Strengthening the role of science and technology in disaster risk reduction: the Chilean strategy.

This paper presents an integrative case study of Chile's national strategy of research, development, and innovation (R&D+i) for disaster resilience and progress towards developing the institutional conditions necessary for its successful implementation. The paper covers the period between 2016 and 2021, concentrating on the work of the Chilean Commission of R&D+i for Resilience to Disasters of Natural Origin (CREDEN). Through an analysis of the official records of the initiative at all of its stages, and 29 semi-structured interviews with CREDEN members and stakeholders, we aim to present a successful example of strengthening the role of science and technology in disaster risk reduction. Chile's experience is particularly interesting because its strategy focused on R&D+i and proposed developing an industry of scientific-based technological solutions for disaster resilience. The study also illustrates how strategic interaction between academia, state, and industry can be a key factor in aligning knowledge production to tackle current socio-technical challenges.

Implementation of Facility Management for Port Infrastructure through the Use of UAVs, Photogrammetry and BIM.

The maintenance of port infrastructures presents difficulties due to their location: an aggressive environment or the variability of the waves can cause progressive deterioration. Maritime conditions make inspections difficult and, added to the lack of use of efficient tools for the management of assets, planning maintenance, important to ensure operability throughout the life cycle of port infrastructures, is generally not a priority. In view of these challenges, this research proposes a methodology for the creation of a port infrastructure asset management tool, generated based on the Design Science Research Method (DSRM), in line with Building Information Modeling (BIM) and digitization trends in the infrastructure sector. The proposal provides workflows and recommendations for the survey of port infrastructures from UAVs, the reconstruction of digital models by photogrammetry (due to scarce technical documentation), and the reconstruction of BIM models. Along with this, the bidirectional linking of traditional asset management spreadsheets with BIM models is proposed, by visual programming, allowing easy visualization of the status and maintenance requirements. This methodology was applied to a port infrastructure, where the methodology demonstrated the correct functionality of the asset management tool, which allows a constant up-dating of information regarding the structural state of the elements and the necessary maintenance activities.

Unmanned Aerial Vehicles (UAVs) for Physical Progress Monitoring of Construction.

The physical progress of a construction project is monitored by an inspector responsible for verifying and backing up progress information, usually through site photography. Progress monitoring has improved, thanks to advances in image acquisition, computer vision, and the development of unmanned aerial vehicles (UAVs). However, no comprehensive and simple methodology exists to guide practitioners and facilitate the use of these methods. This research provides recommendations for the periodic recording of the physical progress of a construction site through the manual operation of UAVs and the use of point clouds obtained under photogrammetric techniques. The programmed progress is then compared with the actual progress made in a 4D BIM environment. This methodology was applied in the construction of a reinforced concrete residential building. The results showed the methodology is effective for UAV operation in the work site and the use of the photogrammetric visual records for the monitoring of the physical progress and the communication of the work performed to the project stakeholders.

Status of trauma quality improvement programs in the Americas: a survey of trauma care providers.

INTRODUCTION: Global disparities in trauma care contribute to significant morbidity and mortality (M&M) in low- and middle-income countries. Implementation of quality improvement (QI) programs has been shown to be a cost-effective strategy to improve trauma care quality. In this study, we aim to characterize the trauma QI programs in a broad range of low- to high-income countries in the Americas to assess areas for targeted improvement in global trauma QI efforts. METHODS: We conducted a mixed methods survey of trauma care providers in North and South America distributed in-person at trauma care conferences and online via a secure survey platform. Responses were analyzed to observe differences across respondent country income categories. RESULTS: One hundred ninety-two surveys were collected, representing 21 different countries from three income strata (three lower-middle-, eleven upper-middle-, and eight high-income countries). Respondents were primarily physicians or physicians-in-training (85%). Eighty-nine percent of respondents worked at an institution where M&M conferences occurred. M&M conferences were significantly more frequent at higher income levels (P = 0.002), as was attending physician presence at M&M conferences (70% in high-income countries versus 43% in lower-middle-income countries). There were also significant differences in the structure, quality, and follow-up of M&M conferences in lower versus higher income countries. Sixty-three percent of respondents reported observing some kind of positive change at their institution due to M&M conferences. The survey also suggested significantly higher utilization of autopsy (P < 0.001) and electronic trauma registries (P = 0.01) at higher income levels. CONCLUSIONS: This survey demonstrated an encouraging pattern of widespread adoption of trauma QI programs in several countries in North and South America. However, there continue to be significant disparities in the structure and function of trauma QI efforts in low- and middle-income countries in the Americas. There are several potential areas for development and improvement of trauma care systems, including standardization of case selection and follow-up for M&M conferences and increased use of medical literature to improve evidence-based care.

Drugs, Violence, and Trauma in Mexico and the USA.

The impact of illicit drug markets on the occurrence of violence varies tremendously depending on many factors. Over the last years, Mexico and the USA have increased security border issues that included many aspects of drug-related trade and criminal activities. Mexico experienced only a small reduction in trauma deaths after the enforcement of severe crime reinforcement policies. This strategy in the war on drugs is shifting the drug market to other Central American countries. This phenomenon is called the ballooning effect, whereby the pressure to control illicit drug-related activities in one particular area forces a shift to other more vulnerable areas that leads to an increase in crime and violence. A human rights crisis characterized by suffering, injury, and death related to drug trafficking continues to expand, resulting in the exorbitant loss of lives and cost in productivity across the continent. The current climate of social violence in Central America and the illegal immigration to the USA may be partially related to this phenomenon of drug trafficking, gang violence, and crime. A health care initiative as an alternative to the current war approach may be one of the interventions needed to reduce this crisis.

Alternative FIB TEM sample preparation method for cross-sections of thin metal films deposited on polymer substrates.

Transmission electron microscopy (TEM) and focused ion beam (FIB) are proven tools to produce site-specific samples in which to study devices from initial processing to causes for failure, as well as investigating the quality, defects, interface layers, etc. However, the use of polymer substrates presents new challenges, in the preparation of suitable site-specific TEM samples, which include sample warping, heating, charging, and melting. In addition to current options that address some of these problems such as cryo FIB, we add an alternative method and FIB sample geometry that address these challenges and produce viable samples suitable for TEM elemental analysis. The key feature to this approach is a larger than usual lift-out block into which small viewing windows are thinned. Significant largely unthinned regions of the block are left between and at the base of the thinned windows. These large unthinned regions supply structural support and thermal reservoirs during the thinning process. As proof-of-concept of this sample preparation method, we also present TEM elemental analysis of various thin metallic films deposited on patterned polycarbonate, lacquer, and poly-di-methyl-siloxane substrates where the pattern (from low- to high-aspect ratio) is preserved.

Quantitative STEM: A method for measuring temperature and thickness effects on thermal diffuse scattering using STEM/EELS, and for testing electron scattering models.

In the last two decades, advances in the dark field detectors and microscopes of scanning transmission electron microscopy (STEM) have inspired a resurgence of interest in quantitative STEM analysis. One promising avenue is the use of STEM as a nanothermometric probe. In this application, thermal diffuse scattering, captured by a CCD camera or an annular dark field detector, acts as an indirect measurement of the specimen temperature. One challenge with taking such a measurement is achieving adequate sensitivity to quantify a change in scattered electron signal on the order of 1% or less of the full electron beam. Another difficulty is decoupling the thermal effect on electron scattering from scattering changes due to differing specimen thicknesses and materials. To address these issues, we have developed a method using STEM, combined with electron energy loss spectroscopy (EELS), to produce a material-specific calibration curve. On silicon, across the range 89 K to 294 K, we measured a monotonically increasing HAADF signal ranging from 4.0% to 4.4% of the direct beam intensity at a thickness-to-mean-free-path ratio of 0.5. This yielded a calibration curve of temperature versus full-beam-normalized, thickness-normalized HAADF signal. The method enables thermal measurements on a specimen of varying local thickness at a spatial resolution of a few nanometers. We demonstrated the potential of the technique for testing electron scattering models by applying single-electron scattering theory to the data collected to extract a measurement of the mean atomic vibration amplitude in silicon at 294 K. The measured value, 0.00738 ± 0.00002 nm, agrees well with reported measurement using X-rays.

Review of the concept of Profilicollis Meyer, 1931 with a description of Profilicollis rancoensis n. sp. (Acanthocephala: Polymorphidae) from the freshwater crab, Aegla abtao Schmitt, 1942 (Decapoda: Anomura) in Chile, with a key to congeneric species.

Profilicollis rancoensis n. sp. is the tenth species of Profilicollis Meyer, 1931 which includes 9 other species mostly known from marine decapod crabs and shore birds. Cystacanths of P. rancoensis are described from the dominant freshwater crab Aegla abtao in Ranco Lake, Chile and are morphologically distinguished from cystacanths of the 9 other species based on a combination of 4 characters. These are body size, number of proboscis hook rows, number of hooks per row, and length of the largest anterior 2-4 hooks. Male and female cystacanths of P. rancoensis are 2.10-3.33 mm long having an ovoid proboscis with 14 rows of 6-7 hooks per row, with the largest anterior 2-4 hooks being 105-110 micrometers long; the anterior trunk has many small spines in 70-80 concentric rings, each with 50-60 spines around them; hook roots are simple, directed posteriorly, about as long as the blades anteriorly with unremarkable anterior manubria; the cephalic ganglion are in mid-receptacle just anterior to the level of the anterior trunk; the lemnisci are long and slender; the testes are in the anterior trunk, posterior trunk, or one in each; the primordia of 2 tubular cement glands are evident; strong bundles of fibers link the anterior and posterior trunk; and the posterior trunk has a corrugated surface cuticula. Molecular analysis (COI and 18S) sequences coincided with the morphology and support its taxonomy. The phylogenetic profile revealed that P. rancoensis n. sp. fell into the Profilicollis clade. Both sequences showed low genetic variation, and three different haplotypes were found. The new species was more closely related to P. botulus (Van Cleave, 1916) Witenberg, 1932 than to other Profilicollis species.

Title: Révision du concept de Profilicollis Meyer, 1931 avec la description de Profilicollis rancoensis n. sp. (Acanthocephala, Polymorphidae) du crabe d'eau douce Aegla abtao Schmitt, 1942 (Decapoda, Anomura) au Chili, avec une clé des espèces congénères. Abstract: Profilicollis rancoensis n. sp. est la dixième espèce de Profilicollis Meyer, 1931 qui comprend neuf autres espèces principalement connues de crabes décapodes marins et d'oiseaux de rivage. Les cystacanthes de P. rancoensis sont décrits chez le crabe d'eau douce dominant Aegla abtao dans le lac Ranco, au Chili et se distinguent morphologiquement des cystacanthes des neuf autres espèces sur la base d'une combinaison de quatre caractères. Il s'agit de la taille du corps, du nombre de rangées de crochets du proboscis, du nombre de crochets par rangée et de la longueur des 2 à 4 crochets antérieurs les plus grands. Les cystacanthes mâles et femelles de P. rancoensis mesurent de 2,10 à 3,33 mm de long et ont une trompe ovoïde avec 14 rangées de 6 à 7 crochets par rangée, les 2 à 4 crochets antérieurs les plus grands mesurant 105 à 110 micromètres de long ; le tronc antérieur a de nombreuses petites épines en 70-80 anneaux concentriques chacun avec 50-60 épines ; les racines des crochets sont simples, dirigées vers l'arrière, à peu près aussi longues que les lames vers l'avant avec une manubrie antérieure sans particularité ; les ganglions céphaliques sont au milieu du réceptacle juste en avant du niveau du tronc antérieur ; les lemnisques sont longs et minces ; les testicules sont dans le tronc antérieur, le tronc postérieur ou un dans chacun ; les ébauches des 2 glandes cémentaires tubulaires sont évidentes ; de solides faisceaux de fibres relient le tronc antérieur et postérieur ; le tronc postérieur a une cuticule à surface ondulée. Les séquences d'analyse moléculaire (COI et 18S) coïncidaient avec la morphologie et confirmaient sa taxonomie. Le profil phylogénétique a révélé que P. rancoensis n. sp. appartient au clade Profilicollis. Les deux séquences ont montré une faible variation génétique et trois haplotypes différents ont été trouvés. La nouvelle espèce était plus proche de P. botulus (Van Cleave, 1916) Witenberg, 1932 que des autres espèces de Profilicollis.

Critical Analysis of the Evaluation Methods of Extended Reality (XR) Experiences for Construction Safety.

The construction industry has high accident rates. The sector is exploring various tools to improve safety management, training, and awareness to achieve zero accidents. This work focuses on extended reality (XR), which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies. Several authors have developed training experiences for construction safety in XR environments with positive conclusions about their effectiveness. However, there is no standardization regarding the evaluation methods used in the sector, and many experiences do not use any method. This lack is critical, as whenever the aim is to evaluate the degree of awareness of security issues, the implementation of evaluation systems is indispensable to make known the methods used in the literature to evaluate the effectiveness of the experiences and represent support for future research. This research identifies developments in XR experiences and analyzes the validation methods through a systematic review using the PRISMA methodology. It identifies two evaluation methods, objective and subjective, which are each broken down into four categories. The results show the types of evaluation, safety-related purposes, and safety application objectives used by the database classification.

A comparative assessment of the morphology of Profilicollis altmani (Acanthocephala, Polymorphidae) from crustaceans and shore birds in Peru, with special notes on hook elemental analysis (EDXA), SEM imaging, histopathology, and molecular profile.

The morphology of cystacanths and adults of Profilicollis altmani (Perry, 1942) Van Cleave, 1947 (Polymorphidae) were studied from the Pacific mole crab Emerita analoga (Stimpson) (Crustacea, Hippidae) and Belcher's gull Larus belcheri (Vigors) (Aves, Laridae), respectively, in Peru. Comparative morphometrics with accounts of other populations of P. altmani from elsewhere off the Pacific and Atlantic coasts of North and South America revealed marked intraspecific population variations. We report scanning electron micrographs (SEM) of new features, not before noted or captured in line drawings by earlier observers. We further present microscope images that reveal internal details not previously reported or possible to see with SEM. Energy dispersive X-ray analysis (EDXA) revealed unusual patterns in the chemistry of proboscis hooks especially the high sulfur and diminished phosphorous and calcium in hook tips and low sulfur and high levels of phosphorous and calcium at mid hooks. The size and shape of all hooks of the cystacanths are reported for the first time. Histopathological studies in L. belcheri from Peru are also included. Cystacanths of P. altmani from California were also analyzed for molecular patterns and compared with other sequences reported from other locations. The molecular data and the analysis of our new sequences of cytochrome oxidase I (COI) showed that haplotypes of P. altmani had low genetic variation; the species is not geographically structured, and within its clade no monophyletic group is formed.

TITLE: Évaluation comparative de la morphologie de Profilicollis altmani (Acanthocephala, Polymorphidae) de crustacés et d'oiseaux de rivage au Pérou, en particulier l'analyse élémentaire des crochet (EDXA), l'imagerie SEM, l'histopathologie et le profil moléculaire. ABSTRACT: La morphologie des cystacanthes et des adultes de Profilicollis altmani (Perry, 1942) Van Cleave, 1947 (Polymorphidae) a été étudiée, respectivement, à partir du crustacé Emerita analoga (Stimpson) (Crustacea, Hippidae) et du Goéland Siméon Larus belcheri (Vigors) (Aves, Laridae), au Pérou. La morphométrie comparative avec des données d'autres populations de P. altmani d'autres localités au large des côtes du Pacifique et de l'Atlantique de l'Amérique du Nord et du Sud a révélé des variations intraspécifiques marquées des populations. Nous rapportons des nouvelles observations de microscopie électronique à balayage, non notées auparavant ou non capturées dans des dessins au trait par des observateurs antérieurs. Nous présentons en outre des images au microscope qui révèlent des détails internes qui n'ont pas été signalés auparavant ni possibles à voir avec MET. L'analyse aux rayons X à dispersion d'énergie (EDXA) a révélé des modèles inhabituels dans la chimie des crochets de la trompe, en particulier la teneur élevée en soufre et une diminution du phosphore et du calcium dans les pointes des crochets et des niveaux faibles en soufre et en phosphore et en calcium au milieu des crochets. La taille et la forme de tous les crochets des cystacanthes sont décrites pour la première fois. Des études histopathologiques sur L. belcheri du Pérou sont également incluses. Les cystacanthes de P. altmani de Californie ont également été analysés pour les modèles moléculaires et comparés à d'autres séquences rapportées d'autres endroits. Les données moléculaires et l'analyse de nos nouvelles séquences de cytochrome oxydase I (COI) ont montré que les haplotypes de P. altmani avaient une faible variation génétique. L'espèce n'est pas structurée géographiquement, et au sein de son clade aucun groupe monophylétique n'est formé.

[Case report. Post cesarean section laparoscopic cholecystectomy for hydrocholecystitis]. / Colecistectomía laparoscópica poscesárea por hidrocolecisto. Reporte de un caso.

BACKGROUND: Acute cholecystitis is the second most common surgical emergency in pregnant women. Although laparoscopic cholecystectomy has been described previously in these cases, there is still controversy regarding the most appropriate moment in which to perform the procedure. OBJECTIVE: To describe the clinical presentation and management of a female with 36.6 weeks of pregnancy and clinical signs of acute cholecystitis. Cesarean section to deliver a healthy newborn was immediately followed by laparoscopic cholecystectomy without complications. A 10 year literature review complements the analysis and discussion of the case. CLINICAL CASE: A 33 year-old female with 36.6 weeks of gestation presented a history of 24 hours with right upper quadrant and epigastric abdominal pain, nausea and vomiting. Symptoms were precipitated by cholecystokinetics and did not subside after expectant and pharmacologic medical treatment. The medical group decided with the patient's consent to interrupt the pregnancy via Cesarean section immediately followed by laparoscopic cholecystectomy. RESULTS: After Cesarean section through a Pfannenstiel incision, laparoscopic trocars were placed and cholecystectomy performed without complications. The postsurgical course was favorable and both patient and newborn were discharged on day four. CONCLUSIONS: Laparoscopic surgery cholecystectomy during pregnancy and in the immediate puerperium is feasible and safe. These combined procedures: rapid pregnancy interruption followed by a minimal invasive approach gives the benefits of laparoscopic surgery in these patients.

Barriers and facilitators to answering clinical questions in the Americas: a cross-sectional study of surgical trauma care providers.

BACKGROUND: We aimed to understand how surgical trauma providers in the Americas acquire answers to clinical questions and what barriers and facilitators they face in efforts to practice according to recommendations for common surgical cases. We hypothesized that increased English proficiency and country income improved providers' acquisition and application of clinical knowledge. METHODS: A 23-question survey evaluated reported confidence in interpretation of evidence, perceived language fluency, and access to and application of recommendations on sepsis and appendicitis. Electronic surveys were distributed across the Americas to Pan American Trauma Society members. RESULTS: 108 participants from 21 countries completed this survey. 59% had ≥21 years of provider experience. 38% reported their English reading comprehension as less than or equal to "limited working proficiency." 44% endorsed using Google Translate; 35% reported they did not need translation tools to evaluate medical literature. 59% felt uncertainty regarding clinical care at least weekly. 65% reported inability to answer their clinical questions at least once per month. 86% felt confident in their ability to interpret and apply evidence for their practice. To answer clinical questions, participants listed guidelines (76%), full-text peer-reviewed journal articles (61%), and meta-analyses (49%) as their most used resources. 25% answered all five clinical questions correctly, whereas 43% answered three or fewer correctly. 79% felt they had adequate access to resources to answer the five clinical questions. When controlling for individual demographic characteristics, decreased age (p<0.01) and increased country income level (p=0.03) positively impacted correct answers to questions. DISCUSSION: Uncertainties in clinical care are unavoidable. Language, age, and country income level impacted provider acquisition and application of knowledge relevant to select clinical scenarios. These findings highlight disparities in access and training and add urgency to the movement for improved dissemination and implementation approaches for evidence-based practice in surgery. LEVEL OF EVIDENCE: IV.

Factors Influencing Safety on Construction Projects (fSCPs): Types and Categories.

Due to the fact of activity, environment and work dynamics, the construction industry is characterised by high accident rates. Different initiatives have emerged to reduce these figures, which focus on using new methodologies and technologies for safety management. Therefore, it is essential to know the key factors and their influence on safety in construction projects (fSCPs) to focus efforts on these elements. Through a systematic literature review, based on PRISMA methodology, this article identifies, describes and categorises 100 factors that affect construction safety. It thus contributes by providing a comprehensive general framework, unifying previous studies focused on specific geographic areas or case studies with factors not considered or insufficiently disaggregated, along with an absence of classifications focused on understanding where and how factors affect the different dimensions of construction projects. The 100 factors identified are described and categorised according to the dimensions and aspects of the project in which these have an impact, along with identifying whether they are shaping or immediate factors or originating influences for the generation of accidents. These factors, their description and classification are a key contribution to improving the systematic creation of safety and generating training and awareness materials to fully develop a safety culture in organisations.

Boldine inhibits the alveolar bone resorption during ligature-induced periodontitis by modulating the Th17/Treg imbalance.

BACKGROUND: During periodontitis, tooth-supporting alveolar bone is resorbed when there is an increased expression of the pro-osteolytic factor termed receptor activator of nuclear factor κB ligand (RANKL), which is responsible for osteoclast differentiation and activation. In periodontitis-affected tissues, the imbalance between T-helper type-17 (Th17) and T-regulatory (Treg) lymphocyte activity favors this RANKL overexpression. In this context, immunotherapeutic strategies aimed at modulating this Th17/Treg imbalance could eventually arrest the RANKL-mediated alveolar bone loss. Boldine has been reported to protect from pathological bone loss during rheumatoid arthritis and osteoporosis, whose pathogenesis is associated with a Th17/Treg imbalance. However, the effect of boldine on alveolar bone resorption during periodontitis has not been elucidated yet. This study aimed to determine whether boldine inhibits alveolar bone resorption by modulating the Th17/Treg imbalance during periodontitis. METHODS: Mice with ligature-induced periodontitis were orally treated with boldine (10/20/40 mg/kg) for 15 consecutive days. Non-treated periodontitis-affected mice and non-ligated mice were used as controls. Alveolar bone loss was analyzed by micro-computed tomography and scanning electron microscopy. Osteoclasts were quantified by histological identification of tartrate-resistant acid phosphatase-positive cells. Production of RANKL and its competitive antagonist osteoprotegerin (OPG) were analyzed by ELISA, quantitative polymerase chain reaction (qPCR), and immunohistochemistry. The Th17 and Treg responses were analyzed by quantifying the T-cell frequency and number by flow cytometry. Also, the expression of their signature transcription factors and cytokines were quantified by qPCR. RESULTS: Boldine inhibited the alveolar bone resorption. Consistently, boldine caused a decrease in the osteoclast number and RANKL/OPG ratio in periodontal lesions. Besides, boldine reduced the Th17-lymphocyte detection and response and increased the Treg-lymphocyte detection and response in periodontitis-affected tissues. CONCLUSION: Boldine, administered orally, inhibited the alveolar bone resorption and modulated the Th17/Treg imbalance during experimental periodontitis.

Impact of liver enzymes on SARS-CoV-2 infection and the severity of clinical course of COVID-19.

BACKGROUND AND AIM: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the current pandemic, can have multi-organ impact. Recent studies show that liver injury could be a manifestation of the disease, and that liver disease could also be related to a worse prognosis. Our aim was to compare the characteristics of patients with severe coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 who required intubation versus stable hospitalized patients to identify the early biochemical predictive factors of a severe course of COVID-19 and subsequent requirement for intubation, specifically in Mexican. METHODS: This was an observational case-control study nested in a cohort study. Complete medical records of patients admitted for confirmed COVID-19 at a tertiary level center in Mexico City were reviewed. Clinical and biochemical data were collected, and the characteristics of patients who required invasive mechanical ventilation (IMV) (cases) were compared with stable hospitalized patients without ventilation (controls). RESULTS: We evaluated 166 patients with COVID-19 due to SARS-CoV-2 infection; 114 (68.7%) were men, the mean age was 50.6 ± 13.3 years, and 27 (16.3%) required IMV. The comparative analysis between cases and controls showed (respectively) significantly lower blood oxygen saturation (SpO2) (73.5 ± 12.0% vs. 83.0 ± 6.8%, P < 0.0001) and elevated alanine aminotransferase (ALT) (128 (14-1123) IU/L vs. 33 (8-453) IU/L, P = 0.003), aspartate aminotransferase (AST) (214 (17-1247) vs. 44 (12-498) IU/L, P = 0.001), lactic dehydrogenase (LDH) (764.6 ± 401.9 IU/L vs. 461.0 ± 185.6 IU/L, P = 0.001), and D-dimer (3463 (524-34,227) ng/mL vs. 829 (152-41,923) ng/mL, P = 0.003) concentrations. Patients in the cases group were older (58.6 ± 12.7 years vs. 49.1 ± 12.8 years, P=0.001). Multivariate analysis showed that important factors at admission predicting the requirement for IMV during hospitalization for COVID-19 were AST ≥250 IU/L (odds ratio (OR) = 64.8, 95% confidence interval (CI) 7.5-560.3, P < 0.0001) and D-dimer ≥ 3500 ng/mL (OR = 4.1, 95% CI 1.2-13.7, P=0.02). CONCLUSIONS: Our study confirms the importance of monitoring liver enzymes in hospitalized patients with COVID-19; seriously ill patients have significantly elevated AST and D-dimer concentrations, which have prognostic implications in the SARS-CoV-2 disease course.

The Age-AST-D Dimer (AAD) Regression Model Predicts Severe COVID-19 Disease.

AIM: Coronavirus disease (COVID-19) ranges from mild clinical phenotypes to life-threatening conditions like severe acute respiratory syndrome (SARS). It has been suggested that early liver injury in these patients could be a risk factor for poor outcome. We aimed to identify early biochemical predictive factors related to severe disease development with intensive care requirements in patients with COVID-19. METHODS: Data from COVID-19 patients were collected at admission time to our hospital. Differential biochemical factors were identified between seriously ill patients requiring intensive care unit (ICU) admission (ICU patients) versus stable patients without the need for ICU admission (non-ICU patients). Multiple linear regression was applied, then a predictive model of severity called Age-AST-D dimer (AAD) was constructed (n = 166) and validated (n = 170). RESULTS: Derivation cohort: from 166 patients included, there were 27 (16.3%) ICU patients that showed higher levels of liver injury markers (P < 0.01) compared with non-ICU patients: alanine aminotrasnferase (ALT) 225.4 ± 341.2 vs. 41.3 ± 41.1, aspartate aminotransferase (AST) 325.3 ± 382.4 vs. 52.8 ± 47.1, lactic dehydrogenase (LDH) 764.6 ± 401.9 vs. 461.0 ± 185.6, D-dimer (DD) 7765 ± 9109 vs. 1871 ± 4146, and age 58.6 ± 12.7 vs. 49.1 ± 12.8. With these finding, a model called Age-AST-DD (AAD), with a cut-point of <2.75 (sensitivity = 0.797 and specificity = 0.391, c - statistic = 0.74; 95%IC: 0.62-0.86, P < 0.001), to predict the risk of need admission to ICU (OR = 5.8; 95% CI: 2.2-15.4, P = 0.001), was constructed. Validation cohort: in 170 different patients, the AAD model < 2.75 (c - statistic = 0.80 (95% CI: 0.70-0.91, P < 0.001) adequately predicted the risk (OR = 8.8, 95% CI: 3.4-22.6, P < 0.001) to be admitted in the ICU (27 patients, 15.95%). CONCLUSIONS: The elevation of AST (a possible marker of early liver injury) along with DD and age efficiently predict early (at admission time) probability of ICU admission during the clinical course of COVID-19. The AAD model can improve the comprehensive management of COVID-19 patients, and it could be useful as a triage tool to early classify patients with a high risk of developing a severe clinical course of the disease.

[Pelvic solitary fibrous nodule, incidental finding and laparoscopic resection. Case report]. / Nódulo fibroso solitario pélvico, hallazgo incidental y resección laparoscópica. Reporte de un caso.

The solitary fibrous nodule is a rare clinical disease that mainly affects the pleura, but has been occasionally described in other anatomical sites. This type of tumors can have malignant components and therefore it is important to differentiate them from other retroperitoneal masses. We describe the case of a patient with ectopic pregnancy in whom a solitary fibrous nodule with laparoscopy was found. A peritoneal pelvic tumor with smooth surface, 20,2 g, firm was detected. The mass was independent of colon, uterus, ovaries or salpinx and was very near to the iliac vessels on the right side. A small fragment was biopsied and sent to trans surgical histopathology study and the rest of the mass was removed completely without complications. The histopathologic report described that the tumor contained sclerosed cells with collagenous bands and sings of hemorrhage and calcification, compatible with a benign pelvic solitary fibrous tumor. The solitary fibrous nodule is a rare, benign disease, but with malignant potential. These tumors must be resected when they are incidentally found during other surgical procedures or if diagnosed preoperatively. The laparoscopic approach has advantages in the identification and resection these tumors.