Empiric antibiotics for community-acquired pneumonia in adult patients: a systematic review and a network meta-analysis.

OBJECTIVE: The main aim of this network meta-analysis is to identify the empiric antibiotic (Em-ATB) with the highest probability of being the best (HPBB) in terms of (1) cure rate and (2) mortality rate in hospitalised patients with community acquired pneumonia (CAP) . METHOD: Inclusion criteria: (1) adult patients (>16 years old) diagnosed with CAP that required hospitalisation; (2) randomised to at least two different Em-ATBs, (3) that report cure rate and (4) are written in English or Spanish. EXCLUSION CRITERIA: (1) ambiguous antibiotics protocol and (2) published exclusively in abstract or letter format. DATA SOURCES: Medline, Embase, Cochrane and citation reviews from 1 January 2000 to 31 December 2018. Risk of bias: Cochrane's tool. Quality of the systematic review (SR): A MeaSurement Tool to Assess systematic Reviews-2. Certainity of the evidence: Grading of Recommendations Assessment, Development and Evaluation. STATISTICAL ANALYSES: frequentist method performed with the 'netmeta' library, R package. RESULTS: 27 randomised controlled trials (RCTs) from the initial 41 307 screened citations were included. Regarding the risk of bias, more than one quarter of the studies presented low risk and no study presented high risk in all domains. The SR quality is moderate. For cure, two networks were constructed. Thus, two Em-ATBs have the HPBB: cetaroline 600 mg (two times a day) and piperacillin 2000 mg (two times a day). For mortality, three networks were constructed. Thus, three Em-ATBs have the HPBB: ceftriaxone 2000 mg (once a day) plus levofloxacin 500 (two times a day), ertapenem 1000 mg (two times a day) and amikacin 250 mg (two times a day) plus clarithromycin 500 mg (two times a day). The certainity of evidence for each results is moderate. CONCLUSION: For cure rate, ceftaroline and piperaciline are the options with the HPBB. However, for mortality rate, the options are ceftriaxone plus levofloxacin, ertapenem and amikacin plus clarithromycin. It seems necessary to conduct an RCT that compares treatments with the HPBB for each event (cure or mortality) (CRD42017060692).

Serum Angiopoietin-2 Predicts Mortality and Kidney Outcomes in Decompensated Cirrhosis.

Acute kidney injury in decompensated cirrhosis has limited therapeutic options, and novel mechanistic targets are urgently needed. Angiopoietin-2 is a context-specific antagonist of Tie2, a receptor that signals vascular quiescence. Considering the prominence of vascular destabilization in decompensated cirrhosis, we evaluated Angiopoietin-2 to predict clinical outcomes. Serum Angiopoietin-2 was measured serially in a prospective cohort of hospitalized patients with decompensated cirrhosis and acute kidney injury. Clinical characteristics and outcomes were examined over a 90-day period and analyzed according to Angiopoietin-2 levels. Primary outcome was 90-day mortality. Our study included 191 inpatients (median Angiopoietin-2 level 18.2 [interquartile range 11.8, 26.5] ng/mL). Median Model for End-Stage Liver Disease (MELD) score was 23 [17, 30] and 90-day mortality was 41%. Increased Angiopoietin-2 levels were associated with increased mortality (died 21.9 [13.9, 30.3] ng/mL vs. alive 15.2 [9.8, 23.0] ng/mL; P < 0.001), higher Acute Kidney Injury Network stage (stage I 13.4 [9.8, 20.1] ng/mL vs. stage II 20.0 [14.1, 26.2] ng/mL vs. stage III 21.9 [13.0, 29.5] ng/mL; P = 0.002), and need for renal replacement therapy (16.5 [11.3, 23.6] ng/mL vs. 25.1 [13.3, 30.3] ng/mL; P = 0.005). The association between Angiopoietin-2 and mortality was significant in unadjusted and adjusted Cox regression models (P ≤ 0.001 for all models), and improved discrimination for mortality when added to MELD score (integrated discrimination increment 0.067; P = 0.001). Conclusion: Angiopoietin-2 was associated with mortality and other clinically relevant outcomes in a cohort of patients with decompensated cirrhosis with acute kidney injury. Further experimental study of Angiopoietin/Tie2 signaling is warranted to explore its potential mechanistic and therapeutic role in this population.

[Occupational health and safety: educational intervention for cleaning workers in research sectors]. / Salud y seguridad laboral: intervención educativa en trabajadores de limpieza en áreas de investigación.

OBJECTIVE: To evaluate the results of educational interven- tion on health and safety regarding principles of biosafety in cleaning workers of a health institution. MATERIALS AND METHODS: Using concurrent mixed methods, we evaluated a total of 31 workers on their knowledge, attitudes, and practices of biosafety and risk perception. We conducted baseline measurements and two follow-ups. Fractional logistic regression models were fitted with study stage as covariate. Additional models included interactions of study stage with key workers characteristics. Thematic qualitative analysis and triangulation was developed. RESULTS: The knowledge (+33.3 points, scale 0-100), attitudes (+10.6), and practices (+23.5) increased significantly in the first follow-up; knowledge de- creased in the second follow-up (p<0.001). The qualitative findings revealed an improvement in risk prevention attitudes and practices, framed by experiences of vulnerability, stigma, and discrimination. CONCLUSIONS: The study provides key elements for biosafety research related to vulnerable groups and it is effective in promoting the health of a disadvantaged and invisible sector.

OBJETIVO: Evaluar los resultados de una intervención educativa sobre salud y seguridad laboral bajo principios de bioseguridad en trabajadores y trabajadoras de limpieza de una institución de salud. MATERIAL Y MÉTODOS: Evaluación con métodos mixtos concurrentes sobre conocimientos, actitudes y prácticas en bioseguridad y percepción de riesgos, con medición basal y dos seguimientos, en 31 trabajadores y trabajadoras. Se realizaron modelos fraccionales separados para estimar interacciones de las mediciones. Se hizo análisis cualitativo temático y triangulación metodológica. RESULTADOS: Los conocimientos (+33.3 puntos, escala 0 - 100), actitudes (+10.6) y prácticas (+23.5) incrementaron signifi- cativamente en el primer seguimiento; los conocimientos disminuyeron en el segundo seguimiento (p<0.001). Los ha- llazgos cualitativos revelaron mejora en actitudes y prácticas de prevención frente al riesgo, enmarcados por experiencias de vulnerabilidad, estigma y discriminación. CONCLUSIONES: El estudio aporta elementos clave para la investigación en bioseguridad relacionada con grupos vulnerables y es efectivo para la promoción de la salud de un sector desfavorecido e invisibilizado.

Ecdysis-related pleiotropic neuropeptides expression during Anopheles albimanus development.

OBJECTIVE: To analyze the transcription pattern of neuropeptides in the ontogeny of a malaria vector, the mosquito Anopheles albimanus. MATERIALS AND METHODS: The transcription pattern of Crustacean CardioActive peptide (CCAP), corazonin, Ecdysis Triggering Hormone (ETH), allatostatin-A, orcokinin, Insulin Like Peptide 2 (ILP2), Insulin Like Peptide 5 (ILP5) and bursicon was evaluated using qPCR on larvae (1st - 4th instar), pupae and adult mosquitoes. RESULTS: Unlike in other insects, transcripts of CCAP (70.8%), ETH (60.2%) and corazonin (76.5%) were expressed in 4th instar larvae, probably because these three neuropeptides are associated with the beginning of ecdysis. The neuropeptide ILP2 showed higher transcription levels in other stages and orcokinin decreased during the development of the mosquito. CONCLUSIONS: The CCAP, corazonin and ETH neuropeptidesare potential targets for the design of control strategies aimed at disrupting An. albiamnus larval development.

Changes in Kidney Function After Transjugular Intrahepatic Portosystemic Shunts Versus Large-Volume Paracentesis in Cirrhosis: A Matched Cohort Analysis.

BACKGROUND: Patients with cirrhosis and refractory ascites have physiologic and hormonal dysregulation that contributes to decreased kidney function. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) can reverse these changes and potentially improve kidney function. We sought to evaluate change in estimated glomerular filtration rate (eGFR) following TIPS placement. STUDY DESIGN: Retrospective, matched cohort analysis. SETTINGS & PARTICIPANTS: Patients who underwent first-time TIPS placement for refractory ascites in 1995 to 2014. Frequency matching was used to generate a comparator group of patients with cirrhosis and ascites treated with serial large-volume paracentesis (LVP) in a 1:1 fashion. PREDICTOR: TIPS placement compared to serial LVP. OUTCOME: Change in eGFR over 90 days' follow-up. MEASUREMENTS: Multivariable regression stratified by baseline eGFR<60 versus ≥60mL/min/1.73m(2); analysis of effect modification between TIPS placement and baseline eGFR. RESULTS: 276 participants (TIPS, n=138; serial LVP, n=138) were analyzed. After 90 days, eGFRs increased significantly after TIPS placement in participants with baseline eGFRs<60mL/min/1.73m(2) compared to treatment with serial LVP (21 [95% CI, 13-29] mL/min/1.73m(2); P<0.001) and was no different in those with eGFRs≥60mL/min/1.73m(2) (1 [95% CI, -9 to 12] mL/min/1.73m(2); P=0.8). There was significant effect modification between TIPS status and baseline eGFR (P=0.001) in a model that included all participants. LIMITATIONS: Outcomes restricted by clinically recorded data; clinically important differences may still exist between the TIPS and LVP cohorts despite good statistical matching. CONCLUSIONS: TIPS placement was associated with significant improvement in kidney function. This was most prominent in participants with baseline eGFRs<60mL/min/1.73m(2). Prospective studies of TIPS use in populations with eGFRs<60mL/min/1.73m(2) are needed to evaluate these findings.

Siglec-7 as a Novel Biomarker to Predict Mortality in Decompensated Cirrhosis and Acute Kidney Injury.

BACKGROUND: Patients with decompensated cirrhosis have high morbidity and are commonly hospitalized with acute kidney injury. AIMS: We examined serum levels of Siglec-7, a transmembrane receptor that regulates immune activity, as a biomarker for mortality in patients with cirrhosis and acute kidney injury. METHODS: Serum Siglec-7 was measured in hospitalized patients with cirrhosis and acute kidney injury, as well as in reference groups with acute liver injury/acute kidney injury, cirrhosis without acute kidney injury, and sepsis without liver disease. Clinical characteristics and subsequent outcomes were examined using univariate and multivariable analyses according to initial Siglec-7 levels. Primary outcome was death by 90 days. RESULTS: One hundred twenty-eight subjects were included, 92 of which had cirrhosis and acute kidney injury and were used in the primary analysis. Average Model for End-Stage Liver Disease (MELD) score was 24 [95 % CI 23, 26], and serum creatinine was 2.5 [2.2, 2.8] mg/dL at the time Siglec-7 was measured. After adjusting for age and MELD score, high serum Siglec-7 level predicted mortality with a hazard ratio of 1.96 [1.04, 3.69; p = 0.04]. There was no difference in Siglec-7 levels by etiology of AKI (p = 0.24). Addition of serum Siglec-7 to MELD score improved discrimination for 90-day mortality [category-free net reclassification index = 0.38 (p = 0.04); integrated discrimination increment = 0.043 (p = 0.04)]. CONCLUSION: Serum Siglec-7 was associated with increased mortality among hospitalized patients with cirrhosis and acute kidney injury. Addition of Siglec-7 to MELD score may increase discrimination to predict 90-day mortality.

[Developments in medical units. 1915]. / Sucesos en las Unidades Médicas: 1915.

In 1915 the political, economic, and social instability initiated the destruction of medical units; they had no administrative bases and they lacked the resources. However, needs encouraged that structures arose to meet the wounded, fractured, and traumatized, called "blood" hospitals and so-called crosses and sanitary trains.

24,25-Dihydroxyvitamin d3 and vitamin D status of community-dwelling black and white Americans.

BACKGROUND: 24,25-Dihydroxyvitamin D [24,25(OH)2D] is a metabolite of 25-hydroxyvitamin D (25D). Blacks frequently have low total 25D without manifestations of vitamin D deficiency, suggesting that total serum 25D may incorrectly reflect vitamin D status in different racial groups. The ratio of serum 24,25(OH)2D to 25D [vitamin D metabolite ratio (VMR)] represents a new candidate biomarker for vitamin D status. METHODS: We measured 24,25(OH)2D3 and 25D3 by mass spectrometry in a random community cohort of black (n = 212) and white (n = 164) Americans to evaluate VMR as a marker for vitamin D status. We measured parathyroid hormone concentrations by immunoassay to compare VMR and 25D3 against a physiological indicator of vitamin D deficiency. RESULTS: Serum 24,25(OH)2D3 strongly correlated with 25D3 in both black and white study participants (r = 0.90, P < 0.001 and r = 0.86, P < 0.001 respectively). Blacks had lower mean 25D3 than whites [17.0 (7.8) vs 27.5 (11.3) ng/mL; 42.4 (19.5) vs 68.6 (28.2) nmol/L, P < 0.001] and lower mean 24,25(OH)2D3 [2.1 (1.3) vs 3.6 (2.0) ng/mL; 5.1 (3.1) vs 8.7 (4.8) nmol/L, P < 0.001]. In contrast to total 25D3 concentrations, mean VMR values were similar in blacks and whites [11.9 (4.0) vs 12.5 (3.4), P = 0.16, respectively] and were negatively correlated with parathyroid hormone concentrations in both races (rs = -0.26, P < 0.001, and rs = -0.25, P < 0.001, respectively). CONCLUSIONS: Our results provide further evidence that measurement of total 25D for assessment of vitamin D status in patients of African descent deserves reevaluation and suggest that alternative measures such as VMR should be considered.

Cross-sectional examination of metabolites and metabolic phenotypes in uremia.

BACKGROUND: Although metabolomic approaches have begun to document numerous changes that arise in end stage renal disease (ESRD), how these alterations relate to established metabolic phenotypes in uremia is unknown. METHODS: In 200 incident hemodialysis patients we used partial least squares discriminant analysis to identify which among 166 metabolites could best discriminate individuals with or without diabetes, and across tertiles of body mass index, serum albumin, total cholesterol, and systolic blood pressure. RESULTS: Our data do not recapitulate metabolomic signatures of diabetes and obesity identified among individuals with normal renal function (e.g. elevations in branched chain and aromatic amino acids) and highlight several potential markers of diabetes status specific to ESRD, including xanthosine-5-phosphate and vanillylmandelic acid. Further, our data identify significant associations between elevated tryptophan and long-chain acylcarnitine levels and both decreased total cholesterol and systolic blood pressure in ESRD. Higher tryptophan levels were also associated with higher serum albumin levels, but this may reflect tryptophan's significant albumin binding. Finally, an examination of the uremic retention solutes captured by our platform in relation to 24 clinical phenotypes provides a framework for investigating mechanisms of uremic toxicity. CONCLUSIONS: In sum, these studies leveraging metabolomic and metabolic phenotype data acquired in a well-characterized ESRD cohort demonstrate striking differences from metabolomics studies in the general population, and may provide clues to novel functional pathways in the ESRD population.

The Effects of Parenteral Amino Acid Therapy on Protein Carbamylation in Maintenance Hemodialysis Patients.

OBJECTIVE: Protein carbamylation is a urea-driven post-translational protein modification associated with mortality in dialysis patients. Free amino acids (AAs) are competitive inhibitors of protein carbamylation and animal studies suggest increasing AA concentrations reduces carbamylation burden. We hypothesized that AA therapy in maintenance hemodialysis patients would reduce carbamylation, carrying the potential to improve clinical outcomes. DESIGN: Prospective pilot clinical trial (NCT1612429). SETTING: The study was conducted from March 2013 to March 2014 in outpatient dialysis facilities in the Boston metropolitan area. SUBJECTS AND INTERVENTION: We enrolled 23 consecutively consenting hemodialysis subjects, infusing the first 12 individuals with 250 cc of AAs 3 times per week postdialysis over 8 weeks. The remaining 11 subjects served as controls. MAIN OUTCOME MEASURE: Change in carbamylated albumin (C-Alb), a measure of total body carbamylation burden, between baseline and 8 weeks was the primary outcome. RESULTS: The treated and control groups had similar clinical characteristics and similar baseline C-Alb levels (mean ± SE 9.5 ± 2.4 and 9.3 ± 1.3 mmol/mol, respectively; P = .61). The treated arm showed a significant reduction in C-Alb compared with controls at 4 weeks (8.4% reduction in the treated arm vs. 4.3% increase in controls; P = .03) and the effect was greater by 8 weeks (15% reduction in the treated vs. 1% decrease in controls; P = .01). CONCLUSION: In this pilot study, AA therapy appeared safe and effective at reducing C-Alb levels in hemodialysis patients compared with no treatment. The impact of reduced protein carbamylation on clinical outcomes should be further investigated.

Efficacy of Continuous vs. Intermittent Administration of Cefepime in Adult ICU Patients with Gram-Negative Bacilli Bacteremia: A Randomized Double-Blind Clinical Study.

INTRODUCTION: The objective of this study was to compare the continuous infusion of cefepime with the intermittent infusion in patients with sepsis caused by Gram-negative bacilli (GNB). METHODS: Randomized 1:1 multicenter double-blinded placebo-controlled study with allocation concealment; multicenter study in the intensive care units of Colombia. Patients with sepsis, severe sepsis or septic shock, and GNB-suspected bacteremia. Cefepime was administered for 7 to 14 days over 30 m intermittently every 8 h over 24 h plus continuous saline solution (0.9%) (G1) or 3 g administered continuously plus saline solution every 8 h (0.9%) (G2). The percentage of clinical response at 3, 7, and 14 days, relapse at 28 days, and mortality at discharge were measured. RESULTS: The recruitment was stopped at the suggestion of the Institutional Review Board (IRB) following an FDA alert about cefepime. Thirty-two patients were randomized; 25 received the intervention, and GNB bacteremia was confirmed in 16 (9 G1 and 7 G2). Favorable clinical response in days 3, 7, and 14 was 88.8%, 88.8%, and 77.8% (G1) and was similar for G2 (85.7%). There were no relapses or deaths in G2, while in G1, one relapse and two deaths were observed. CONCLUSIONS: The results of this study support the use of cefepime for the treatment of Gram-negative infections in critically ill patients, but we could not demonstrate differences between continuous or intermittent administration because of the small sample size, given the early suspension of the study.

Evaluating the response of current biotic indices and functional metrics to natural and anthropogenic predictors in disconnected pools of temporary rivers.

Temporary rivers, forming the majority of river networks worldwide, are key biodiversity hotspots. Despite their great value for maintaining biodiversity and ecosystem functioning, they are often neglected in biomonitoring programs due to several challenges, such as their variable hydromorphology and the difficulty of establishing reference conditions given their dynamic nature, resulting in highly variable communities. Disconnected pools often form in temporary rivers when flow ceases, providing refuge for aquatic taxa. Given their importance for biodiversity conservation, revising and adapting biotic indices are needed. Here, we evaluate the performance of current biological indices designed for perennial rivers (macroinvertebrates, diatoms) and functional metrics (macroinvertebrates) in assessing biological quality of disconnected pools. We sampled 55 disconnected pools in Catalonia, NE Spain, covering local (e.g., physico-chemical variables, water chemistry) and regional (e.g., human influence, hydrological variables at the water body level) natural and anthropogenic gradients. Only a few macroinvertebrate biotic indices (e.g., family richness, EPT/EPT + OCH and OCH) showed strong responses to anthropogenic predictors and were unaffected by natural predictors at both local and regional scales, making them suitable for biomonitoring. Of the newly adopted functional metrics of macroinvertebrate communities tested, only two (i.e., functional redundancy of predators and response diversity based on the total community) responded strongly to anthropogenic predictors. The rest showed varying responses to the interactive effect of anthropogenic and natural predictors, requiring calibration efforts. Models assessing these metrics explained <40 % of the total variation, likely due to the interplay of colonization/extinction dynamics and density-dependent trophic interactions governing community assemblages in disconnected pools. Although some existing biological metrics could potentially be used to monitor the ecological status of disconnected pools, we call for further development of biomonitoring tools specifically designed for these habitats since they will become more widespread with global change.

Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals.

BACKGROUND: Sepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality. METHODS: This is a secondary analysis of a multicenter cohort of inpatients hospitalized in general wards or intensive care units (ICUs). The general estimating equations (GEE) model was used to estimate the risk of progression and the determinants of stages of infection over the first week. Cox regression with time-dependent covariates and fixed covariates was used to determine the factors related with 7-day and 28-day mortality, respectively. RESULTS: In 2681 patients we show that progression to severe sepsis and septic shock increases with intraabdominal and respiratory sources of infection [OR = 1,32; 95%IC = 1,20-1,46 and OR = 1.21, 95%CI = 1,11-1,33 respectively], as well as according to Acute Physiology and Chronic Health Evaluation II (APACHE II) [OR = 1,03; 95%CI = 1,02-1,03] and Sequential Organ Failure Assessment (SOFA) [OR = 1,16; 95%CI = 1,14-1,17] scores. The variables related with first-week mortality were progression to severe sepsis [HR = 2,13; 95%CI = 1,13-4,03] and septic shock [HR = 3,00; 95%CI = 1,50-5.98], respiratory source of infection [HR = 1,76; 95%IC = 1,12-2,77], APACHE II [HR = 1,07; 95% CI = 1,04-1,10] and SOFA [HR = 1,09; 95%IC = 1,04-1,15] scores. CONCLUSIONS: Intraabdominal and respiratory sources of infection, independently of SOFA and APACHE II scores, increase the risk of clinical progression to more severe stages of sepsis; and these factors, together with progression of the infection itself, are the main determinants of 7-day and 28-day mortality.

[Revista Médica del IMSS: Institutional heritage and Important reference]. / Revista Médica del IMSS: patrimonio institucional e importante referente formativo.

In a context that has tended towards globalization, in which obtaining economic resources is usually the driving force of societies, information resources have frequently been treated as private goods for which one must pay. A strategy for the above has been open and free access to information, a factor of great importance for the construction of more open media.

En un contexto que ha tendido a lo globalizado, en el que la obtención de recursos económicos suele ser el motor de las sociedades, los recursos de información han sido tratados con frecuencia como bienes privados por los que hay que pagar. Una estrategia a lo anterior ha sido el acceso abierto y gratuito a la información, un factor de gran importancia para la construcción de medios más abiertos.

Application of artificial neural networks in assigned leadership and academic success in medical graduates.

OBJECTIVE: To apply an artificial neural networks analysis (ANN) model to identify variables that predict assigned leadership and academic success in graduates of six generations of medical school. METHOD: Analytical, retrospective, comparative study. A total of 1434 graduates participated. A questionnaire was sent to them by e-mail including a voluntary participation consent. A multivariate statistical analysis using multi-layer perceptron ANN, decision trees and driver analysis was performed. RESULTS: The ANN identified seven independent variables that predicted professional success and eight for leadership in medical graduates. The decision trees identified significant differences in the variables professional performance (p = 0.000), age (p = 0.005) and continuing education activities (p = 0.034) related to professional success, and for leadership the variables gender (p = 0.000), high school grades (p = 0.042), performing clinical practice during the social service year (p = 0.002) and continuing education activities (p = 0.011). CONCLUSIONS: The ANN identified the main independent predictor variables of professional success and leadership of the graduates. This study opens up two new lines of research little studied with the techniques of in the area of medicine.

OBJETIVO: Aplicar un modelo de análisis de redes neuronales artificiales (RNA) para identificar las variables que predicen el liderazgo asignado y el éxito académico en egresados de seis generaciones de la carrera de Medicina. MÉTODO: Estudio analítico, retrospectivo y comparativo. Participaron 1434 egresados. Se envió un cuestionario por correo electrónico que incluyó el consentimiento de participación voluntaria. Se realizó análisis estadístico multivariado mediante RNA del tipo perceptrón multicapa, árboles de decisión y análisis de impulsores. RESULTADOS: Las RNA identificaron siete variables independientes que predijeron el éxito profesional y ocho para el liderazgo en los médicos egresados. Los árboles de decisión identificaron diferencias significativas en las variables desempeño profesional (p = 0.000), edad (p = 0.005) y actividades de educación continua (p = 0.034) relacionadas con el éxito profesional, y para el liderazgo las variables sexo (p = 0.000), promedio en el bachillerato (p = 0.042), realizar práctica clínica en el servicio social (p = 0.002) y actividades de educación continua (p = 0.011). ­. CONCLUSIONES: Las RNA identificaron las principales variables independientes predictoras del éxito profesional y el liderazgo de los egresados. El estudio abre dos líneas de investigación poco estudiadas con las técnicas de RNA en el área de la medicina.

[First steps of medical administration at the IMSS]. / Primeros pasos de la administración médica en el IMSS.

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

La creación de una organización tan grande como el Instituto Mexicano del Seguro Social (IMSS) requirió de mucha planeación para lograr administrar todas las prestaciones que se brindan a la población. Siendo así una necesidad contar con personal de salud con conocimientos y experiencia en administración en servicios de salud. El presente manuscrito es un reconocimiento a los doctores Manuel Barquín Calderón, Antonio Ríos Vargas y Carlos Zamarripa Torres, pioneros y protagonistas reconocidos en la planeación y organización (administración) de los servicios médicos del IMSS entre 1945 y 1955, quienes además tuvieron iniciativas racionales y constructivas, cumpliendo con su deber. Por otro lado, el Instituto expuso y proyectó que las actividades médico-administrativas eran una tarea compleja, y que su práctica necesitaba conocimientos especializados que no podían dejarse al azahar, al empirismo, a la buena voluntad, a las creencias o a la imaginación no objetiva.

[Farewell to a great doctor and extraordinary believer, creator of Quality of Care: Dr. Héctor Aguirre Gas]. / Despedida a un gran médico y extraordinario creyente, creador de la Calidad de la Atención: Dr. Héctor Aguirre Gas.

From these lines a farewell is expressed to Dr. Héctor Gerardo Aguirre Gas, excellent doctor and great exponent of the Quality of Medical Care and Patient Safety, trained and servant in the medical services of the Instituto Mexicano del Seguro Social (IMSS), noble companion and friend. A man with universal ethical values and a straight and humble figure, active and bold behavior, committed to serving others.

Desde estas líneas se expresa una despedida al Dr. Héctor Gerardo Aguirre Gas, excelente médico y gran exponente de la Calidad de la Atención Médica y Seguridad del Paciente, formado y servidor en los servicios médicos del Instituto Mexicano del Seguro Social (IMSS), noble compañero y amigo. Un hombre con valores éticos universales y una figura recta y sencilla, proceder activo y audaz, empeñado en servir al prójimo.

Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study: A prospective, multicenter, multinational, cohort study.

PURPOSE: The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19. MATERIAL AND METHODS: This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19. RESULTS: A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)], p<0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074], p<0.001). CONCLUSIONS: This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries.