NAFLD determined by Dallas Steatosis Index is associated with poor outcomes in COVID-19 pneumonia: a cohort study.

Coronavirus disease 2019 is a worldwide health challenge. Liver steatosis diagnosis based on imaging studies has been implicated in poor outcomes of COVID-19 pneumonia, but results are inconsistent. The Dallas Steatosis Index (DSI) is an available calculator developed to identify patients with non-alcoholic fatty liver disease (NAFLD). We hypothesized that it would be associated with in-hospital mortality, intensive care unit admission (ICU), and invasive mechanical ventilation (IMV). We conducted a retrospective cohort study on inpatients with confirmed COVID-19 pneumonia between February 26 and April 11, 2020. We computed the DSI on admission, and patients with high DSI were considered with NAFLD. We employed logistic regression to study the association between NAFLD, mortality, ICU admission, and IMV. We studied the association between liver steatosis on computed tomography (CT) and these outcomes, and also between Metabolic Associated Fatty Liver Disease (MAFLD) based on CT findings and risk factors and the outcomes. 470 patients were included; 359 had NAFLD according to the DSI. They had a higher frequency of type 2 diabetes (31% vs 14%, p < 0.001), obesity (58% vs 14%, p < 0.001), and arterial hypertension (34% vs 22%, p = 0.02). In univariable analysis, NAFLD was associated with mortality, ICU admission, and IMV. Liver steatosis by CT and MAFLD were not associated with any of these outcomes. In multivariable logistic regression, high DSI remained significantly associated with IMV and death. High DSI, which can be easily computed on admission, was associated with IMV and death, and its use to better stratify the prognosis of these patients should be explored. On the other hand, liver steatosis by CT and MAFLD were not associated with poor outcomes.

Large-scale screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) among healthcare workers: Prevalence and risk factors for asymptomatic and pauci-symptomatic carriers, with emphasis on the use of personal protective equipment (PPE).

Healthcare workers (HCWs) not fulfilling the coronavirus disease 2019 (COVID-19) case definition underwent severe acute respiratory coronavirus virus 2 (SARS-CoV-2) screening. Risk of exposure, adherence to personal protective equipment (PPE), and symptoms were assessed. In total, 2,000 HCWs were screened: 5.5% were positive for SARS-CoV-2 by polymerase chain reaction (PCR). There were no differences in PPE use between SARS-CoV-2-positive and -negative HCWs (adherence, >90%). Nursing and kitchen staff were independently associated with positive SARS-CoV-2 results.

Understanding the concept of compassion from the perspectives of nurses.

BACKGROUND: The high level of satisfaction of users of a health service is largely due to the fact that they receive excellent care from healthcare professionals. Compassionate care is an essential component of excellent care. But what do nurses understand compassion to be? RESEARCH OBJECTIVES: To analyse the concept of compassion from the perspective of nurses in the Andalusian Public Health System, Spain. RESEARCH DESIGN: This is a qualitative study following the grounded theory model. Four focus groups and 25 in-depth interviews were conducted. PARTICIPANTS AND RESEARCH CONTEXT: A total of 68 nursing professionals working in the Andalusian Public Health System (Spain) participated. Theoretical sampling was used, with participants being recruited using the snowball technique. ETHICAL CONSIDERATIONS: This research was approved by the Research Ethics Committee of the Centro-Almería Health District (CEICA 27/9/17). FINDINGS: From the analysis of the data, four themes emerged that helped to understand the concept of compassion according to nurses: 'Negative perception of the term compassion', 'Compassion and empathy as synonyms', 'Beyond empathy', and 'Effects of having a compassionate attitude'. DISCUSSION: Nurses perceive the concept of compassion differently to each other and even contradictorily. This concept is imbued with cultural elements, which adds confusion to understanding it, and is even perceived as something negative similar to pity. CONCLUSION: Nurses confuse the concepts of empathy and compassion as if they were synonymous. Before considering training in compassion for healthcare professionals, it is essential to clarify the concept of compassion through educational interventions.

Low Thoracic Skeletal Muscle Area Is Not Associated With Negative Outcomes in Patients With COVID-19.

OBJECTIVE: Sarcopenia has been related to negative outcomes in different clinical scenarios from critical illness to chronic conditions. The aim of this study was to verify whether there was an association between low skeletal muscle index and in-hospital mortality, intensive care unit admission, and invasive mechanical ventilation need in hospitalized patients with COVID-19. DESIGN: This was a retrospective cohort study of a referral center for COVID-19. We included all consecutive patients admitted to the hospital between February 26 and May 15, 2020, with a confirmed diagnosis of COVID-19. Skeletal muscle index was assessed from a transverse computed tomography image at the level of twelfth thoracic vertebra with National Institutes of Health ImageJ software, and statistical analysis was performed to find an association between skeletal muscle index and in-hospital mortality, need of invasive mechanical ventilation, and intensive care unit admission. RESULTS: We included 519 patients, the median age was 51 (42-61) yrs, and 115 patients (22%) had low skeletal muscle index. On multivariable analysis, skeletal muscle index was not associated with mortality, intensive care unit admission, or invasive mechanical ventilation need nor in a subanalysis of patients 65 yrs or older. CONCLUSIONS: Skeletal muscle index determined by computed tomography at the level of twelfth thoracic vertebra was not associated with negative outcomes in hospitalized patients with COVID-19.

Qualitative study on the causes and consequences of compassion fatigue from the perspective of nurses.

Compassion is one of the core elements of nursing care. Continued exposure to patient pain and suffering puts nurses at risk of developing compassion fatigue. The aim of this study was to understand the causes and consequences of compassion fatigue from the perspective of nurses. To this end, a qualitative design based on the hermeneutic phenomenology paradigm was used. Five focus group sessions were held with 43 nursing professionals. Two themes and six sub-themes emerged from the analysis of their discourses in relation to the impact of compassion fatigue on nurses. Based on the results obtained, the causes perceived as generating compassion fatigue are the lack of time and resources to provide comprehensive nursing care. The consequences identified were difficulties in carrying out their work, repercussions on family and private life, anxiety, stress, and, in some cases, the desire to quit the profession. This study concluded that healthcare organizations are key to fostering compassionate care and that cultivating compassion is necessary to prevent compassion fatigue.

CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF PATIENTS DIAGNOSED WITH COVID-19 IN A TERTIARY CARE CENTER IN MEXICO CITY: A PROSPECTIVE COHORT STUDY.

BACKGROUND: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. OBJECTIVE: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). METHODS: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. RESULTS: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. CONCLUSIONS: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

Clinical and epidemiological characteristics of patients diagnosed with covid-19 in a tertiary care center in Mexico City: a prospective cohort study

ABSTRACT Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

High prevalence of MDR gram-negative bacteria in feces of healthy blood donors in Mexico.

During the initial stage of a study to recruit universal intestinal microbiota donors in Mexico City, we found multiple "healthy" subjects that colonized with MDRO (Multidrug-resistant organisms). We aimed to describe clinical and demographic characteristics of these individuals. This was a prospective observational study. Participants were consecutively recruited among blood donors. A fecal sample was collected from each subject and analyzed at the same day in search of MDRO through chromographic culture media and, if growth observed, later confirmed by MALDI-TOF and susceptibility testing in Vitek 2 system. From July 2018 to March 2019, 85 individuals were screened for fecal colonization. Median age was 35 years (IQR 27-46 years), and 48/85 (56.4%) were males. Seventy-two (84.7%) subjects harbored at least one MDRO. ESBL-producing microorganisms were found in 72/85 (84.3%) subjects, and E. coli was the most frequent (63/85, 74.1%). Four samples (2 E. coli, 2 P. aeruginosa, 2.4% each) harbored carbapenem-resistant Enterobacteriaceae (CRE), together with an ESBL-producing microorganism. Antibiotic use (p = 0.06) and PPIs or H2-blockers intake (p = 0.03) were more common in the colonized subjects during the previous 6-month period. We report a high incidence of enteric colonization of healthy subjects with MDRO, a condition that may be related to antibiotics or PPIs/H2-blockers consumption. This surprisingly high MDRO colonization rate in potential FMT donors emphasizes the need for careful screening of donors to avoid possible transmission to FMT recipients.

Quality of Life in Nursing Professionals: Burnout, Fatigue, and Compassion Satisfaction.

The objective of this research was to analyse the quality of life of nursing professionals and its relationship with socio-demographic variables and the work context. A multi-centre, descriptive, cross-sectional design was used. Questionnaires were administered to 1521 nurses working in the Andalusian Public Health System (APHS), Spain. Professional quality of life (ProQOL v. IV) was measured, as well as several socio-demographic and work-related variables. To this end, a descriptive analysis and multiple exploratory analyses were conducted. The levels of compassion fatigue (CF) and burnout (BO) were elevated. The level of compassion satisfaction (CS) was below the estimated mean. Marital status, the healthcare setting, the area where the centre is located, and the work shift are variables associated with CF. According to the multiple linear regression model, the predicting factors for the occurrence of CF were being married, working in primary care, in urban areas, and working a morning/evening/night shift. The variables related to CS were the professional's age, sex, marital status, the healthcare setting of the centre, the location of the centre, and the work shift. Specifically, according to the exploratory model, the factors that predicted a reduction in CS were working in primary care, in urban areas, and working a morning/evening/night shift. However, being divorced increased CS. BO was influenced only by the work shift. Nursing professionals are exposed to certain factors that may influence professional quality of life. Some of these factors are related to the work context.

Educar para la vida y la muerte a los estudiantes de Enfermería: "del miedo al amor" / Educar estudantes de Enfermagem para a vida e a morte: "do medo ao amor" / Educate Nursing students for life and death: "from fear to love"

Resumen: Esta investigación surge de la observación fenomenológica como enfermera asistencial cuidando a pacientes al final de la vida y como docente de enfermería en la asignatura "Afrontamiento de la muerte: intervención interdisciplinar". Existen grandes carencias sobre formación en los cuidados al final de la vida, la muerte y el duelo. Para cubrir esta necesidad de formación de los alumno/as realizo una propuesta de intervención docente en la asignatura "Afrontamiento de la muerte: intervención interdisciplinar", cuyo objetivo es evaluar el impacto que la propuesta educativa de la asignatura tiene sobre los estudiantes de Enfermería. Metodología: Esta investigación está enmarcada en el paradigma interpretativo o hermenéutico, de enfoque cualitativo. Desde una mirada fenomenológica, se plantea un estudio descriptivo y como instrumento de investigación se tomarán los diarios reflexivos de los alumnos/as, matriculados en la asignatura que eligieron la opción de asistencia a clase. Resultados: El número de diarios fueron 36, pero se seleccionaron de forma aleatoria 14. El análisis cualitativo ha permitido estructurar el discurso del alumnado en 5 categorías de análisis: Motivo de elección de la asignatura; Crecimiento personal; Logros en el proceso de aprendizaje; Aplicación profesional de las técnicas desarrolladas en la asignatura; Valoración de la asignatura por parte del alumno. Conclusiones: La intervención educativa de la asignatura, ha tenido un alto impacto en los alumnos/as, en dos dimensiones importantes para sus vidas. Por un lado, aumentando sus competencias académicas como futuros profesionales, y por otro adquiriendo habilidades y actitudes positivas sobre la muerte, para vivir y amar la vida

Resumo: Esta pesquisa decorre da observação fenomenológica como enfermeira assistencial que cuida de pacientes no final da vida e professora de enfermagem na disciplina "Enfrentando a morte: intervenção interdisciplinar". Existem grandes deficiências no treinamento de cuidados no final da vida, morte e sofrimento. Para suprir essa necessidade de formação dos alunos, faço uma proposta de intervenção docente na disciplina "Lidando com a morte: intervenção interdisciplinar", cujo objetivo é avaliar o impacto que a proposta educacional da disciplina tem sobre os estudantes de enfermagem. Metodologia: Esta pesquisa está enquadrada no paradigma interpretativo ou hermenêutico, com abordagem qualitativa. Do ponto de vista fenomenológico, propõe-se um estudo descritivo e, como instrumento de pesquisa, serão realizados os diários reflexivos dos alunos, matriculados na disciplina que escolheram a opção de presença nas aulas. Resultados: o número de jornais foi 36, mas foram selecionados aleatoriamente 14. A análise qualitativa permitiu estruturar o discurso do aluno em 5 categorias de análise: Motivo da escolha do assunto; Crescimento pessoal; Realizações no processo de aprendizagem; Aplicação profissional das técnicas desenvolvidas no assunto; Avaliação do assunto pelo aluno. Conclusões: A intervenção educativa do sujeito teve um alto impacto sobre os alunos, em duas dimensões importantes para sua vida. Por um lado, aumentando suas habilidades acadêmicas como futuros profissionais e, por outro, adquirindo habilidades e atitudes positivas em relação à morte, para viver e amar a vida.

Abstract: This research is based on phenomenological observation both as a nurse caring for patients at the end of life and as a nursing teacher of the subject "Coping with death: an interdisciplinary intervention". The considerable deficiencies in training nurses for care at the end of life, death and grief led me to propose a teaching intervention "Coping with death: an interdisciplinary intervention", the general aim of which was to evaluate the impact of this subject on nursing students. Methodology: this research is framed by the interpretive or hermeneutical paradigm, with a qualitative approach. From a phenomenological point of view, a descriptive study was proposed, and the reflective journals written by students enrolled on the course were used as the research tool. Results: of the 36 journals gathered at the end of the course, 14 were selected randomly. Qualitative analysis enabled the students' discourse to be structured in 5 categories for analysis: reason for choosing the subject; personal development; what I have achieved in the learning process; how to apply the techniques learnt on the course to my professional activity; the students' assessment of the subject. Conclusions: The impact of the educational intervention was high, according to the students, who acknowledged the positive effect on two important dimensions of their lives. On the one hand, it enhanced their academic skills as future nursing professionals, and, they acquired skills and positive attitudes towards coping with death, and how to live and love life

Viabilidad de una intervención basada en la web y en la telefonía móvil para apoyar el autocuidado en pacientes ambulatorios con dolor por cáncer / Feasibility of a web- and phone-based intervention to support self-care of patients with cancer pain in outpatient settings

OBJETIVO: El dolor por cáncer es un síntoma frecuente y angustiante. Se desarrolló una intervención multicomponente para mejorar el autocuidado en pacientes ambulatorios, integrando dicho autocuidado y la atención profesional a través de tecnología sanitaria. Este artículo describe la viabilidad de la intervención en la práctica cotidiana. MÉTODO: Pacientes con dolor, de moderado a severo, por cáncer (n=11) y enfermeras especializadas en dolor y cuidados paliativos (n=3) participaron en un estudio de cuatro semanas. La intervención consistió en la supervisión diaria, información gráfica, educación y asesoramiento por medio de una aplicación móvil para pacientes y una aplicación web para las enfermeras. Los pacientes evaluaron la capacidad de aprendizaje, facilidad de uso y conveniencia con un cuestionario de 20 preguntas (escala de 1 a 5), las puntuaciones más altas indican una mejor viabilidad. La adhesión de los pacientes se basó en las tasas de finalización de los registros en el servidor. Se realizaron entrevistas semiestructuradas a los pacientes y mediante la técnica de grupo focal con las enfermeras que proporcionaron conocimientos sobre la experiencia. RESULTADOS: Las conclusiones del estudio, según los datos obtenidos del cuestionario, confirmaron la capacidad de aprendizaje (4,8), las posibilidades de uso (4,8) y la conveniencia (4,6) de la aplicación móvil para los pacientes. El promedio de las tasas de finalización fue del 76,8% para el control del dolor, del 50,4% respecto a la monitorización de la medicación y del 100% para las sesiones educativas. Las entrevistas revelaron que los pacientes estaban satisfechos con la simplicidad de la aplicación móvil y apreciaban los diferentes componentes. Las enfermeras estaban de acuerdo con el valor añadido y, en su mayoría, valoraron positivamente las posibilidades de la aplicación web. Los pacientes y las enfermeras aportaron ideas para introducir mejoras en relación con el contenido y el rendimiento técnico de la intervención. CONCLUSIONES: Los resultados de este estudio demuestran la factibilidad de la intervención en la práctica cotidiana. Siempre y cuando se realicen ajustes técnicos y relacionados con el contenido, la intervención permite a los pacientes con dolor por cáncer la práctica de la autogestión de sus cuidados y a las enfermeras brindar asistencia remota a estos pacientes

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Enfermería y necesidades espirituales en el paciente con enfermedad en etapa terminal / Nursing and spiritual needs in the terminal patient / Enfermagem e necessidades espirituais no paciente terminal

La espiritualidad forma parte de la dimensión humana de la persona, es precisamente lo que nos hace humanos. Pero se trata de un fenómeno poco estudiado por las enfermeras, quizás porque estamos inmersos en un mundo científico que niega todo aquello que no se percibe por los sentidos y porque no existe una definición clara del concepto. Las necesidades espirituales, como manifestación de la espiritualidad, se encuentran igualmente relegadas y no hay un modelo claro de actuación para las enfermeras. Sin embargo, la enfermería es precisamente la profesión que debe garantizar un cuidado de excelencia a los pacientes frente al "dolor total" propugnado por Cicely Saunders. Este hecho es aún más palpable en el ámbito de los cuidados paliativos, cuando nuestros pacientes afrontan sus últimos días. No obstante, son muchos los profesionales enfermeros/as que no perciben como propia la satisfacción de las necesidades espirituales de los pacientes, aún cuando ello está en los principios de su profesión. En este aspecto la mejor herramienta de actuación con la que cuentan las enfermeras es la comunicación, que debe afrontarse en un contexto de counselling

The spirituality is part of the human dimension of man, it is precisely what makes us human. But this is a phenomenon little studied by nurses, perhaps because we are immersed in a scientific world that denies everything that is not perceived by the senses and because there is no clear definition of the concept. The spiritual needs, as a manifestation of the spirituality, are similarly relegated and there is not a clear action model for nurses. However, nursing is precisely the profession which must ensure the "total care" of patients compared to "total pain" advocated by Cicely Saunders. This fact is even more palpable in the field of palliative care, when our patients face their last days. However, many professionals nurses who do not perceive as its own satisfaction of the patients' spiritual needs, even if this is in the principles of their profession. In this aspect, the best action tool that nurses have is communication, which should be addressed in a context of counselling.

A espiritualidade é parte da dimensão humana do homem, é precisamente o que nos torna humanos. Mas é um fenômeno pouco estudado por enfermeiros, talvez porque estamos imersos em um mundo de ciência que nega tudo que não é percebido pelos sentidos, e não há uma definição clara do conceito. Necessidades espirituais, como uma manifestação de espiritualidade, também são relegados e lá não é um modelo de funcionamento claro para enfermeiros. No entanto, a enfermagem é a profissão que deve garantir a "cuidados total" pacientes enfrentando "dor total", defendida por Cicely Saunders. Este fato é ainda mais palpável no campo dos cuidados paliativos, quando nossos pacientes enfrentam seus últimos dias. No entanto, existem muitos profissionais enfermeiros que não vêem como sua própria espiritual dos pacientes precisa de satisfação, mesmo quando é sobre os princípios de sua profissão. Neste aspecto, a melhor ferramenta de ação que as enfermeiras têm é comunicação, que deve ser abordada no contexto do counselling

Experiencias de pacientes con cáncer en estado paliativo respecto a su participación en un estudio de intervención sobre el estilo de vida mientras reciben quimioterapia / Palliative cancer patient's experiences of participating in a lifestyle intervention study while receiving chemotherapy

Antecedentes: Las intervenciones sobre el estilo de vida han resultado una herramienta potencialmente beneficiosa sobre la salud de los pacientes con cáncer. Sin embargo, la documentación existente de experiencias previas en intervenciones sobre el estilo de vida de pacientes con cáncer sigue siendo escasa. Objetivos: El objetivo de este estudio fue explorar cómo experimentan su participación en el estudio pacientes con cáncer en estado paliativo, enfocando su viabilidad en múltiples intervenciones del estilo de vida (física, nutricional, cese del tabaquismo y manejo del estrés) mientras recibían quimioterapia. Método: Diseño cualitativo con entrevistas semiestructuradas a 9 pacientes con cáncer en estado paliativo realizadas de 3 a 4 meses después de su inclusión en el estudio de intervención sobre el estilo de vida. Los datos fueron analizados de acuerdo con metodología cualitativa, siguiendo un análisis hermenéutico de contenido. Resultados: Surgieron 3 temas principales: 1) adoptar un estilo de vida más saludable, 2) adoptar un papel más activo y 3) aumentar la confianza. Algunos participantes en el estudio se sintieron culpables cuando no fueron capaces de alcanzar sus objetivos respecto al estilo de vida. Conclusiones: La participación en el estudio de intervenciones sobre el estilo de vida es valorada por los pacientes con cáncer como motivadora y reforzadora de sus habilidades de afrontamiento. Sin embargo, algunos pacientes expresaron sentimientos de culpa e inadecuación. Por lo tanto, los aspectos organizativos de las intervenciones necesitan ser considerados con cuidado para minimizar la posibilidad de causar un aumento del estrés en los participantes, los cuales ya experimentan la carga de afrontar su enfermedad. Implicaciones para la práctica: Este estudio nos aporta una visión única de las experiencias de pacientes con cáncer en estado paliativo centrado en múltiples intervenciones sobre el estilo de vida mientras reciben quimioterapia. Los resultados nos aportan una guía a los profesionales sanitarios en nuestro esfuerzo por ayudar a los pacientes con cáncer que reciben cuidados paliativos, a adoptar un estilo de vida más saludable y a incrementar su afrontamiento

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Merosesquiterpenes from two sponges of the genus Dysidea.

The chemical study of two sponges of the genus Dysidea collected in the Gulf of California has led to the isolation of the new merosesquiterpenes 20-O-acetyl-21-hydroxy-ent-isozonarol (2), 20-O-acetylneoavarol (3), ent-yahazunol (4), and dysienone (5), together with the known compounds 1 and 6-9. The structures of the new metabolites have been established by spectroscopic techniques. The absolute configuration of compounds 5 and 6 has been investigated by application of a procedure developed by Riguera et al. Compounds 2 and 5 showed cytotoxic activity against three human tumor cell lines.