Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus.

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

Ureteral obstruction swine model through laparoscopy and single port for training on laparoscopic pyeloplasty.

This study aims firstly to assess the most adequate surgical approach for the creation of an ureteropelvic juntion obstruction (UPJO) animal model, and secondly to validate this model for laparoscopic pyeloplasty training among urologists. Thirty six Large White pigs (28.29±5.48 Kg) were used. The left ureteropelvic junction was occluded by means of an endoclip. According to the surgical approach for model creation, pigs were randomized into: laparoscopic conventional surgery (LAP) or single port surgery (LSP). Each group was further divided into transperitoneal (+T) or retroperitoneal (+R) approach. Time needed for access, surgical field preparation, wound closure, and total surgical times were registered. Social behavior, tenderness to the touch and wound inflammation were evaluated in the early postoperative period. After ten days, all animals underwent an Anderson-Hynes pyeloplasty carried out by 9 urologists, who subsequently assessed the model by means of a subjective validation questionnaire. Total operative time was significantly greater in LSP+R (p=0.001). Tenderness to the touch was significantly increased in both retroperitoneal approaches, (p=0.0001). Surgeons rated the UPJO porcine model for training on laparoscopic pyeloplasty with high or very high scores, all above 4 on a 1-5 point Likert scale. Our UPJO animal model is useful for laparoscopic pyeloplasty training. The model created by retroperitoneal single port approach presented the best score in the subjective evaluation, whereas, as a whole, transabdominal laparoscopic approach was preferred.

The Importance of Material Used in Speech Therapy: Two Case Studies in Minimally Conscious State Patients.

Speech therapy can be part of the care pathway for patients recovering from comas and presenting a disorder of consciousness (DOC). Although there are no official recommendations for speech therapy follow-up, neuroscientific studies suggest that relevant stimuli may have beneficial effects on the behavioral assessment of patients with a DOC. In two case studies, we longitudinally measured (from 4 to 6 weeks) the behavior (observed in a speech therapy session or using items from the Coma Recovery Scale-Revised) of two patients in a minimally conscious state (MCS) when presenting music and/or autobiographical materials. The results highlight the importance of using relevant material during a speech therapy session and suggest that a musical context with a fast tempo could improve behavior evaluation compared to noise. This work supports the importance of adapted speech therapy for MCS patients and encourages larger studies to confirm these initial observations.

Klebsiella pneumoniae and Streptococcus agalactiae: Passengers in the sperm travel. / Klebsiella pneumoniae y Streptococcus agalactiae: Pasajeros en el viaje del espermatozoide.

During their journey through the female reproductive tract to reach the oocyte in the ampulla of the fallopian tube, spermatozoa interact with substances and microorganisms that affect sperm quality, thus altering their fertilizing capacity. OBJECTIVES: To determine in vitro the effect of Streptococcus agalactiae, Klebsiella pneumoniae and their soluble factors on sperm parameters, and to evaluate the ability of human sperm to interact with and transport these bacteria. METHODS: The effects of S. agalactiae, K. pneumoniae and their soluble factors on the viability, sperm motility and functional sperm parameters were quantified. In addition, motile spermatozoa were incubated with decreasing concentrations of bacteria for one hour, washed and post-infection treatments were performed with trypsin and transport capacity was assessed by quantitative cultures. RESULTS: Incubation of spermatozoa with K. pneumoniae decreased progressive motility. The soluble factors of K. pneumoniae increased the number of necrotic spermatozoa and the soluble factors of S. agalactiae increased lipid peroxidation of the sperm membrane (p<0.05). A strong interaction between sperm and bacteria was observed in the transport assays even in washed trypsin-treated samples. CONCLUSION: Human spermatozoa act as vectors for infections, generating strong interactions with K. pneumoniae and S. agalactiae favoring their diffusion through the female reproductive tract. This interaction affects male fertility by altering progressive motility, increasing the number of necrotic cells and inducing apoptosis.

Los espermatozoides durante su recorrido por el tracto reproductivo femenino en busca del oocito interactúan con sustancias y microorganismos que afectan la calidad seminal alterando su capacidad fecundante.OBJETIVOS: Determinar el efecto in vitro de Streptococcus agalactiae, Klebsiella pneumoniae y sus factores evaluar la capacidad de los espermatozoides humanos para interactuar y transportar estas bacterias.MÉTODOS: Se cuantificó el efecto de la incubación de S. agalactiae, K. pneumoniae y sus factores solubles sobre la viabilidad, la movilidad y los parámetros espermáticos funcionales. Adicionalmente, espermatozoides móviles fueron incubados con concentraciones decrecientes de bacterias durante una hora, se realizaron lavados y tratamientos post infección con tripsina y se evaluó la capacidad de transporte mediante cultivos cuantitativos.RESULTADOS: La incubación de los espermatozoides con K. pneumoniae ATCC 1705 disminuyó la movilidad espermática tipo I. Los factores solubles de K. pneumoniae ATCC 700603 aumentaron el número de espermatozoides necróticos mientras que los factores solubles de S. agalactiae aumentaron la lipoperoxidación de la membrana espermática (p<0,05). En los ensayos de transporte se observó una interacción fuerte entre los espermatozoides y las bacterias, incluso en las muestras tratadas con tripsina y lavados.CONCLUSIÓN: Los espermatozoides humanos sirven como vectores de infecciones, generan interacciones fuertes con K. pneumoniae y S. agalactiae, favoreciendo su difusión por el tracto reproductivo femenino. Esta interacción afecta la fertilidad masculina alterando la movilidad progresiva, aumentando el número de células necróticas y la apoptosis espermática.

Relevancia de los factores de riesgo laborales en personal de recolección de residuos: una revisión / Relevance of Labor Risk Factors in Waste Collection Personnel. A Review / Relevância dos fatores de risco ocupacional nos trabalhadores de coleta de resíduos: uma revisão

Introducción: En la prestación del servicio público de aseo, los trabajadores se encuentran expuestos a múltiples factores de riesgo que pueden afectar su integridad personal, debido a la ocurrencia de accidentes o enfermedades laborales. Dentro de las actividades que agrupa este servicio se encuentran la disposición, recolección, almacena-miento, transporte y disposición final de residuos; así como el barrido, limpieza de vías, corte de césped o poda de árboles. Objetivo: Describir los factores de riesgo laborales asociados con la recolección de residuos sólidos urbanos dentro de la prestación del servicio público de aseo tanto en el ámbito internacional como en el nacional. Metodología: Se llevó a cabo una revisión bibliográfica descriptiva con un enfoque narrativo, usando palabras clave validadas en tesauros, en idioma inglés y español (entre ellas factores de riesgo, ergonomía, residuos sólidos, segregadores de residuos sólidos), y se seleccionaron artículos en un intervalo de tiempo de quince años, para un total de 50 referencias seleccionadas. Resultados: Los factores de riesgo más estudiados están relacionados con los ambientales, los psicosociales, los biológicos, los mecánicos y los ergonómicos, y dentro de este último el trastorno musculoesquelético es el factor más detectado en los artículos consultados. Conclusiones: Dentro de los factores de riesgo más prevalentes están los riesgos ergonómicos y el riesgo biológi-co, teniendo en cuenta las posturas que realizan para la ejecución de las actividades y el contacto directo con los desechos.

Introduction: In the provision of the public cleaning service worldwide, workers are continuously exposed to multiple risk factors that can affect their personal integrity, through the appearance of ac-cidents or occupational diseases, within the activities that the provision groups together. This service includes the disposal, collection, storage, transportation and final disposal of waste, as well as swee-ping, cleaning roads, cutting grass, pruning trees. Objective: To describe the occupational risk factors associated with the collection of urban solid waste within the provision of the public cleaning service both internationally and nationally. Methodology: A descriptive bibliographic review was carried out with a narrative approach using keywords validated in thesauri, in English and Spanish, including risk factors, ergonomics, solid waste, solid waste segregators, articles were selected in a time interval of 15 years, extracting the informa-tion from 50 selected references. Results: The most studied risk factors are related to environmental, psychosocial, biological, mecha-nical and ergonomic risks, where in the latter the musculoskeletal disorder is the most predominant factor detected in the articles consulted. Conclusions: Among the most prevalent risk factors are ergonomic risks and biological risk, taking into account the postures they perform for the execution of activities and direct contact with waste

Introdução: Na prestação de serviços de saneamento público, os trabalhadores são expostos a múlti-plos fatores de risco que podem afetar sua integridade pessoal, devido á ocorrência de acidentes ou doenças profissionais. Entre as atividades incluídas neste serviço estão à eliminação, recolha, armaze-namento, transporte e eliminação final de resíduos, bem como varrer, limpeza de estradas, corte de grama ou poda de árvores. Objetivo: Descrever os fatores de rico ocupacional associados a recolha de resíduos sólidos urbanos na prestação de serviços de saneamento público, tanto a nível internacional como nacional. Metodologia: Foi realizada uma revisão bibliográfica descritiva com uma abordagem narrativa, utili-zando palavras-chave validadas em thesaurus, em inglês e espanhol (entre elas fatores de risco, ergo-nomia, resíduos sólidos, segregadores de resíduos sólidos), e foram selecionados artigos ao longo de um período de quinze anos, para um total de 50 referências selecionadas. Resultados: Os fatores de risco mais estudados estão relacionados com fatores de risco ambientais, psicossociais, biológicos, mecânicos e ergonômicos, e dentre estes últimos às perturbações múscu-lo-esqueléticas são o fator mais detectado nos artigos consultados. Conclusões: Entre os fatores de risco mais prevalecentes estão os ricos ergonômicos e o risco bio-lógico, tendo em conta as posturas utilizadas na execução das atividades e o contato direto com os resíduos.

A propósito de la cardiopatía periparto: una etiología olvidada / Regarding peripartum heart disease: a forgotten etiology

Resumen Objetivo: Identificar la epidemiología clínica y los procesos diagnósticos y terapéuticos de las mujeres con miocardiopatía periparto en un centro de referencia cardiovascular. Método: Se realizó un estudio observacional descriptivo retrospectivo con pacientes de sexo femenino de entre 15 y 50 años con diagnóstico de cardiopatía periparto durante los últimos 10 años en una institución especializada de la ciudad de Medellín. Resultados: Hubo 17 mujeres con diagnóstico de cardiopatía periparto, con una edad media de 31 años (± 6.7). El número promedio de embarazos fue de 1.0, con un 52.9%. Las condiciones más frecuentes durante la gestación fueron obesidad y preeclampsia, con un 23.5% para ambas; se halló diabetes gestacional en una paciente (5.9%) y dos presentaron hemorragia del primer trimestre (11.8%). El 41.2% de las mujeres tuvieron parto vértice espontáneo. Ninguna mujer tuvo antecedentes cardiovasculares. Los síntomas presentados al momento del diagnóstico fueron deterioro de la clase funcional (100%), edema en miembros inferiores (52.9%), ortopnea (76.4%) y disnea paroxística nocturna (88.2%). La terapia farmacológica iniciada incluyó diuréticos (58.8%), inhibidores de la enzima convertidora de angiotensina (IECA) (64.7%), betabloqueadores (82.4%), bromocriptina (5.8%), ivabradina (23.5%) y antagonistas de la aldosterona (64.7%). Conclusiones: Este registro señala la similitud en nuestro medio de esta enfermedad, respecto a la epidemiología, la presentación y el manejo, con el resto del mundo. Muestra que el tratamiento farmacológico para falla cardiaca con la combinación de betabloqueadores, IECA y diuréticos sigue siendo el pilar fundamental en el tratamiento; además, destaca que la miocardiopatía periparto aún es una afección grave, con alta morbilidad y que permanece en insuficiencia cardiaca después del diagnóstico y con un riesgo importante de mortalidad.

Abstract Objective: To identify the epidemiology and the diagnostic and therapeutic processes of women with peripartum cardiomyopathy on a cardiovascular reference center. Method: A retrospective descriptive observational study was conducted with female patients between 15 and 50 years of age with a diagnosis of peripartum cardiomyopathy during the last 10 years. Results: 17 women with a diagnosis of peripartum cardiomyopathy where included, with a mean age of 31 (± 6,7) years at the time of diagnosis. The average number of previous pregnancies was 1.0 in 52.9% of the population. Obesity and preeclampsia were present in 23.5% and 18.8%, respectively. Diabetes was found in one patient (5.9%) and two had hemorrhage of the first trimester (11.8%). 41.2% of the women had a spontaneous vertex delivery. The symptoms presented at the time of diagnosis were deterioration of their functional class in 100.0%, edema in the lower limbs in 52.9%, orthopnea in 76.4% and paroxysmal nocturnal dyspnea in 88.2%. Conclusions: Our data show that peripartum cardiomyopathy occurs with a mode of presentation similar to the rest of the world, pharmacological treatment for heart failure with the combination of beta blockers, ACE inhibitors/ARBs, and diuretics continue to be the fundamental pillar in the treatment of peripartum cardiomyopathy; It is also important to note that peripartum cardiomyopathy remains a serious condition with a high rate of critically ill patients who remain in heart failure after diagnosis with a significant risk of mortality.

Changes on Adipose Tissue Distribution After Laparoscopic Roux-en-Y Gastric Bypass in Obese Göttingen Minipig. Effects on Glucose Metabolism.

BACKGROUND: The objective of the study was to assess Roux-en-Y independent-to-weight metabolic effects on an obese Gottingen minipig. METHODS: Eleven castrated Göttingen minipigs were enrolled. Minipigs became obese after a 9-month period of experimental diet. The animals were then subjected to a laparoscopic Roux-en-Y gastric bypass (period P1) followed by 4 months of follow-up (period P2). During this last period, they were fed to maintain similar body weight to that observed at the day of surgery. Registered parameters during each period included biometric variables; abdominal adipose tissue (AT) distribution; lipid profile; HOMA-IR; and fasting plasma leptin, adiponectin, glucose, insulin and fructosamine. RESULTS: Two pigs were unable to complete the study due to postoperative complications. Four months after surgery, the body weight (kg) was maintained (P1 51.90 ± 5.78 vs P2 51.47 ± 5.68). On the contrary, intraperitoneal AT (p < 0.0001), glucose (mmol/L) (P1: 5.53 ± 0.37 vs 4.66 ± 0.72, p = 0.019), fructosamine (µmol/L) (p = 0.0001) and insulin (pmol/L) (P1: 36.66 ± 13.94 vs P2: 21.42 ± 12.62, p = 0.001) significantly decreased after surgery. Lipid profile showed a significant increase after high-fat feeding period and a slight reduction at P2, which continued increasing. At the end of the study, leptin plasma levels (ng/mL) showed a significant reduction compared to basal value (p = 0.001). CONCLUSIONS: The improvement in glucose metabolism seems to occur by means of the redistribution of body fat. In order to fully confirm this hypothesis, more studies including the evaluation of incretins and inflammatory molecules, as well as a glycaemia control study against glucose load, are needed.

Conocimiento del riesgo de presentar un infarto de miocardio y las barreras para el acceso al estilo de vida saludable / Knowledge of the risk of a myocardial infarction presentation and barriers to a healthy life style in a population of Medellin, Colombia

Introducción: La falta de infomación sobre los factores de riesgo para presentar un infarto agudo de miocardio es un elemento que permite incrementar su prevalencia en nuestra comunidad. Objetivos: Identificar el conocimiento de los factores de riesgo cardiovasculares y las barreras para su modificación en una población de Medellín, Colombia. Metodología: Estudio descriptivo de corte transversal, se incluyó a la población que asistió a las jornadas del día mundial del corazón y se registraron variables antropométricas. Adicionalmente se indagó sobre el conocimiento de la principal causa de muerte en Colombia y en el mundo, su intención de realizar cambios en el estilo de vida y las barreras para implementarlo. Se realizó análisis bivariado según el sexo. Resultados: Se incluyeron 1.324 adultos. El 46% de los hombres vs. el 41,4% de las mujeres identificó la enfermedad coronaria como la primera causa de muerte. La mayoría de los hombres y las mujeres manifestaron su interés en iniciar un estilo de vida saludable (91,8 vs. 94,5% p = 0,07). La falta de tiempo fue la principal barrera. El 2,2% de los hombres y 2,6% de las mujeres manifestaron desconocer cómo pueden iniciar un estilo de vida saludable. Conclusión: Existe un pobre reconocimiento de la enfermedad coronaria como causa de muerte, especialmente en las mujeres, la falta de tiempo y los factores económicos son la principal barrera para implementar cambios en los factores de riesgo modificables.

Introduction: The lack of information about cardiovascular risk factors is an element that increases their prevalence in our community. Objective: To identify the knowledge of cardiovascular risk factors and barriers for their modification in a population of men and women of Medellin, Colombia. Methodology: A descriptive, cross-sectional study was conducted including the population that assisted to the world heart day event. Anthropometric variables, vital signs and blood glucometry were performed. People were asked about their knowledge of the main cause of dead in Colombia and worldwide, their intention to implement changes in their lifestyle and the barriers to implement it. A bivariate analysis was performed by sex. Results: 1,324 adults were included; 46 vs. 41.4% of men and women identified coronary heart disease as the first cause of dead worldwide and in Colombia. The majority of men and women talk about their interest in changing their life style (91.8 vs. 94.5% p=.07). Lack of time was identified as the leading barrier to access a healthy lifestyle. 2.2% of men and 2.6% of women didn’t know how to start a healthy lifestyle. Conclusion: There is a poor recognition of coronary heart disease as a cause of dead, especially in women; lack of time and economical factors are the main barrier to implement changes in modifiable risk factors.