Simultaneous mechanical ventilation of several patients with a single ventilator.

INTRODUCTION: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. OBJECTIVE: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. RESULTS: No statistically significant differences were observed between programmed, recorded and measured positive end-expiratory pressure, mean airway pressure and peak pressure, except when simultaneously ventilating four lung simulators. CONCLUSIONS: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.

INTRODUCCIÓN: La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. OBJETIVO: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultáneamente en dos y cuatro. RESULTADOS: No se observaron diferencias estadísticamente significativas entre la presión positiva al final de la espiración, presión media de la vía aérea y presión pico programadas, registradas y medidas, excepto al ventilar simultáneamente cuatro simuladores de pulmón. CONCLUSIONES: La ventilación mecánica simultánea debe ser instaurada por personal médico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos.

[Índice de Saturación Modificado y Ambulancias (ISMA): Ambulance assignment and remote Emergency Room Bed Reservation]. / Índice de Saturación Modificado y Ambulancias (ISMA): asignación de ambulancias y reservación remota de camas en los Servicios de Urgencias Médicas.

INTRODUCTION: In most places all over the world­including our country­services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. OBJECTIVE: To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. MATERIAL AND METHODS: The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. RESULTS: The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. CONCLUSIONS: This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.

[An automated registry program for nosocomial infections]. / Programa de registro automatizado de infecciones nosocomiales.

Las infecciones nosocomiales presentan un gran reto para la medicina hospitalaria, en general, y para las Unidades de Cuidados Intensivos, en particular. Su elevada prevalencia, la gran morbilidad y mortalidad asociadas, el incremento de la estancia hospitalaria y, en consecuencia, los costos de la atención médica han hecho que los programas de vigilancia, control y prevención de infecciones nosocomiales sean una parte toral de los protocolos de seguridad para el paciente y un indicador de calidad de la atención médica.

[Modified overcrowd index in emergency room]. / Índice de saturación modificado en el servicio de urgencias médicas.

INTRODUCTION: Overcrowd of emergency rooms affects efficiency and quality of medical care. OBJECTIVES: To describe the mathematical-computational system modified overcrowd index which measures in real time and in four levels of warnings (non crowded, crowded, overcrowded and extreme overcrowded) emergency room saturation in a network of hospitals, from only seven simple variables (number of available beds, physicians and nurses, number of patients in the waiting room, in medical consultation and admitted for further evaluation, as well as number of critically ill patients admitted). MATERIALS AND METHODS: The modified overcrowd index was exhaustively tested with 245,280 virtual transactions from seven hospitals in an uninterrupted schedule basis simulating hourly surveillance for four years. RESULTS: From 224 episodes of overcrowd, 216 (97%) where correctly identified and verified by the network of hospitals warnings, its time series also provided useful information about available personnel and resource distribution within the hospital network. CONCLUSIONS: Modified overcrowd index is an efficient tool detecting emergency room overcrowd outbreaks in a network of hospitals.

[Survey about responsiveness of third-level hospitals to a medical disaster: after the pandemic influenza in Mexico]. / Encuesta sobre la capacidad de respuesta de los hospitales de alta especialidad ante un desastre médico: después de la influenza pandémica en México.

BACKGROUND: The recent pandemic influenza AH1N1 virus made it clear that planning for medical disaster response is critical. OBJECTIVE: To know the responsiveness of a sample of highly specialized hospitals in Mexico to a medical disaster, with the previous pandemic influenza AH1N1 as reference. METHODS: A survey was conducted among the Medical Directors of a sample of highly specialized hospitals, covering: previous experience with the pandemic influenza, space considerations, material resources, staff, logistics, and current general perspectives. Descriptive statistics were used for analysis. RESULTS: A 95% response was obtained from the institutions (19 hospitals). Of these, 47.4% considered that the medical institution was not ready to respond to pandemic influenza. The median surge capacity for the Intensive Care Unit beds was 30% (range 0 to 32 beds). The least reserve in medication was found in the antivirals (26.3%). Only 47.4% considered having enough intensive care nurses and 57.9% enough respiratory technicians; 42.1% would not have an easy access to resources in an emergency. CONCLUSIONS: Prevention is key in responsiveness to medical disasters, and therefore the basic steps for planning strategies must be considered.

Bioinformatics-based Characterization of the Sequence Variability of Zika Virus Polyprotein and Envelope Protein (E).

Background: Zika virus, which is widely spread and infects humans through the bites of Aedes albopictus and Aedes aegypti female mosquitoes, represents a serious global health issue. Objective: The objective of the present study is to computationally characterize Zika virus polyproteins (UniProt Name: PRO_0000443018 [residues 1-3423], PRO_0000445659 [residues 1-3423] and PRO_0000435828 [residues 1-3419]) and their envelope proteins using their physico-chemical properties. Methods: To achieve this, the Polarity Index Method (PIM) profile and the Protein Intrinsic Disorder Predisposition (PIDP) profile of 3 main groups of proteins were evaluated: structural proteins extracted from specific Databases, Zika virus polyproteins, and their envelope proteins (E) extracted from UniProt Database. Once the PIM profile of the Zika virus envelope proteins (E) was obtained and since the Zika virus polyproteins were also identified with this profile, the proteins defined as "reviewed proteins" extracted from the UniProt Database were searched for the similar PIM profile. Finally, the difference between the PIM profiles of the Zika virus polyproteins and their envelope proteins (E) was tested using 2 non-parametric statistical tests. Results: It was found and tested that the PIM profile is an efficient discriminant that allows obtaining a "computational fingerprint" of each Zika virus polyprotein from its envelope protein (E). Conclusion: PIM profile represents a computational tool, which can be used to effectively discover Zika virus polyproteins from Databases, from their envelope proteins (E) sequences.

Impact of obesity and diabetes mellitus in critically ill patients with SARS-CoV-2.

PURPOSE: Evaluate the associations of obesity and diabetes with the risk of mortality in critically ill patients infected with SARS-CoV-2. MATERIALS AND METHODS: This cohort study included 115 adult patients admitted to the ICU with SARS-CoV-2 pneumonia. Anthropometric variables and biochemical (C-reactive protein, ferritin, leukocyte, neutrophils, and fibrinogen) were measured. Multivariate logistic regression analyses were used to investigate the associations. RESULTS: Mean age was 50.6±11.2 years, 68.7% were male. Median BMI was 30.9kg/m2. All patients had invasive mechanical ventilation. Patients with diabetes had increased risk of mortality with OR of 2.86 (CI 95% 1.1-7.4, p=0.026); among those patients who, in addition to diabetes had obesity, the risk was de 3.17 (CI 95% 1.9-10.2, p=0.038). Patients with obesity had 1.25 times greater risk of developing a severe SARS-CoV-2 infection (95% CI 1.09-1.46, p=0.025). Negative correlation was observed between BMI and the PaO2/FiO2 ratio (r=-0.023, p<0.05). Obese patients required more days of mechanical ventilation and longer hospital stay compared to non-obese patients. CONCLUSIONS: Diabetes and obesity are risk factors for increasing severity of SARS-CoV-2 infection, and they are both associated with an increase in mortality.

[Ogilvie syndrome. Report of two cases]. / Pseudoobstrucción colónica aguda (síndrome de Ogilvie). Informe de dos casos.

Acute colonic pseudo-obstruction or "Ogilvie syndrome (OS)," is a gastrointestinal motility disorder characterized by marked dilatation of the colon in the absence of mechanical obstruction. It occurs most commonly in the postoperative state or with severe medical illness; it has been associated with a wide range of comorbidities, including trauma, pelvic surgery (orthopedic, gynecologic, urologic), metabolic disorders, central nervous system disorders, and prostaglandin abnormalities. OS may also be drug induced or idiopathic. Left untreated, it can progress to perforation, peritonitis, and death. Definitive management of OS traditionally has consisted of mechanical decompression. However, neostigmine, an acetyl-cholinesterase inhibitor, has recently emerged as a safe and effective pharmacologic alternative in the adult population. We present two cases of OS attended in the intensive care unit treated with colonoscopy and cecostomy respectively.

[Respiratory tract fluid microbiology in an intensive care unit]. / Microbiología de secreciones bronquiales en una unidad de cuidados intensivos.

OBJECTIVE: to know patterns of antimicrobial resistance of bacterial isolates from tracheal aspirates in an Intensive Care Unit and to evaluate the cases of ventilator-associated pneumonia. METHODS: antibiotic sensitivity test was done. A comparison was made between patients with nosocomial pneumonia reported by infection surveillance team against those reported by the attending physician with the infectious disease consultant. RESULTS: Pseudomonas aeruginosa was the bacteria most frequently reported with 134 isolates (26 %), 71 were multiple-drug-resistant; followed by Staphylococcus with 122 isolates (24 %), of which 88 were S. aureus with 62 of them (70 %) methicillin-resistant. Enterobacteriaceae, E. coli, K. pneumoniae, E. cloacae, S. marcescens, as well as Acinetobacter sp. and S. maltophilia were occasionally isolated. Candida represented 17 % of the isolates. Three peaks of isolates of S. aureus and P. aeruginosa were identified during the two years of surveillance. There were differences in cases of ventilator associated pneumonia reported by the hospital based epidemiology team and the attending clinicians in collaboration with an Infectious disease consultant. CONCLUSIONS: prevalence of multiple-drug-resistant Pseudomonas aeruginosa (53 %) and methicillin resistant Staphylococcus (70 %) isolated from the airway is high in our Intensive Care Unit. Enterobacterias, Acinetobacter sp. and Stenotrophomonas maltophilia colonization are low in our Intensive Care Unit.

Electronegativity and intrinsic disorder of preeclampsia-related proteins.

Preeclampsia, hemorrhage, and infection are the leading causes of maternal death in underdeveloped countries. Since several proteins associated with preeclampsia are known, we conducted a computational study which evaluated the commonness and potential functionality of intrinsic disorder of these proteins and also made an attempt to characterize their origin. The origin of the preeclampsia-related proteins was assessed with a supervised technique, a Polarity Index Method (PIM), which evaluates the electronegativity of proteins based solely on their sequence. The commonness of intrinsic disorder was evaluated using several disorder predictors from the PONDR family, the charge-hydropathy plot (CH-plot) and cumulative distribution function (CDF) analyses, and using the MobiDB web-based tool, whereas potential functionality of intrinsic disorder was studied with the D2P2 resource and ANCHOR predictor of disorder-based binding sites, and the STRING tool was used to build the interactivity networks of the preeclampsia-related proteins. Peculiarities of the PIM-derived polar profile of the group of preeclampsia-related proteins were then compared with profiles of a group of lipoproteins, antimicrobial peptides, angiogenesis-related proteins, and the intrinsically disordered proteins. Our results showed a high graphical correlation between preeclampsia proteins, lipoproteins, and the angiogenesis proteins. We also showed that many preeclampsia-related proteins contain numerous functional disordered regions. Therefore, these bioinformatics results led us to assume that the preeclampsia proteins are highly associated with the lipoproteins group, and that some preeclampsia-related proteins contain significant amounts of functional disorders.

Electronic Devices That Identify Individuals with Fever in Crowded Places: A Prototype.

Most epidemiological surveillance systems for severe infections with epidemic potential are based on accumulated symptomatic cases in defined geographical areas. Eventually, all cases have to be clinically verified to confirm an outbreak. These patients will present high fever at the early stages of the disease. Here, we introduce a non-invasive low-cost electronic device (bracelet) that measures and reports 24/7, year-round information on the temperature, geographical location, and identification of the subject using the device. The data receiver can be installed in a tower (ground) or a drone (air) in densely populated or remote areas. The prototype was made with low-cost electronic components, and it was tested indoors and outdoors. The prototype shows efficient ground and air connectivity. This electronic device will allow health professionals to monitor the prevalence of fever in a geographical area and to reduce the time span between the presentation of the first cases of a potential outbreak and their medical evaluation by giving an early warning. Field tests of the device, programs, and technical diagrams of the prototype are available as Supplementary Materials.

[Mean airway pressure during pressure-controlled ventilation with static vs. dynamic positive end-expiratory pressure]. / Presión media de la vía aérea con la aplicación de presión positiva al final de la espiración estática vs. dinámica.

BACKGROUND: Positive end-expiratory pressure increases mean airway pressure (Paw) in patients with mechanical ventilation. We undertook this study to compare mean airway pressure (Paw) generated with static PEEP (sPEEP) vs. dynamic PEEP (dPEEP) at the same level of total PEEP (tPEEP) in the same patient with pressure-controlled mechanical ventilation (PC). METHODS: We conducted a prospective clinical trial at the Intensive Care Unit of a university-affiliated hospital. Consecutive patients in PC with SaO2>90%; FiO2<50%; sPEEP of 4 cm H2O and inspiration-expiration ratio (I:E ratio) 1:2 were included in the study. After a basal period of time of 15 min, Paw was registered (phase one of the study protocol). In phase 2 with the ventilator settings constant, only the I:E ratio was switched to 2:1 to generate dPEEP, and after 15 min Paw and total PEEP (tPEEP) were registered (tPEEP=sPEEP+dPEEP). In phase 3, the I:E ratio was switched back to 1:2 substituting the dPEEP generated in the second phase of the study by sPEEP to maintain the same level of tPEEP of phase 2. After 15 min, Paw was again registered. Friedman and Wilcoxon's test were used, p value<0.05 was considered statistically significant. RESULTS: Thirty eight patients were admitted to the study protocol, tPEEP was 4, 8 and 8 cm H2O and median of the Paw 8.7, 13.8, and 11.4 cm H2O, respectively, with a p value<0.05 in the first, second and third phases of the study. CONCLUSIONS: During pressure control ventilation, mean airway pressure is affected by the level of total PEEP and its composition. Paw is higher when dynamic PEEP participates in the composition of total PEEP.

[Reflections concerning the care process in the emergency medical services]. / Reflexiones sobre el proceso de atención en los servicios de urgencias.

In this paper we share some reflections regarding the care process in the emergency medical services, as well as some of the challenges with which these fundamental services deal. We highlight the increasing amount of patients and the complexity of some of the clinical cases, which are some of the causes that lead to the overcrowding of these services.

En el presente artículo se presentan algunas reflexiones sobre el proceso de atención en los servicios de urgencias médicas, así como algunos de los retos que enfrentan estos componentes fundamentales del sector salud de nuestro país. Se hace énfasis en el creciente volumen y la complejidad de los casos atendidos en estos servicios, lo cual contribuye a su saturación.

Classifying lipoproteins based on their polar profiles.

The lipoproteins are an important group of cargo proteins known for their unique capability to transport lipids. By applying the Polarity index algorithm, which has a metric that only considers the polar profile of the linear sequences of the lipoprotein group, we obtained an analytical and structural differentiation of all the lipoproteins found in UniProt Database. Also, the functional groups of lipoproteins, and particularly of the set of lipoproteins relevant to atherosclerosis, were analyzed with the same method to reveal their structural preference, and the results of Polarity index analysis were verified by an alternate test, the Cumulative Distribution Function algorithm, applied to the same groups of lipoproteins.

Identification of proteins associated with Mycobacterium tuberculosis virulence pathway by their polar profile.

With almost one third of the world population infected, tuberculosis is one of the most devastating diseases worldwide and it is a major threat to any healthcare system. With the mathematical-computational method named "Polarity Index Method", already published by this group, we identified, with high accuracy (70%), proteins related to Mycobacterium tuberculosis bacteria virulence pathway from the Tuberculist Database. The test considered the totality of proteins cataloged in the main domains: fungi, bacteria, and viruses from three databases: Antimicrobial Peptide Database (APD2), Tuberculist Database, Uniprot Database, and four antigens of Mycobacterium tuberculosis: PstS-1, 38-kDa, 19-kDa, and H37Rv ORF. The method described was calibrated with each database to achieve the same performance, showing a high percentage of coincidence in the identification of proteins associated with Mycobacterium tuberculosis bacteria virulence pathway located in the Tuberculist Database, and identifying a polar pattern regardless of the group studied. This method has already been used in the identification of diverse groups of proteins and peptides, showing that it is an effective discriminant. Its metric considers only one physico-chemical property, i.e. polarity.

Ventilación mecánica simultánea con un solo ventilador a varios pacientes / Simultaneous mechanical ventilation of several patients with a single ventilator

Resumen Introducción: La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. Objetivo: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultáneamente en dos y cuatro simuladores. Resultados: No se observaron diferencias estadísticamente significativas entre la presión positiva al final de la espiración, presión media de la vía aérea y presión pico programadas, registradas y medidas, excepto al ventilar simultáneamente cuatro simuladores de pulmón. Conclusiones: La ventilación mecánica simultánea debe ser instaurada por personal médico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos.

Abstract Introduction: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. Objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. Results: No statistically significant differences were observed between positive end-expiratory pressure, mean airway pressure, and programmed, recorded and measured peak pressure, except when simultaneously ventilating four lung simulators. Conclusions: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.