Prediction of Noninvasive Ventilation Failure in COVID-19 Patients: When Shall We Stop?

INTRODUCTION: In coronavirus disease 2019 (COVID-19), there are no tools available for the difficult task of recognizing which patients do not benefit from maintaining respiratory support, such as noninvasive ventilation (NIV). Identifying treatment failure is crucial to provide the best possible care and optimizing resources. Therefore, this study aimed to build a model that predicts NIV failure in patients who did not progress to invasive mechanical ventilation (IMV). METHODS: This retrospective observational study included critical COVID-19 patients treated with NIV who did not progress to IMV. Patients were admitted to a Portuguese tertiary hospital between October 1, 2020, and March 31, 2021. The outcome of interest was NIV failure, defined as COVID-19-related in-hospital death. A binary logistic regression was performed, where the outcome (mortality) was the dependent variable. Using the independent variables of the logistic regression a decision-tree classification model was implemented. RESULTS: The study sample, composed of 103 patients, had a mean age of 66.3 years (SD=14.9), of which 38.8% (40 patients) were female. Most patients (82.5%) were autonomous for basic activities of daily living. The prediction model was statistically significant with an area under the curve of 0.994 and a precision of 0.950. Higher age, a higher number of days with increases in the fraction of inspired oxygen (FiO2), a higher number of days of maximum expiratory positive airway pressure, a lower number of days on NIV, and a lower number of days from disease onset to hospital admission were, with statistical significance, associated with increased odds of death. A decision-tree classification model was then obtained to achieve the best combination of variables to predict the outcome of interest. CONCLUSIONS: This study presents a model to predict death in COVID-19 patients treated with NIV in patients who did not progress to IMV, based on easily applicable variables that mainly reflect patients' evolution during hospitalization. Along with the decision-tree classification model, these original findings may help clinicians define the best therapeutical approach to each patient, prioritizing life-comforting measures when adequate, and optimizing resources, which is crucial within limited or overloaded healthcare systems. Further research is needed on this subject of treatment failure, not only to understand if these results are reproducible but also, in a broader sense, helping to fill this gap in modern medicine guidelines.

Consumer Awareness of the Degree of Industrial Food Processing and the Association with Healthiness-A Pilot Study.

Consumption of ultraprocessed foods (UPFs) has been associated with lower diet quality, obesity, and adverse health effects. Not much is known about how consumers evaluate the degree of processing of a food product and how they relate this to healthiness. An online questionnaire was completed by a total of 277 Dutch, 204 Italian, and 181 Brazilian consumers. Consumers were aged 18-65 year, mean 38 ± 13 year, 31% were males, and 71% were highly educated. Pictures of several common food products were evaluated on the degree of industrial processing and healthiness. Thirteen food categories were included, each including one minimally processed food (MPF), one High NS_UPF (Nutri-Score A or B), and one Low NS_UPF (Nutri-Score D or E). Lastly, knowledge and attitude about UPFs were assessed. Ultraprocessing was perceived as unhealthy by the majority of consumers (Dutch, Italian: 55%; Brazilian: 75%) and contributed to weight gain according to: 38% Dutch, 51% Italian, and 70% Brazilian consumers. Low NS_UPFs were correctly rated toward "processed" and "not healthy" in all countries. High NS_UPF were rated as processed but showed large variations in healthiness scores. In conclusion, consumers rated UPFs relatively low in healthiness compared with MPFs with similar Nutri-Scores within the same food category. These preliminary findings suggest that consumers incorporate, to some extent, the degree of industrial processing while assessing the healthiness of food products.

Aplicación de árnica en gel para el manejo del dolor y reabsorción del hematoma profundo / Application of arnica gel for pain management and deep hematoma reabsorption

Árnica es una planta medicinal de la especie Arnica montana, endémica en Europa Central y Meridional, perteneciente a la familia Asteracae; rica en flavonoides y compuestos fenólicos, lactonas, helenalina y ácido hexurónico que le dan propiedades cicatrizantes, antiinflamatorias, analgésicas, antimicrobianas y anticoagulantes. Se utiliza en casos de contusiones, dolores musculares, reumáticos y hematomas profundos. El artículo describe ocho casos, que presentaron hematoma profundo por punción infructuosa, en pacientes con insuficiencia renal crónica terminal con esquema de hemodiálisis, donde se aplicó árnica en gel. Por medio de fotografías se registró cómo los hematomas revirtieron a partir del tercer día, mientras que el dolor disminuyó en un 50% al tercer día. (AU)

Arnica is a medicinal plant of the species Arnica Montana, endemic in Central and Southern Europe, it belongs to the Asteracae family, rich in flavonoids and phenolic compounds, lactones, helenalin and hexuronic acid that give it healing, anti-inflammatory, analgesic, antimicrobial and anticoagulant properties. It is used in cases of bruises, muscle pain, rheumatic pain and deep bruises. The article describes eight patients with terminal chronic renal failure under hemodialysis, who presented deep hematoma due to unsuccessful puncture of their dialysis fistula. All patients were treated with local gel arnica. Verbal analogue scale (VAS) and qualitative visual image analysis (photography) on how the hematomas reverted on the third day was analyzed. (AU)

Designing food for the elderly: the critical impact of food structure.

Ageing is an unavoidable progressive process causing many changes of the individual life. However, if faced in an efficient way, living longer in a healthy status could be an opportunity for all. In this context, food consumption and dietary patterns are pivotal factors in promoting active and healthy ageing. The development of food products tailored for the specific needs of the elderly might favour the fulfilment of nutritionally balanced diets, while reducing the consequences of malnutrition. To this aim, the application of a food structure design approach could be particularly profitable, being food structure responsible to the final functionalities of food products. In this narrative review, the physiological changes associated to food consumption occurring during ageing were firstly discussed. Then, the focus shifted to the possible role of food structure in delivering target functionalities, considering food acceptability, digestion of the nutrients, bioactive molecules and probiotic bacteria.

Effect of presence of gluten and spreads on the oral processing behavior of breads.

Little is known about the oral processing behavior of gluten-free (GF) products. This study investigated the oral processing behavior of one commercial GF bread and one gluten-containing (GC) equivalent with and without spreads. Oral processing parameters were determined through video recording and the predominant texture attributes were accessed using a check-all-that-apply test. The GF bread was perceived crumbly, dry and sandy and had a longer eating duration than the GC bread, which was perceived soft, spongy, pasty and sticky. Results suggest that the structure of the GF bread was easily fragmented during mastication and a longer period in the mouth was required to prepare a cohesive bolus for swallowing. The addition of spreads increased softness perception but did not affect chewing behavior. Oral processing behavior of GF products should be further investigated to understand how eating rate, satiation responses and food intake can be modulated in GF products.

Effect of pasta shape and gluten on pasta cooking quality and structural breakdown during mastication.

Oral processing behaviour of food is affected by the structural characteristics of the food matrix, including rheological and mechanical attributes as well as the size and shape. Pasta, a staple starchy food, may have a very similar macrostructure (shape) but a very different microstructure in gluten-containing (GC) and gluten-free (GF) products. In this context, this study aims to investigate the effect of pasta shape (in the presence and absence of gluten) on cooking/textural properties, chewing behaviour and structural breakdown during oral processing. The results suggest that the shape and presence of gluten affect not only the pasta texture but also the mastication behavior with gluten significantly increasing the mastication effort whereas a small pasta shape may trigger swallowing of almost not masticated pieces. The shape and gluten can therefore be used as a strategy to modulate chewing behavior, with possible effects on both perception and intake.

Infective endocarditis by a rare and fastidious agent: Abiotrophia defectiva.

Abiotrophia defectiva is a nutritional variant streptococcus, with affinity for endovascular structures that cannot be cultured on non-supplemented media, leading to a delay in diagnosis. This case describes a 36-year-old woman with a previously known bicuspid aortic valve that presented with asthenia, myalgias and anorexia with 2-month onset. On admission, we documented fever and a systolic murmur. Transthoracic echocardiography revealed an oscillating mass attached to the aortic valve. The patient was admitted with a possible diagnosis of infective endocarditis. Later, blood cultures were positive for A. defectiva Due to severe aortic regurgitation and congestive heart failure, she underwent surgical aortic valve replacement. After 6 weeks of antimicrobial therapy, the patient experienced full recovery. Despite of its rarity, A. defectiva endocarditis is associated with significant morbidity with mortality and physicians must have a high level of suspicion to ensure a prompt diagnosis and provide the appropriate treatment.

Addison's Disease: A Diagnosis Easy to Overlook.

Addison's disease is a rare and potentially life-threatening clinical condition that often presents with an insidious onset of nonspecific symptoms and signs, frequently resulting in a significant delay in diagnosis. Clinical presentation usually includes fatigue and electrolyte imbalance disorders such as hyponatremia. However, specific diagnostic features, such as hyperpigmentation, should raise clinical suspicion. This case report describes a 43-year-old Caucasian male who presented with general malaise, fatigue, anorexia, and weight loss (7 Kg in four weeks). On physical examination, he was found to have severe hyperpigmentation of the skin and mucosal surfaces as well as hypotension. Laboratory tests revealed hypoosmolar hyponatremia and serum potassium levels in the upper limit of normal. Findings of high serum adrenocorticotropic hormone (ACTH) and renin, as well as low cortisol and aldosterone levels, helped establish a diagnosis of Addison's disease. After the initiation of treatment, the patient experienced full recovery of symptoms, normalization of hyponatremia, and improvement of hyperpigmentation. Patients with Addison's disease have the potential to resume normal daily activities with a highly functional status. However, this condition requires lifelong follow-up and surveillance.

Effect of CO2 Preservation Treatments on the Sensory Quality of Pomegranate Juice.

Due to the interest in identifying cost-effective techniques that can guarantee the microbiological, nutritional, and sensorial aspects of food products, this study investigates the effect of CO2 preservation treatment on the sensory quality of pomegranate juice at t0 and after a conservation period of four weeks at 4 °C (t28). The same initial batch of freshly squeezed non-treated (NT) juice was subjected to non-thermal preservation treatments with supercritical carbon dioxide (CO2), and with a combination of supercritical carbon dioxide and ultrasound (CO2-US). As control samples, two other juices were produced from the same NT batch: A juice stabilized with high pressure treatment (HPP) and a juice pasteurized at high temperature (HT), which represent an already established non-thermal preservation technique and the conventional thermal treatment. Projective mapping and check-all-that-apply methodologies were performed to determine the sensory qualitative differences between the juices. The volatile profile of the juices was characterized by gas chromatography-mass spectrometry. The results showed that juices treated with supercritical CO2 could be differentiated from NT, mainly by the perceived odor and volatile compound concentration, with a depletion of alcohols, esters, ketones, and terpenes and an increase in aldehydes. For example, in relation to the NT juice, limonene decreased by 95% and 90%, 1-hexanol decreased by 9% and 17%, and camphene decreased by 94% and 85% in the CO2 and CO2-US treated juices, respectively. Regarding perceived flavor, the CO2-treated juice was not clearly differentiated from NT. Changes in the volatile profile induced by storage at 4 °C led to perceivable differences in the odor quality of all juices, especially the juice treated with CO2-US, which underwent a significant depletion of all major volatile compounds during storage. The results suggest that the supercritical CO2 process conditions need to be optimized to minimize impacts on sensory quality and the volatile profile.

Small food texture modifications can be used to change oral processing behaviour and to control ad libitum food intake.

Little is known whether small modifications of food texture are sufficient to influence satiation. This study used four iso-caloric yogurts differing in viscosity (low/high) and granola particle size (small/large) to investigate the influence of small texture modifications on oral processing behaviour, eating rate and ad libitum intake. Yogurt viscosity differed by a factor of 1.57x to 1.81x. Granola particle size was 6 mm and 12 mm (2-fold difference). Granola particle concentration based on weight was constant (15% w/w). Oral processing behaviour was quantified by video recording consumers eating yogurt ad libitum (n = 104). Ratings for appetite, liking and product familiarity were also quantified. A decrease in yogurt viscosity significantly decreased spoon size, number of chews per spoon and oral exposure time per spoon but did not significantly affect eating rate and ad libitum intake. A decrease in granola particle size from 12 mm to 6 mm at constant weight concentration significantly increased number of chews per spoon and decreased spoon size, eating rate and ad libitum intake without affecting liking. The differences in eating rate and ad libitum intake between yogurts containing small and large granola particles were 5 g/min (7%) and 17 g (5%), respectively. We suggest that the volume of granola particles added to the yogurt and not the size of particles per se was the driver of oral processing behaviour. We conclude that relatively small modifications in yogurt texture, especially granola particle size, are sufficient to change oral processing behaviour and ad libitum intake. These findings demonstrate that small texture modifications of foods, such as the size of granola particles added to yogurt, can be used to modulate eating rate and food intake within a meal.

Eosinophilic fasciitis: an atypical presentation of a rare disease.

Eosinophilic fasciitis, or Shulman's disease, is a rare disease of unknown etiology. It is characterized by peripheral eosinophilia, hypergammaglobulinemia, and high erythrocyte sedimentation rate. The diagnosis is confirmed by a deep biopsy of the skin. The first line of treatment is corticotherapy. We present a rare case of eosinophilic fasciitis in a 27-year-old woman with an atypical presentation with symmetrical peripheral edema and a Groove sign. The patient responded well to treatment with corticosteroids at high doses and, in this context, was associated with hydroxychloroquine and azathioprine. After two and a half years, peripheral eosinophilia had increased, and more of her skin had hardened. At that time, the therapy was modified to include corticoids, methotrexate, and penicillamine. It is of great importance to publicize these cases that allow us to gather experience and better treat our patients.

Easy resolution of severe obstructive kidney injury.

Chronic constipation is a common diagnosis with a high prevalence in the elderly. Constipation affects the quality of life of sick individuals, bringing several clinical complications.

Eosinophilic fasciitis: an atypical presentation of a rare disease

SUMMARY Eosinophilic fasciitis, or Shulman's disease, is a rare disease of unknown etiology. It is characterized by peripheral eosinophilia, hypergammaglobulinemia, and high erythrocyte sedimentation rate. The diagnosis is confirmed by a deep biopsy of the skin. The first line of treatment is corticotherapy. We present a rare case of eosinophilic fasciitis in a 27-year-old woman with an atypical presentation with symmetrical peripheral edema and a Groove sign. The patient responded well to treatment with corticosteroids at high doses and, in this context, was associated with hydroxychloroquine and azathioprine. After two and a half years, peripheral eosinophilia had increased, and more of her skin had hardened. At that time, the therapy was modified to include corticoids, methotrexate, and penicillamine. It is of great importance to publicize these cases that allow us to gather experience and better treat our patients.

RESUMO A fasciite eosinofílica ou doença de Shulman é uma doença rara de etiologia desconhecida. É caracterizada por eosinofilia periférica, hipergamaglobulinemia e velocidade de sedimentação eritrocitária elevada. O diagnóstico é confirmado por biópsia profunda da pele. O tratamento de primeira linha é a corticoterapia. Apresentamos um caso raro de fasciite eosinofílica numa mulher de 27 anos com uma apresentação atípica com edema periférico simétrico e sinal de Groove. A paciente respondeu bem ao tratamento com corticoides, mas em doses elevadas, e, nesse contexto, associou-se hidroxicloroquina e azatioprina. Ao fim de dois anos e meio verificou-se aumento de eosinofilia e novamente pele mais endurecida. Nessa altura alterou-se a terapêutica para corticoides, metrotexato e penicilamina. É de grande importância a divulgação desses casos que nos permitem reunir experiência e assim melhor tratar os nossos doentes.

Easy resolution of severe obstructive kidney injury

SUMMARY Chronic constipation is a common diagnosis with a high prevalence in the elderly. Constipation affects the quality of life of sick individuals, bringing several clinical complications.

RESUMO A obstipação crônica é um diagnóstico com alta prevalência comum em idosos. A constipação afeta a qualidade de vida das pessoas doentes, carregando muitas complicações clínicas.

How are macronutrient intake, BMI, ethnicity, age, and gender related to the composition of unstimulated saliva? A case study.

This study investigated how macronutrient intake, BMI, ethnicity, age, and gender are related to the composition of unstimulated saliva. First, two groups of Caucasian, Dutch subjects varying in daily intake of carbohydrate, fat, and protein were selected. The daily intake of macronutrients differed by two- to threefold between the low (n = 14) and high (n = 16) macronutrient intake groups. The same subjects were divided into two groups based on BMI: normal weight (n = 14, 22.5 ± 2.0 kg/m2 ) and overweight (n = 16, 28.1 ± 3.4 kg/m2 ). Second, one group of Caucasian, Dutch (n = 15) and one group of Asian, Chinese (n = 15) subjects were selected. Unstimulated saliva was collected from all groups. Protein concentration, amylolytic activity, lipolytic activity, and saliva flow rate were determined. None of the salivary parameters varied according to macronutrient intake and BMI. An effect of ethnicity on protein concentration was observed (p < .01; η2 = 0.142), with Asians having a 45% higher protein concentration in unstimulated saliva than Caucasians. Age had a significant effect on all salivary parameters. Protein concentration (p < .01; η2 = 0.256), amylolytic activity (p < .01; η2 = 0.234), and lipolytic activity (p < .05; η2 = 0.207) increased with age, while saliva flow rate decreased (p < .01; η2 = 0.262). Gender had a significant effect on saliva flow rate (p < .01; η2 = 0.130), with male subjects having a 32% higher flow rate than females. Age was the factor that had the greatest impact on the characteristics of unstimulated saliva. As the modulation of saliva composition according to diet has been reported previously, the extent to which macronutrient intake can affect saliva composition needs to be further investigated. PRACTICAL APPLICATIONS: Saliva plays an important role in food oral processing. From the breakdown of food structures to the binding of flavor compounds and the formation of a swallowable bolus, saliva is essential for the perception and appreciation of foods. Identifying the factors that affect saliva composition is, therefore, necessary to understand the differences in eating behavior, food perception, and preference across different consumer groups. This article aims to highlight the importance of considering saliva variability when designing food products that meet the needs of specific consumer groups.