriminators for proactive treatment (reperfusion before decompensated shock) in a population of intermediate-high risk pulmonary embolism (PE). DESIGN: Using a database from a retrospective cohort with clinical variables and the outcome variable of "proactive treatment", a comparison of the populations was conducted. Optimal cut-off for "proactive treatment" points were obtained according to the SI and PSI. Comparisons were carried out based on the cut-off points of both indices. SETTING: Patients admitted to a mixed ICU for PE. PARTICIPANTS: Patients >18 years old admitted to the ICU with intermediate-high risk PE recruited from January 2015 to October 2022. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Population comparison and metrics regarding predictive capacity when determining proactive treatment. RESULTS: SI and PSI independently have a substandard predictive capacity for discriminating patients who may benefit from an early reperfusion therapy. However, their combined use improves detection of sicker intermediate-high risk PE patients (Sensitivity = 0.66) in whom an early reperfusion therapy may improve outcomes (Specificity = 0.9). CONCLUSIONS: The use of the SI and PSI in patients with intermediate-high risk PE could be useful for selecting patients who would benefit from proactive treatment.

Research, Reading, and Publication Habits of Nurses and Nursing Students Applied to Impact Journals: International Multicentre Study.

Publishing in JCR and SJR journals has become crucial for curricular development. Results from nursing investigations "compete" for publication in journals which are not specific to the field of care, affecting the academic development of these investigators. This phenomenon may lead to an ongoing adverse effect on nursing researchers and academics engaged in research in nursing care. The aim of this study was to evaluate habits regarding scientific literature consulting, the transfer of published material, and the citation of nursing investigations. A cross-sectional descriptive study by means of questionnaires was carried out, focusing on both Spanish and Portuguese nurses. The findings of the study reveal the following reasons for reading the scientific literature: that the language was understood; for learning and applying what was learnt; that the journal was of open access; for elaborating protocols and work procedures; and that the journal was indexed in scientific databases and in nursing databases. The reasons for reading, using, and publishing in journals were related to knowledge of the language and the associated usefulness of learning and applying knowledge. Creating a specific index of research publications in nursing will have a positive effect on the scientific production of caring methodologies.

Gender differences regarding informal caregivers of older people.

PURPOSE: The aim of this study was to examine differences related to gender among informal caregivers serving older disabled individuals. DESIGN AND METHODS: A secondary analysis of the most recent national cross-sectional survey, which was conducted in Spain on informal caregivers who served older individuals (65 years of age or older), was conducted in 2011 (N= 1,272, probability sample). The relationships between gender and intensity of care (amount and type of care provided), duration of caregiving, subjective burden, and satisfaction with caregiving were analyzed by bivariate and multivariate procedures. FINDINGS: No statistically significant gender differences were found with regard to the intensity of care, duration of caregiving, or satisfaction; however, subjective burden was found to differ between men and women, and this difference was statistically significant (odds ratio = 1.98; p= .012). CONCLUSIONS: Because this study was conducted in Spain, a country with strong patriarchal norms with regard to caregiving and familism, whereas gender differences in intensity of care have been reported in countries with low familism, we conclude that cultural diversity can influence the relationship between gender and intensity of care. On the other hand, our study increases the evidence in support of there being gender-based differences in subjective burden among family caregivers serving older people in Western industrial countries. Finally, the results of our study support the hypothesis that sources of satisfaction are more strongly related to the caregiver's personal context and characteristics than to his or her gender. CLINICAL RELEVANCE: These findings support the following recommendations regarding nursing interventions: (a) nurses should take into account specific cultural patterns in caregiving to improve their understanding concerning the relationships between gender and intensity of care, and (b) gender should be taken into account in interventions that are tailored toward addressing subjective burden.

[Evolution of primary health care in Spain]. / Evolución de la Atención Primaria en España. A través de 35 anos de la revista rol de enfermería.

Coinciding with the celebration of the 35th anniversary of the journal of nursing, invented in 1977, conducted a systematic review of all issues published (371) to identify items (222) and news (94) related to primary care health. Events are arranged temporarily and refer to accompanying the evolution of primary care model. The Analysis Shows the evolution of primary care, since its inception in 1978, has been reflected in the type of articles and the content of news published, be an excellent indicator of its development and contribution for the nurses.

[Crisis and nurses]. / Crisis y enfermeras.

Nobody can escape that we are in crisis. Already are responsible every day media, risk agencies and abstract but crucial markets reminded us. In this crisis, deep, prolonged and distressing health systems have been in the spotlight of national Governments and corporations, as key elements of building and resolution of the crisis. Generation because it interprets its inefficiency is responsible for much of the crisis. Resolution because it is understood that actions that envelope the same are carried out they shall foster the output. So then we have two key elements: crisis and health systems, which combine very differently but which inevitably and unfortunately have been associated on a permanent basis. To understand this symbiosis and try to analyze it I operate the simple formula of semantically understanding what is crisis and what health crisis.

Community Assets for Health Model and Assessment Scale: A Delphi-Based Analysis and Expert Validation.

The salutogenesis theory of Aaron Antonovsky and the Health Assets Model of Morgan and Ziglio have given rise to a notable interest in defining the resources available to individuals and the community to maintain or improve their health and well-being. The present study began by identifying the universal dimensions of Community Assets for Health, and then analyzed and validated an assessment scale following the Delphi method. A high degree of consensus was achieved among 13 experts from different disciplines. The results of the content analysis and statistical analysis led to a reconfiguring of an instrument that is so far unique in its approach. It is composed of 103 items across 14 dimensions (utility, intention, previous use, affordability, proximity, walkability, connectivity, intelligibility, identity, design, safety, diversity, public dimension, and sustainability).

Feeding Difficulties Associated with IBD during the Working Day: Qualitative Study, Alicante Spain.

Inflammatory bowel disease (IBD) is a chronic disease characterized by inflammation of the gastrointestinal tract. Nutrition is a key aspect as it can modulate much of the symptomatology. People affected by IBD often experience difficulties at work in all areas, including adapting their dietary management to workplace situations. The aim of this study is to identify the difficulties associated with eating during the working day in people diagnosed with IBD. A qualitative study was conducted through a nominal and focus group with people affected by IBD. After the thematic analysis of the data, three main themes emerged: management of food during the working day, searching for strategies to live with the disease, and the importance of visibility and support. This study shows that IBD influences the working life of people with IBD and makes it difficult to maintain an adequate diet. The institutions in charge of the treatment of IBD patients should consider the support of multidisciplinary teams, including nutrition professionals, as a fundamental part of the pathology control and dietary treatment to minimize its repercussions at work.