Alliance for the development of the Argentinian Hip Fracture Registry.

Age expectancy has significantly increased over the last 50 years, as well as some age-related health conditions such as hip fractures. The development of hip fracture registries has shown enhanced patient outcomes through quality improvement strategies. The development of the Argentinian Hip Fracture Registry is going in the same direction. INTRODUCTION: Age expectancy has increased worldwide in the last 50 years, with the population over 64 growing from 4.9 to 9.1%. As fractures are an important problem in this age group, specific approaches such as hip fracture registries (HFR) are needed. Our aim is to communicate the Argentinian HFR (AHFR) development resulting from an alliance between Fundación Trauma, Fundación Navarro Viola, and the Argentinian Network of Hip Fracture in the elderly. METHODS: Between October 2020 and May 2021, an iterative consensus process involving 5 specialty-focused meetings and 8 general meetings with more than 20 specialists was conducted. This process comprised inclusion criteria definitions, dataset proposals, website deployment with data protection and user validation, the definition of hospital-adjusted registry levels, implementation planning, and sustainability strategies. RESULTS: By June 2021, we were able to (1) outline data fields, including epidemiological, clinical, and functional dimensions for the pre-admission, hospitalization, discharge, and follow-up stages; (2) define three levels: basic (53 fields), intermediate (85), and advanced (99); (3) identify 21 benchmarking indicators; and (4) make a correlation scheme among fracture classifications. Simultaneously, we launched a fundraising campaign to implement the AHFR in 30 centers, having completed 18. CONCLUSION: AHFR development was based on four pillars: (1) representativeness and support, (2) solid definitions from onset, (3) committed teams, and (4) stable funding. This tool may contribute to the design of evidence-based health policies to improve patient outcomes, and we hope this experience will help other LMICs to develop their own tailored-to-their-needs registries.

Airway Management of Patients with Suspected or Confirmed COVID-19: Survey Results from Physicians from 19 Countries in Latin America.

Airway management during the COVID-19 pandemic has been one of the most challenging aspects of care that anesthesiologists and intensivists face. This study was conducted to evaluate the management of tracheal intubation in patients with suspected or confirmed COVID-19 infection. This is a cross-sectional and international multicenter study based on a 37-item questionnaire. The survey was available to physicians who had performed intubations and tracheostomies in patients with suspected or confirmed COVID-19 and had provided informed consent to participate. The primary outcome is the preference to use a specific device for tracheal intubation. Secondary outcomes are clinical practice variables, use of video laryngoscopes, difficult airway management, and safety features to prevent cross-infection. This study included 2411 physicians who performed an average of 11.90 and 20.67 tracheal intubations in patients diagnosed or suspected of having COVID-19 disease, respectively. Physicians were mainly from the specialties of Anesthesiology (61.2%) and Intensive Care (7.4%). COVID-19 infection diagnosed by positive PCR or serology in physicians participating in intubation in this study was 15.1%. Respondents considered preoxygenation for more than three minutes very useful (75.7%). The preferred device for tracheal intubation was the video laryngoscope (64.8%). However, the direct laryngoscope (57.9%) was the most commonly used, followed by the video laryngoscope (37.5%). The preferred device to facilitate intubation was the Eschmann guide (34.2%). Percutaneous tracheostomy was the preferred technique (39.5%) over the open tracheostomy (22%). The predicted or unpredicted difficult airway management in these patients was preferably performed with a video laryngoscope (61.7% or 63.7, respectively). Intubation was mostly performed by two or more expert airway physicians (61.6%). The use of personal protective equipment increased the practitioners' discomfort during intubation maneuvers. The video laryngoscope is the preferred device for intubating patients with COVID-19, combined with the Eschmann guide, flexible stylet within the endotracheal tube, or Frova guide to facilitate intubation. The sub-analysis of the two groups of physicians by the level of intubation experience showed a higher use of the video laryngoscope (63.4%) in the experts group and no significant differences between the two groups in terms of cross-infection rates in physicians, in their preference for the use of the video laryngoscope or in the number of intubations performed in confirmed or suspected COVID-19 patients.

Nonintensivist Training to Increase the Staff Capacity of Intensive Care Units During COVID-19 Pandemic Surge in Argentina.

OBJECTIVE: The aim of this study was to report the results of a nationwide critical-care course for non-intensivists to increase staff capacity of intensive care units (ICUs) during the coronavirus disease 2019 (COVID-19) pandemic in Argentina. METHODS: Three academic organizations, with special funding from 55 private companies, developed a short virtual course comprised of Web-based videos, virtual tutorials, and a forum chat. Each state assigned scholarships to non-ICU staff from public hospitals. Students received active follow-up for the completion of the course and took a survey upon course completion. RESULTS: After 4 m, there were 10,123 students registered from 661 hospitals in 328 cities. Of these, 67.8% passed the course, 29.1% were still ongoing, and 3.1% were inactive. Most students were female (74.2%) with a median of 37 y old (IQR 31-44). The group was composed of 56.5% nurses, 36.2% physicians, and 7.4% physiotherapists, of whom 48.3% did not have any experience in critical care. Mean overall satisfaction was 4.4/5 (standard deviation, 0.9), and 90.7% considered they were able to apply the contents to their practice. CONCLUSIONS: This course was effective for rapid training of non-ICU personnel. The assignment strategy, the educational techniques, and the close follow-up led to low dropout and high success rates and satisfaction.

A public-private collaborative model for a trauma program implementation: findings from a prospective trauma registry at 14 hospitals in Buenos Aires, Argentina.

INTRODUCTION: Trauma is a leading cause of mortality and comprises an important cause of functional impairment among young people worldwide. The trauma registry (TR) is an integral component of modern comprehensive trauma care systems. Nevertheless, TRs have not been yet established in most developing countries. The objective of this study was to summarize the challenges, results, and lessons learned from a trauma program including initial results from a TR at tertiary-care public hospitals of Buenos Aires, Argentina. MATERIAL AND METHODS: This is a descriptive study of the implementation of a trauma program in 14 hospitals and analysis of the initial results in the period between January 2010 and December 2018, using data from Fundación Trauma TR. Patients fitting injury definition that remained in hospital for more than 23 h were included. Injured patients were divided by age groups. Data on patients' demographics, mechanism of injury and severity, complications, treatments, and in-hospital mortality were analyzed between groups. A descriptive analysis is presented. RESULTS: There were 29,970 trauma cases during the study period. Median age was 23 years (RIC 12, 39) with a 2.4:1 male-to-female ratio. Road traffic injuries (RTI) were the leading mechanism (30.8%) of admission and head was the most frequently injured body region (33.2%). Two-thirds of RTIs were motorcycle-related. Overall in-hospital mortality was 6.1%. Intentional self-harm in adult males and burns in adult females had the highest mortality rates (17.6% and 17.9%, respectively). CONCLUSIONS AND DISCUSSION: The implementation of a trauma program within a public-private collaborative program in a resource-limited environment is feasible. The hospital-based TR can be used as a tool for injury surveillance, monitoring of the quality of trauma care, development of a trauma system, and to guide public health policies.

How Do Induced Affective States Bias Emotional Contagion to Faces? A Three-Dimensional Model.

Affective states can propagate in a group of people and influence their ability to judge others' affective states. In the present paper, we present a simple mathematical model to describe this process in a three-dimensional affective space. We obtained data from 67 participants randomly assigned to two experimental groups. Participants watched either an upsetting or uplifting video previously calibrated for this goal. Immediately, participants reported their baseline subjective affect in three dimensions: (1) positivity, (2) negativity, and (3) arousal. In a second phase, participants rated the affect they subjectively judged from 10 target angry faces and ten target happy faces in the same three-dimensional scales. These judgments were used as an index of participant's affective state after observing the faces. Participants' affective responses were subsequently mapped onto a simple three-dimensional model of emotional contagion, in which the shortest distance between the baseline self-reported affect and the target judgment was calculated. The results display a double dissociation: negatively induced participants show more emotional contagion to angry than happy faces, while positively induced participants show more emotional contagion to happy than angry faces. In sum, emotional contagion exerted by the videos selectively affected judgments of the affective state of others' faces. We discuss the directionality of emotional contagion to faces, considering whether negative emotions are more easily propagated than positive ones. Additionally, we comment on the lack of significant correlations between our model and standardized tests of empathy and emotional contagion.

Optical design and Initial Results from The National Institute of Standards and Technology's AMMT/TEMPS Facility.

The National Institute of Standards and Technology's (NIST) Physical Measurement and Engineering Laboratories are jointly developing the Additive Manufacturing Measurement Testbed (AMMT)/ Temperature and Emittance of Melts, Powders and Solids (TEMPS) facilities. These facilities will be co-located on an open architecture laser-based powder bed fusion system allowing users full access to the system's operation parameters. This will provide users with access to machine-independent monitoring and control of the powder bed fusion process. In this paper there will be emphasis on the AMMT, which incorporates in-line visible light collection optics for monitoring and feedback control of the powder bed fusion process. We shall present an overview of the AMMT/TEMPS program and its goals. The optical and mechanical design of the open architecture powder-bed fusion system and the AMMT will also be described. In addition, preliminary measurement results from the system along with the current status of the system will be described.

[Saint Louis encephalitis virus in Buenos Aires city during the outbreak of dengue in 2009]. / Encefalitis por virus San Luis en la ciudad de Buenos Aires durante el brote de dengue 2009.

We report the case of a male, 80-year-old resident in the City of Buenos Aires, with a diagnosis of St. Louis encephalitis (SLE) during a countrywide dengue outbreak, from January to May 2009. The patient had a chronic lymphocytic leukemia treated with chlorambucil, prostate cancer (hormone therapy and radiotherapy) and images consistent with bone metastases. Cerebrospinal fluid examination showed pleocytosis with a predominance of mononuclear cells and high protein concentration. Bacteria, fungi and mycobacteria cultures, as well as the PCR for herpes virus, HSV, CMV and EBV, were negative. We confirmed the diagnosis of SLE by detection of IgM antibodies in both CSF and serum sample with IgG seroconversion by neutralization in cell cultures and negative results for other flaviviruses with known circulation in Argentina. We review the evidence for the presence of the St. Louis virus in our country and point to the importance of the diagnosis and the search of other Flavivirus in suspected dengue cases with severe or atypical presentation. This work emphasizes the need to strengthen both the epidemiological surveillance of SLE, and vector control to prevent different infections transmitted by mosquitoes and to understand their true impact on public health in Argentina.

Encefalitis por virus San Luis en la Ciudad de Buenos Aires durante el brote de dengue 2009 / Saint Louis encephalitis virus in Buenos Aires city during the outbreak of dengue in 2009

Se presenta un paciente de 80 años de edad, residente en la Ciudad de Buenos Aires, con diagnóstico serológico para el virus de la encefalitis de San Luis (SLE) durante el brote de dengue ocurrido entre enero y mayo de 2009. Presentaba leucemia linfoide crónica en tratamiento con clorambucilo, cáncer de próstata tratado con hormonoterapia y radioterapia, e imágenes óseas compatibles con metástasis. El estudio del líquido cefalorraquídeo demostró pleocitosis con predominio de mononucleares y proteinorraquia elevada. El resultado de los cultivos para bacterias, hongos y micobacterias, así como el PCR en LCR para herpes virus, HSV, CMV y EBV, fue negativo. Se detectaron anticuerpos IgM para virus SLE tanto en LCR como en muestra de suero, con seroconversión IgG por neutralización en cultivos celulares y resultados negativos para los demás Flavivirus con circulación en Argentina. Se revisan evidencias sobre la presencia de virus de San Luis en nuestro país, y se señala la importancia de la confirmación diagnóstica y el estudio de otros Flavivirus en casos sospechosos de dengue con presentación grave o atípica. Este trabajo remarca la necesidad de fortalecer tanto la vigilancia epidemiológica del virus SLE, como el control vectorial para prevenir las diferentes infecciones transmitidas por mosquitos y conocer su efecto en Salud Pública en la Argentina.

We report the case of a male, 80-year-old resident in the City of Buenos Aires, with a diagnosis of St. Louis encephalitis (SLE) during a countrywide dengue outbreak, from January to May 2009. The patient had a chronic lymphocytic leukemia treated with chlorambucil, prostate cancer (hormone therapy and radiotherapy) and images consistent with bone metastases. Cerebrospinal fluid examination showed pleocytosis with a predominance of mononuclear cells and high protein concentration. Bacteria, fungi and mycobacteria cultures, as well as the PCR for herpes virus, HSV, CMV and EBV, were negative. We confirmed the diagnosis of SLE by detection of IgM antibodies in both CSF and serum sample with IgG seroconversion by neutralization in cell cultures and negative results for other flaviviruses with known circulation in Argentina. We review the evidence for the presence of the St. Louis virus in our country and point to the importance of the diagnosis and the search of other Flavivirus in suspected dengue cases with severe or atypical presentation. This work emphasizes the need to strengthen both the epidemiological surveillance of SLE, and vector control to prevent different infections transmitted by mosquitoes and to understand their true impact on public health in Argentina.

La enfermedad trauma / Trauma disease

Reports of the World Health Organization make known that the non-intentional lesions and the violence (intentional injuries) are a threatening possibility for the world's health and they represnt a 9 per cent of the whole mortality. Around 5,804,000 subjects die yearly due to lesions (16,000 subjects each day). Eight of the 15 causes of death, of the persons between 15 through 25 years old are related to violence or non-intentional injuries, whether they are produced by vehicular collisions, suicides, homicides, suffocation, burns, wars, poisoning or fallz. In Argentina, each year 8,000 subjects die due to vehicular collisions. According with the National Ministry of health, this number represents the 25 per cent of the deaths due to trauma. We think that it is interesing to present two aspects that require a conceptualization with a scientific support: The recognition of trauma as a disease (the disease trauma), and the necessity to not use the term accident to design the lesional mechanism described for non-intentional truama. The participation of institutions in the control of the disease trauma is considered by the authors.

Pandemic 2009 influenza A in Argentina: a study of 337 patients on mechanical ventilation.

RATIONALE: The rapid spread of the 2009 Influenza A (H1N1) around the world underscores the need for a better knowledge of epidemiology, clinical features, outcomes, and mortality predictors, especially in the most severe presentations. OBJECTIVES: To describe these characteristics in patients with confirmed, probable, and suspected viral pneumonia caused by 2009 influenza A (H1N1) admitted to 35 intensive care units with acute respiratory failure requiring mechanical ventilation in Argentina, between June 3 and September 7. METHODS: Inception-cohort study including 337 consecutive adult patients. Data were collected in a form posted on the Argentinian Society of Intensive Care website. MEASUREMENTS AND MAIN RESULTS: Proportions of confirmed, probable, or suspected cases were 39%, 8%, and 53% and had similar outcomes. APACHE II was 18 +/- 7; age 47 +/- 17 years; 56% were male; and 64% had underlying conditions, with obesity (24%), chronic obstructive respiratory disease (18%), and immunosupression (15%) being the most common. Seven percent were pregnant. On admission, patients had severe hypoxemia (Pa(O(2))/Fi(O(2)) 140 [87-200]), extensive lung radiologic infiltrates (2.87 +/- 1.03 quadrants) and bacterial coinfection, (25%; mostly with Streptococcus pneumoniae). Use of adjuvants such as recruitment maneuvers (40%) and prone positioning (13%), and shock (72%) and acute kidney injury requiring hemodialysis (17%), were frequent. Mortality was 46%, and was similar across all ages. APACHE II, lowest Pa(O(2))/Fi(O(2)), shock, hemodialysis, prone positioning, and S. pneumoniae coinfection independently predicted death. CONCLUSIONS: Patients with 2009 influenza A (H1N1) requiring mechanical ventilation were mostly middle-aged adults, often with comorbidities, and frequently developed severe acute respiratory distress syndrome and multiorgan failure requiring advanced organ support. Case fatality rate was accordingly high.

Exposure of neonates to ochratoxin A: first biomonitoring results in human milk (colostrum) from Chile.

The mycotoxin ochratoxin A (OTA) and its metabolite ochratoxin alpha (OTα) were determined in milk and blood from nine lactating women who provided samples soon after delivery at a hospital in southern Chile. The analytical method applied liquid-liquid extraction with chloroform, and in the case of blood, an extra purification with solid phase extraction prior to HPLC analysis with fluorescence detection. OTA was detected in all human milk samples, with an average concentration of 106 ± 45 ng/L (range 44-184 ng/L). Levels of OTα were 40 ± 30 ng/L (LOQ 40 ng/L), but increased considerably upon enzymatic hydrolysis with ß-glucuronidase/sulfatase (up to 840 ± 256 ng/L) in human milk. By contrast, there was no evidence for conjugates of OTA. The data on OTA in breast milk and levels reported in blood from women in Chile are indicative of an efficient lactational transfer of the mycotoxin. Infant exposure to OTA was estimated by considering their daily OTA intake with human milk at early stages of nursing. For the majority of milk samples, the calculated OTA intake of infants exceeded the tolerable daily intake (TDI) of 5 ng/kg body weight (bw)/day proposed by the Nordic Expert Group, and infant exposure approached the provisional tolerable doses of 14-16 ng/kg bw/day suggested by the Joint FAO/WHO Expert Committee on Food Additives (JEFCA) and by EFSA for adults. The present study documents and confirms the presence of OTA in human milk at levels where the TDI can be exceeded. These results point out the need to continue food and biological monitoring and to develop strategies, e.g. dietary recommendations to pregnant and lactating women, aimed to reduce OTA exposure in early periods of life.

La enfermedad trauma / The disease trauma

Reports of the World Health Organization make known that the non-intentional lesions and the violence (intentional injuries) are a threatening possibility for the world's health and they represent a 9% of the whole mortality. Around 5.840.000 subjects die yearly due to lesions (16.000 subjects each day). Eight of the 15 causes of death, of the persons between 15 trough 25 years old are related to violence or non-intentional injuries, whether they are produced by vehicular collisons, suicides, homicides, suffocation, burns, wars, poisoning or falls. In Argentina, each year 8.000 subjects die due to vehicular collisions. According with the National Ministery of Health, this number represents the 25% of the deaths due to trauma. We think that it is interesting to present two aspects that require a conceptualization with a scientific support: The recognition of trauma as a disease (the disease trauma), and the necessity to not use the term accident to design the lesional mechanism described for non-intentional trauma. The participation of Institutions in the control of the disease trauma is considered by the authors.

Efecto de la asociación L-glutamina - Etilenglicol en la criopreservación de semen equino / Effect of the association l-glutamine - ethylene glycol in equine semen cryopreservation

Con el objeto de mejorar la eficiencia en la criopreservación de semen equino, se evaluó el efecto de la asociación L-glutamina con el Etilenglicol y glicerol en el medio de congelación seminal. Se usaron 4 reproductores criollos Colombianos para completar un total de 21 muestras que fueron congeladas en diferentes medios de congelación constituidos de medio INRA 97 y crioprotectante según estudio: L-glutamine 80mM + Etilenglicol 2,5 por ciento (protocolo 1), L-glutamine 80mM + Glycerol 2,5 por ciento (protocolo 2), Etilenglicol 2,5 por ciento (rotocolo 3) y glycerol 2,5 por ciento (protocolo 4). la metodología de congelación fue: 60 minutos para descender la temperatura de 38ºC a 5ºC (0,55ºC/min) durante el transporte. Se centrifugaron las muestras a 600G/10min, se duluyó el semen con los cuatro protocolos en pajillas de 0,5 ml. Luego 60 minutos de equilibrio en refrigeración; 20 minutos en vapores de nitrógeno líquido y posterior inmersión. En la evaluación de la motilidad progresiva no se encontró diferencia significativa entre protocolos al tiempo 0 (P<0.6383), al tiempo 30 min (P<0.511) y al tiempo 60 min (P<0.1659)...

The role of the surgeon as intensivist: an international perspective.

PURPOSE OF REVIEW: Critical care is a young specialty. It emerged less than 50 years ago in response to new technologies that could prolong the survival of patients who previously would have died. The diseases that posed this threat to life were varied and the original practitioners of critical care came from a variety of medical backgrounds, and created a multidisciplinary specialty. As it continues to evolve, however, the participation and influence of surgeons is waning. CONTENT: We have sought the perspectives of an international group of intensivists on the role of surgeons in the future of critical care. These perspectives are varied. Surgeons play the largest role in North American critical care, although even here that role is diminishing, and new models of practice are needed. Surgical involvement is even less in Japan, Europe, and South America. The important role of the surgical perspective in differentiating heroic from futile intervention is underlined by Alsanea from Saudi Arabia. CONCLUSIONS: Surgical involvement in the practice of critical care is declining around the world. The reasons are complex, and include competing clinical imperatives, economics, and the demands of training programs. New models are needed to revitalize critical care as a multidisciplinary specialty.

Effects of high-dose of intravenous immunoglobulin and antibiotics on survival for severe sepsis undergoing surgery.

The objective of this study was to assess the impact on outcome of adjuvant therapy (high-dose of immunoglobulin [Ig] M-enriched intravenous Ig, IVIG) in intensive care unit (ICU) patients who underwent surgery by abdominal sepsis. This was a prospective, randomized, double-blind, controlled study set in the medical/surgical ICUs of seven teaching hospitals. Patients with severe sepsis and septic shock of intra-abdominal origin admitted to the ICU within 24 h after the onset of symptoms were included in the study. Polyvalent IgM-enriched Ig (Pentaglobin; IVIG group) at a dosage of 7 mL/kg/day for 5 days or an equal amount of 5% human albumin (control group) was randomized. Fifty-six patients were enrolled. The overall mortality rate was 37.5.%. Twenty patients had shock and 36 had severe sepsis (the mortality rate was 55.0% and 25.0%, respectively). In the intent-to-treat analysis, the mortality rate was reduced from 48.1% in patients treated with antibiotic (ATB) plus albumin to 27.5% (P = 0.06) for patients with ATB plus IVIG. The organ failure score (1.0 +/- 0.6 vs. 1.2 +/- 0.9), organ dysfunction score (1.7 +/- 1.1 vs. 1.8 +/- 1.0), and reoperation rate (17.2% vs. 29.6%) were not different between IVIG and control groups, respectively. Eight patients (14.3%) received inappropriate ATB initial therapy (IAT), and seven died (87.5%). IAT was the only variable independently associated with death (odds ratio, 19.4) in a logistic regression model. We conclude that IVIG administration, when used in combination with adequate antibiotics, improved the survival of surgical ICU patients with intra-abdominal sepsis. The initial choice of antibiotic has a dramatic impact on outcome.

Sinusitis nosocomial en terapia intensiva / Nosocomial sinusitis in intensive care

La fiebre sin foco clínico aparente es un cuadro frecuente el el paciente crítico. Dentro de las probables causas, debe considerarse a la infección de los senos paranasales como causa de fiebre de origen desconocido en pacientes con ventilación mecánica. La incidencia global de sinusitis nosocomial es muy variable (0-100%) y se encuentra determinada por la población estudiada y el criterio diagnóstico utilizado para definirla. La SN se desarrolla a partir de una sumatoria de factores de riesgo, y parece no ser uno más importante que el otro de acuerdo a nuestra experiencia. Para su diagnóstico es fundamental discernir entre sinusitis radiológica mediante tomografía, de sinusitis infecciosa mediante la toma de muestra por punción-aspiración de los senos paranasales con cultivo positivo y presencia de reacción inflamatoria en el examen directo. Los microorganismos más comúnmente involucrados son los bacilos gramnegativos. Dentro de las complicaciones, la más común es la neumonía, no hallada en nuestra serie de pacientes. No existe un consenso en relación al tratamiento, pero sí recomendaciones sugeridas.

Utilidad del doppler transcraneal en el diagnóstico de la muerte encefálica / Utilization of Doppler transcranial ultrasonography in the diagnosis of the brain death

Se realizó un estudio descriptivo para valorar la utilidad del Doppler transcraneal en el diagnóstico de la muerte encefálica desde enero del 2002 hasta mayo del 2003 en el Hospital Provincial Docente Manuel Ascunce Domenech de Camagüey. El universo estuvo constituido por 45 pacientes. Las ventanas óseas temporal y orbital fueron utilizadas en todos los pacientes. Nueve sujetos presentaron patrón de separación diástole-sístole, dentro de las primeras dos horas del diagnóstico de muerte cerebral. El flujo reverberante y espicular se demostró en 34 enfermos, solamente siete de ellos en las primeras dos horas. En dos individuos (mujeres) no se detectó flujo a través de la ventana temporal y sí a través de la orbitaria. Con el uso de la ventana transorbitaria y la arteria carótida interna extracraneal el porcentaje de resultados positivos para la confirmación de la muerte encefálica se elevó al 100 por ciento