Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial.

BACKGROUND: It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation. METHODS: This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete. FINDINGS: Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. INTERPRETATION: Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. FUNDING: Instituto de Salud Carlos III and the European Regional Development Funds.

Serum Levels of Myonectin Are Lower in Adults with Metabolic Syndrome and Are Negatively Correlated with Android Fat Mass.

Myonectin has shown beneficial effects on lipid regulation in murine models; therefore, it may have implications in the pathophysiology of metabolic syndrome (MS). We evaluated the relationship between serum myonectin and serum lipids, global and regional fat mass, intramuscular lipid content, and insulin resistance (IR) in adults with metabolic risk factors. This was a cross-sectional study in sedentary adults who were diagnosed with MS or without MS (NMS). Serum myonectin was quantified by enzyme-linked immunosorbent assay, lipid profile by conventional techniques, and free fatty acids (FFA) by gas chromatography. Body composition was assessed by dual-energy X-ray absorptiometry and intramuscular lipid content through proton nuclear magnetic resonance spectroscopy in the right vastus lateralis muscle. IR was estimated with the homeostatic model assessment (HOMA-IR). The MS (n = 61) and NMS (n = 29) groups were comparable in age (median (interquartile range): 51.0 (46.0-56.0) vs. 53.0 (45.5-57.5) years, p > 0.05) and sex (70.5% men vs. 72.4% women). MS subjects had lower serum levels of myonectin than NMS subjects (1.08 (0.87-1.35) vs. 1.09 (0.93-4.05) ng·mL-1, p < 0.05). Multiple linear regression models adjusted for age, sex, fat mass index and lean mass index showed that serum myonectin was negatively correlated with the android/gynoid fat mass ratio (R2 = 0.48, p < 0.01), but not with the lipid profile, FFA, intramuscular lipid content or HOMA-IR. In conclusion, serum myonectin is lower in subjects with MS. Myonectin negatively correlates with a component relevant to the pathophysiology of MS, such as the android/gynoid fat mass ratio, but not with other components such as FFA, intramuscular fat or IR.

Covid-19, manejo obstétrico de un caso exitoso / COVID-19, obstetrical management of a successful case / COVID-19, gestão obstétrica de um caso de sucesso

RESUMEN La infección COVID-19 en su amplia manifestación de sintomas y comportamiento clínico hemodinámico en la paciente embarazada, ha demostrado que puede variar su espectro desde leve a severo. En el presente trabajo se reporta el manejo y abordaje exitoso de paciente de 24 SS de gestación con insuficiência respiratoria tipo I asociada al Sindrome de dificultad respiratoria aguda (SDRA) primario severo con fenotipo H de tipo infamatorio con hipoxemia severa y ocupación alveolar de los cuatro cuadrantes con choque séptico y neumonía severa por SARS-CoV-2 con PCR positiva para COVID-19.

ABSTRACT The COVID-19 infection, in its broad manifestation of symptoms and hemodynamic clinical behavior in the pregnant patient, has shown that its spectrum can vary from severe level. In the present work, we report the successful management and approach of a 24-SS patient with type I respiratory failure associated with severe primary Acute Respiratory Distress Syndrome (ARDS) with inflammatory-type H phenotype with severe hypoxemia and alveolar occupation quadrants with septic shock and severe pneumonia due to SARS-CoV-2 with positive PCR for COVID-19.

RESUMO A infecção pela COVID-19 em sua ampla manifestação de sintomas e comportamento clínico hemodinâmico na paciente grávida mostrou variar em espectro de leve a grave. No presente trabalho relatamos a gestão e abordagem bem sucedida de um paciente de 24 semanas de gestação com insuficiência respiratória tipo I associada à síndrome de desconforto respiratório agudo primário grave (SARS-CoV-2) com fenótipo H de tipo inflamatório com hipoxemia grave e ocupação alveolar dos quatro quadrantes com choque séptico e pneumonia grave devido à SARS-CoV-2 com PCR positiva para COVID-19.

Clinical, histopathological, and molecular characterization of leprosy in an endemic area of the colombian caribbean.

Background: Mycobacterium leprae was considered the only causal agent of leprosy until Mycobacterium lepromatosis was identified' which it has been suggested has greater pathogenicity and is linked to diffuse lepromatous leprosy (DLL) and Lucio's phenomenon (LPh). Our objective is to identify Mycobacterium spp. in an endemic area of leprosy in Colombia. Methods: The study included cases with a diagnosis of leprosy by clinical and histopathological analysis. DNA extraction and two specific rounds of semi-nested polymerase chain reaction (PCR) were performed in paraffin biopsies skin to identify M. leprae and M. lepromatosis. Demographic, clinical, and histopathological data were extracted and tabulated for analysis. Results: Forty-one cases of leprosy were analyzed. The most frequent clinical diagnosis was lepromatous leprosy (36.6%); there was one case with DLL and two with LPh. The most common histopathological finding was tuberculoid leprosy (36.59%); three cases had negative histopathology. M. lepromatosis was not detected; all cases corresponded to M. leprae including cases with negative histopathology' DLL, and LPh. Conclusion: In this study, M. leprae was the causative agent of leprosy, encompassing even its most severe phenotypic forms. It is appropriate to consider PCR as an indispensable tool for the diagnosis of leprosy and to continue to carry out the active search for M. lepromatosis.

Concordance of estimated glomerular filtration rate according to the formulas used in Colombia for patients with chronic kidney disease not on dialysis / Concordancia de la filtración glomerular estimada según las fórmulas utilizadas en Colombia en pacientes con enfermedad renal crónica no en diálisis

Abstract Introduction: the Colombian guidelines for chronic kidney disease (CKD) recommend estimating glomerular filtration (GF) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. No studies have been performed in the Colombian population to compare the accuracy of this equation to that of others used in clinical practice. Design and methods: we evaluated the GF estimation performance of the Modification of Diet in Renal Disease (MDRD-4), Cockroft-Gault (CG) and body surface area adjusted Cockroft-Gault (CG-BSA) equations against the CKD-EPI equation in 757 adult patients. Performance was evaluated using bias, precision and accuracy measurements. Results: the mean GF by CKD-EPI was 37.32±12.71 mL/min/1.73m2; by MDRD-4 it was 39.8±13.2 mL/min/1.73m2, by CG it was 35±12.6 mL/min and by CG-BSA it was 34.52±11.34 mL/ min/1.73m2. All the equations had bias with respect to GF by CKD-EPI. The most accurate equation was GF estimated by MDRD-4 (MeGF) with 97.1 and 99.74% of measurements within 15 and 30%, respectively; and the least accurate was GF estimated by CG (CGeGF) with 59.7 and 81.77% of the measurements within 15 and 30%, respectively. The concordance correlation coefficient between GF by CKD-EPI and MDRD-4 was 0.97, with CG and CG-BSA at 0.78 and 0.85, respectively Conclusions: the most accurate alternative equation for estimating glomerular filtration in this Colombian population is MDRD-4, which has a high concordance with the CKD-EPI equation. Estimation of GF with the CG equation is not recommended.

Resumen Introducción: las guías colombianas de enfermedad renal crónica (ERC) recomiendan estimar la filtración glomerular (FG) con la fórmula de epidemiología de la enfermedad renal crónica (CKD-EPI). No se han realizado estudios que comparen en la población colombiana la exactitud de esta fórmula con otras utilizadas en la práctica clínica. Diseño y métodos: en 757 pacientes adultos evaluamos el desempeño para estimar la FG por las fórmulas de la modificación de la dieta en la enfermedad renal (MDRD-4), Cockroft-Gault (CG) y Cockroft-Gault corregida para la superficie corporal (CG-SC) comparada con la fórmula de CKD-EPI. El desempeño se evaluó con mediciones del sesgo, precisión y exactitud. Resultados: la media de la FG por CKD-EPI fue 37.32±12.71 mL/min/1.73m2, por MDRD-4 de 39.8±13.2 mL/min/1.73m2, por CG fue 35±12.6 mL/min y por CG-SC de 34.52±11.34 mL/ min/1.73m2. Todas las fórmulas tuvieron un sesgo con relación a la FG por CKD-EPI. La fórmula más exacta fue la FG estimada por MDRD-4 (FGeM) con una proporción de mediciones dentro del 15 y 30% en 97.1 y 99.74% de las mediciones respectivamente, y la menos exacta fue la FG estimada por CG (FGeCG) con 59.7 y 81.77% de las mediciones dentro del 15 y 30% respectivamente. El coeficiente de correlación de concordancia entre la FG por CKD-EPI y MDRD-4 fue de 0.97, con CG y CG-SC de 0.78 y 0.85, respectivamente. Conclusiones: la fórmula alterna más exacta para estimar la filtración glomerular en esta población colombiana es la MDRD-4 que tiene una alta concordancia con la fórmula de CKD-EPI. Se sugiere no utilizar la estimación de la FG con la fórmula de CG.

Negative Correlation between Altitude and COVID-19 Pandemic in Colombia: A Preliminary Report.

It has been suggested that high altitude can reduce the infectivity and case fatality rate of COVID-19. We investigated the relationship between altitude and the COVID-19 pandemic in Colombia. Epidemiological data included the number of positive cases, deaths, and the case fatality rate of COVID-19. In particular, we analyzed data from 70 cities with altitudes between 1 and 3,180 m. Correlations and linear regression models adjusted to population density were performed to examine the relationship and contribution of altitude to epidemiological variables. The case fatality rate was negatively correlated with the altitude of the cities. The incidence of cases and deaths from COVID-19 had an apparent correlation with altitude; however, these variables were better explained by population density. In general, these findings suggest that living at high altitude can reduce the impact of COVID-19, especially the case fatality rate.

Anisákidos y anisakidosis: generalidades y su actualidad en Colombia. Revisión bibliográfica / Anisakis and Anisakiasis: General aspects and current situation in Colombia

RESUMEN La anisakidosis es una parasitosis ocasionada por nematodos de la familia Anisakidae, causa-da por el consumo de pescado parasitado con larvas infectivas (L3) de estos nematodos. En Europa y Asia es un problema de salud pública. Sin embargo, en Colombia y en general en los países de América del Sur, es poco conocida. El objetivo de este trabajo es presentar una revisión de las generalidades de los parásitos anisákidos y mostrar la situación actual de esta parasitosis en Colombia. Se realizó una búsqueda estructurada de términos MeSH y DeCS en MEDLINE, Cochrane, Embase, LILACS y Scopus; esta se complementó con otra no estructurada en SciELO y Google Scholar. Se incluye un reporte de caso y seis registros de hospederos. Se describen registros de peces de consumo humano parasitados por Anisakis sp., Anisakis physeteris y Pseudoterranova decipiens para el Océano Pacífico y, los géneros Pseudoterranova y Contracaecum en peces del Océano Atlántico y aguas continentales. Se concluye que la anisakidosis representa un riesgo latente para Colombia, es necesario instaurar legislaciones efectivas para un control eficiente sobre esta parasitosis y educar a la población sobre los cui-dados necesarios para el consumo de pescado.

SUMMARY Anisakidosis is a parasitic disease derived from the consumption of infective larvae from Anisakidae family. In Europe and Asia is a public health problem, however, in Colombia and South American countries is little known. The objective is to review Anikids general aspects and find out about the current situation of this disease in Colombia. Search of MeSH and DeCS terms, through MEDLINE, Cochrane, Embase, and Scopus databases, complemented with grey literature from SciELO and Google Scholar, was made. One case report and six host records were included. Records of fish for human consumption from Pacific Ocean parasitized by Anisakis sp., Anisakis physeteris and Pseudoterranova decipiens are described, as well as for fish from Atlantic Ocean and inland waters with genera Pseudoterranova and Contracaecum. Anisakidosis represents a latent risk for Colombia; it is necessary to establish effective legislations for an efficient control of the emergence of this parasitic disease, as well as to educate people about needed precautions considering fish consumption.

Systematic review: An approach to identifying health inequalities through case studies / Revisión sistemática: un enfoque para identificar desigualdades en salud a través de estudios de casos

Introduction: Health inequalities, among other factors, reflect the wellbeing level of a population. Interventions aimed at eliminating or preventing such inequalities require an understanding of their origins. Objective: To perform a systematic review to identify case studies reporting health inequalities worldwide. Methodology: Case reports, case studies and case series written in English, Spanish and Portuguese reporting health inequalities were included. Databases like Medline and EMBASE, and grey literature sources such as LILACS, OpenGrey, Google, and others were included. Results: Initially, the search produced 1272 articles. 139 articles were selected by their title, while, based on their abstract, 28 articles were chosen for full text reading. Finally, 23 articles were included. Gender difference was the most frequent factor in terms of health inequalities (23.2%), followed by socio economic condition (20%), belonging to a migrant population (13.3%), ethnic origin (13.3%), age (10%), geographic origin (3.3%), and others (16.6%). Discussion: This approach, which is based on reviewing case reports to study health inequalities, contrasts with the majority of the studies carried out in this field. This research proposes to study inequalities specific to population groups that suffer such inequalities within communities in a particular geographic area and are not able to access to optimal health services.

Introducción: las desigualdades en salud, entre otros factores, reflejan el nivel de bienestar de una población. Para realizar intervenciones dirigidas a eliminar o prevenir estas desigualdades es necesario comprender su origen. Objetivo: realizar una revisión sistemática para identificar estudios de casos en los que se reportan desigualdades en salud en todo el mundo. Metodología: en este estudio se incluyeron reportes de caso, estudios de casos y series de casos, escritos en inglés, español y portugués, en los que se informan desigualdades en salud. Se utilizaron bases de datos como Medline y EMBASE, así como fuentes de literatura gris como LILACS, OpenGrey, Google, entre otras. Resultados: la búsqueda inicial arrojó 1272 artículos; de los cuales se seleccionaron 139 por su título; luego, basándose en su resumen, se escogieron 28 para realizar una lectura completa. Finalmente se incluyeron 23 artículos. En términos de inequidad en salud, la diferencia de género fue el factor más frecuente (23.2%), seguido por condición socioeconómica (20%), pertenecer a una población migrante (13.3%), origen étnico (13.3%), edad (10%), origen geográfico (3.3%) y otros (16,6%). Discusión: este enfoque, que se basa en la revisión de reportes de caso para estudiar las desigualdades en salud, contrasta con la mayoría de estudios que se han realizado al respecto. En esta investigación se propone analizar las desigualdades en salud que son específicas a poblaciones que viven dentro de comunidades en un área geográfica en particular y que no tienen acceso a servicios óptimos de salud.

The role of enamelysin (MMP-20) in tooth development: systematic review / El papel de la enamelisina (MMP-20) en el desarrollo dentario: revisión sistemática

ABSTRACT. Introduction: ameloblasts are cells responsible for the production and mineralization of the organic matrix of enamel through several stages: pre-secretory, secretory, transition, and maturation. The organic matrix components are produced in the secretory phase. In the maturation phase, the organic component is removed and the mineralization process starts. This process requires the involvement of matrix metalloproteinase 20 (MMP-20), also called enamelysin. Several studies have shown the presence of MMP-20 in tooth development and its relationship to alterations in enamel formation. The objective was: to classify the different studies and laboratory techniques used to demonstrate the involvement of enamelysin in tooth development and its relation to pathologies during enamel formation. Methods: a systematic review was conducted with the following bibliographic databases: PubMed, Science-Direct, Hinari, and SciELO, in order to classify the different studies related to the involvement of MMP-20 in tooth development and the methods to detect its expression, between the years of 2009 and 2014. Results and conclusions: 11 in vitro models show that MMP-20 has specific cleavage sites for enamel matrix proteins. This process is altered by chemical composition, ions, and the presence of hydroxyapatite. Enamel morphology is altered in the knockout models. In human studies, MMP-20 has been associated with increased susceptibility to dental caries, enamel thickness, and dental agenesis.

RESUMEN. Introducción: el ameloblasto es la célula encargada de la producción y mineralización de la matriz orgánica del esmalte. Atraviesa varias etapas: la fase pre-secretora, secretora, de transición y maduración. En la fase secretora se producen los componentes de la matriz orgánica. En la fase de maduración se elimina el componente orgánico y se inicia el proceso de mineralización. Este proceso requiere de la participación de la metaloproteinasa de matriz 20 (MMP-20) o también llamada enamelisina. Diversos estudios demuestran la presencia de MMP-20 en el desarrollo dentario y su relación con alteraciones en la formación del esmalte. El objeto fue clasificar los diferentes estudios y técnicas de laboratorio empleadas que demuestren la participación de enamelisina en el desarrollo dentario y su relación con patologías en la formación del esmalte. Métodos: se realizó una revisión sistemática de la literatura con las siguientes bases bibliográficas: PubMed, Science-Direct, Hinari y SciELO, con el fin de clasificar los diferentes estudios relacionados con la participación de MMP-20 en el desarrollo dental y los métodos utilizados para detectar su expresión, entre los años de 2009 a 2014. Resultados y conclusiones: los modelos in vitro evidencian que MMP-20 tiene sitios específicos de escisión para las proteínas de matriz de esmalte. Este proceso se ve alterado por la composición química, iones, y la presencia de hidroxiapatita. En los modelos knockout la morfología del esmalte está alterada. En los estudios en humanos, se ha relacionado la MMP-20 con una mayor susceptibilidad de caries dental, el grosor completo de esmalte y agenesias dentales.

Examination of the excess thermodynamic properties of n-alkane binary mixtures: a molecular approach.

A modification of the statistical associating fluid theory, the so-called Soft-SAFT equation of state, is proposed to predict the excess thermodynamic properties of binary mixtures of n-alkanes. n-Alkane molecules are modeled as fully flexible Lennard-Jones chains. This molecular model accounts for the most important microscopic features of real chainlike molecules: attractive and repulsive interactions between different chemical groups and the connectivity of the segments that form the molecules. In this work we consider an additional microscopic effect that can profoundly affect certain thermodynamic properties, namely, the conformational changes when two different n-alkane molecules are mixed. We propose, following the work of Vega and co-workers [J. Chem. Phys. 1999, 111, 3192], a simple model to account for the conformational changes in molecules. The resulting free energy is combined with the SAFT free energy to describe the excess thermodynamic properties of binary mixtures of n-alkanes. Predictions from the theory are compared with experimental data taken from the literature. The agreement between the experiments and the theoretical predictions is excellent in all cases. This work shows that although minor microscopic effects, such as the conformational changes in the molecules that form the mixtures, have only a very small effect on the usual thermodynamic properties, such as pressure, chemical potential, phase equilibria, and excess volumes, they can contribute significantly to other thermodynamic properties. In fact, one of the main conclusions of this work is that it is essential that conformational effects be taken into account in molecular-based theories if an accurate description of certain excess properties (excess enthalpy for instance) is desired.

Revisión de miastenia gravis: a propósito de un caso / Revision of gravis myasthenia: a purpose of a case

La miastenia gravis es un trastorno neuromuscular caracterizado por la presencia de anticuerpos contra receptores de acetilcolina y disminución del número de dichos receptores en las uniones neuromusculares que ocasiona debilidad y fatigabilidad de los músculos esqueléticos. Se trata de una enfermedad crónica sujeta a brotes y remisiones. Debido a su tendencia de presentarse durante los años reproductivos de la vida en la población femenina, la asociación entre la talla y el embarazo reviste especial importancia. A continuación presentamos un caso ocurrido en la Maternidad Concepción Palacios, en abril de 1998 a través del cual realizamos una revisión de conceptos y manejo terapéutico adecuado de esta patología durante la gestación