How to use meropenem in pediatric patients undergoing CKRT? Integrated meropenem pharmacokinetic model for critically ill children.

Standard dosing could fail to achieve adequate systemic concentrations in ICU children or may lead to toxicity in children with acute kidney injury. The population pharmacokinetic analysis was used to simultaneously analyze all available data (plasma, prefilter, postfilter, effluent, and urine concentrations) and provide the pharmacokinetic characteristics of meropenem. The probability of target fT > MIC attainment, avoiding toxic levels, during the entire dosing interval was estimated by simulation of different intermittent and continuous infusions in the studied population. A total of 16 critically ill children treated with meropenem were included, with 7 of them undergoing continuous kidney replacement therapy (CKRT). Only 33% of children without CKRT achieved 90% of the time when the free drug concentration exceeded the minimum inhibitory concentration (%fT > MIC) for an MIC of 2 mg/L. In dose simulations, only continuous infusions (60-120 mg/kg in a 24-h infusion) reached the objective in patients <30 kg. In patients undergoing CKRT, the currently used schedule (40 mg/kg/12 h from day 2 in a short infusion of 30 min) was clearly insufficient in patients <30 kg. Keeping the dose to 40 mg/kg q8h without applying renal adjustment and extended infusions (40 mg/kg in 3- or 4-h infusion every 12 h) was sufficient to reach 90% fT > MIC (>2 mg/L) in patients >10 kg. In patients <10 kg, only continuous infusions reached the objective. In patients >30 kg, 60 mg/kg in a 24-h infusion is sufficient and avoids toxicity. This population model could help with an individualized dosing approach that needs to be adopted in critically ill pediatric patients. Critically ill patients subjected to or not to CKRT may benefit from the administration of meropenem in an extended or continuous infusion.

The impact of meteorological factors on tuberculosis incidence in Spain: a spatiotemporal analysis.

Tuberculosis (TB) remains a global leading cause of death, necessitating an investigation into its unequal distribution. Sun exposure, linked to vitamin D (VD) synthesis, has been proposed as a protective factor. This study aimed to analyse TB rates in Spain over time and space and explore their relationship with sunlight exposure. An ecological study examined the associations between rainfall, sunshine hours, and TB incidence in Spain. Data from the National Epidemiological Surveillance Network (RENAVE in Spanish) and the Spanish Meteorological Agency (AEMET in Spanish) from 2012 to 2020 were utilized. Correlation and spatial regression analyses were conducted. Between 2012 and 2020, 43,419 non-imported TB cases were reported. A geographic pattern (north-south) and distinct seasonality (spring peaks and autumn troughs) were observed. Sunshine hours and rainfall displayed a strong negative correlation. Spatial regression and seasonal models identified a negative correlation between TB incidence and sunshine hours, with a four-month lag. A clear spatiotemporal association between TB incidence and sunshine hours emerged in Spain from 2012 to 2020. VD levels likely mediate this relationship, being influenced by sunlight exposure and TB development. Further research is warranted to elucidate the causal pathway and inform public health strategies for improved TB control.

Cory's shearwater as a key bioindicator for monitoring floating plastics.

The potential of using organisms as bioindicators of marine litter has been an area of general interest in multiple scientific and monitoring programs across the globe. Procellariiformes seabirds are particularly vulnerable to plastic contamination, which makes them a research focus group. This study investigated plastic ingestion in deceased fledglings and adults Cory's shearwaters (Calonectris borealis) collected over eight years (2015 to 2022) at two Atlantic archipelagos: the Azores and the Canaries. Necropsies were carried out in a total of 1,238 individuals showing a high prevalence of plastic ingestion (90%), with approximately 80% of items recovered from the gizzard. Fledglings carried greater plastic loads compared to adults, yet plastic morphologies were similar between both age classes. The temporal analyses conducted with generalised additive mixed-effect models revealed a distinct temporal trend in plastic numbers, but not in terms of plastic mass. In addition, the spatial analyses showed that Cory's shearwaters from the Canary Islands ingest a higher quantity of plastic and a greater proportion of threadlike items than the Azorean birds. These results suggest higher contamination at the NW Africa foraging grounds next to the Canaries and highlight fisheries as a potential source of marine litter in that region. On the other hand, the information gathered from the Azorean birds suggests they would be able to monitor changes in the composition of the plastic items floating in the North Atlantic Subtropical Gyre. Overall, our outcomes support the use of Cory's shearwater fledglings that are victims of light pollution as a key bioindicator of plastic contamination in the North Atlantic. For its policy application, the presented threshold value in combination with the assessment method will enable effective tracking of floating plastic litter in the framework of the MSFD and OSPAR.

The epidemiological situation of tuberculosis in Spain according to surveillance and hospitalization data, 2012-2020.

BACKGROUND: Before the COVID-19 pandemic, tuberculosis (TB) was the leading cause of death from a single infectious agent. In Spain, TB notifications are registered through the National Epidemiological Surveillance Network (RENAVE). The Minimum Basic Data Set (CMBD) provides information on TB hospital discharges. This study aims to assess both registries to complete the picture of TB in order to improve national control strategies and make further progress toward its elimination. METHODS: A retrospective study was performed considering CMBD´s hospital discharges with TB as first diagnosis and notifications to RENAVE between 2012 and 2020. After describing the records of both systems and their differences by using descriptive and multivariate analysis, annual incidences rates were calculated in order to evaluate temporal trends and geographical patters. RESULTS: According to the CMBD database, there were 29,942 hospitalizations due to TB (65% pulmonary forms and 66% male) during the study period. RENAVE collected 44,520 reported cases, mostly males (62%) with pulmonary forms (72%). Young children were similar in both groups, showing the high frequency of hospitalization in this group. Almost all autonomous communities showed a downward trend, especially Asturias. Hospitalizations in 2020 were analyzed by month separately, and comparing with previous years, the impact of the COVID-19 pandemic can be seen. CONCLUSIONS: A decreasing trend on TB incidence was observed in Spain since 2012, although this trend might change after COVID-19 pandemic. The analysis of both databases, CMBD and RENAVE, has contributed to improve our knowledge of TB in Spain and will help improve the control of this disease.

Network Analysis of Comorbid Depressive and Anxious Symptoms in Family Caregivers of People with Dementia.

OBJECTIVES: The aim of this study is an in-depth approach to depressive-anxious comorbidity in caregivers according to stress reactivity to disruptive behaviors using network analysis. METHODS: The sample was composed of 317 primary family caregivers recruited through Day Care Centers and Neurology Services. The sample was split into low and high stress reactivity groups, based on their reports of reaction to disruptive behaviors. Depressive and anxious symptoms, daily hours dedicated to caregiving, time of caring, frequency of disruptive behaviors, co-residence, and kinship were also cross-sectionally measured. RESULTS: The sample had a mean age of 62.38 years (SD = 12.97) and 68.5% were women. Regarding the network analysis, while the low reactivity group presents a sparse network, with no connection between anxious and depressive symptoms, the high reactivity group shows a high connection of intra and intercategory symptoms, with apathy, sadness, feeling depressed, and tension being the bridge symptoms between disorders. CONCLUSIONS: Caregivers' stress reaction to disruptive behaviors might be a key factor for understanding comorbidity between depressive and anxious symptoms. CLINICAL IMPLICATIONS: Tension, apathy, sadness, and feeling depressed should be clinical targets in the interventions, as they act as bridge symptoms between anxious and depressive symptomatology.

Antifungal activity of Co(II) and Cu(II) complexes containing 1,3-bis(benzotriazol-1-yl)-propan-2-ol on the growth and virulence traits of fluconazole-resistant Candida species: synthesis, DFT calculations, and biological activity.

Relevant virulence traits in Candida spp. are associated with dimorphic change and biofilm formation, which became an important target to reduce antifungal resistance. In this work, Co(II) complexes containing a benzotriazole derivative ligand showed a promising capacity of reducing these virulence traits. These complexes exhibited higher antifungal activities than the free ligands against all the Candida albicans and non-albicans strains tested, where compounds 2 and 4 showed minimum inhibitory concentration values between 15.62 and 125 µg mL-1. Moreover, four complexes (2-5) of Co(II) and Cu(II) with benzotriazole ligand were synthesized. These compounds were obtained as air-stable solids and characterized by melting point, thermogravimetric analysis, infrared, Raman and ultraviolet/visible spectroscopy. The analysis of the characterization data allowed us to identify that all the complexes had 1:1 (M:L) stoichiometries. Additionally, Density Functional Theory calculations were carried out for 2 and 3 to propose a probable geometry of both compounds. The conformer Da of 2 was the most stable conformer according to the Energy Decomposition Analysis; while the conformers of 3 have a fluxional behavior in this analysis that did not allow us to determine the most probable conformer. These results provide an important platform for the design of new compounds with antifungal activities and the capacity to attack other target of relevance to reduce antimicrobial resistance.

Predicting the distribution and abundance of abandoned, lost or discarded fishing gear (ALDFG) in the deep sea of the Azores (North Atlantic).

Abandoned, lost, or discarded fishing gear (ALDFG), represents a significant percentage of the global plastic pollution, currently considered one of the major sources from sea-based activities. However, there is still limited understanding of the quantities of ALDFG present on the seafloor and their impacts. In this study, data on the presence of ALDFG was obtained from a large archive of seafloor video footage (351 dives) collected by different imaging platforms in the Azores region over 15 years (2006-2020). Most ALDFG items observed in the images relate to the local bottom longline fishery operating in the region, and include longlines but also anchors, weights, cables and buoys. A generalized additive mixed model (GAMM) was used to predict the distribution and abundance of ALDFG over the seafloor within the limits of the Azores Exclusive Economic Zone (EEZ) using a suite of environmental and anthropogenic variables. We estimated an average of 113 ± 310 items km-2 (597 ± 756 per km-2 above 1000 m depth), which could imply that over 20 million ALDFG items are present on the deep seafloor of the Azores EEZ. The resulting model identified potential hotspots of ALDFG along the seabed, some of them located over sensitive benthic habitats, such as specific seamounts. In addition, the interactions between ALDFG and benthic organisms were also analysed. Numerous entanglements were observed with several species of large anthozoans and sponges. The use of predictive distribution modelling for ALDFG should be regarded as a useful tool to support ecosystem-based management, which can provide indirect information about fishing pressure and allow the identification of potential high-risk areas. Additional knowledge about the sources, amounts, fates and impacts of ALDFG will be key to address the global issue of plastic pollution and the effects of fishing on marine ecosystems.

Duelo anticipado en familiares de personas con demencia. Variables psicosociales asociadas y su impacto sobre la salud del cuidador. Una revisión de literatura / Anticipatory grief in family caregivers of persons with dementia. Psychosocial correlates and impact on caregiver's health: A literature review

Introducción Cuidar de un familiar con demencia puede suponer consecuencias negativas en el bienestar del cuidador. Uno de los procesos que se pueden vivenciar es el duelo anticipado, que se define como los sentimientos de dolor y pérdida que aparecen en el cuidador previamente al fallecimiento de la persona cuidada. Objetivos La revisión tuvo como objetivos conceptualizar el duelo anticipado en esta población, estudiar las variables psicosociales relacionadas, y conocer las repercusiones para la salud del cuidador. Método Se realizó una búsqueda sistemática siguiendo las directrices PRISMA en las bases de datos ProQuest, PubMed, Web of Science (WOS) y Scopus, incluyendo los estudios publicados en los últimos 10 años (2013-2023). Resultados Se obtuvo un total de 160 artículos, seleccionándose 15 finalmente. Se observa que el duelo anticipado se define como un proceso ambiguo al aparecer antes de la muerte del familiar enfermo. Ser cuidadora mujer, cónyuge del familiar con demencia, tener una relación más cercana con él y/o tener una importante responsabilidad en el cuidado se asocian a una mayor probabilidad de experimentar duelo anticipado. Respecto a la persona cuidada, si esta se encuentra en una fase severa de la enfermedad, es más joven y/o presenta comportamientos problemáticos, también se observa un mayor duelo anticipado en el cuidador. El duelo anticipado tiene un impacto significativo en la salud física, psicológica y social de los cuidadores, asociándose con una mayor sobrecarga, sintomatología depresiva y aislamiento social. Conclusiones El duelo anticipado resulta un concepto relevante en el contexto de las demencias, siendo necesario incluirlo en programas de intervención para esta población (AU)

Introduction Taking care of a relative with dementia may be linked to negative consequences for the caregiver. One of the processes that can be experienced is anticipatory grief, that is defined as the feelings of pain and loss that appear in the caregiver before the death of the person cared for. Objectives The review aimed to conceptualize anticipatory grief in this population, to study the related psychosocial variables, and to know the repercussions for the health of the caregiver. Method A systematic search was made under the directives of PRISMA statement in the ProQuest, PubMed, Web of Science (WOS), and Scopus databases, including studies published in the last 10 years (2013–2023). Results A total of 160 articles were obtained, 15 being finally selected. It is observed that anticipatory grief is defined as an ambiguous process since it appeared before the death of the sick family member. Being a female caregiver, spouse of a family member with dementia, having a closer relationship with him and/or having an important responsibility in care, are associated with a greater chance of experiencing anticipatory grief. In relation to the person cared for, if he or she is in a severe phase of the disease, is younger, and/or presents problematic behaviours, there is also greater anticipatory grief in the family caregiver. Anticipatory grief has a significant impact on caregivers’ physical, psychological, and social health, being associated with greater burden, depressive symptomatology, and social isolation. Conclusions Anticipatory grief turns out to be a relevant concept in the context of dementia, being necessary to include it in intervention programs for this population (AU)

Three-dimensional evaluation of beaches of oceanic islands as reservoirs of plastic particles in the open ocean.

The quantification of plastic debris on beaches has been extensively used as an indicator of plastic pollution in the marine environment. However, most efforts have focused on surface layers, with few investigations looking deeper into the substrate, thus underestimating total standing stocks. Such information is crucial to improve our understanding of where plastic accumulates in the oceans. In this study, we investigated the three-dimensional distribution of plastic (>1 mm) in three sandy beaches located in oceanic islands of the North Atlantic (Azores and the Canary Islands) that are known to accumulate significant quantities of small plastic debris at the surface layer. On each beach, we collected a total of 16 sediment cores down to 1 m depth, from the high tide line up to the backshore following a stratified random sampling design spread across four different levels across the beach. Samples were taken every 10 cm down to 1 m into the sand. Our results revealed the presence of plastic items in the deepest layers with subsurface layers accounting for 84 % of the total plastic abundance and with a similar pattern in terms of size, shape, colour and composition. Furthermore, we found increasing plastic concentrations towards the upper levels of the beach, indicating longer term accumulation in the backshore. Collectively, this study suggests that the plastic items reaching sandy beaches of the Macaronesia are being incorporated into its deepest layers, acting as reservoirs of plastic in the open ocean.

Volumetric capnography and return of spontaneous circulation in an experimental model of pediatric asphyxial cardiac arrest.

A secondary analysis of a randomized study was performed to study the relationship between volumetric capnography (VCAP) and arterial CO2 partial pressure (PCO2) during cardiopulmonary resuscitation (CPR) and to analyze the ability of these parameters to predict the return of spontaneous circulation (ROSC) in a pediatric animal model of asphyxial cardiac arrest (CA). Asphyxial CA was induced by sedation, muscle relaxation and extubation. CPR was started 2 min after CA occurred. Airway management was performed with early endotracheal intubation or bag-mask ventilation, according to randomization group. CPR was continued until ROSC or 24 min of resuscitation. End-tidal carbon dioxide (EtCO2), CO2 production (VCO2), and EtCO2/VCO2/kg ratio were continuously recorded. Seventy-nine piglets were included, 26 (32.9%) of whom achieved ROSC. EtCO2 was the best predictor of ROSC (AUC 0.72, p < 0.01 and optimal cutoff point of 21.6 mmHg). No statistical differences were obtained regarding VCO2, VCO2/kg and EtCO2/VCO2/kg ratios. VCO2 and VCO2/kg showed an inverse correlation with PCO2, with a higher correlation coefficient as resuscitation progressed. EtCO2 also had an inverse correlation with PCO2 from minute 18 to 24 of resuscitation. Our findings suggest that EtCO2 is the best VCAP-derived parameter for predicting ROSC. EtCO2 and VCO2 showed an inverse correlation with PCO2. Therefore, these parameters are not adequate to measure ventilation during CPR.

[Anticipatory grief in family caregivers of persons with dementia. Psychosocial correlates and impact on caregiver's health: A literature review]. / Duelo anticipado en familiares de personas con demencia. Variables psicosociales asociadas y su impacto sobre la salud del cuidador. Una revisión de literatura.

INTRODUCTION: Taking care of a relative with dementia may be linked to negative consequences for the caregiver. One of the processes that can be experienced is anticipatory grief, that is defined as the feelings of pain and loss that appear in the caregiver before the death of the person cared for. OBJECTIVES: The review aimed to conceptualize anticipatory grief in this population, to study the related psychosocial variables, and to know the repercussions for the health of the caregiver. METHOD: A systematic search was made under the directives of PRISMA statement in the ProQuest, PubMed, Web of Science (WOS), and Scopus databases, including studies published in the last 10 years (2013-2023). RESULTS: A total of 160 articles were obtained, 15 being finally selected. It is observed that anticipatory grief is defined as an ambiguous process since it appeared before the death of the sick family member. Being a female caregiver, spouse of a family member with dementia, having a closer relationship with him and/or having an important responsibility in care, are associated with a greater chance of experiencing anticipatory grief. In relation to the person cared for, if he or she is in a severe phase of the disease, is younger, and/or presents problematic behaviours, there is also greater anticipatory grief in the family caregiver. Anticipatory grief has a significant impact on caregivers' physical, psychological, and social health, being associated with greater burden, depressive symptomatology, and social isolation. CONCLUSIONS: Anticipatory grief turns out to be a relevant concept in the context of dementia, being necessary to include it in intervention programs for this population.

Identification of Mycobacterium abscessus Subspecies by MALDI-TOF Mass Spectrometry and Machine Learning.

Mycobacterium abscessus is one of the most common and pathogenic nontuberculous mycobacteria (NTM) isolated in clinical laboratories. It consists of three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. bolletii, and M. abscessus subsp. massiliense. Due to their different antibiotic susceptibility pattern, a rapid and accurate identification method is necessary for their differentiation. Although matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) has proven useful for NTM identification, the differentiation of M. abscessus subspecies is challenging. In this study, a collection of 325 clinical isolates of M. abscessus was used for MALDI-TOF MS analysis and for the development of machine learning predictive models based on MALDI-TOF MS protein spectra. Overall, using a random forest model with several confidence criteria (samples by triplicate and similarity values >60%), a total of 96.5% of isolates were correctly identified at the subspecies level. Moreover, an improved model with Spanish isolates was able to identify 88.9% of strains collected in other countries. In addition, differences in culture media, colony morphology, and geographic origin of the strains were evaluated, showing that the latter had an impact on the protein spectra. Finally, after studying all protein peaks previously reported for this species, two novel peaks with potential for subspecies differentiation were found. Therefore, machine learning methodology has proven to be a promising approach for rapid and accurate identification of subspecies of M. abscessus using MALDI-TOF MS.

Crianza kichwa en Medellín: tensiones entre lo ancestral y lo occidental / Kichwa childrearing in Medellin: tensions between ancestral and western practices / Criação Kichwa em Medellín: tensões entre o ancestral e o occidental

Resumen (analítico) El abordaje de la crianza indígena en el ámbito científico y occidental es complejo e interesante, en un contexto de realidades diversas que requieren ser visibilizadas para ampliar la comprensión de la crianza infantil. La investigación es cualitativa, apoyada en el inter-accionismo simbólico, y cuenta con la participación de cuatro familias y cinco líderes de la comunidad kichwa. Los resultados dan cuenta de la noción de infancia y de las prácticas que implementa esta comunidad para mantener la identidad kichwa. Asimismo, se evidencian las tensiones que produce la crianza, según el entorno. Como conclusión, los kichwa han buscado mantener sus tradiciones en la crianza de los infantes; sin embargo, las dinámicas de la ciudad afectan su cotidianidad, en especial en entornos citadinos como el comercio y la educación.

Abstract (analytical) Addressing a topic such as indigenous child rearing using scientific and western concepts becomes complex and interesting in a context of diverse realities that need to be examined to broaden understanding of these practices. This research study is qualitative and uses a symbolic interactionism approach. It involved the participation of four families and five leaders from the Kichwa community living in the city of Medellin. The results capture the notion of childhood for this indigenous group and the practices they implement to maintain the Kichwa identity, as well as the complexities that a non-indigenous environment creates for raising their children. In conclusion, the Kichwa have sought to maintain their traditions for the upbringing of the children. However, the dynamics of the city affect these practices, especially in urban scenarios such as commerce and education.

Resumo (analítico) Abordar um tópico como a criação indígena em escopos científicos e ocidentais torna-se complexo e interessante em um contexto de diversas realidades que precisam ser tornadas visíveis para ampliar a compreensão da criação infantil. A pesquisa é qualitativa com foco no interacionismo simbólico, e contou com a participação de quatro famílias e cinco lideranças da comunidade Kichwa habitantes de Medellín. Os achados mostram a importância de manter a identidade Kichwa e a noção de infância partindo da própria cultura e a complexidade que traz um meio distinto de formação e acompanhamento familiar. Concluindo, o povo Kichwa tem procurado manter suas tradições desde a formação das crianças, porém, as dinâmicas da cidade e suas interações influenciam na sua cotidianidade particularmente nos meios comerciais e educativos.

Litter ingestion and entanglement in green turtles: An analysis of two decades of stranding events in the NE Atlantic.

Survivorship of early life stages is key for the well-being of sea turtle populations, yet studies on animals that distribute around oceanic areas are very challenging. So far, the information on green turtles (Chelonia mydas) that use the open NE Atlantic as feeding grounds is scarce. Strandings occurring in oceanic archipelagos can provide relevant information about the biology, ecology and current anthropogenic pressures for megafauna inhabiting the open ocean. In this study, we analysed stranding events of green turtles found in the Azores archipelago to investigate interactions with marine litter. In addition, we quantified and characterized litter items stranded on beaches to provide a direct comparison between the ingested items with the debris found in the environment. A total of 21 juvenile green turtles were found stranded in the region between 2000 and 2020 (size range: 12-49 cm, CCL). Overall, 14% of the animals were entangled in marine litter and 86% of the turtles necropsied had ingested plastic. The mean abundance of items ingested was 27.86 ± 23.40 and 98% were white/transparent. Hard plastic fragments between 1 and 25 mm were the most common shape recovered in the turtles, similarly to what was found on the coastline. All of the litter items analysed with pyrolysis GC-MS revealed to be polyethylene (PE). This study provides the first baseline assessment of interactions of plastic litter with juvenile green turtles found at the east edge of the North Atlantic Subtropical Gyre. The combination of these results supports the hypothesis that migratory megafauna that use remote oceanic islands as a feeding ground are exposed to anthropogenic litter contamination dominated by plastics, even when these regions are located far away from big industrial centers or populated cities.

The interplay of immunology and cachexia in infection and cancer.

Diverse inflammatory diseases, infections and malignancies are associated with wasting syndromes. In many of these conditions, the standards for diagnosis and treatment are lacking due to our limited understanding of the causative molecular mechanisms. Here, we discuss the complex immunological context of cachexia, a systemic catabolic syndrome that depletes both fat and muscle mass with profound consequences for patient prognosis. We highlight the main cytokine and immune cell-driven pathways that have been linked to weight loss and tissue wasting in the context of cancer-associated and infection-associated cachexia. Moreover, we discuss the potential immunometabolic consequences of cachexia on the basis of newly identified pathways and explore the multilayered area of immunometabolic crosstalk both upstream and downstream of tissue catabolism. Collectively, this Review highlights the intricate relationship of the immune system with cachexia in the context of malignant and infectious diseases.

Caring for Relatives with Dementia in Times of COVID-19: Impact on Caregivers and Care-recipients.

OBJECTIVES: To analyze caregivers' perceived impact of the pandemic in their mental health and the well-being of the care-recipients. METHODS: Caregivers (N = 88) were asked if they had COVID-19 and about their perceptions of change of care-recipients' health conditions as well as whether their own mental health, conflicts with care-recipients and other relatives, thoughts of giving up caregiving, and feelings of coping well with the situation. RESULTS: A large percentage of caregivers perceived a worsening of care-recipients' symptoms and of their own negative emotions, an increase in the number of conflicts and thoughts of needing to give up caregiving. Having had COVID-19 and reporting higher levels of distress as well as giving up caregiving were related to perceived worsening in care-recipients well-being. Perceived increases were mainly reported by younger caregivers, those who perceived to have not coped well, and those reporting an increase in conflicts. Some caregivers perceived an increase in positive emotions. CONCLUSIONS: The pandemic has a negative impact on caregivers' perceptions about the course of their own emotions and care-recipients' well-being. CLINICAL IMPLICATIONS: Interventions are needed to train caregivers in strategies to cope with the sources of stress caused by the pandemic and to promote social support.

Effects of airway management and tidal volume feedback ventilation during pediatric resuscitation in piglets with asphyxial cardiac arrest.

To compare the effect on the recovery of spontaneous circulation (ROSC) of early endotracheal intubation (ETI) versus bag-mask ventilation (BMV), and expiratory real-time tidal volume (VTe) feedback (TVF) ventilation versus without feedback or standard ventilation (SV) in a pediatric animal model of asphyxial cardiac arrest. Piglets were randomized into five groups: 1: ETI and TVF ventilation (10 ml/kg); 2: ETI and TVF (7 ml/kg); 3: ETI and SV; 4: BMV and TVF (10 ml/kg) and 5: BMV and SV. Thirty breaths-per-minute guided by metronome were given. ROSC, pCO2, pO2, EtCO2 and VTe were compared among groups. Seventy-nine piglets (11.3 ± 1.2 kg) were included. Twenty-six (32.9%) achieved ROSC. Survival was non-significantly higher in ETI (40.4%) than BMV groups (21.9%), p = 0.08. No differences in ROSC were found between TVF and SV groups (30.0% versus 34.7%, p = 0.67). ETI groups presented lower pCO2, and higher pO2, EtCO2 and VTe than BMV groups (p < 0.05). VTe was lower in TVF than in SV groups and in BMV than in ETI groups (p < 0.05). Groups 1 and 3 showed higher pO2 and lower pCO2 over time, although with hyperventilation values (pCO2 < 35 mmHg). ETI groups had non significantly higher survival rate than BMV groups. Compared to BMV groups, ETI groups achieved better oxygenation and ventilation parameters. VTe was lower in both TVF and BMV groups. Hyperventilation was observed in intubated animals with SV and with 10 ml/kg VTF.