Ventilatory load reduction by combined mild hypothermia and ultraprotective mechanical ventilation strategy in severe COVID-19-related acute respiratory distress syndrome: A physiological study.

We report the feasibility of a combined approach of very low low tidal volume (VT) and mild therapeutic hypothermia (MTH) to decrease the ventilatory load in a severe COVID-19-related acute respiratory distress syndrome (ARDS) cohort. Inclusion criteria was patients ≥18-years-old, severe COVID-19-related ARDS, driving pressure ∆P >15 cmH2O despite low-VT strategy, and extracorporeal therapies not available. MTH was induced with a surface cooling device aiming at 34°C. MTH was maintained for 72 h, followed by rewarming of 1°C per day. Data were shown in median (interquartile range, 25%-75%). Mixed effects analysis and Dunnett's test were used for comparisons. Seven patients were reported. Ventilatory load decreased during the first 24 h, minute ventilation (VE) decreased from 173 (170-192) to 152 (137-170) mL/kg/min (P = 0.007), and mechanical power (MP) decreased from 37 (31-40) to 29 (26-34) J/min (P = 0.03). At the end of the MTH period, the VT, P, and plateau pressure remained consistently close to 3.9 mL/kg predicted body weight, 12 and 26 cmH2O, respectively. A combined strategy of MTH and ultraprotective mechanical ventilation (MV) decreased VE and MP in severe COVID-19-related ARDS. The decreasing of ventilatory load may allow maintaining MV within safety thresholds.

Airway Management of Critically Ill Pediatric Patients with Suspected or Proven Coronavirus Disease 2019 Infection: An Intensivist Point of View.

Advanced airway management of critically ill children is crucial for novel coronavirus disease 2019 (COVID-19) management in the pediatric intensive care unit, whether due to shock and hemodynamic collapse or acute respiratory failure. In this article, intubation is challenging due to the particularities of children's physiology and the underlying disease's pathophysiology, especially when an airborne pathogen, like COVID-19, is present. Unfortunately, published recommendations and guidelines for COVID-19 in pediatrics do not address in-depth endotracheal intubation in acutely ill children. We discussed the caveats and pitfalls of intubation in critically ill children.

Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the LARed Network registry.

OBJECTIVES: To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). DESIGN: Secondary analysis of a prospective cohort. SETTING: PICUs in centers that are part of the LARed Network between April 2017 and January 2022. PARTICIPANTS: Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. RESULTS: 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). CONCLUSIONS: Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.

Lung mechanics in pediatric acute respiratory distress syndrome associated to acute COVID-19 and MIS-C: implications for therapies and outcomes. / Mecánica pulmonar en el síndrome de distrés respiratorio agudo pediátrico asociado a COVID-19 aguda y MIS-C.

OBJECTIVE: To describe lung mechanics in Pediatric Acute Respiratory Distress Syndrome (PARDS) associated with acute COVID-19 and MIS-C with respiratory failure. METHODS: A concurrent multicenter observational study was performed, analyzing clinical variables and pulmonary mechanics of PARDS associated with COVID-19 in 4 Pediatric intensive care units (PICU) in Peru. The subgroup analysis included PARDS associated with multisystem inflammatory syndrome in children (MIS-C), MIS-PARDS, and PARDS with COVID-19 primary respiratory infection, C-PARDS. In addition, receiver operating characteristic (ROC) curve analysis for mortality and lung mechanics was performed. RESULTS: 30 patients were included. The age was 7.5 (4-11) years, 60% were male, and mortality was 23%. 47% corresponded to MIS-PARDS and 53% to C-PARDS groups. C-PARDS had positive RT-PCR in 67% and MIS-PARDS none (p < 0.001). C-PARDS group had more profound hypoxemia (P/F ratio < 100, 86% vs. 38%, p < 0.01) and higher driving-pressure [14(10-22) vs 10(10-12) cmH2O], and lower compliance of the respiratory system (CRS) [0.5 (0.3-0.6) vs 0.7(0.6-0.8) ml/ kg/cmH2O] compared with MIS-PARDS (all p < 0.05). The ROC analysis for mortality showed that driving pressure had the best performance [AUC 0.91(95%CI0.81-1.00), with the best cut-off point of 15 cmH2O (100% sensitivity and 87% specificity). Mortality in C-PARDS was 38% and 7% in MIS-PARDS (p = 0.09). MV-free days were 12(0-23) in C-PARDS and 23(21-25) in MIS-PARDS (p = 0.02). CONCLUSION: Patients with C-PARDS have lung mechanics characteristics similar to classic moderate to severe PARDS. This was not observed in patients with MIS-C. As seen in other studies, a driving pressure ≥ 15 cmH2O was the best discriminator for mortality. These findings may help guide ventilatory management strategies for these two different presentations.

[New morbidity following critical illness in Latin American children under 18 years old with lower respiratory tract infection]. / Nueva Morbilidad tras Enfermedad Crítica en Niños Latinoamericanos menores de 18 años con infección severa del tracto respiratorio inferior.

Acquisition of new morbidity (NM) has become a key clinical outcome measure after pediatric critical illness. Data on Latin American children are still scarce. OBJECTIVE: to analyze the development of new morbidities acquired after hospitalization due to lower respiratory tract infection (LRTI) in pediatric intensive care units (PICU). PATIENTS AND METHOD: we included patients from 35 PICUs from 8 countries, aged 0 to 18 years with a diagnosis of LRTI, discharged alive, registered between April 2018 and September 2019, and who required some type of ventilatory support (high-flow system, noninvasive ventilation or invasive ventilation), included in the LARed Network registry, which includes the Functional Status Scale (FSS) validated in the pediatric population, which assesses functional status in six domains: mental status, sensory, communication, motor skills, feeding, and respiratory status. NM considered LRTI after hospitalization and was defined as an increase of ≥ 3 points in the FSS. RESULTS: Of 3280 children with LRTI, 85 (2.6%) developed NM, associated with diagnoses of sepsis and acute respiratory distress syndrome (ARDS), pneumococcal or adenovirus infection, healthcare-associated infections (HAIs), and invasive mechanical ventilation. Adenovirus infection, ARDS, and HAIs were independently associated with NM. CONCLUSIONS: We observed that the development of NM at PICU discharge is infrequent but is associated with modifiable risk factors. These data define certain risk groups for future interventions and initiatives to improve the quality of care.

Enhanced Astrocyte Activity and Excitatory Synaptic Function in the Hippocampus of Pentylenetetrazole Kindling Model of Epilepsy.

Epilepsy is a chronic condition characterized by recurrent spontaneous seizures. The interaction between astrocytes and neurons has been suggested to play a role in the abnormal neuronal activity observed in epilepsy. However, the exact way astrocytes influence neuronal activity in the epileptogenic brain remains unclear. Here, using the PTZ-induced kindling mouse model, we evaluated the interaction between astrocyte and synaptic function by measuring astrocytic Ca2+ activity, neuronal excitability, and the excitatory/inhibitory balance in the hippocampus. Compared to control mice, hippocampal slices from PTZ-kindled mice displayed an increase in glial fibrillary acidic protein (GFAP) levels and an abnormal pattern of intracellular Ca2+-oscillations, characterized by an increased frequency of prolonged spontaneous transients. PTZ-kindled hippocampal slices also showed an increase in the E/I ratio towards excitation, likely resulting from an augmented release probability of excitatory inputs without affecting inhibitory synapses. Notably, the alterations in the release probability seen in PTZ-kindled slices can be recovered by reducing astrocyte hyperactivity with the reversible toxin fluorocitrate. This suggests that astroglial hyper-reactivity enhances excitatory synaptic transmission, thereby impacting the E/I balance in the hippocampus. Altogether, our findings support the notion that abnormal astrocyte-neuron interactions are pivotal mechanisms in epileptogenesis.

Relación entre síndrome metabólico, enfermedades metabólicas e hipoacusia: una revisión sistemática con metaanálisis

Objetivo: Realizar una revisión sistemática y metaanálisis que resuma el riesgo de hipoacusia de personas con diagnóstico de síndrome o enfermedades metabólicas versus aquellas sin síndrome metabólico. Material y Métodos: Siguiendo las recomendaciones PRISMA para revisión sistemática y metaanálisis, se realizaron búsquedas en 3 indexadores (PubMed, Web of Science y SciELO). Se incluyeron sólo estudios transversales que reportan asociaciones de hipoacusia con obesidad, Hipertensión; Diabetes, Dislipidemia, Colesterol, síndrome metabólico e Hiperglicemia. Las odds ratios (OR) con sus intervalos de confianza (IC) del 95% de los estudios se agruparon en un modelo de efectos aleatorios por el método de Mantel Haenszel. Con Rev Manager 5.1, se evaluó la heterogeneidad OR mediante las estadísticas I2 y Q. Resultados: 28 estudios observacionales fueron incluidos en el análisis cuantitativo. Las OR para hipoacusia prevalente fue de 1.27 (95% IC 1.07, 1.51) en obesidad, 1.97 (95% IC 1.51, 2.57) en diabetes, 1.53 (95% IC 1.31, 1.79) en hipertensión y 4.22 (95% IC 1.74, 10.20) para síndrome metabólico. Conclusiones: Los hallazgos sugieren que tanto el síndrome metabólico como algunas enfermedades como obesidad, diabetes e hipertensión podrían asociarse con el riesgo de hipoacusia, pudiendo el control de estas enfermedades atenuar este riesgo.

Introduction: Various studies have linked lifestyle and metabolic diseases to hearing loss. Research on metabolic syndrome has reported a higher prevalence of hearing loss in individuals with it than those without it. Objectives: To conduct a systematic review and meta-analysis summarizing the risk of hearing loss in people diagnosed with metabolic syndrome or diseases versus those without metabolic syndrome. Methods. Following the PRISMA recommendations for systematic review and meta-analysis, searches were conducted in PubMed, Web of Science, and SciELO. Only cross-sectional studies associate hearing loss with obesity, hypertension, Diabetes, Dyslipidemia, Cholesterol, metabolic syndrome, and Hyperglycemia. The odds ratios (OR) with their 95% confidence intervals (CI) of the studies were pooled in a random effects model using the Mantel-Haenszel method. Using Rev Manager 5.1, OR heterogeneity was assessed using the I2 and Q statistics. Results. Twenty-eight observational studies were included in the quantitative analysis. The OR for prevalent hearing loss was 1.27 (95% CI 1.07, 1.51) in obesity, 1.97 (95% CI 1.51, 2.57) in diabetes, 1.53 (95% CI 1.31, 1.79) in hypertension, and 4.22 (95% CI 1.74, 10.20) for metabolic syndrome. Conclusions. The findings suggest that both metabolic syndrome and some diseases, such as obesity, diabetes, and hypertension, could be associated with the risk of hearing loss, and control of these diseases could reduce this risk.

Capnometry after an inspiratory breath hold, PLAT CO2 , as a surrogate for P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ in mild to moderate pediatric acute respiratory distress syndrome: A feasibility study.

OBJECTIVE: Accurate and reliable noninvasive methods to estimate gas exchange are necessary to guide clinical decisions to avoid frequent blood samples in children with pediatric acute respiratory distress syndrome (PARDS). We aimed to investigate the correlation and agreement between end-tidal P CO 2 ${P}_{{\mathrm{CO}}_{2}}$ measured immediately after a 3-s inspiratory-hold (PLAT CO2 ) by capnometry and P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ measured by arterial blood gases (ABG) in PARDS. DESIGN: Prospective cohort study. SETTING: Seven-bed Pediatric Intensive Care Unit, Hospital El Carmen de Maipú, Chile. PATIENTS: Thirteen mechanically ventilated patients aged ≤15 years old undergoing neuromuscular blockade as part of management for PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All patients were in volume-controlled ventilation mode. The regular end-tidal P CO 2 ( P ETCO 2 ) ${P}_{{\mathrm{CO}}_{2}}({P}_{{\mathrm{ETCO}}_{2}})$ (without the inspiratory hold) was registered immediately after the ABG sample. An inspiratory-hold of 3 s was performed for lung mechanics measurements, recording P ETCO 2 ${P}_{{\mathrm{ETCO}}_{2}}$ in the breath following the inspiratory-hold. (PLAT CO2 ). End-tidal alveolar dead space fraction (AVDSf) was calculated as [ ( P aCO 2 - P ETCO 2 ) / P aCO 2 ] $[({P}_{{\mathrm{aCO}}_{2}}\mbox{--}{P}_{{\mathrm{ETCO}}_{2}})/{P}_{{\mathrm{aCO}}_{2}}]$ and its surrogate (S)AVDSf as [ ( PLAT CO 2 - P ETCO 2 ) / PLAT CO 2 ] $[{(}_{\mathrm{PLAT}}{\mathrm{CO}}_{2}\mbox{--}{P}_{{\mathrm{ETCO}}_{2}}){/}_{\mathrm{PLAT}}{\mathrm{CO}}_{2}]$ . Measurements of P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ were considered the gold standard. We performed concordance correlation coefficient (ρc), Spearman's correlation (rho), and Bland-Altmann's analysis (mean difference ± SD [limits of agreement, LoA]). Eleven patients were included, with a median (interquartile range) age of 5 (2-11) months. Tidal volume was 5.8 (5.7-6.3) mL/kg, PEEP 8 (6-8), driving pressure 10 (8-11), and plateau pressure 17 (17-19) cm H2 O. Forty-one paired measurements were analyzed. P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ was higher than P ETCO 2 ${P}_{{\mathrm{ETCO}}_{2}}$ (52 mmHg [48-54] vs. 42 mmHg [38-45], p < 0.01), and there were no significant differences with PLAT CO2 (50 mmHg [46-55], p > 0.99). The concordance correlation coefficient and Spearman's correlation between P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ and PLAT CO2 were robust (ρc = 0.80 [95% confidence interval [CI]: 0.67-0.90]; and rho = 0.80, p < 0.001.), and for P ETCO 2 ${P}_{{\mathrm{ETCO}}_{2}}$ were weak and strong (ρc = 0.27 [95% CI: 0.15-0.38]; and rho = 0.63, p < 0.01). The bias between PLAT CO2 and P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ was -0.4 ± 3.5 mmHg (LoA -7.2 to 6.4), and between P ETCO 2 ${P}_{{\mathrm{ETCO}}_{2}}$ and P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ was -8.5 ± 4.1 mmHg (LoA -16.6 to -0.5). The correlation between AVDSf and (S)AVDSf was moderate (rho = 0.55, p < 0.01), and the mean difference was -0.5 ± 5.6% (LoA -11.5 to 10.5). CONCLUSION: This pilot study showed the feasibility of measuring end-tidal CO2 after a 3-s end-inspiratory breath hole in pediatric patients undergoing controlled ventilation for ARDS. Encouraging preliminary results warrant further study of this technique.

Plateau Pressure and Driving Pressure in Volume- and Pressure-Controlled Ventilation: Comparison of Frictional and Viscoelastic Resistive Components in Pediatric Acute Respiratory Distress Syndrome.

OBJECTIVES: To examine frictional, viscoelastic, and elastic resistive components, as well threshold pressures, during volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in pediatric patients with acute respiratory distress syndrome (ARDS). DESIGN: Prospective cohort study. SETTING: Seven-bed PICU, Hospital El Carmen de Maipú, Chile. PATIENTS: Eighteen mechanically ventilated patients less than or equal to 15 years old undergoing neuromuscular blockade as part of management for ARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All patients were in VCV mode during measurement of pulmonary mechanics, including: the first pressure drop (P1) upon reaching zero flow during the inspiratory hold, peak inspiratory pressure (PIP), plateau pressure (P PLAT ), and total positive end-expiratory pressure (tPEEP). We calculated the components of the working pressure, as defined by the following: frictional resistive = PIP-P1; viscoelastic resistive = P1-P PLAT ; purely elastic = driving pressure (ΔP) = P PLAT -tPEEP; and threshold = intrinsic PEEP. The procedures and calculations were repeated on PCV, keeping the same tidal volume and inspiratory time. Measurements in VCV were considered the gold standard. We performed Spearman correlation and Bland-Altman analysis. The median (interquartile range [IQR]) for patient age was 5 months (2-17 mo). Tidal volume was 5.7 mL/kg (5.3-6.1 mL/kg), PIP cm H 2 O 26 (23-27 cm H 2 O), P1 23 cm H 2 O (21-26 cm H 2 O), P PLAT 19 cm H 2 O (17-22 cm H 2 O), tPEEP 9 cm H 2 O (8-9 cm H 2 O), and ΔP 11 cm H 2 O (9-13 cm H 2 O) in VCV mode at baseline. There was a robust correlation (rho > 0.8) and agreement between frictional resistive, elastic, and threshold components of working pressure in both modes but not for the viscoelastic resistive component. The purely frictional resistive component was negligible. Median peak inspiratory flow with decelerating-flow was 21 (IQR, 15-26) and squared-shaped flow was 7 L/min (IQR, 6-10 L/min) ( p < 0.001). CONCLUSIONS: P PLAT , ΔP, and tPEEP can guide clinical decisions independent of the ventilatory mode. The modest purely frictional resistive component emphasizes the relevance of maintaining the same safety limits, regardless of the selected ventilatory mode. Therefore, peak inspiratory flow should be studied as a mechanism of ventilator-induced lung injury in pediatric ARDS.

[Association between Metabolic Syndrome and Risk of Hearing Loss: a Systematic Review and Meta-analysis]. / Relación entre síndrome metabólico, enfermedades metabólicas e hipoacusia: una revisión sistemática con metaanálisis.

INTRODUCTION: Various studies have linked lifestyle and metabolic diseases to hearing loss. Research on metabolic syndrome has reported a higher prevalence of hearing loss in individuals with it than those without it. OBJECTIVES: To conduct a systematic review and meta-analysis summarizing the risk of hearing loss in people diagnosed with metabolic syndrome or diseases versus those without metabolic syndrome. METHODS: Following the PRISMA recommendations for systematic review and meta-analysis, searches were conducted in PubMed, Web of Science, and SciELO. Only cross-sectional studies associate hearing loss with obesity, hypertension, Diabetes, Dyslipidemia, Cholesterol, metabolic syndrome, and Hyperglycemia. The odds ratios (OR) with their 95% confidence intervals (CI) of the studies were pooled in a random effects model using the Mantel-Haenszel method. Using Rev Manager 5.1, OR heterogeneity was assessed using the I2 and Q statistics. RESULTS: Twenty-eight observational studies were included in the quantitative analysis. The OR for prevalent hearing loss was 1.27 (95% CI 1.07, 1.51) in obesity, 1.97 (95% CI 1.51, 2.57) in diabetes, 1.53 (95% CI 1.31, 1.79) in hypertension, and 4.22 (95% CI 1.74, 10.20) for metabolic syndrome. CONCLUSIONS: The findings suggest that both metabolic syndrome and some diseases, such as obesity, diabetes, and hypertension, could be associated with the risk of hearing loss, and control of these diseases could reduce this risk.

Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes.

Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4-36.3).

Spontaneous breathing promotes lung injury in an experimental model of alveolar collapse.

Vigorous spontaneous breathing has emerged as a promotor of lung damage in acute lung injury, an entity known as "patient self-inflicted lung injury". Mechanical ventilation may prevent this second injury by decreasing intrathoracic pressure swings and improving regional air distribution. Therefore, we aimed to determine the effects of spontaneous breathing during the early stage of acute respiratory failure on lung injury and determine whether early and late controlled mechanical ventilation may avoid or revert these harmful effects. A model of partial surfactant depletion and lung collapse was induced in eighteen intubated pigs of 32 ±4 kg. Then, animals were randomized to (1) SB-group: spontaneous breathing with very low levels of pressure support for the whole experiment (eight hours), (2) Early MV-group: controlled mechanical ventilation for eight hours, or (3) Late MV-group: first half of the experiment on spontaneous breathing (four hours) and the second half on controlled mechanical ventilation (four hours). Respiratory, hemodynamic, and electric impedance tomography data were collected. After the protocol, animals were euthanized, and lungs were extracted for histologic tissue analysis and cytokines quantification. SB-group presented larger esophageal pressure swings, progressive hypoxemia, lung injury, and more dorsal and inhomogeneous ventilation compared to the early MV-group. In the late MV-group switch to controlled mechanical ventilation improved the lung inhomogeneity and esophageal pressure swings but failed to prevent hypoxemia and lung injury. In a lung collapse model, spontaneous breathing is associated to large esophageal pressure swings and lung inhomogeneity, resulting in progressive hypoxemia and lung injury. Mechanical ventilation prevents these mechanisms of patient self-inflicted lung injury if applied early, before spontaneous breathing occurs, but not when applied late.

Scientific publication speed and retractions of COVID-19 pandemic original articles.

Objective: To describe the editorial processing time of published COVID-19 research articles and compare this with a similar topic, human influenza, and analyze the number of publications, withdrawals, and retractions. Methods: A descriptive-analytical study using PubMed on research articles with the MeSH terms human influenza and COVID-19. Time to acceptance (from submission to acceptance) and time to publication (from acceptance to publication) were compared. Retractions and withdrawals were reviewed both qualitatively and quantitatively. Results: There were 31 319 research articles on COVID-19 and 4 287 on human influenza published during 2020. The median time to acceptance for COVID-19 was lower than that for human influenza (8 vs. 92 days). The median time to publication for COVID-19 articles was shorter than those on human influenza (12 vs. 16 days); 47.0% of COVID-19 research articles were accepted within the first week of submission, and 19.5% within one day. There were 82 retractions and withdrawals for COVID-19 articles, 1 for human influenza, and 5 for articles that contain both terms; these were mainly related to ethical misconduct, and 27 (31.0%) were published by the same group of authors in one highest-quartile journal. Conclusions: The conundrum between fast publishing and adequate standards is shown in this analysis of COVID-19 research articles. The speed of acceptance for COVID-19 manuscripts was 11.5 times faster than for human influenza. The high number of acceptances within a day or week of submission and the number of retractions and withdrawals of COVID-19 papers might be a warning sign about the possible lack of a quality control process in scientific publishing and the peer review process.

Scientific publication speed and retractions of COVID-19 pandemic original articles

[ABSTRACT]. Objective. To describe the editorial processing time of published COVID-19 research articles and compare this with a similar topic, human influenza, and analyze the number of publications, withdrawals, and retractions. Methods. A descriptive-analytical study using PubMed on research articles with the MeSH terms human influenza and COVID-19. Time to acceptance (from submission to acceptance) and time to publication (from acceptance to publication) were compared. Retractions and withdrawals were reviewed both qualitatively and quantitatively. Results. There were 31 319 research articles on COVID-19 and 4 287 on human influenza published during 2020. The median time to acceptance for COVID-19 was lower than that for human influenza (8 vs. 92 days). The median time to publication for COVID-19 articles was shorter than those on human influenza (12 vs. 16 days); 47.0% of COVID-19 research articles were accepted within the first week of submission, and 19.5% within one day. There were 82 retractions and withdrawals for COVID-19 articles, 1 for human influenza, and 5 for articles that contain both terms; these were mainly related to ethical misconduct, and 27 (31.0%) were published by the same group of authors in one highest-quartile journal. Conclusions. The conundrum between fast publishing and adequate standards is shown in this analysis of COVID-19 research articles. The speed of acceptance for COVID-19 manuscripts was 11.5 times faster than for human influenza. The high number of acceptances within a day or week of submission and the number of retractions and withdrawals of COVID-19 papers might be a warning sign about the possible lack of a quality control process in scientific publishing and the peer review process.

[RESUMEN]. Objetivo. Describir el tiempo de procesamiento editorial de los artículos de investigación sobre la COVID-19 publicados, compararlo con un tema similar, la gripe humana, y analizar el número de publicaciones realizadas, el de artículos retirados y el de retractaciones. Métodos. Usando PubMed, se llevó a cabo un estudio descriptivo y analítico sobre artículos de investigación con los términos en inglés correspondientes a “gripe humana” y “COVID-19” en el MeSH. Se compararon el tiempo de aceptación (desde la presentación hasta la aceptación) y el tiempo de publicación (desde la aceptación hasta la publicación). Se examinaron las publicaciones retiradas y las retractaciones de manera cualitativa y cuantitativa. Resultados. Hubo 31 319 artículos de investigación sobre la COVID-19 y 4 287 sobre la gripe humana publicados en el año 2020. La mediana del tiempo de aceptación de los artículos sobre la COVID-19 fue inferior que la mediana de la gripe humana (8 días en contraste con 92 días). La mediana del tiempo de publicación de los artículos sobre la COVID-19 fue menor que la de los artículos sobre la gripe humana (12 días en contraste con 16 días). El 47,0 % de los artículos de investigación sobre la COVID-19 se aceptaron en la primera semana de presentación, y el 19,5 %, en un día. Hubo 82 retractaciones y retiradas de artículos sobre la COVID-19, una sobre la gripe humana y 5 de artículos que contenían ambos términos; estas retractaciones y retiradas estuvieron relacionadas principalmente con faltas de conducta ética. Además, hubo 27 artículos (31,0 %) publicados por el mismo grupo de autores en una revista de cuartil más alto. Conclusiones. El dilema entre la publicación rápida y unas normas adecuadas se muestra en este análisis de artículos de investigación sobre la COVID-19. La velocidad de aceptación de los manuscritos sobre la COVID-19 fue 11,5 veces mayor que la velocidad de aceptación de los artículos sobre la gripe humana. El alto número de aceptaciones en un día o una semana desde la presentación y el número de retractaciones y retiradas de artículos sobre la COVID-19 podría ser un signo de advertencia acerca de la posible falta de un proceso de control de calidad en las publicaciones científicas y especialmente en el proceso de arbitraje.

[RESUMO]. Objetivo. Descrever o tempo de processamento editorial dos artigos de pesquisa publicados sobre COVID-19, compará-lo com o de artigos sobre um tema semelhante (gripe humana) e analisar o número de publicações, suspensões e retratações. Métodos. Estudo descritivo-analítico. Foi realizada uma busca no PubMed usando os descritores MeSH “human influenza” e “COVID-19”. O tempo até a aceitação (da submissão à aceitação) e o tempo até a publicação (da aceitação à publicação) foram comparados. Retratações e suspensões foram analisadas qualitativa e quantitativamente. Resultados. Foram publicados 31 319 artigos de pesquisa sobre a COVID-19 e 4 287 sobre a gripe humana em 2020. O tempo médio de aceitação de artigos sobre COVID-19 foi menor que o de artigos sobre gripe humana (8 versus 92 dias). O tempo médio até publicação dos artigos sobre COVID-19 foi menor que o de artigos sobre gripe humana (12 versus 16 dias); 47,0% dos artigos sobre COVID-19 foram aceitos na primeira semana após a submissão, e 19,5%, dentro de um dia. Houve 82 retratações e suspensões de artigos sobre COVID-19, 1 sobre gripe humana, e 5 de artigos que continham ambos os termos, principalmente relacionadas a má conduta ética; 27 (31,0%) desses artigos foram publicados pelo mesmo grupo de autores, em uma revista do mais alto quartil. Conclusões. O dilema entre publicar rapidamente e manter padrões adequados fica claro nesta análise de artigos sobre COVID-19. Manuscritos sobre COVID-19 foram aceitos 11,5 vezes mais rapidamente do que artigos sobre gripe humana. O alto número de aceitações em um dia ou semana após a submissão e o número de retratações e suspensões de artigos sobre COVID-19 alertam sobre uma possível falta de controle de qualidade na publicação científica e no processo de revisão por pares.

[Acute flaccid myelitis and enterovirus infection: a severe emerging disease]. / Mielitis flácida aguda e infección por enterovirus: una enfermedad grave emergente.

Acute flaccid myelitis (AFM) is a neuroinflammatory disease characterized by acute asymmetric weakness of the limbs associated with lesions of the gray matter of the spinal cord. It mainly affects children and has been increasingly identified since 2014. OBJECTIVE: To describe a severe emerging neurological disease in Chile. CLINICAL CASE: Three children (2 females), previously healthy were in cluded. The age at the onset was between 4 and 6 years. All presented an acute febrile illness associated with upper respiratory symptoms, rapid onset of proximal asymmetric limb weakness, spinal fluid pleocytosis, and enterovirus isolated from nasopharyngeal swab; two patients developed tetraparesis. The MRI of the spinal cord showed T2 hyperintensity of the grey matter. The three patients were admitted to the Pediatric Intensive Care Unit (PICU), and two required mechanical ventilation. No significant improvements were observed after the use of immunomodulatory therapy and plasma ex change. At 12 months of follow-up, one case was quadriplegic and ventilator-dependent; the second died of ventricular arrhythmia in the PICU, and the third one is under rehabilitation with partial recovery. CONCLUSIONS: We report the first cases of this severe emerging neurological disease in our country. In a child with predominantly proximal and asymmetric acute limb paralysis, pediatricians must have a high index of suspicion for AFM. Since it can progress rapidly and lead to respiratory failure, suspected AFM should be considered a medical emergency.