Assistência pré-natal às usuárias de substâncias psicoativas: dificuldades elencadas pelos profissionais da saúde / Prenatal care for users of psychoactive substances: difficulties listed by health professionals / Atención prenatal a consumidoras de sustancias psicoactivas: dificultades mencionadas por los profesionales de la salud

Objetivo: conhecer as dificuldades elencadas pelos profissionais de saúde na assistência pré-natal às usuárias de substâncias psicoativas. Método: estudo qualitativo, exploratório-descritivo, realizado nas mídias sociais, com profissionais da área da saúde que realizam atendimento pré-natal. A coleta de dados ocorreu de novembro de 2022 a janeiro de 2023 por meio de questionário eletrônico. Os dados foram analisados por meio da análise temática. Protocolo aprovado pelo Comitê de Ética em Pesquisa. Resultados: os profissionais destacam o déficit de conhecimento para abordar este público em específico. A abordagem superficial e condenatória do uso de substâncias pelas políticas públicas corrobora para que os profissionais se sintam preparados em parte para atender essas gestantes. Considerações finais: a capacitação dos profissionais é necessária para superar práticas condenatórias e retrógradas de cuidado que focam unicamente a abstinência; como também, o investimento na capacitação acerca da rede de atenção à saúde, buscando ampliar sua visibilidade e utilização.

Objective: understanding the difficulties listed by health professionals in prenatal care for users of psychoactive substances. Method: this is a qualitative, exploratory-descriptive study carried out on social media with health professionals who provide prenatal care. Data was collected from November 2022 to January 2023 using an electronic questionnaire. The data was analyzed using thematic analysis. Protocol approved by the Research Ethics Committee. Results: the professionals highlight the lack of knowledge to deal with this specific public. The superficial and condemnatory approach to substance use by public policies contributes to making professionals feel partly prepared to deal with these pregnant women. Final considerations: the training of professionals is necessary to overcome condemnatory and retrograde care practices that focus solely on abstinence; and investment in training about the health care network, seeking to increase its visibility and use.

Objetivo: conocer las dificultades mencionadas por los profesionales de la salud en la atención prenatal de las consumidoras de sustancias psicoactivas. Método: estudio cualitativo, exploratorio-descriptivo, realizado en redes sociales, con profesionales de la salud que brindan atención prenatal. La recolección de datos se llevó a cabo de noviembre de 2022 a enero de 2023 a través de un cuestionario electrónico. Los datos se analizaron mediante análisis temático. El protocolo fue aprobado por el Comité de Ética en Investigación. Resultados: los profesionales destacan que les falta el conocimiento para atender a este público específico. El abordaje superficial y condenatorio del consumo de sustancias por parte de las políticas públicas contribuye a que los profesionales se sientan parcialmente preparados para atender a esas gestantes. Consideraciones finales: es necesario capacitar a los profesionales para superar las prácticas asistenciales condenatorias y retrógradas que se centran únicamente en evitar el consumo; e invertir en capacitación sobre la red de atención de salud, para ampliar su visibilidad y uso.

La percepción de cansancio en decatlonistas, en diferentes etapas del macrociclo de entrenamiento

El control del comportamiento de la percepción de cansancio a lo largo del macrociclo de entrenamiento en decatlonistas constituye un indicador para la valoración del proceso de asimilación psicofísica del trabajo realizado acorde a la etapa del macrociclo de entrenamiento por la que transita el atleta. Sin embargo, el insuficiente conocimiento sobre el tema en el decatlón ha limitado el uso de este indicador en el control psicológico de la preparación en este deporte. El objetivo de este trabajo consiste en determinar el comportamiento de la percepción de cansancio en las diferentes etapas del macrociclo de entrenamiento, en decatlonistas de la selección nacional de atletismo de Cuba. Es un estudio descriptivo, en el que se aplica la entrevista para un diagnóstico inicial y la Escala de Borg (modificada), para la medición de la percepción de cansancio. Fueron realizadas 416 mediciones de la percepción de cansancio, durante las etapas de preparación física, general, especial y competitiva. Como principales resultados, la percepción de cansancio aumentó en la etapa de preparación física general en una magnitud de 3.48, en la etapa especial en un 3.43 y en la competitiva en un 2.56. La percepción de cansancio en los decatlonistas estudiados aumentó, significativamente, posterior a las cargas de entrenamiento en cada una de las etapas estudiadas y disminuyó, a medida que avanzó el macrociclo de entrenamiento. La etapa competitiva resultó ser aquella de menor cansancio percibido pre- y poscarga, y la de preparación física general, la de mayor aumento en este proceso.

O controle do comportamento da percepção da fadiga ao longo do macrociclo de treinamento em decatletas constitui um indicador para a avaliação do processo de assimilação psicofísica do trabalho realizado de acordo com a etapa do macrociclo de treinamento pela qual o atleta passa. Contudo, o conhecimento insuficiente sobre o tema no decatlo tem limitado a utilização deste indicador no controle psicológico da preparação neste esporte. O objetivo deste trabalho é determinar o comportamento da percepção da fadiga nas diferentes etapas do macrociclo de treinamento, em decatlonistas da seleção cubana de atletismo. Trata-se de um estudo descritivo, no qual é aplicada a entrevista para diagnóstico inicial e a Escala de Borg (modificada) para mensurar a percepção de fadiga. Foram realizadas 416 medidas de percepção de fadiga durante as etapas de preparação física, geral, especial e competitiva. Como principais resultados, a percepção de fadiga aumentou na etapa de preparação física geral em uma magnitude de 3,48, na etapa especial em 3,43 e na etapa competitiva em 2,56. A percepção de fadiga no decatleta estudado aumentou significativamente após as cargas de treinamento em cada uma das etapas estudadas e diminuiu à medida que o macrociclo de treinamento avançava. A etapa competitiva acabou sendo a que apresentou menor fadiga percebida pré e pós-carga, e a etapa de preparação física geral, a que apresentou maior aumento nesse processo.

The control of the behavior of the perception of tiredness throughout the training macrocycle in decathletes constitutes an indicator for the assessment of the process of psychophysical assimilation of the work carried out according to the stage of the training macrocycle through which the athlete goes. However, insufficient knowledge on the subject in the decathlon has limited the use of this indicator in the psychological control of preparation in this sport. The objective of this work is to determine the behavior of the perception of tiredness in the different stages of the training macrocycle, in tiredness of the Cuban national athletics team. It is a descriptive study, in which the interview is applied for an initial diagnosis and the Borg Scale (modified) to measure the perception of tiredness. 416 measurements of the perception of tiredness were carried out during the stages of general, special and competitive physical preparation. As the main results, the perception of tiredness increased in the general physical preparation stage by a magnitude of 3.48, in the special stage by 3.43 and in the competitive stage by 2.56. The perception of tiredness in the decathletes studied increased significantly after the training loads in each of the stages studied and decreased as the training macrocycle progressed. The competitive stage turned out to be the one with the least perceived pre- and post-load tiredness, and the general physical preparation stage was the one with the greatest increase in this process.

Rehabilitación respiratoria en pacientes post COVID-19 con tres tratamientos; experiencia en un hospital militar peruano / Respiratory rehabilitation in post-COVID-19 patients with three treatments; experience in a Peruvian military hospital / Reabilitação respiratória em pacientes pós-COVID-19 com três tratamentos; experiência em um hospital militar peruano

La pandemia de COVID-19 ha destacado la importancia de la rehabilitación en pacientes con COVID prolongado. Objetivo: describir los efectos de tres tratamientos en un programa de rehabilitación respiratoria en pacientes post COVID-19 en un hospital militar peruano. Materiales y métodos: se llevó a cabo un estudio descriptivo y observacional. La muestra se dividió en tres grupos con diferentes tratamientos: RR+VNI+O2, Oxigenoterapia convencional y RR+CNAF+O2. Se evaluaron 348, 151 y 113 pacientes respectivamente en cada grupo. Se utilizó la Escala de Borg, mMRC, el cuestionario específico de Saint George y el genérico SF-12 para medir la percepción de falta de aire, fatiga y calidad de vida post pandemia. Resultados: tras los tratamientos, se observó un aumento significativo en la saturación de oxígeno, disminución en la frecuencia cardíaca, disnea y fatiga percibida. Conclusión: esto indica una mejora notable en la intensidad del cansancio y una significativa recuperación en la calidad de vida de los pacientes evaluados.

The COVID-19 pandemic has highlighted the importance of rehabilitation in patients with long COVID. objective: Describe the effects of three treatments in a respiratory rehabilitation program in post-COVID-19 patients in a Peruvian military hospital. Materials and methods: a descriptive and observational study was carried out. The sample was divided into three groups with different treatments: RR+NIV+O2, conventional oxygen therapy and RR+CNAF+O2. 348, 151 and 113 patients were evaluated respectively in each group. The Borg Scale, mMRC, the specific Saint George questionnaire and the generic SF-12 were used to measure the perception of shortness of breath, fatigue and post-pandemic quality of life. Results: after the treatments, a significant increase in oxygen saturation, decrease in heart rate, dyspnea and perceived fatigue was observed. Conclusion: this indicates a notable improvement in the intensity of fatigue and a significant recovery in the quality of life of the patients evaluated.

A pandemia de COVID-19 destacou a importância da reabilitação em pacientes com COVID longa. Objetivo: descrever os efeitos de três tratamentos em um programa de reabilitação respiratória em pacientes pós-COVID-19 em um hospital militar peruano. Materiais e métodos: foi realizado um estudo descritivo e observacional. A amostra foi dividida em três grupos com diferentes tratamentos: FR+VNI+O2, oxigenoterapia convencional e FR+CNAF+O2. Foram avaliados 348, 151 e 113 pacientes respectivamente em cada grupo. A Escala de Borg, mMRC, o questionário específico de Saint George e o SF-12 genérico foram utilizados para mensurar a percepção de falta de ar, fadiga e qualidade de vida pós-pandemia. Resultados: após os tratamentos foi observado aumento significativo da saturação de oxigênio, diminuição da frequência cardíaca, dispneia e fadiga percebida. Conclusão: isto indica uma melhora notável na intensidade da fadiga e uma recuperação significativa na qualidade de vida dos pacientes avaliados.

Polyomavirus ALTOs, but not MTs, downregulate viral early gene expression by activating the NF-κB pathway.

Polyomaviruses are small, circular dsDNA viruses that can cause cancer. Alternative splicing of polyomavirus early transcripts generates large and small tumor antigens (LT, ST) that play essential roles in viral replication and tumorigenesis. Some polyomaviruses also express middle tumor antigens (MTs) or alternate LT open reading frames (ALTOs), which are evolutionarily related but have distinct gene structures. MTs are a splice variant of the early transcript whereas ALTOs are overprinted on the second exon of the LT transcript in an alternate reading frame and are translated via an alternative start codon. Merkel cell polyomavirus (MCPyV), the only human polyomavirus that causes cancer, encodes an ALTO but its role in the viral lifecycle and tumorigenesis has remained elusive. Here, we show MCPyV ALTO acts as a tumor suppressor and is silenced in Merkel cell carcinoma (MCC). Rescuing ALTO in MCC cells induces growth arrest and activates NF-κB signaling. ALTO activates NF-κB by binding SQSTM1 and TRAF2&3 via two N-Terminal Activating Regions (NTAR1+2), resembling Epstein-Barr virus (EBV) Latent Membrane Protein 1 (LMP1). Following activation, NF-κB dimers bind the MCPyV noncoding control region (NCCR) and downregulate early transcription. Beyond MCPyV, NTAR motifs are conserved in other polyomavirus ALTOs, which activate NF-κB signaling, but are lacking in MTs that do not. Furthermore, polyomavirus ALTOs downregulate their respective viral early transcription in an NF-κB- and NTAR-dependent manner. Our findings suggest that ALTOs evolved to suppress viral replication and promote viral latency and that MCPyV ALTO must be silenced for MCC to develop.

Impact of high-flow oxygen therapy via high velocity nasal insufflation on diaphragmatic thickening fraction in healthy subjects.

OBJECTIVE: The primary objective of this study was to evaluate the impact of high-flow nasal cannula oxygen therapy [HFNC] on the diaphragm thickening fraction. DESIGN: Prospective, descriptive, cohort study SETTING: The study was conducted in the Physiology and Respiratory Care Laboratory, Intensive Care Unit, Hospital Británico de Buenos Aires. PARTICIPANTS: Thirteen healthy subjects >18 years old INTERVENTIONS: High-flow nasal cannula oxygen therapy MAIN VARIABLES OF INTEREST: Demographic data (age and gender), anthropometric data (weight, height, and body mass index), and clinical and respiratory variables (Diaphragm thickening fraction [DTf], esophageal pressure swing, respiratory rate [RR], esophageal pressure-time product per minute [PTPes/min]). RESULTS: Median DTf decreased significantly as flow increased (p < 0.05). The baseline DTf measurement was 21.4 %, 18.3 % with 20 L/m, and 16.4 % with 40 L/m. We also observed a significant decrease in RR as flow increased in HFNC (p < 0.05). In the 8 subjects with recordings, the PTPes/min was 81.3 (±30.8) cmH2O/sec/min and 64.4 (±25.3) cmH2O/sec/min at baseline and 40 L/m respectively (p = 0.044). CONCLUSIONS: The use of high-flow oxygen therapy through nasal cannula of HFNC in healthy subjects decreases the DTf and RR in association with increased flow. In addition, the use of 40 L/m flow may reduce the muscular work associated with respiration.

Taxonomic Impediment for Conservation: The Case of Bees in an Undersampled Tropical Mid-Elevation Site, San Martín, Peru.

In this first field survey of an entire bee fauna for any part of Peru, we report a total of 1796 bees belonging to 181 species or morphospecies in four families. The taxonomic impediment was pronounced with only 80 species of 181 that could be named. With such a high proportion of undetermined species, it is not possible to adequately compare pollinator communities across different studies, assess historical changes or analyze endemism patterns to document ecology, behavior and evolution of the species and genera. This information is required to provide a sound basis for policymakers to protect habitats for the conservation of native pollinators.

Disclosing the virome of Aedes, Anopheles and Culex female mosquitoes, Alto Pantanal of Mato Grosso, Brazil, 2019.

Using Illumina NextSeq sequencing and bioinformatics, we identified and characterized thirty-three viral sequences of unsegmented and multipartite viral families in Aedes spp., Culex sp. and Anopheles darlingi female mosquito pools from Porto São Luiz and Pirizal, Alto Pantanal. Seventeen sequences belong to unsegmented viral families, twelve represent putative novel insect-specific viruses (ISVs) within families Chuviridae (3/33; partial genomes) and coding-complete sequences of Xinmoviridae (1/33), Rhabdoviridae (2/33) and Metaviridae (6/33); and five coding-complete sequences of already-known ISVs. Notably, two putative novel rhabdoviruses, Corixo rhabdovirus 1 and 2, were phylogenetically related to Coxipo dielmovirus, but separated from other Alpharhabdovirinae genera, sharing Anopheles spp. as host. Regarding multipartite families, sixteen segments of different putative novel viruses were identified (13 coding-complete segments) within Durnavirales (4/33), Elliovirales (1/33), Hareavirales (3/33) and Reovirales (8/33) orders. Overall, this study describes twenty-eight (28/33) putative novel ISVs and five (5/33) already described viruses using metagenomics approach.

EFECTOS DE DIETAS RICAS EN FRUCTOSA AÑADIDA EN LA PATOGÉNESIS DEL HÍGADO GRASO NO ALCOHÓLICO / EFFECTS OF DIETS RICH IN ADDED FRUCTOSE ON THE PATHOGENESIS OF NON-ALCOHOLIC FATTY LIVER DISEASE

Introducción: El hígado graso no alcohólico se enmarca en un grupo de patologías de etiología multifactorial, en el que la alimentación tendría un papel protagónico. En este sentido, el consumo de dietas ricas en fructosa, en especial a partir de fructosa añadida o jarabe de maíz alto en fructosa, ha sido motivo de investigación por su probable rol en la patogénesis de esta enfermedad. Metodología: Se realizó una búsqueda de artículos en relación con los efectos de las dietas ricas en fructosa sobre parámetros que podrían afectar la esteatosis hepática con el objetivo de organizar las principales evidencias al respecto. Resultados: Los estudios analizados tienden a evidenciar asociaciones positivas entre estas dietas y un mayor riesgo de desarrollar disbiosis intestinal, pérdida de integridad de la barrera intestinal y esteatosis hepática. Conclusiones: Los antecedentes recopilados en la presente revisión muestran evidencia de que este tipo de dietas favorecerían una serie de eventos que pueden conducir al hígado graso no alcohólico; por lo tanto, procurar un consumo adecuado de este monosacárido representaría una interesante alternativa de prevención para esta patología

Introduction: The non-alcoholic fatty liver disease falls within the group of multifactorial etiology pathologies in which food would play an important role. It is in this regard that the consumption of diets rich in fructose, especially from added fructose or corn syrup in fructose, has been a subject of investigation due to its likely roll in the pathogenesis of this disease. Methodology: A research for articles was performed about the effects of very rich fructose diets on parameters who could affect the liver steatosis in order to organize the main evidences. Results: The studies analized tend to report positive association between this diets and a higher risk of intestinal dysbiosis, intestinal barrier loss and partially with increased hepatic steatosis. Conclusions: The records compiled in the present review show evidence that this type of diets promote a serie of events that could result in non-alcoholic fatty liver disease so try a adequate consumption of this monosaccharides it would represent an interesting alternative to prevent this pathology

Polyomavirus ALTOs, but not MTs, downregulate viral early gene expression by activating the NF-κB pathway.

Polyomaviruses are small, circular dsDNA viruses that can cause cancer. Alternative splicing of polyomavirus early transcripts generates large and small tumor antigens (LT, ST) that play essential roles in viral replication and tumorigenesis. Some polyomaviruses also express middle tumor antigens (MTs) or Alternate LT ORFs (ALTOs), which are evolutionarily related but have distinct gene structures. MTs are a splice variant of the early transcript whereas ALTOs are overprinted on the second exon of the LT transcript in an alternate reading frame and are translated via an alternative start codon. Merkel cell polyomavirus (MCPyV), the only human polyomavirus that causes cancer, encodes an ALTO but its role in the viral lifecycle and tumorigenesis has remained elusive. Here, we show MCPyV ALTO acts as a tumor suppressor and is silenced in Merkel cell carcinoma (MCC). Rescuing ALTO in MCC cells induces growth arrest and activates NF-κB signaling. ALTO activates NF-κB by binding SQSTM1 and TRAF2&3 via two N-Terminal Activating Regions (NTAR1+2), resembling Epstein-Barr virus (EBV) Latent Membrane Protein 1 (LMP1).. Following activation, NF-κB dimers bind the MCPyV non-coding control region (NCCR) and downregulate early transcription. Beyond MCPyV, NTAR motifs are conserved in other polyomavirus ALTOs, which activate NF-κB signaling, but are lacking in MTs that do not. Furthermore, polyomavirus ALTOs downregulate their respective viral early transcription in an NF-κB and NTAR dependent manner. Our findings suggest that ALTOs evolved to suppress viral replication and promote viral latency and that MCPyV ALTO must be silenced for MCC to develop.

Adherencia de pacientes de alto riesgo heredo-familiar de cáncer de mama a "Programa de Vigilancia Activa": experiencia de la Clínica de Alto Riesgo de Cáncer de Mama del Centro Mamario del Hospital Universitario Austral / Adherence of patients with high hereditary-familial risk of breast cancer to the "Active Surveillance Program": experience of the High Risk Breast Cancer Clinic of the Breast Center of the Austral University Hospital

Introducción: Las mujeres con predisposición genética-familiar presentan un riesgo más elevado de desarrollar cáncer de mama. La vigilancia es una de las estrategias más efectivas para ofrecer a este subgrupo de mujeres, sin embargo la adherencia a la misma puede ser dificultosa. Objetivo: Analizar la adherencia de las pacientes con Alto Riesgo Heredo-Familiar (ARHF) al programa específico de "Seguimiento de pacientes de Alto Riesgo" del Hospital Universitario Austral. Material y método: Se revisaron de forma retrospectiva datos de 104 mujeres sanas con ARHF que ingresaron al programa de vigilancia: "Seguimiento de pacientes de Alto Riesgo" del Hospital Universitario Austral en el período comprendido entre junio de 2016 a febrero de 2022. Resultados: La adherencia al programa fue total en 38 pacientes (36,54%) y parcial en 42 (40,38%). Se observó falta de adherencia en 24 pacientes (23,07%). La causa más prevalente fue la incomodidad al realizar la resonancia (54,16%). Analizando la adherencia según el año de ingreso al programa se observa una caída significativa a partir del 3er año de seguimiento y solo 48,98% completaron la sexta ronda. Conclusiones: La falta de adherencia observada fue significativa. Los datos demostrados apuntan a una necesidad de continuar desarrollando estrategias que faciliten el seguimiento(AU)

Introduction: Women with a genetic-familial predisposition have a higher risk of developing breast cancer. Surveillance is one of the most effective strategies to offer this subgroup of women, however adherence to it can be difficult. Objetive: To analize the adherence of patients with High Risk of Familial-Hereditary (HRFH) breast cancer to a specific program: "Follow-up in High Risk patients" of the Austral University Hospital. Material and method: Data from 104 women with HRFH who were admitted to the surveillance program: "Follow-up in High Risk patients" of the Austral University Hospital in the period from june 2016 to february 2022 were retrospectively reviewed. Results: Adherence to the program was complete in 38 patients (36,54%) and partial in 42 (40,38%). 24 (23,07%) patients had lack of adherence. The most prevalent cause was discomfort when performing the resonance (54,16%). When we analyze adherence according to the year of admission to the program, a significant drop is observed from de 3rd year of follow-up and only 48,98% completed round six. Conclusions: The observed lack of adherence was significant. The demonstrated data points to a need to continue developing strategies that facilitate monitoring(AU)

Sentimentos da mulher frente a gestação de alto risco / Sentimientos de la mujer frente al embarazo de alto riesgo / Women's feelings facing High-Risk pregnancy

Resumo Introdução: A gestação configura-se como um acontecimento único e memorável para a vida de uma mulher. A gravidez de alto risco é uma experiência estressante em razão dos riscos a que estão submetidos a mãe e o bebê e devido às mudanças que afetam negativamente o seu equilíbrio emocional. Objetivo: Identificar os sentimentos vivenciados pela gestante frente à gravidez de alto risco. Método: Descritivo e exploratório com abordagem qualitativa, com amostra por conveniência composta por mulheres com gestação de alto risco, selecionadas de acordo com a disponibilidade do serviço de internamento, até a saturação das entrevistas. A coleta dos dados foi realizada em um período de dois meses através de entrevistas guiadas por um roteiro. Os dados foram analisados por meio da técnica de análise de conteúdo segundo Minayo. Resultados: Fizeram parte 37 mulheres. Os resultados foram oeganizados nas categorias: Como se deu o diagnóstico de alto risco; Sentimentos ao descobrir que a gestação é/era de risco; Sentimentos em relação ao apoio familiar acerca da gestação de alto risco. Os sentimentos relatados pelas gestantes e puérperas que conviveram com a gravidez de alto risco, deixam evidentes os impactos que este evento traz não somente na saúde física sobretudo para a emocional, deixando as gestantes fragilizadas. Conclusão: Assim, o estudo nos permitiu perceber que os sentimentos vivenciados nesse processo podem interfir na vida dessas mulheres, e de forma negativa. Mas, que apesar dessa situação, estas expressam sentimentos ambíguos, pois mesmo com o risco gestacional, muitas mostram-se felizes pela dádiva de ser mãe.

Resumen Introducción: El embarazo se considera un evento único y memorable en la vida de una mujer. El embarazo de alto riesgo es una experiencia estresante debido a los riesgos a los que están expuestas tanto la madre como su bebé y a los cambios que afectan negativamente su equilibrio emocional. Objetivo: Identificar los sentimientos experimentados por las mujeres embarazadas frente a un embarazo de alto riesgo. Metodología: Descriptivo y exploratorio con enfoque cualitativo, con una muestra a conveniencia compuesta por mujeres con embarazos de alto riesgo, seleccionadas según la disponibilidad del servicio de hospitalización, hasta la saturación de las entrevistas. La recopilación de datos se llevó a cabo durante un período de dos meses a través de entrevistas guiadas. Los datos fueron analizados utilizando la técnica de análisis de contenido según Minayo. Resultados: Participaron 37 mujeres y los resultados se organizaron en las siguientes categorías: cómo se realizó el diagnóstico de alto riesgo; sentimientos al descubrir que el embarazo era de riesgo; sentimientos con respecto al apoyo familiar en relación con el embarazo de alto riesgo. Los sentimientos relatados por las mujeres embarazadas y posparto que vivieron un embarazo de alto riesgo evidencian los impactos que tiene este evento no solo en la salud física sino, especialmente, en el bienestar emocional, pues deja a las mujeres embarazadas en un estado de vulnerabilidad. Conclusión: El estudio nos permitió darnos cuenta de que los sentimientos experimentados en este proceso pueden interferir en la vida de estas mujeres de manera negativa. Sin embargo, a pesar de esta situación, muchas de ellas expresan sentimientos ambiguos, porque, incluso con el riesgo gestacional, están agradecidas por el regalo de la maternidad.

Abstract Introduction: Pregnancy is considered a unique and memorable event in a woman's life. High-risk pregnancy is a stressful experience due to the risks to which the mother and the baby are exposed, and due to the changes that negatively affect their emotional balance. Objective: To identify the feelings experienced by pregnant women facing high-risk pregnancy. Method: Descriptive and exploratory, employing a qualitative approach, the study featured a convenience sample of women with high-risk pregnancies, selected based on inpatient service availability, until interview saturation was achieved. Data collection was conducted over a two-month period through scripted interviews. Data analysis was performed utilizing Minayo's content analysis technique. Results: Thirty-seven women participated in the study. The results were categorized as follows: How the high-risk diagnosis was determined; Feelings upon discovering the pregnancy was high-risk; Feelings regarding family support regarding the high-risk pregnancy. The feelings reported by pregnant and postpartum women who experienced high-risk pregnancies clearly reveal the impacts this event has, not only on physical health, but especially on emotional well-being, leaving the pregnant women in a vulnerable state. Conclusion: The study allowed us to realize that the feelings experienced in this process can negatively interfere in the lives of these women. However, despite this situation, many of them express mixed feelings, because even with the gestational risk, they are grateful for the gift of motherhood.

Estrategias de destete y desmonte de cánula nasal de alto flujo en adultos / Adult High-Flow Nasal Cannula Weaning and Disassembly Strategies

Introducción: La cánula nasal de alto flujo es un sistema que utiliza una mezcla de aire-oxígeno humidificado y calentado con un caudal de hasta 70 litros por minuto. Es utilizada mayoritariamente en la insuficiencia respiratoria aguda de origen hipoxémico, donde ha demostrado brindar mayor comodidad y poder resolutivo de la hipoxemia, en comparación con la oxigenoterapia convencional. Aunque se conocen sus indicaciones y estrategia de seguimiento, en la práctica clínica no es claro su proceso de destete/desmonte. Objetivo: Identificar en la bibliografía la literatura existente acerca de estrategias de destete/desmonte de la cánula nasal de alto flujo en adultos. Métodos: Se realizó una revisión bibliográfica en las bases de datos del portal regional de la BVS, PubMed, Web Of Science, Scopus y Google scholar, sin límite de tiempo y es- tructurando una ecuación PIO con palabras clave y operadores booleanos. Se asumieron artículos publicados en inglés y español, texto completo. Resultados: En la bibliografía, aún se reporta discrepancia en el proceso de destete y desmonte de la cánula nasal de alto flujo, pero en la mayoría de los estudios encontrados en esta revisión se propone disminuir la FiO2 primero de forma gradual (5-10%) hasta valores de 30-50% y, posteriormente, el flujo. Para desmontarla, se podría considerar tener una FiO2 entre 30-50%, flujo entre 20-30 litros por minuto, SaO2 >92%, con adecuada mecánica respiratoria y estado de conciencia. Conclusión: Aún no existe unanimidad en el proceso de destete/desmonte en la cánula nasal de alto flujo en el paciente adulto.

Introduction: The high-flow nasal cannula is a system that uses a humidified and heated air-oxygen mixture with a flow rate of up to 70 liters per minute. It is mostly used in acute respiratory failure of hypoxemic origin, where it has been shown to provide greater comfort and resolving power of hypoxemia, compared to conventional oxygen therapy. Although its indications and follow-up strategy are known, in clinical practice the weaning/weaning process is not clear. Objective: To identify in the bibliography the existing literature on weaning/ weaning strategies of high-flow nasal cannula in adults. Methods: A bibliographic review was carried out in the databases of the regional portal of the BVS, PubMed, Web Of Science, Scopus and Google scholar, without time limit and structuring a PIO equation with keywords and boléan connectors. Articles published in English and Spanish, full text, were assumed. Results: The literature still reports discrepancy in the process of weaning and disassembling the high-flow nasal cannula, but most of the studies found in this review propose to decrease the FiO2 first gradually (5-10%) to values of 30-50% and then the flow. To dismantle it, one could consider having a FiO2 between 30-50%, flow between 20-30 liters per minute, SaO2 >92%, with adequate respiratory mechanics and state of consciousness. Conclusion: There is still no unanimity on the weaning/weaning process in the high- flow nasal cannula in the adult patient.

Terapia de alto flujo en pacientes con traqueostomía. Una revisión narrativa / High-Flow Therapy in Tracheostomized Patients. A Narrative Review

La terapia de alto flujo se ha popularizado durante los últimos años, basada en sus efectos fisiológicos, la entrega de una fracción inspirada de oxígeno segura y estable, sumada al flujo calefaccionado y humidificado, lo que hizo posible su utilización en distintos escenarios. Sin embargo, los estudios que muestran estos beneficios y efectos se han realizado, principalmente, con el empleo de una cánula nasal; mientras que las características de esta terapia en los pacientes traqueostomizados no se ha desarrollado suficientemente. Proponemos aquí una revisión narrativa con las características más salientes de la terapia de alto flujo en este subgrupo de pacientes.

High-flow therapy has become popular in recent years, based on its physiological effects, the delivery of a safe and stable inspired fraction of oxygen, combined with heated and humidified flow, which made its use possible in different scenarios. However, studies demonstrating these benefits and effects have been mainly conducted using a nasal cannula, while the characteristics of this therapy in tracheostomized patients have not been sufficiently developed. We propose a narrative review highlighting the most relevant characteristics of high-flow therapy in this subgroup of patients.

Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study.

PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

Cuando el carcinoma de tiroides no es indolente: carcinoma de alto grado derivado del epitelio folicular / When Thyroid Carcinoma is not Indolent: High-Grade Carcinoma Derived From The Follicular Epithelium

Los carcinomas de tiroides derivados de células foliculares de alto grado (HGFDTC) son tumores poco frecuentes con un pronóstico intermedio entre carcinomas tiroideos bien diferenciados y anaplásicos. La clasificación de la OMS más reciente identifica dos tipos distintos de HGFDTC: 1) carcinoma de tiroides mal diferenciado (arquitectura sólida, trabecular o insular, falta de características nucleares de núcleos nucleares papilares y contorneados, necrosis mitosis (≥3/2mm2), y 2 ) Diferenciar carcinoma de tiroides de alto grado (recuento mitótico alto (≥5/mm2) y/o necrosis). Estos tumores son frecuentemente refractarios de radioyodo, tienen una alta propensión a metástasis distantes y una mala supervivencia general a largo plazo. Desde un punto de vista molecular, HGFDTC comparten mutaciones del controlador es decir, BRAF) y, con menos frecuencia, las fusiones genéticas (es decir, NTRK, RET) con arcinomas de tiroides diferenciados. A medida que ocurre la desdiferenciación, se adquieren alteraciones secundarias (como el promotor TERT y TP53). En esta revisión, nuestro objetivo es describir las características clínicas, moleculares y patológicas de HGFDTC, así como su gestión e investigación futura

High-grade follicular cell derived thyroid carcinomas (HGFDTC) are infrequent tumors with a prognosis intermediate between well differentiated and anaplastic thyroid carcinomas. The most recent WHO classification identifies two distinct types of HGFDTC: 1) Poorly differentiated thyroid carcinoma (solid, trabecular or insular architecture, lack of nuclear features of papillary nuclear and either convoluted nuclei, necrosis or mitosis (≥3/2mm2), and 2) differentiated high-grade thyroid carcinoma (high mitotic count (≥5/mm2) and/or necrosis). These tumors are frequently radioiodine refractory, have a high propensity for distant metastases, and poor long term overall survival. From a molecular standpoint, HGFDTC share driver mutations (ie BRAF) and, less frequently, gene fusions (ie NTRK, RET) with differentiated thyroid carcinomas. As dedifferentiation occurs, secondary alterations (such as TERT promoter, and TP53) are acquired. In this review, we aim to describe the clinical, molecular and pathological characteristics of HGFDTC, as well as their management and future research

Partos y cesáreas en edad de riesgo en hospitales del Maule desde 2017 a 2021 / Births and cesarean sections at risk age in Maule hospitals from 2017 to 2021

Pregnancy, despite being a physiological process, can lead to morbidity and mortality, which is increased at risk ages, defined as younger or equal to15 years and older or equal to 35 years. For an adequate approach it is necessary to know the local reality of the population, therefore, the objective of this study is to describe and analyze the discharges of births and cesarean sections at risk age in the Maule Region from 2017 to 2021 using the database collected from the Biostatistics Unit of the Maule Health Service, which includes the hospitals of the region. Within the observed period, a total of 30,599 deliveries and cesarean sections were studied, being these a total of 5,581 at risk age, of which 0.65% corresponds to women younger or equal to 15 years and 17.57% to women older or equal to 35 years. There is a downward tendency in births in general, mostly evidenced in less or equal to 15 years, and on the contrary, a rise in births and cesarean sections of more or equal to 35 years, differing with the statistics at the country level. The tendency of increasing maternal age of pregnancies in the Maule region and its consequences are a fundamental factor when planning new public policies, so we consider it of vital importance to promote research and update the evidence, with a focus on the local population.

El embarazo a pesar de ser un proceso fisiológico puede conllevar morbimortalidad, la cual se acrecienta en edades de riesgo, definida como menor o igual a 15 años y mayor o igual a 35 años. Para el adecuado enfrentamiento se necesita conocer la realidad local, por ello, el objetivo de este estudio es describir y analizar los egresos de partos y cesáreas en edad de riesgo en la Región del Maule desde el año 2017 a 2021 utilizando la base de datos recogida desde la Unidad de Bioestadística del Servicio de Salud Maule, la cual incluye los hospitales de la región. Dentro del periodo observado se estudió un total de 30.599 partos y cesáreas, siendo estos un total de 5.581 en edad de riesgo, de los cuales 0.65% corresponde a mujeres menores o igual a 15 años y 17.57% a mujeres mayores o igual a 35 años. Existe una tendencia a la baja de los nacimientos en general, mayormente evidenciado en menores o igual a 15 años, y por el contrario, un alza en los partos y cesáreas de mayores o igual a 35 años, difiriendo con las estadísticas a nivel país. El aumento de la edad materna de los embarazos en la región del Maule y sus consecuencias son un factor fundamental a la hora de planificar nuevas políticas públicas, por lo que consideramos de vital importancia promover la realización de investigaciones y actualización de la evidencia sobre el tema, con un enfoque en la población local.

Valor pronóstico de la perfusión cerebral por RM en el estudio inicial de los gliomas de alto grado / Prognostic value of brain perfusion by MRI in the initial study of high grade gliomas

Objetivos: Valorar si la perfusión tumoral en el estudio diagnóstico inicial de RM es un marcador pronóstico para la supervivencia en pacientes diagnosticados de gliomas de alto grado. Analizar los factores de riesgo que influyen en la mortalidad por gliomas de alto grado para poder cuantificar la supervivencia global esperada del paciente. Pacientes y métodos: Se seleccionaron las RM de todos los pacientes diagnosticados de glioma de alto grado en un hospital de tercer nivel entre los años 2017 y 2019. Se recogieron variables clínicas y tumorales. Se usó el análisis de supervivencia para determinar la asociación entre la perfusión tumoral y el tiempo de supervivencia. Se estudió la relación entre las variables recogidas y la supervivencia mediante el estadístico de Wald, cuantificando esta relación mediante la regresión de Cox. Por último, se analizó el tipo de relación existente entre la perfusión tumoral y la supervivencia a través del estudio de regresión lineal. Estos análisis estadísticos se realizaron con el software SPSS v.17. Resultados: Se incluyeron 38 pacientes (media de edad 61,1años). La supervivencia media global fue de 20,6meses. Se observó asociación entre la perfusión tumoral en la RM diagnóstica y la supervivencia global, mostrando el grupo con valores intratumorales de volumen sanguíneo cerebral relativo (rVSC) >3,0 una disminución significativa en el tiempo medio de supervivencia respecto al grupo con valores <3,0 (14,6meses vs 22,8meses, p=0,046). También han demostrado influir significativamente en la supervivencia media variables como la escala de Karfnosky y el tiempo de recidiva desde la intervención. Conclusiones: Se ha evidenciado que la perfusión tumoral por RM tiene valor pronóstico en el estudio inicial de los gliomas de alto grado.(AU)

Objectives: To evaluate if the tumour perfusion at the initial MRI scan is a marker of prognosis for survival in patients diagnosed with high grade gliomas (HGG). To analyse the risk factors which influence on the mortality from HGG to quantify the overall survival to be expected in patients. Patients and methods: The patients diagnosed with HGG through a MRI scan in a third-level hospital between 2017 and 2019 were selected. Clinical and tumour variables were collected. The survival analysis was used to determine the association between the tumour perfusion and the survival time. The relation between the collected variables and the survival period was assessed through Wald's statistical method, measuring the relationship via Cox's regression model. Finally, the type of relationship that exists between the tumour perfusion and the survival was analysed through the lineal regression method.Those statistical analysis were carried out using the software SPSS v.17. Results: Thirty-eight patients were included (average age: 61.1years old). The general average survival period was 20.6months. A relationship between the tumour perfusion at the MRI scan and the overall survival has been identified, in detail, a group with intratumor values of relative cerebral blood volume (rCBV) >3.0 has shown a significant decline in the average survival period with regard to the average survival period of the group with values <3.0 (14.6months vs. 22.8months, P=.046). It has also been proved that variables like Karnofsky's scale and the response time since the intervention significantly influence on the survival period. Conclusions: It has become evident that the tumour perfusion via MRI scan has a prognostic value in the initial analysis of HGG. The average survival period of patients with rCBV less than or equal to 3.0 is significantly higher than those patients whose values are higher, which allows to be more precise with the prognosis of each patient.(AU)

Abemaciclib as adjuvant treatment for high-risk early breast cancer / Abemaciclib en adyuvancia para el tratamiento del cáncer de mama precoz de alto riesgo

Objective: To adapt the GHEMA report of abemaciclib, an inhibitor of cyclin-dependent kinases 4 and 6. European Medicines Agency authorization (April 2022) includes, in combination with endocrine therapy, the adjuvant treatment of adult patients with hormone receptor positive, human epidermal growth factor receptor 2 negative, node-positive, early breast cancer at high risk of recurrence. Method: The efficacy and safety of abemaciclib were evaluated in a randomized, open-label, and multicenter phase III study. A total of 5637 patients diagnosed with early breast cancer with hormone receptor positive, human epidermal growth factor receptor 2 negative, node positive, and high risk of recurrence were included. High risk was defined as patients with 4 or more positive axillary lymph nodes, or 1–3 positive axillary lymph nodes and at least one of the following: tumor size ≥5 cm, histologic grade 3, or Ki-67≥20%. Patients were randomized (1:1) to receive adjuvant abemaciclib+endocrine therapy (n = 2808) or endocrine therapy alone (n = 2829) for 2 years, with endocrine therapy prescribed for at least 5 years. Results: With a median follow-up of 15.5 months, abemaciclib+endocrine therapy demonstrated a statistically significant improvement in invasive disease-free survival versus endocrine therapy alone [HR = 0.747 (95% CI 0.598–0.932), P = 0.0096]; achieving an absolute improvement of 3.5% invasive disease-free survival rate at 2-years. These results were maintained, with a median follow-up of 27.7 months: absolute improvement of 2.7% and 5.4% in invasive disease-free survival rate at 2 and 3 years, respectively. All-causality grade 3 or 4 adverse events were 45.9% for abemaciclib and 12.9% for endocrine therapy, and included neutropenia (19.6% vs. 0.8%), leukopenia (11.4% vs. 0.4%), and diarrhea (7.8% vs. 0.2%). Conclusions: The results of the pivotal trial are sufficient to consider abemaciclib as adjuvant treatment for...(AU)

Objetivo: Adaptar el informe GHEMA de abemaciclib, un inhibidor de quinasas dependientes de ciclinas 4 y 6, con autorización de la Agencia Europea del Medicamento en abril de 2022 para el tratamiento adyuvante de pacientes adultos con cáncer de mama precoz, receptor hormonal positivo, receptor del factor de crecimiento epidérmico negativo, con afectación ganglionar y riesgo elevado de recaída; en combinación con hormonoterapia. Método: La eficacia y seguridad de abemaciclib se evaluó en un estudio fase III multicéntrico, aleatorizado y abierto. Se incluyeron 5.637 pacientes diagnosticados de cáncer de mama precoz con ganglios positivos, receptor hormonal positivo, receptor del factor de crecimiento epidérmico negativo y alto riesgo de recaída. El criterio de alto riesgo se definió como la presencia de ≥ 4 ganglios positivos, o de 1–3 ganglios y al menos una de las siguientes características: tamaño del tumor ≥5 cm, grado histológico 3 o Ki-67 ≥ 20%. Los pacientes fueron aleatorizados (1:1) a recibir durante 2 años abemaciclib + hormonoterapia (n = 2.808) u hormonoterapia sola (n = 2.829). En ambos brazos el tratamiento con hormonoterapia se mantuvo mínimo 5 años. Resultados: Con una mediana de seguimiento de 15,5 meses, abemaciclib + hormonoterapia mostró beneficio significativo frente a la hormonoterapia sola [HR = 0,747 (IC95% 0,598-0,932), p = 0,0096], con una mejora absoluta del 3,5% en la tasa de supervivencia libre de enfermedad invasiva a 2 los años. Este beneficio se mantuvo con una mediana de seguimiento de 27,7 meses, logrando una mejora en la tasa de supervivencia libre de enfermedad invasiva del 2,7% y del 5,4% a los 2 y 3 años, respectivamente. La incidencia de efectos adversos grado 3–4 fue superior en el brazo de abemaciclib (45,9% vs. 12,9%); e incluía neutropenia (19,6% vs. 0,8%), leucopenia (11,4% vs. 0,4%) y diarrea (7,8% vs. 0,2%). Conclusiones: Los resultados del ensayo pivotal son suficientes para considerar abemaciclib como...(AU)

Abemaciclib en adyuvancia para el tratamiento del cáncer de mama precoz de alto riesgo / Abemaciclib as adjuvant treatment for high-risk early breast cancer

Objective: To adapt the GHEMA report of abemaciclib, an inhibitor of cyclin-dependent kinases 4 and 6. European Medicines Agency authorization (April 2022) includes, in combination with endocrine therapy, the adjuvant treatment of adult patients with hormone receptor positive, human epidermal growth factor receptor 2 negative, node-positive, early breast cancer at high risk of recurrence. Method: The efficacy and safety of abemaciclib were evaluated in a randomized, open-label, and multicenter phase III study. A total of 5637 patients diagnosed with early breast cancer with hormone receptor positive, human epidermal growth factor receptor 2 negative, node positive, and high risk of recurrence were included. High risk was defined as patients with 4 or more positive axillary lymph nodes, or 1–3 positive axillary lymph nodes and at least one of the following: tumor size ≥5 cm, histologic grade 3, or Ki-67≥20%. Patients were randomized (1:1) to receive adjuvant abemaciclib+endocrine therapy (n = 2808) or endocrine therapy alone (n = 2829) for 2 years, with endocrine therapy prescribed for at least 5 years. Results: With a median follow-up of 15.5 months, abemaciclib+endocrine therapy demonstrated a statistically significant improvement in invasive disease-free survival versus endocrine therapy alone [HR = 0.747 (95% CI 0.598–0.932), P = 0.0096]; achieving an absolute improvement of 3.5% invasive disease-free survival rate at 2-years. These results were maintained, with a median follow-up of 27.7 months: absolute improvement of 2.7% and 5.4% in invasive disease-free survival rate at 2 and 3 years, respectively. All-causality grade 3 or 4 adverse events were 45.9% for abemaciclib and 12.9% for endocrine therapy, and included neutropenia (19.6% vs. 0.8%), leukopenia (11.4% vs. 0.4%), and diarrhea (7.8% vs. 0.2%). Conclusions: The results of the pivotal trial are sufficient to consider abemaciclib as adjuvant treatment for...(AU)

Objetivo: Adaptar el informe GHEMA de abemaciclib, un inhibidor de quinasas dependientes de ciclinas 4 y 6, con autorización de la Agencia Europea del Medicamento en abril de 2022 para el tratamiento adyuvante de pacientes adultos con cáncer de mama precoz, receptor hormonal positivo, receptor del factor de crecimiento epidérmico negativo, con afectación ganglionar y riesgo elevado de recaída; en combinación con hormonoterapia. Método: La eficacia y seguridad de abemaciclib se evaluó en un estudio fase III multicéntrico, aleatorizado y abierto. Se incluyeron 5.637 pacientes diagnosticados de cáncer de mama precoz con ganglios positivos, receptor hormonal positivo, receptor del factor de crecimiento epidérmico negativo y alto riesgo de recaída. El criterio de alto riesgo se definió como la presencia de ≥ 4 ganglios positivos, o de 1–3 ganglios y al menos una de las siguientes características: tamaño del tumor ≥5 cm, grado histológico 3 o Ki-67 ≥ 20%. Los pacientes fueron aleatorizados (1:1) a recibir durante 2 años abemaciclib + hormonoterapia (n = 2.808) u hormonoterapia sola (n = 2.829). En ambos brazos el tratamiento con hormonoterapia se mantuvo mínimo 5 años. Resultados: Con una mediana de seguimiento de 15,5 meses, abemaciclib + hormonoterapia mostró beneficio significativo frente a la hormonoterapia sola [HR = 0,747 (IC95% 0,598-0,932), p = 0,0096], con una mejora absoluta del 3,5% en la tasa de supervivencia libre de enfermedad invasiva a 2 los años. Este beneficio se mantuvo con una mediana de seguimiento de 27,7 meses, logrando una mejora en la tasa de supervivencia libre de enfermedad invasiva del 2,7% y del 5,4% a los 2 y 3 años, respectivamente. La incidencia de efectos adversos grado 3–4 fue superior en el brazo de abemaciclib (45,9% vs. 12,9%); e incluía neutropenia (19,6% vs. 0,8%), leucopenia (11,4% vs. 0,4%) y diarrea (7,8% vs. 0,2%). Conclusiones: Los resultados del ensayo pivotal son suficientes para considerar abemaciclib como...(AU)

Switches in non-invasive respiratory support strategies during acute hypoxemic respiratory failure: Need to monitoring from a retrospective observational study

Objective To explore combined non-invasive-respiratory-support (NIRS) patterns, reasons for NIRS switching, and their potential impact on clinical outcomes in acute-hypoxemic-respiratory-failure (AHRF) patients. Design Retrospective, single-center observational study. Setting Intensive Care Medicine. Patients AHRF patients (cardiac origin and respiratory acidosis excluded) underwent combined NIRS therapies such as non-invasive-ventilation (NIV) and High-Flow-Nasal-Cannula (HFNC). Interventions Patients were classified based on the first NIRS switch performed (HFNC-to-NIV or NIV-to-HFNC), and further specific NIRS switching strategies (NIV trial-like vs. Non-NIV trial-like and single vs. multiples switches) were independently evaluated. Main variables of interest Reasons for switching, NIRS failure and mortality rates. Results A total of 63 patients with AHRF were included, receiving combined NIRS, 58.7% classified in the HFNC-to-NIV group and 41.3% in the NIV-to-HFNC group. Reason for switching from HFNC to NIV was AHRF worsening (100%), while from NIV to HFNC was respiratory improvement (76.9%). NIRS failure rates were higher in the HFNC-to-NIV than in NIV-to-HFNC group (81% vs. 35%, p < 0.001). Among HFNC-to-NIV patients, there was no difference in the failure rate between the NIV trial-like and non-NIV trial-like groups (86% vs. 78%, p = 0.575) but the mortality rate was significantly lower in NIV trial-like group (14% vs. 52%, p = 0.02). Among NIV to HFNC patients, NIV failure was lower in the single switch group compared to the multiple switches group (15% vs. 53%, p = 0.039), with a shorter length of stay (5 [2–8] vs. 12 [8–30] days, p = 0.001). Conclusions NIRS combination is used in real life and both switches’ strategies, HFNC to NIV and NIV to HFNC, are common in AHRF management. Transitioning from HFNC to NIV is suggested as a therapeutic escalation and in this context performance of a NIV-trial could be beneficial. ... (AU)

Objetivo Explorar los patrones combinados de soporte-respiratorio-no-invasivo (SRNI), las razones para cambiar de SRNI y su potencial impacto en los resultados clínicos en pacientes con insuficiencia-respiratoria-aguda-hipoxémica (IRAH). Diseño Estudio observacional retrospectivo unicéntrico. Ámbito Cuidados Intensivos. Pacientes Pacientes con IRAH (excluyendo causa cardíaca y acidosis respiratoria) que recibieron tanto ventilación-no-invasiva (VNI) como cánula-nasal-de-alto-flujo (CNAF). Intervenciones Se categorizó a los pacientes según el primer cambio de SRNI realizado (CNAF-to-VNI o VNI-to-CNAF) y se evaluaron estrategias específicas de SRNI (VNI trial-like vs. Non-VNI trial-like y cambio único vs. múltiples cambios de NIRS) de manera independiente. Variables de interés principales Razones para el cambio, así como las tasas de fracaso de SRNI y la mortalidad. Resultados Un total de 63 pacientes recibieron SRNI combinado, 58,7% clasificados en el grupo CNAF-to-VNI y 41,3% en el grupo VNI-to-CNAF. Los cambios de CNAF a VNI ocurrieron por empeoramiento de la IRHA (100%) y de VNI a CNAF por mejora respiratoria (76.9%). Las tasas de fracaso de SRNI fueron mayores de CNAF a VNI que de VNI a CNAF (81% vs. 35%, p < 0.001). Dentro de los pacientes de CNAF a VNI, no hubo diferencia en las tasas de fracaso entre los grupos VNI trial-like y no-VNI trial-like (86% vs. 78%, p = 0.575), pero la mortalidad fue menor en el grupo VNI trial-like (14% vs. 52%, p = 0.02). Dentro de los pacientes de VNI a CNAF, el fracaso de VNI fue menor en grupo de cambio único vs. múltiple (15% vs. 53%, p = 0.039). Conclusiones Los cambios de estrategia de SRNI son comunes en el manejo clínico diario de la IRHA. El cambio de CNAF a VNI impresiona de ser una escalada terapéutica y en este contexto la realización de un VNI-trial puede ser beneficioso. Al contrario, cambiar de VNI a CNAF impresiona de ser una desescalada terapéutica y parece segura si no hay fracaso ... (AU)