Bioinformatics-based Characterization of the Sequence Variability of Zika Virus Polyprotein and Envelope Protein (E).

Background: Zika virus, which is widely spread and infects humans through the bites of Aedes albopictus and Aedes aegypti female mosquitoes, represents a serious global health issue. Objective: The objective of the present study is to computationally characterize Zika virus polyproteins (UniProt Name: PRO_0000443018 [residues 1-3423], PRO_0000445659 [residues 1-3423] and PRO_0000435828 [residues 1-3419]) and their envelope proteins using their physico-chemical properties. Methods: To achieve this, the Polarity Index Method (PIM) profile and the Protein Intrinsic Disorder Predisposition (PIDP) profile of 3 main groups of proteins were evaluated: structural proteins extracted from specific Databases, Zika virus polyproteins, and their envelope proteins (E) extracted from UniProt Database. Once the PIM profile of the Zika virus envelope proteins (E) was obtained and since the Zika virus polyproteins were also identified with this profile, the proteins defined as "reviewed proteins" extracted from the UniProt Database were searched for the similar PIM profile. Finally, the difference between the PIM profiles of the Zika virus polyproteins and their envelope proteins (E) was tested using 2 non-parametric statistical tests. Results: It was found and tested that the PIM profile is an efficient discriminant that allows obtaining a "computational fingerprint" of each Zika virus polyprotein from its envelope protein (E). Conclusion: PIM profile represents a computational tool, which can be used to effectively discover Zika virus polyproteins from Databases, from their envelope proteins (E) sequences.

Impact of obesity and diabetes mellitus in critically ill patients with SARS-CoV-2.

PURPOSE: Evaluate the associations of obesity and diabetes with the risk of mortality in critically ill patients infected with SARS-CoV-2. MATERIALS AND METHODS: This cohort study included 115 adult patients admitted to the ICU with SARS-CoV-2 pneumonia. Anthropometric variables and biochemical (C-reactive protein, ferritin, leukocyte, neutrophils, and fibrinogen) were measured. Multivariate logistic regression analyses were used to investigate the associations. RESULTS: Mean age was 50.6±11.2 years, 68.7% were male. Median BMI was 30.9kg/m2. All patients had invasive mechanical ventilation. Patients with diabetes had increased risk of mortality with OR of 2.86 (CI 95% 1.1-7.4, p=0.026); among those patients who, in addition to diabetes had obesity, the risk was de 3.17 (CI 95% 1.9-10.2, p=0.038). Patients with obesity had 1.25 times greater risk of developing a severe SARS-CoV-2 infection (95% CI 1.09-1.46, p=0.025). Negative correlation was observed between BMI and the PaO2/FiO2 ratio (r=-0.023, p<0.05). Obese patients required more days of mechanical ventilation and longer hospital stay compared to non-obese patients. CONCLUSIONS: Diabetes and obesity are risk factors for increasing severity of SARS-CoV-2 infection, and they are both associated with an increase in mortality.

Takotsubo (stress cardiomyopathy) syndrome and inappropriate antidiuretic hormone secretion.

El Síndrome de Takotsubo es una disfunción ventricular aguda reversible en ausencia de obstrucción coronaria. Una mujer de 85 años de edad con antecedentes de reemplazo valvular aórtico transcatéter, ingresó por dos semanas de dolor severo por una cadera desplazada por osteosíntesis fallida. Mientras se programaba para cirugía, se documentó hiponatremia severa secundaria a secreción inapropiada de hormona antidiurética. Súbitamente desarrolló edema agudo pulmonar. El ecocardiograma confirmó una válvula protésica funcional y aquinesia medial y apical de las paredes del ventrículo izquierdo. Recibió tratamiento con ventilación mecánica no invasiva, restricción de líquidos y diuréticos. La hiponatremia y la cardiomiopatía resolvieron.Takotsubo syndrome is a form of acute reversible left ventricular dysfunction in the absence of coronary obstruction. An 85-year-old lady with a medical history of transcatheter aortic valve replacement was readmitted complaining of 2 weeks of severe pain by a displaced hip and failed osteosynthesis. While she was scheduled for hip surgery, severe hyponatremia secondary to inappropriate antidiuretic hormone secretion was documented, and sudden-onset pulmonary edema ensued. Echocardiography confirmed normally functioning aortic prosthetic valve and classical features of Takotsubo. She was treated with non-invasive mechanical ventilation, water restriction, and diuretics. Hyponatremia and the cardiomyopathy resolved and the patient recovered completely.

Simultaneous mechanical ventilation of several patients with a single ventilator.

INTRODUCTION: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. OBJECTIVE: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. RESULTS: No statistically significant differences were observed between programmed, recorded and measured positive end-expiratory pressure, mean airway pressure and peak pressure, except when simultaneously ventilating four lung simulators. CONCLUSIONS: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.

INTRODUCCIÓN: La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. OBJETIVO: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultáneamente en dos y cuatro. RESULTADOS: No se observaron diferencias estadísticamente significativas entre la presión positiva al final de la espiración, presión media de la vía aérea y presión pico programadas, registradas y medidas, excepto al ventilar simultáneamente cuatro simuladores de pulmón. CONCLUSIONES: La ventilación mecánica simultánea debe ser instaurada por personal médico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos.

Melena after endoscopic retrograde cholangiopancreatography: A warning sign of an impending subcapsular hepatic hematoma / Melena posterior a colangiopancreatografía retrógrada endoscópica: un signo de alarma de inminente hematoma hepático subcapsular

No disponible

Ventilación mecánica simultánea con un solo ventilador a varios pacientes / Simultaneous mechanical ventilation of several patients with a single ventilator

Resumen Introducción: La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. Objetivo: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultáneamente en dos y cuatro simuladores. Resultados: No se observaron diferencias estadísticamente significativas entre la presión positiva al final de la espiración, presión media de la vía aérea y presión pico programadas, registradas y medidas, excepto al ventilar simultáneamente cuatro simuladores de pulmón. Conclusiones: La ventilación mecánica simultánea debe ser instaurada por personal médico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos.

Abstract Introduction: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. Objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. Results: No statistically significant differences were observed between positive end-expiratory pressure, mean airway pressure, and programmed, recorded and measured peak pressure, except when simultaneously ventilating four lung simulators. Conclusions: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.

A novel disposable sensor for measure intra-abdominal pressure.

BACKGROUND: Measurement of intra-abdominal pressure (IAP) is realized with the Kron's method. However, this technique has drawbacks like an infusion of water into the bladder of the patient. OBJECTIVE: The prove a new novel disposable sensor in the way to measure the IAP (DSIAP) this one addresses some limitations of the Kron method. MATERIALS AND METHODS: The DSIAP was tested in vitro and clinical settings. The proposed technique was compared with Kron's method through Pearson correlation and Bland-Altman analysis. For in vitro tests, 159 measurements were taken performed by simulating the IAP in the bladder. For the clinical test, 20 pairs of measurements were made in patients with routine IAP monitoring in the intensive care unit. RESULTS: In vitro measurements showed a strong correlation between the DSIAP and the reference (r = 0.99, p-value < 2.2 × 10-16). The bias and 95% confidence intervals were 0.135 and -0.821-1.091 cmH2O, respectively. Measurements in patients with DSIAP versus Kron's method shown a very good correlation (r = 0.973, p-value < 5.46 × 10-13), while the bias and confidence intervals were 0.018 and -3.461-3.496 mmHg, respectively. CONCLUSIONS: The results suggest that the proposed DSIAP showed a profile similar to pressure transducers already in clinical use while overcoming some limitations of the former.

ANTECEDENTES: La medición de la presión intraabdominal (PIA) generalmente se realiza con el método de Kron, a pesar de presentar inconvenientes como la infusión de agua en la vejiga del paciente. OBJETIVO: Introducir un nuevo sensor desechable para medir la PIA (SDPIA) que aborda algunas limitaciones del método de Kron. MÉTODO: Se probó el SDPIA en pruebas in vitro y clínicas. La técnica se contrastó con el método de Kron empleando la correlación de Pearson y el análisis de Bland-Altman. Para las pruebas in vitro se realizaron 159 mediciones simulando la PIA en la vejiga. Para las pruebas clínicas se realizaron 20 mediciones en pacientes con monitorización rutinaria de la PIA en la unidad de cuidados intensivos. RESULTADOS: En las mediciones in vitro se encontró una alta correlación (r = 0.99; p < 2.2 × 10−16). El sesgo para la diferencia entre los dos métodos de medición fue de 0.135 cmH2O, con un intervalo de confianza del 95% de −0.821 a 1.091 cmH2O. En las mediciones clínicas también se encontró una alta correlación (r = 0.973; p < 5.46 × 10−13) para la diferencia entre los dos métodos de medición de 0.18, con un intervalo de confianza del 95% de −3.302 a 3.650 mmHg. CONCLUSIONES: Los resultados sugieren que el SDPIA propuesto muestra un desempeño similar al de los transductores de presión actualmente en uso clínico, mientras sobrelleva algunas limitaciones de estos últimos.

Surveillance system for acute severe infections with epidemic potential based on a deterministic-stochastic model, the StochCum Method.

BACKGROUND: The dynamic interactions of severe infectious diseases with epidemic potential and their hosts are complex. Therefore, it remains uncertain if a sporadic zoonosis restricted to a certain area will become a global pandemic or something in between. OBJECTIVE: The objective of the study was to present a surveillance system for acute severe infections with epidemic potential based on a deterministic-stochastic model, the StochCum Method. DESIGN: The StochCum Method is founded on clinical, administrative, and sociodemographic variables that provide a space/time map as a preventive warning of possible outbreaks of severe infections that can be complemented based on the sum of all the first accumulated cases. If the outbreak is happening in high-risk areas, an early warning can be elicited to activate the health response system and save time while waiting for the confirmation of symptomatic cases. RESULTS: The surveillance system was tested virtually for 1 month on admissions to the emergency room of a public hospital located in Mexico City, Mexico. It promptly identified simulated cases of acute respiratory infections with epidemic potential. CONCLUSIONS: The StochCum Method proved to be a practical and useful system for conducting epidemic surveillance on a hospital network.