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Sensors used in precision agriculture for the detection of heavy metals in irrigation water are generally expensive and sometimes their deployment and maintenance represent a permanent investment to keep them in operation, leaving a lasting polluting footprint in the environment at the end of their lifespan. This represents an area of opportunity to design new biological devices that can replace part, or all of the sensors currently used. In this article, a novel workflow is proposed to fully carry out the complete process of design, modeling, and simulation of reprogrammable microorganisms in silico. As a proof-of-concept, the workflow has been used to design three whole-cell biosensors for the detection of heavy metals in irrigation water, namely arsenic, mercury and lead. These biosensors are in compliance with the concentration limits established by the World Health Organization (WHO). The proposed workflow allows the design of a wide variety of completely in silico biodevices, which aids in solving problems that cannot be easily addressed with classical computing. The workflow is based on two technologies typical of synthetic biology: the design of synthetic genetic circuits, and in silico synthetic engineering, which allows us to address the design of reprogrammable microorganisms using software and hardware to develop theoretical models. These models enable the behavior prediction of complex biological systems. The output of the workflow is then exported in the form of complete genomes in SBOL, GenBank and FASTA formats, enabling their subsequent in vivo implementation in a laboratory. The present proposal enables professionals in the area of computer science to collaborate in biotechnological processes from a theoretical perspective previously or complementary to a design process carried out directly in the laboratory by molecular biologists. Therefore, key results pertaining to this work include the fully in silico workflow that leads to designs that can be tested in the lab in vitro or in vivo, and a proof-of-concept of how the workflow generates synthetic circuits in the form of three whole-cell heavy metal biosensors that were designed, modeled and simulated using the workflow. The simulations carried out show realistic spatial distributions of biosensors reacting to different concentrations (zero, low and threshold level) of heavy metal presence and at different growth phases (stationary and exponential) that are backed up by the whole design and modeling phases of the workflow.
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Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.
Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neumonía/complicaciones , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria del Recién Nacido/complicaciones , Choque/complicaciones , Comorbilidad , Insuficiencia Renal/complicaciones , SARS-CoV-2 , COVID-19/epidemiología , Argentina/epidemiología , Chile/epidemiología , Factores de Riesgo , Mortalidad , Estudio MulticéntricoRESUMEN
Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article.
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Introducción: los inhaladores de dosis medida (MDI) ocupan un lugar fundamental en el tratamiento de las enfermedades obstructivas. Sin embargo, existe evidencia de su in-correcta utilización y, por consiguiente, limitados beneficios. El objetivo de este traba-jo es evaluar el uso de los MDI y conocer el impacto que tiene la educación en la técnica inhalatoria. Método: estudio prospectivo, antes-después realizado en pacientes hos-pitalizados y ambulatorios. Se registraron datos demográficos y sobre el uso del MDI. Posteriormente, se pidió al paciente que realizara dos inhalaciones con su MDI y aero-cámara, se otorgó un puntaje según la escala ESTI y se educó en forma oral, visual y con folleto explicativo. Los pacientes fueron reevaluados antes de cumplir un mes de la primera evaluación. Resultados: se incluyeron 119 pacientes, 53,8% masculinos, con edad media de 60,6 (± 16) años. El 60,5% utilizaba aerocámara siempre y el 19,3% casi siempre. El 65% tenía la percepción de que su técnica inhalatoria era buena o muy bue-na. El 32% no sabía identificar su inhalador de rescate. El puntaje en la escala ESTI ba-sal fue de 6,8 (± 2,3) ptos. el que mejoró en la reevaluación, 8,7 (± 1,5) ptos.; p<0,0001. La técnica inhalatoria calificada de muy buena o buena mejoró de un 24,4% a un 63%; p<0.0001. Conclusión: nuestros resultados muestran que la técnica de inhalación con MDI es deficiente y una educación activa evidencia un impacto significativo en el co-rrecto uso de estos dispositivos. (AU)
Introduction: metered dose inhalers (MDI) are fundamental in treating obstructive dis-eases. However, there is evidence of its incorrect use and therefore limited benefits. This work aims to evaluate the use of MDIs and to know the impact of education on the cor-rect inhalation technique. Method: prospective, before-after study, carried out in hospitalized and outpatients. Demographic data and data on the use of the MDI are re-corded. Subsequently, the patient was asked to take 2 inhalations with his MDI and valved-holding chamber, a score was given according to the ESTI score and he was ed-ucated orally, visually, and with an explanatory brochure. The patients were reassessed within 1 month of the first evaluation. Results: 119 patients were included, 53.8% male, with a mean age of 60.6 (±16) years. 60.5% always used an aero chamber and 19.3% almost always. 65% had the perception that their inhalation technique was good or very good. 32% did not know how to identify their rescue inhaler. The score on the base-line ESTI scale was 6.8 (± 2.3) points, which improved in the reassessment, 8.7 (± 1.5) points; p<0.0001. The inhalation technique rated as very good or good improved from 24.4% to 63%; p<0.0001. Conclusion: our results show that the inhalation technique with MDI is deficient and active education demonstrates a significant impact on the cor-rect use of these devices. (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Educación del Paciente como Asunto , Inhaladores de Dosis Medida , Pacientes Ambulatorios/educación , Chile , HospitalizaciónRESUMEN
BACKGROUND: Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. RESEARCH QUESTION: There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP. STUDY DESIGN AND METHODS: This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. RESULTS: The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens. INTERPRETATION: This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.
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Infecciones Comunitarias Adquiridas , Huésped Inmunocomprometido , Manejo de Atención al Paciente , Neumonía , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/terapia , Consenso , Humanos , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/normas , Neumonía/microbiología , Neumonía/terapiaRESUMEN
INTRODUCTION: Bronchiectasis is a very heterogeneous disease but some homogeneous groups with similar clinical characteristics and prognosis have been identified. Exacerbations have been shown to have a negative impact on the natural history of bronchiectasis. The objective of this study was to identify the definition and characteristics of the "frequent exacerbator patient" with the best prognostic value and its relationship with the severity of bronchiectasis. METHODS: A historical cohort of 651 patients diagnosed with bronchiectasis was included. They had all received 5 years of follow-up since their radiological diagnosis. Exacerbation was defined as a worsening of the symptoms derived from bronchiectasis that required antibiotic treatment. The main outcome was all-cause mortality at the end of follow-up. RESULTS: The mean age was 48.2 (16) years (32.9% males). 39.8% had chronic infection by Pseudomonas aeruginosa. Mean BSI, FACED, and E-FACED were 7 (4.12), 2.36 (1.68), and 2.89 (2.03), respectively. There were 95 deaths during follow-up. The definition of the "frequent exacerbator patient" that presented the greatest predictive power for mortality was based on at least two exacerbations/year or one hospitalization/year (23.3% of patients; AUC-ROC: 0.75 [95% CI: 0.69-0.81]). Its predictive power was independent of the patient's initial severity. The clinical characteristics of the frequent exacerbator patient according to this definition varied according to the initial severity of bronchiectasis, presence of systemic inflammation, and treatment. CONCLUSIONS: The combination of two exacerbations or one hospitalization per year is the definition of frequent exacerbator patient that has the best predictive value of mortality independent of the initial severity of bronchiectasis.
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Bronquiectasia/mortalidad , Progresión de la Enfermedad , Índice de Severidad de la Enfermedad , Área Bajo la Curva , Argentina , Brasil , Bronquiectasia/clasificación , Bronquiectasia/microbiología , Chile , Estudios de Cohortes , Femenino , Hospitalización , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Fenotipo , Pronóstico , Pseudomonas aeruginosa , Curva ROCRESUMEN
Both FACED and E-FACED scores have shown good short-term prognostic value for predicting mortality in bronchiectasis http://ow.ly/albl30i11bv.
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BACKGROUND: The FACED score is an easy-to-use multidimensional grading system that has demonstrated an excellent prognostic value for mortality in patients with bronchiectasis. A Spanish group developed the score but no multicenter international validation has yet been published. METHODS: Retrospective and multicenter study conducted in six historical cohorts of patients from Latin America including 651 patients with bronchiectasis. Clinical, microbiological, functional, and radiological variables were collected, following the same criteria used in the original FACED score study. The vital status of all patients was determined in the fifth year of follow-up. The area under ROC curve (AUC-ROC) was used to calculate the predictive power of the FACED score for all-cause and respiratory deaths and both number and severity of exacerbations. The discriminatory power to divide patients into three groups of increasing severity was also analyzed. RESULTS: Mean (SD) age of 48.2 (16), 32.9% of males. The mean FACED score was 2.35 (1.68). During the follow up, 95 patients (14.6%) died (66% from respiratory causes). The AUC ROC to predict all-cause and respiratory mortality were 0.81 (95% CI: 0.77 to 0.85) 0.84 (95% CI: 0.80 to 0.88) respectively, and 0.82 (95% CI: 078-0.87) for at least one hospitalization per year. The division into three score groups separated bronchiectasis into distinct mortality groups (mild: 3.7%; moderate: 20.7% and severe: 48.5% mortality; p < 0.001). CONCLUSIONS: The FACED score was confirmed as an excellent predictor of all-cause and respiratory mortality and severe exacerbations, as well as having excellent discriminative capacity for different degrees of severity in various bronchiectasis populations.
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Bronquiectasia/mortalidad , Bronquiectasia/fisiopatología , Progresión de la Enfermedad , Hospitalización/estadística & datos numéricos , Adulto , Área Bajo la Curva , Causas de Muerte , Comorbilidad , Femenino , Volumen Espiratorio Forzado , Mortalidad Hospitalaria/tendencias , Humanos , Estimación de Kaplan-Meier , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE OF REVIEW: The increase in drug-resistant community-acquired pneumonia (CAP) is an important problem all over the world. This article explores the current state of antimicrobial resistance of different bacteria that cause CAP and also assesses risk factors to identify those pathogens. RECENT FINDINGS: In the last two decades, it has been documented that there is a significant increase in drug-resistant Streptococcus pneumoniae and other bacteria causing CAP. The most important risk factors are overuse of antibiotics, prior hospitalization, and lung comorbidities. The direct consequences can be severe, including prolonged stays in hospital, increased costs, and morbi-mortality. However, drug-resistant CAP declined after the introduction of the pneumococcal conjugate vaccine. This review found an increase in resistance to the antibiotics used in CAP, and the risk factor can be used for identifying patients with drug-resistant CAP and initiate appropriate treatment. Judicious use of antibiotics and the development of effective new vaccines are needed.
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Background: Early HIV (human immunodeficiency virus) diagnosis optimizes therapies aimed at reducing viral load, increasing survival, lowering health costs and reducing the number of people infected with the virus. In Chile, despite widespread and readily available HIV testing, infected people continue to get tested in a late fashion and are usually diagnosed in advanced stages of the disease. Aim: To determine the elements that facilitate or impede a timely HIV testing and to evaluate how to improve the access to HIV testing. Material and Methods: Descriptive, in-depth interviews to 30 participants with unknown serology, 15 participants diagnosed at AIDS stage and 15 health care professionals working at a primary healthcare settings. Results: Users and professionals formulated three suggestions to improve timely access to ELISA test for HIV diagnosis. Namely, to inform users and professionals about the characteristics of the disease and diagnostic test, to offer fast and easy access to HIV testing, and to train the whole healthcare team about obtaining informed consent for testing. Conclusions: These recommendations should be implemented at healthcare centers to attain a timely HIV diagnosis.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Infecciones por VIH/diagnóstico , Accesibilidad a los Servicios de Salud/normas , Actitud del Personal de Salud , Chile , Diagnóstico PrecozRESUMEN
BACKGROUND: In US and European literature, Legionella pneumophila is reported as an important etiologic agent of severe community-acquired pneumonia (CAP), but in Chile this information is lacking. The aim of this study was to determine the incidence and identify predictors of severe CAP caused by L pneumophila in Santiago, Chile. METHODS: A multicenter, prospective clinical study lasting 18 months was conducted; it included all adult patients with severe CAP admitted to the ICUs of four hospitals in Santiago. We excluded patients who were immunocompromised, had been hospitalized in the previous 4 weeks, or presented with another disease during their hospitalization. All data for the diagnosis of severe CAP were registered, and urinary antigens for L pneumophila serogroup 1 were determined. RESULTS: A total of 104 patients with severe CAP were included (mean ± SD age, 58.3 ± 19.3 years; men, 64.4%; APACHE (Acute Physiology and Chronic Health Evaluation) II score, 16.7 ± 6.3; Sepsis-related Organ Failure Assessment score, 6.1 ± 3.2; Pitt Bacteremia Score, 3.4 ± 2.5; Pao2/Fio2, 170.8 ± 87.1). An etiologic agent was identified in 62 patients (59.6%), with the most frequent being Streptococcus pneumoniae (27 patients [26%]) and L pneumophila (nine patients [8.6%]). Logistic regression analysis showed that a plasma sodium level of ≤ 130 mEq/L was an independent predictor for L pneumophila severe CAP (OR, 11.3; 95% CI, 2.5-50.5; P = .002). Global mortality was 26% and 33% for L pneumophila. The Pitt bacteremia score and pneumonia score index were the best predictors of mortality. CONCLUSIONS: We found that in Santiago, L pneumophila was second to S pneumoniae as the etiologic agent of severe CAP. Severe hyponatremia at admission appears to be an indicator for L pneumophila etiology in severe CAP.
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Infecciones Comunitarias Adquiridas/microbiología , Legionella pneumophila/fisiología , Enfermedad de los Legionarios/complicaciones , Neumonía/microbiología , APACHE , Adulto , Anciano , Anciano de 80 o más Años , Antígenos Bacterianos/orina , Chile/epidemiología , Infecciones Comunitarias Adquiridas/epidemiología , Comorbilidad , Femenino , Humanos , Hiponatremia/epidemiología , Legionella pneumophila/inmunología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/complicaciones , Neumonía/epidemiología , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Streptococcus pneumoniae/inmunología , Streptococcus pneumoniae/fisiología , Adulto JovenRESUMEN
BACKGROUND: Early HIV (human immunodeficiency virus) diagnosis optimizes therapies aimed at reducing viral load, increasing survival, lowering health costs and reducing the number of people infected with the virus. In Chile, despite widespread and readily available HIV testing, infected people continue to get tested in a late fashion and are usually diagnosed in advanced stages of the disease. AIM: To determine the elements that facilitate or impede a timely HIV testing and to evaluate how to improve the access to HIV testing. MATERIAL AND METHODS: Descriptive, in-depth interviews to 30 participants with unknown serology, 15 participants diagnosed at AIDS stage and 15 health care professionals working at a primary healthcare settings. RESULTS: Users and professionals formulated three suggestions to improve timely access to ELISA test for HIV diagnosis. Namely, to inform users and professionals about the characteristics of the disease and diagnostic test, to offer fast and easy access to HIV testing, and to train the whole healthcare team about obtaining informed consent for testing. CONCLUSIONS: These recommendations should be implemented at healthcare centers to attain a timely HIV diagnosis.
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Infecciones por VIH/diagnóstico , Accesibilidad a los Servicios de Salud/normas , Adulto , Anciano , Actitud del Personal de Salud , Chile , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
PURPOSE: The purpose of the study was to describe the clinical characteristics and outcomes of critically ill patients with 2009 influenza A(H1N1). METHODS: An observational study of patients with confirmed or probable 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation was performed. RESULTS: We studied 96 patients (mean age, 45 [14] years [mean, SD]; 44% female). Shock and acute respiratory distress syndrome were diagnosed during the first 72 hours of admission in 43% and 72% of patients, respectively. Noninvasive positive pressure ventilation was used in 45% of the patients, but failed in 77% of them. Bacterial pneumonia was diagnosed in 33% of cases, 8% during the first week (due to community-acquired microorganisms) and 25% after the first week (due to gram-negative bacilli and resistant gram-positive cocci). Intensive care unit mortality was 50%. Nonsurvivors differed from survivors in the prevalence of cardiovascular, respiratory, and hematologic failure on admission and late pneumonia. Reported causes of death were refractory hypoxia, multiorgan failure, and shock (50%, 38%, and 12% of all causes of death, respectively). CONCLUSIONS: Patients with 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation often present with clinical criteria of acute respiratory distress syndrome and shock. Bacterial pneumonia is a frequent complication. Mortality is high and is primarily due to refractory hypoxia.
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Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/mortalidad , Síndrome de Dificultad Respiratoria/mortalidad , Choque/mortalidad , Adulto , Femenino , Mortalidad Hospitalaria , Humanos , Hipoxia/etiología , Hipoxia/mortalidad , Gripe Humana/complicaciones , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/mortalidad , Respiración con Presión Positiva , Síndrome de Dificultad Respiratoria/etiología , Índice de Severidad de la Enfermedad , Choque/etiologíaRESUMEN
En la primera pandemia del siglo XXI por virus influenza A/H1N1, una importante proporción de paciente que desarrollaron neumonía y Falla Respiratoria Aguda (FRA) eran obesos. La obesidad ha sido propuesta como un factor de riesgo que aumenta la morbimortalidad; sin embargo, hay controversia al respecto. Objetivo: evaluar el impacto de la obesidad en complicaciones, estadía y/o mortalidad en pacientes adultos graves por virus influenza A/H1N1. Estudio observacional y multicéntrico realizado en 17 UCIs de Chile durante el periodo mayo-agosto 2009. Fueron incluidos en el estudio solo paciente con infección por virus Influenza A/H1N1 confirmada o probable. Los paciente obesos (IMC>30) fueron comparados con pacientes no obesos. Resultados: De un total de 136 pacientes incluidos en el estudio, 64 (47 por ciento) fueron obesos y de estos 13 obesos mórbidos (BMI >40). Los pacientes obesos tienen mayor frecuencia de: comorbilidades, ventilación mecánica y complicaciones. La estadía en UCI y en el hospital fue más prolongada en pacientes obesos (18,1+/-15 vs. 10,9+/-10,2, p=0,002 y 27,2+/-24,7 vs17,7 +/- 14,6, p=0,01 respectivamente). La mortalidad fue mayor en pacientes obesos (36 por ciento vs. 19,4 por ciento; OR 2,32; IC95 por ciento 1,07-5,05, p=0.035). El estudio de regresión logística encuentra que la FOM es un factor pronóstico independiente de mortalidad en pacientes obesos. Conclusiones: Los pacientes obesos con neumonía grave por virus influenza A/H1N1 tienen una mayor morbi-mortalidad y prolongación de su estadía en UCI y en el hospital. El desarrollo de FOM en pacientes obesos es un factor de mal pronóstico.
In the first pandemic of the 21st century due to influenza A/H1N1 virus, a significant proportion of patients who developed pneumonia and acute respiratory failure (ARF) were obese. Obesity has been proposed as a risk factor that increases morbidity and mortality, however, there is controversy about it. Objective: To determine the impact of obesity on complications, stay and / or mortality in adult patients with severe influenza A/H1N1 virus. Multicenter observational study conducted in 17 ICUs of Chile during the period May to August 2009. Were included only patients with influenza A/H1N1 virus infection confirmed or probable. Obese patients (BMI> 30) were compared with non obese patients. The results: Of a total of 136 patients included in the study, 64 (47 percent) were obese and of these 13 morbidly obese (BMI> 40). Obese patients have a higher frequency of: comorbidities, mechanical ventilation and complications. The stay in ICU and hospital was longer in obese patients (18.1 +/- 15 vs. 10.9 +/- 10.2, p = 0.002 and 27.2 +/- 24.7 vs17, 7 +/- 14.6, p = 0.01 respectively). Mortality was higher in obese patients (36 percent vs. 19.4 percent, OR 2.32, 95 percent CI 1.07 to 5.05, p = 0,035). The logistic regression analysis found that the MOF is an independent predictor of mortality in obese patients. Conclusions: Obese patients with severe pneumonia due to the influenza A/H1N1 virus have a high morbidity and mortality and prolonged stay in ICU and hospital. MOF development in obese patients is a poor prognostic factor.
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Humanos , Masculino , Adolescente , Adulto , Femenino , Persona de Mediana Edad , Gripe Humana/epidemiología , Neumonía Viral/epidemiología , Obesidad/epidemiología , Índice de Masa Corporal , Comorbilidad , Chile/epidemiología , Gripe Humana/mortalidad , Gripe Humana/virología , Unidades de Cuidados Intensivos , Tiempo de Internación , Modelos Logísticos , Estudios Multicéntricos como Asunto , Neumonía Viral/mortalidad , Obesidad/complicaciones , Obesidad/mortalidad , Análisis de Supervivencia , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificaciónRESUMEN
Recently, the World Health Organization declared a pandemic mediated by the novel A H1N1 influenza virus. Soon after the first report from Mexico, the disease arrived in Chile, where it spread quickly from south to north, mimicking cold weather progression through the country. Between May and September 2009, 366,624 cases of H1N1 were reported; 12,248 were confirmed by real-time reverse-transcription polymerase chain reaction and 1562 were hospitalized. One hundred thirty-two deaths were attributable to the infection, creating a death rate of 0.78 per 100,000 inhabitants. Common comorbidities were present in 59%, including obesity, chronic obstructive pulmonary disease, hypertension, type II diabetes, and congestive heart failure. Nine percent were pregnant. Severe disease developed early; the median time to admittance was 5 days, and the most common clinical manifestations were cough, fever, dyspnea, and myalgia. Mean acute physiology and chronic health evaluation II and sequential organ failure assessment scores were 14 and 5, respectively. Highlighted laboratory data were lactate dehydrogenase and creatine kinase elevation, leukocytosis in 50%, elevated creatinine in a 25%, and thrombocytopenia in 20%. Severe respiratory failure requiring high-frequency oscillatory ventilation and extracorporeal membrane oxygenation as sophisticated modes of respiratory support was seen in 17%. Acute renal failure occurred in 25% of the intensive care unit patients, with death rates near 50%. Health systems reinforced outpatient guards with extra staff and extension of the duty schedules. Antivirals were supplied free for medically diagnosed cases. Admissions for severe cases were prioritized, reconverting hospital beds into advanced care ones; a central coordination station rationed their assignment. Recommendations for small hospitals include adding ventilators, using videoconferences, providing tutorial activity from experts, developing guidelines for disease management, and outlining criteria for transport.
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Planificación en Desastres/organización & administración , Brotes de Enfermedades , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Distribución por Edad , Chile/epidemiología , Comorbilidad , Cuidados Críticos/organización & administración , Administración Hospitalaria , Humanos , Gripe Humana/complicaciones , Insuficiencia Renal/etiología , Insuficiencia Respiratoria/etiología , Factores de TiempoRESUMEN
La sepsis grave en pacientes quirúrgicos tiene una mortalidad elevada. Hay evidencias que el uso de proteína C activada recombinante (Drotrecogin alfa) mejora la sobrevida en estos pacientes. Presentamos el caso de un hombre de 40 años con síndrome de Marfán sometido a cirugía cardiaca valvular que desarrolla sepsis grave por lo cual se administra proteína C activada recombinante con resultados favorables.
Severe sepsis in surgical patients has a high mortality. There is evidence that the use of recombinant human activated protein C (Drotrecogin alfa) improves survival in these patients. We report the use of drotrecogin alfa, in a 40-year-old male with Marfans syndrome undergone cardiac valve surgery that develops severe sepsis, with good results.