Predictors and outcomes associated with right ventricular function in patients with acute respiratory distress syndrome treated with Veno-venous extracorporeal membrane oxygenation.

INTRODUCTION: Right ventricular dysfunction is associated with mortality in patients with acute respiratory distress syndrome (ARDS) but information in veno-venous extracorporeal membrane oxygenation (ECMO) settings is limited. Study objectives were to examine factors associated with right ventricular (RV) systolic dysfunction (RVSD) and RV dilation in ECMO patients with ARDS, to compare outcomes in those with and without RVSD and RV dilation defined by qualitative and quantitative parameters, and to describe RVSD evolution during ECMO. METHODS: Retrospective observational study of adult ARDS patients supported with ECMO at a tertiary care hospital. RESULTS: Of a total of 62 patients, 56% had RVSD and 61% had RV dilation by qualitative assessment. Male gender, COVID-19, hypercarbia, and pneumothorax were associated with RVSD and RV dilation. In-hospital mortality was significantly higher in patients with RV dilation vs. no dilation (42% vs. 17%, p = .05) but comparisons for patients with and without RVSD (37% vs. 26%, respectively) did not reach statistical significance. Findings were similar when RV size and function were quantified by right to left ventricle end-diastolic area ratio and fractional area change (39% vs. 21% and 36% vs. 20% respectively; p = NS). Of 39 patients with multiple echocardiograms, 9 of 18 with initially normal RV function developed RVSD while RV function normalized in 10 of 21 patients who began ECMO with RVSD. CONCLUSIONS: Study results suggest an association of RV dilation and RVSD with worse outcomes and a dynamic nature of RV function necessitating close monitoring during the ECMO course.

Outcomes of patients with blastomycosis-associated respiratory failure requiring veno-venous ECMO: a case series.

Blastomycosis can result in lung injury with high mortality rates. The literature on veno-venous extracorporeal membrane oxygenation (VV-ECMO) used as a rescue therapy is limited to case reports and small case series collected over extended time periods. This report describes the clinical course and post-hospitalization outcomes among patients with blastomycosis-induced respiratory failure requiring VV-ECMO in the most recent time frame. The data were collected retrospectively from the health records of eight patients with blastomycosis-induced respiratory failure admitted to a tertiary care center between 2019 and 2023. The mean time from the start of mechanical ventilation to ECMO initiation was 57 h. All patients survived to ECMO decannulation, and seven of them survived to hospital discharge. All six patients whose post-discharge follow-up information was available were weaned from mechanical ventilation and lived at home while two required supplemental oxygen. This includes a case where the provision of adequate ECMO support was challenging due to the patient's morbid obesity. The most common residual imaging abnormalities included pulmonary infiltrates and pneumatoceles. The study demonstrates the feasibility of VV-ECMO as a rescue therapy in patients with blastomycosis-related refractory respiratory failure. Rapid initiation of ECMO support in eligible patients may have contributed to the good outcomes.

Prognostic factors and outcomes in COVID-19 patients requiring prolonged mechanical ventilation: a retrospective cohort study.

BACKGROUND: Mechanical ventilation (MV) in coronavirus disease 2019 (COVID-19) patients is associated with high mortality and extensive resource utilization. The aim of this study was to investigate prognostic factors and outcomes associated with prolonged mechanical ventilation (PMV) in COVID-19 patients. METHODS: This was a retrospective cohort study of COVID-19 patients requiring invasive MV who were hospitalized between 1 March 2020 and 30 June 2021 in the intensive care units (ICUs) of three referral hospitals belonging to a single health system. Data were extracted from electronic health records. PMV was defined as > 17 days of MV. RESULTS: Of 355 patients studied, 86 (24%) required PMV. PMV patients had lower PaO2/FiO2 ratio, higher PCO2, and higher plateau and driving pressures during the first 2 weeks of MV than their short MV (SMV; ⩽ 17 days) counterparts. PMV patients received more proning, neuromuscular blockade, and tracheostomy, had longer ICU and hospital length of stay (LOS), and required discharge to an inpatient rehabilitation facility more frequently (all p < 0.001). Overall 30-day mortality was 43.9%, with no statistically significant difference between PMV and SMV groups. In PMV patients, smoking, Charlson comorbidity index > 6, and week 2 PaO2/FiO2 ratio < 150 and plateau pressure ⩾ 30 were positively associated with 30-day mortality. In a multivariate model, results were directionally consistent with the univariate analysis but did not reach statistical significance. CONCLUSION: PMV is commonly required in COVID-19 patients with respiratory failure. Despite the higher need for critical care interventions and LOS, more than half of the PMV cohort survived to hospital discharge. Higher PaO2/FiO2 ratio, lower plateau pressure, and fewer comorbidities appear to be associated with survival in this group.

Evaluación comparativa de moxidectin e ivermectina para el control de nematodes gastrointestinales y pulmonares de llamas (Lamas glama)

La investigación tiene por objeto evaluar la eficacia del Moxidectin e Ivermectina en el control de nematodes gastrointestinales de llamas en la zona de Tiraque Alto Cochabamba. Se utilizó 30 llamas entre los tipo K'ara y Thampulli divididos en tres grupos experimentales. Los endectocidas se aplicaron el primer dia de la evaluación y el muestreo de heces se realizó a 0, 7, 14, 21 días después del tratamiento. Por método de flotación directa, se identificaron los huevos de nematodes por géneros, y para cuantificar la carga parasitaria se utilizó el método de Mc Master y la técnica de Ueno para identificar los nematodos pulmonares. A 21 días después del tratamiento se realizó la necropcia de las 30 llamas para identificar y cuantificar los nematodos adultos por método de recuperación de nematodos gastrointestinales y la técnica de baermanización para pulmonares. La mayor eficacia en el control de la carga parasitaria se obtuvo con Moxidectin a 7 días, mientras a 14 días después del tratamiento hubo similar efecto de ambos medicamentos. Por otro lado a 21 días, la Moxidectin tuvo una eficacia de 100

. Igualmente, la Moxidectin tiene mayor eficacia en el control de nematodes adultos como tipo Strongylus, Nematodirus spp. Lamanema spp y Dictyocaulus spp y presenta alta sensibilidad al afecto de Moxidectin en relacióin a Ivermectina que controla mejor a Trichuris spp a 21 días después del tratamiento

Sistema electoral, sistema de partidos y democracia en Bolivia / Electoral system, system of parties and democracy in Bolivia

El presente libro ha sido escrito preocupado por lo dificultoso y abstracto que resulta hablar sobre los sistemas electorales, en donde se ha convenido en utilizar un lenguaje menos tecnico por uno o mas didactico y pedagógico, la tematica investigativa abarca los periodos que van de 1980 hasta las ultimas elecciones nacionales llevadas acavo en el año 2002, donde la preocupación principal es que influencias y efectos politicos causa el sistema electoral sobre la representación politica, sistema de partidos y conformación de coaliciones gubernamentales...