Optimizing Harvesting Efficiency: Development and Assessment of a Pneumatic Air Jet Excitation Nozzle for Delicate Biostructures in Food Processing.

This study presents a new pneumatic air jet excitation nozzle, specifically designed for food processing applications. The device, which uses compressed air equipment and a precision solenoid valve, controls air discharge through a parametric air jet nozzle. Tests showed that the device could achieve shooting frequencies in the 40-45 Hz range, with operational pressures between 5 and 7 bar. A sensor system was used to measure the force generated by the device at different frequencies and pressures. Using the Design of Experiments (DOE) methodology, we identified optimal cavity designs for 5 and 6 bar pressures. These designs outperformed others in generating uniform force and maintaining consistent vibration voltage behavior. This highlights the efficacy of our approach in enhancing device performance under different conditions. The device's practical application in food processing was demonstrated, particularly in delicate tasks such as the selective harvesting of sensitive crops like coffee fruits. The precise vibrations generated by the device could potentially enhance harvesting efficiency while significantly reducing mechanical damage to plants. The results position the device as a compelling proof of concept, offering an alternative method for exciting biostructures in food processing. This device opens up new possibilities in agricultural and biological fields, providing a non-intrusive and practical approach to manipulating and interacting with delicate, contactless structures, with a specific focus on improving food processing efficiency and quality.

[ROX index to predict failure with low flow devices in COVID-19]. / Índice ROX para predecir falla con dispositivos de bajo flujo en COVID-19.

Background: The ROX index (iROX) obtained from pulse oximetry saturation/inspired fraction of oxygen and respiratory rate, predicts success with high-flow nasal cannula (HFNC), however its performance for low-flow oxygenation devices (DOBF) is unknown. Objective: To determine suitability of iROX at 12 hours as a predictor of mechanical ventilation (VMI) in hospitalized patients with severe COVID-19 and DOBF. Material and methods: An historical cohort was performed. Adults with COVID-19, hospitalized, with supplemental oxygen supply are included, excluding patients with pathologies in chronic stages that could alter the results, calculating the iROX at 12 hours, obtaining the cut-off point using a ROC curve and Youden index, the risk of VMI is prolonged using relative risk (RR), with 95% confidence intervals (95%CI). Confounding variables were evaluated to determine the performance of the iROX. The dependent variable mechanical ventilation recorded as reported in the file and the independent iROX obtained in the same way as the previous one. Results: 63 patients with a median age of 62 years were included. The best iROX cut-off point at 12 hours was 5.35. With this cut-off point, VMI was associated with a RR of 8.75 (95% CI 2.36-32.35). In the multivariate model with an OR of 9.26; (95% CI, 2.39 - 35.78), after initiation of DOBF was consistently associated with an increased risk of intubation. Conclusion: In hospitalized patients with severe COVID-19, an iROX < 5.35 at 12 hours appears to be a predictor for the onset of VMI.

Introducción: el índice ROX (iROX) obtenido a partir de la saturación por oximetría de pulso/fracción inspirada de oxígeno y frecuencia respiratoria, pronostica el éxito con cánulas nasales de alto flujo (CNAF), pero se desconoce su desempeño para dispositivos de oxigenación de bajo flujo (DOBF). Objetivo: determinar el punto de corte y el desempeño del iROX a las 12 horas como predictor para el inicio de la ventilación mecánica (VMI) en los pacientes hospitalizados con COVID-19 grave y DOBF. Material y métodos: se realizó un estudio tipo cohorte histórica, en el que se incluyeron pacientes adultos con COVID-19, hospitalizados, con aporte de oxígeno suplementario. Se excluyeron los pacientes con patologías en etapas crónicas que pudieran alterar los resultados, calculando el iROX a las 12 horas y obteniendo el punto de corte mediante una curva ROC e índice de Youden, determinando el riesgo de VMI usando riesgo relativo (RR), con intervalos de confianza de 95% (IC95%). Evaluando otras variables confusoras para conocer el desempeño del iROX. La variable dependiente fue ventilación mecánica, obtenida por lo reportado en el expediente y la independiente el iROX, obtenida igual que la anterior. Resultados: se incluyeron 63 pacientes con una mediana de edad de 62 años. El mejor punto de corte del iROX a las 12 horas fue de 5.35. Con este punto de corte se asoció a VMI con un RR de 8.75 (IC95%: 2.36-32.35). En el modelo multivariado con un OR de 9.26; (IC95%: 2.39-35.78), después del inicio del DOBF se asoció consistentemente con un mayor riesgo de intubación. Conclusión: en pacientes hospitalizados con COVID-19 grave, un iROX < 5.35 a las 12 horas es un predictor para el inicio de la VMI.

Potential biomarkers for fatal outcome prognosis in a cohort of hospitalized COVID-19 patients with pre-existing comorbidities.

The difficulty in predicting fatal outcomes in patients with coronavirus disease 2019 (COVID-19) impacts the general morbidity and mortality due to severe acute respiratory syndrome-coronavirus 2 infection, as it wears out the hospital services that care for these patients. Unfortunately, in several of the candidates for prognostic biomarkers proposed, the predictive power is compromised when patients have pre-existing comorbidities. A cohort of 147 patients hospitalized for severe COVID-19 was included in a descriptive, observational, single-center, and prospective study. Patients were recruited during the first COVID-19 pandemic wave (April-November 2020). Data were collected from the clinical history whereas immunophenotyping by multiparameter flow cytometry analysis allowed us to assess the expression of surface markers on peripheral leucocyte. Patients were grouped according to the outcome in survivors or non-survivors. The prognostic value of leucocyte, cytokines or HLA-DR, CD39, and CD73 was calculated. Hypertension and chronic renal failure but not obesity and diabetes were conditions more frequent among the deceased patient group. Mixed hypercytokinemia, including inflammatory (IL-6) and anti-inflammatory (IL-10) cytokines, was more evident in deceased patients. In the deceased patient group, lymphopenia with a higher neutrophil-lymphocyte ratio (NLR) value was present. HLA-DR expression and the percentage of CD39+ cells were higher than non-COVID-19 patients but remained similar despite the outcome. Receiver operating characteristic analysis and cutoff value of NLR (69.6%, 9.4), percentage NLR (pNLR; 71.1%, 13.6), and IL-6 (79.7%, 135.2 pg/mL). The expression of HLA-DR, CD39, and CD73, as many serum cytokines (other than IL-6) and chemokines levels do not show prognostic potential, were compared to NLR and pNLR values.

Evaluation and Performance of a Positive Airway Pressure Device (CPAP-AirFlife™): A Randomized Crossover Non-Inferiority Clinical Study in Normal Subjects.

Background and Objectives: During the COVID-19, the demand for non-invasive ventilatory support equipment significantly increased. In response, a novel non-invasive ventilatory support model called CPAP-AirFlife™ was developed utilizing existing technologies. This model offers technological advantages, including an aerosol-controlled helmet suitable for high-risk environments such as ambulances. Additionally, it is cost-effective and does not require medical air, making it accessible for implementation in low-level hospitals, particularly in rural areas. This study aimed to assess the efficacy of CPAP-AirFlife™ by conducting a non-inferiority comparison with conventional ventilation equipment used in the Intensive Care Unit. Materials and Methods: A clinical study was conducted on normal subjects in a randomized and sequential manner. Parameters such as hemoglobin oxygen saturation by pulse oximetry, exhaled PCO2 levels, vital signs, and individual tolerance were compared between the CPAP-AirFlife™ and conventional equipment. The study population was described in terms of demographic characteristics and included in the analysis. Results: It was shown that the CPAP-AirFlife™ was not inferior to conventional equipment in terms of efficacy or tolerability. Hemoglobin oxygen saturation levels, exhaled PCO2 levels, vital signs, and individual tolerance did not significantly differ between the two models. Conclusions: The findings suggest that CPAP-AirFlife™ is a practical and cost-effective alternative for non-invasive ventilatory support. Its technological advantages, including the aerosol-controlled helmet, make it suitable for high-risk environments. The device's accessibility and affordability make it a promising solution for implementation in low-level hospitals, particularly in rural areas. This study supports using CPAP-AirFlife™ as a practical option for non-invasive ventilatory support, providing a valuable contribution to respiratory care during the COVID-19 pandemic and beyond.

Neurofibromatosis tipo 1 o enfermedad de Von Recklinghausen. Presentación de caso

La neurofibromatosis tipo I o enfermedad de Von Recklinghausen es una de las enfermedades genéticas que afectan el sistema nervioso, denominada así por su origen común embrionario. Es una enfermedad autosómica dominante, progresiva, de evolución impredecible, que afecta la piel y el sistema nervioso central y periférico. Se presenta el caso de una escolar, femenina, de siete años de edad que ingresó en el Hospital Pediátrico Paquito Gonzáles Cueto debido a la presencia de varias manchas en la piel color "café con leche". Se recogió como antecedente familiar la presencia de neurofibromatosis tipo 1 en la abuela y bisabuela materna, esta última ya fallecida por dicha causa. Al examen físico se constataron nódulos de Lisch en espesor del iris del ojo izquierdo. Los estudios de imágenes evidenciaron varias lesiones nodulares hiperintensas en T2 y FLAIR, a nivel de la cápsula interna y externa bilateral y ventricular izquierda, la mayor de 20 x 11 mm, así como imagen hipointensa a nivel del nervio óptico izquierdo, de 7 mm. Se diagnosticó como neurofibromatosis tipo I. Por ser una de las enfermedades menos estudiadas en nuestro medio se decidió la publicación de este caso.

Neurofibromatosis type I or Von Recklinghausen's disease is one of the genetic diseases that affect the nervous system, named for its common embryonic origin. It is an autosomal dominant, progressive disease with an unpredictable course that affects the skin and the central and peripheral nervous system. The case of a seven-year-old female schoolchild who was admitted to the Paquito Gonzáles Cueto Pediatric Hospital due to the presence of several "coffee-with-milk" spots on her skin is presented. The presence of type 1 neurofibromatosis in her maternal grandmother and great-grandmother, the latter already deceased from said cause, was collected as a family history. On physical examination, Lisch nodules were found in the thickness of the iris of the left eye. Imaging studies revealed several hyperintense nodular lesions on T2 and FLAIR, at the level of the internal and external bilateral and left ventricular capsule, the largest measuring 20 x 11 mm, as well as a hypointense image at the level of the left optic nerve, measuring 7 mm. It was diagnosed as neurofibromatosis type I. Because it is one of the least studied diseases in our environment, it was decided to publish this case.

Physicians' Distress Related to Moral Issues and Mental Health In-Between Two Late Waves of COVID-19 Contagions.

In addition to the sanitary constrains implemented due to the pandemic, frontline physicians have faced increased workloads with insufficient resources, and the responsibility to make extraordinary clinical decisions. In 108 physicians who were at the forefront of care of patients with COVID-19 during the first two years of the pandemic, mental health, moral distress, and moral injury were assessed twice, in between two late waves of COVID-19 contagions, according to their adverse psychological reactions, in-hospital experience, sick leave due to COVID-19, quality of sleep, moral sensitivity, clinical empathy, resilience, and sense of coherence. Three months after the wave of contagions, the adverse emotional reactions and moral distress decreased, while moral injury persisted. Moral distress was related to clinical empathy, with influence from burnout and sick leave due to COVID-19, and moral injury was related to the sense of coherence, while recovery from moral distress was related to resilience. The results suggest that measures to prevent physician infection, as well as strengthening resilience and a sense of coherence, may be helpful to prevent persistent mental damage after exposure to a sanitary crisis.

[Hematological indices associated with mortality in critically ill patients with COVID-19]. / Índices hematológicos asociados con mortalidad en pacientes críticos con COVID-19.

Background: The COVID-19 disease has represented one of the most important threats to health. The most severe form is acute respiratory distress syndrome (ARDS). The inflammatory response can cause hematologic changes. Objective: To determine the association between the Neutrophil/lymphocyte ratio (NLR) and the mean platelet volume (MPV) associated with mortality in critically ill patients with COVID-19 and ARDS. Material and methods: A retrospective study was carried out in an intensive care unit (ICU) in a public hospital, with patients in critical condition due to COVID-19 and on mechanical ventilation. The clinical characteristics of admission and severity of the disease were recorded. The end point was the ICU discharge condition. Results: 162 subjects were gathered, 103 were men, with a mean age of 54.54 ± 13.53 years. 66.7% died in the ICU. The NLR had an area under the curve (aROC) of 0.62, with a cut-off point for mortality of > 7.04, sensitivity of 94.4%, specificity of 29.63%. The VPM had an aROC of 0.65 with a cut-off point > 9.5, sensitivity of 30.84%, and specificity of 92.59%; finally, the APACHE II had an aROC of 0.67 with a cut-off point > 14, sensitivity of 51.4% and specificity of 80%. The NLR presented an odds ratio (OR) of 5.02, the VPM 2.06 and the APACHE II score 1.16. Conclusions: NLR, MPV, and APACHE II at ICU admission are associated with mortality for critically ill patients with COVID-19.

Introducción: la enfermedad por COVID-19 ha representado una de las amenazas más importantes para la salud. La forma más grave es el síndrome de insuficiencia respiratoria aguda (SIRA). La respuesta inflamatoria puede ocasionar cambios hematológicos. Objetivo: determinar la asociación entre el Índice neutrófilo/linfocito (INL) y el volumen plaquetario medio (VPM) asociado con la mortalidad en pacientes críticos con COVID-19 y SIRA. Material y métodos: se hizo un estudio de corte retrospectivo en una unidad de cuidados intensivos (UCI) de un hospital público, con pacientes en estado crítico por COVID y en ventilación mecánica. Se registraron las características clínicas de ingreso y severidad de la enfermedad. El punto final fue la condición de egreso de la UCI. Resultados: se reunieron 162 sujetos, 103 fueron hombres, con edad promedio de 54.54 ± 13.53 años. El 66.7% murieron en la UCI. El INL tuvo un área bajo la curva (aROC) de 0.62, con un punto de corte para mortalidad > 7.04, sensibilidad del 94.4% y especificidad del 29.63%. El VPM tuvo una aROC de 0.65 con un punto de corte > 9.5, sensibilidad de 30.84% y especificidad de 92.59%; finalmente, el APACHE II tuvo una ROC de 0.67, con un punto de corte > 14, sensibilidad de 51.4% y especificidad de 80%. El INL presentó una razón de momios (RM) de 5.02, el VPM una de 2.06 y el puntaje APACHE II una de 1.16. Conclusiones: el INL, el VPM y el APACHE II al ingreso a la UCI están asociados con la mortalidad para los pacientes críticos con COVID-19.

[Ketamine as a treatment of bronchospasm due to an anaphylaxis. A case report]. / Ketamina como tratamiento de broncoespasmo asociado a anafilaxia. Reporte de un caso.

Background: Ketamine is used in intravenous anesthesia for the maintenance in the general anesthesia. It has characteristics to prevent the difficult of breathing due to bronchospasm, as well as the delivery of histamine associated with asthmatic attack. These effects come from the direct action in the bronchial muscle, as well as from the potentiation of its catecholamines, which is why its use is very controversial, given that there are not enough trials to back it up. Moreover, the effect of ketamine on bronchospasm due to anaphylactic reaction has not been studied. The election treatment is epinephrine and there are factors associated with its use. The objective was to present the case of a patient with a history of allergic reaction to midazolam, who presented bronchospasm due to the administration of this drug, and who received unconventional treatment with positive outcomes. Clinical case: We present the case of a young female with a history of allergies to medicines, specifically to benzodiazepines, who presented bronchospasm and oxygen saturation drop after receiving a dose of midazolam into her eye while she was working. The use of ketamine was proposed after adrenaline, a beta-agonist, inhaled anticholinergics, a steroid and antihistamine drugs were used. Conclusion: Trials are needed in order to demonstrate the efficacy of ketamine in this particular context; however, the outcome in this case was positive.

Introducción: la ketamina es utilizada en anestesia intravenosa en el mantenimiento en la anestesia general. Su efecto cuenta con propiedades para prevenir la dificultad respiratoria asociada a broncoconstricción y la secreción de histamina asociada a crisis asmática. Estos efectos derivan de la acción directa en el músculo bronquial, así como de la potencialización de las catecolaminas, por lo que su uso muy controversial, ya que hasta el día de hoy no hay suficientes estudios que lo sustenten. Además, el efecto de la ketamina en el broncoespasmo debido a anafilaxia no está estudiado. El tratamiento de elección es la epinefrina y hay factores que están asociados en el éxito de esta. El objetivo fue presentar el caso de una paciente con antecedente de alergia a midazolam, que presentó broncoespasmo al estar en contacto con este y a la que se le administró tratamiento no convencional con resultados favorables. Caso clínico: presentamos el caso de una mujer joven con antecedentes de alergias a medicamentos, específicamente a benzodiacepinas, la cual presentó broncoespasmo y caída de la saturación posteriores al contacto con midazolam intraocular mientras laboraba. Se propuso la utilización de ketamina posterior a adrenalina, betaagonista y anticolinérgicos inhalados, esteroide y antihistamínico. Conclusión: es necesario hacer estudios que demuestren la eficacia de la ketamina en este contexto en particular; en este caso, los resultados fueron positivos.

Genetic identification and diversity of stocks of the African bonytongue, Heterotis niloticus (Osteoglossiformes: Arapaiminae), in Nigeria, West Africa.

Inland fisheries are an important source of protein and income for people in Africa. Their sustainable management can greatly benefit from identification of regional genetic stocks and characterization of their genetic diversity, but such information is lacking for most African freshwater fisheries. The African bonytongue, Heterotis niloticus, is an important component of inland fisheries in West Africa. Nigeria has the largest fishery for African bonytongues, representing ~ 86% of the global total. Recent declines in yields at some Nigerian locations, however, suggest current levels of exploitation may be unsustainable. Habitat degradation also may be impacting some stocks. Despite its commercial and nutritional importance, the African bonytongue has been the subject of scant genetic research to support management. We examined patterns of genetic diversity in natural populations of H. niloticus at four locations in Nigeria, including Kainji Lake, a reservoir on the Niger River in north-central Nigeria, and three southern localities (Ethiope River, Igbokoda River, and Epe Lagoon), as well fish from the Ouémé River delta near Porto Novo, Benin. Eighty-five specimens were genotyped for nine microsatellite-loci. Genetic diversity estimates were highest at Kainji Lake, and substantially lower at southern localities. High levels of genetic differentiation were detected between samples from Kainji Lake and those from southern localities. Low, yet significant FST values were observed among samples from southern Nigerian localities that were more differentiated from the sample from nearby coastal Benin. We thus recommend that African bonytongues from the five locations be considered distinct genetic stocks and managed accordingly.

Risk Factors Associated with Mortality among Patients with COVID-19: Analysis of a Cohort of 1213 Patients in a Tertiary Healthcare Center.

The presence of cardio-metabolic and respiratory comorbidities, immunosuppression, and chronic kidney disease have been associated with an increase in mortality from COVID-19. The objective of this study is to establish the risk factors associated with 30-day mortality in a cohort of hospitalized patients with COVID-19. This paper conducts a retrospective and analytical study of patients hospitalized for COVID-19 in a tertiary care center. A Cox proportional hazard analysis was performed to estimate the association of comorbidities with 30-day mortality. A total of 1215 patients with a median age of 59 years were included. In the adjusted Cox proportional hazards regression model, hypothyroidism, D-dimer ≥ 0.8 µg/mL, LHD ≥ 430 IU/L, CRP ≥ 4.83 ng/mL, and triglycerides ≥ 214 mg/dL were associated with an increased risk of death. The presence of a history of hypothyroidism and biomarkers (D-dimer, lactic dehydrogenase, CRP, and triglycerides) were associated with an increase in mortality in the studied cohort.

Factores de riesgo en infecciones del tracto urinario asociadas a instalación de catéter vesical en adultos / Risk factors in urinary tract infections associated with bladder catheter installation in adults

Introducción: las infecciones de las vías urinarias relacionadas con la instalación de catéter vesical son de las infecciones asociadas a la atención sanitaria más comunes en México y el mundo. Representan un riesgo latente para el desarrollo de complicaciones y pueden ocasionar la muerte. Objetivo: analizar los factores de riesgo que se asocian directamente a la infección del tracto urinario en la instalación del catéter vesical. Metodología: estudio observacional, descriptivo y transversal, con muestra de 90 pacientes de un hospital de segundo nivel de atención en el que se identificaron los factores de riesgo de infección de vías urinarias asociadas a la instalación de sonda vesical. Resultados: se observó un tipo de cumplimiento de los indicadores de calidad durante la instalación de sonda vesical con frecuencia en el 52.22% de los participantes. Un tipo de cumplimiento con frecuencia en el 48.90% de los participantes durante el mantenimiento de la sonda vesical, y un tipo de cumplimiento con frecuencia del 47.78% al momento del retiro de la sonda. Los principales factores de riesgo identificados asociados a la infección del tracto urinario fueron: a) que la sonda sea instalada por un médico interno, b) una estancia mayor a 3 días en urgencias y c) que la sonda sea instalada por una enfermera general. Conclusiones: se encontraron indicadores de cumplimiento cercano al 50%, lo que se considera muy bajo en la medición de los indicadores de calidad durante la instalación, mantenimiento y retiro de la sonda vesical, incluso estos están por debajo del porcentaje nacional.

Introduction: Urinary tract infections related to the installation of a bladder catheter are the most common infections associated with health care in Mexico and the world. They represent a latent risk for the development of complications and can cause death. Objective: To analyze the risk factors that are directly associated with urinary tract infection in the installation of the bladder catheter. Methods: Observational, descriptive and cross-sectional study; with a sample of 90 patients from a second-level care hospital in which the risk factors for urinary tract infection associated with the installation of a urinary catheter were identified. Results: A type of compliance with the quality indicators was observed during the urinary catheter installation with a frequency of 52.22% of the participants. A type of compliance with a frequency of 48.90% of the participants during the maintenance of the urinary catheter, and a type of compli- ance with a frequency of 47.78% at the time of catheter removal. The main risk factors identified associated with urinary tract infection were: a) that the catheter is installed by an intern, b) a stay of more than 3 days in the emergency room, and c) that the catheter is installed by a general nurse. Conclusions: Compliance indicators were found close to 50%, which is considered very low in the measurement of quality indicators during the installation, maintenance and removal of the urinary catheter, even these are below the national percentage.

Development and Usability Validation of a Social Robot Platform for Physical and Cognitive Stimulation in Elder Care Facilities.

This article shows our work for developing an elder care platform for social interaction and physical and cognitive stimulation using the Pepper robot and Android OS as clients, based on the knowledge acquired on our long-term social robotics research experience. The first results of the user's acceptance of the solution are presented in this article. The platform is able to provide different services to the user, such as information, news, games, exercises or music. The games, which have a bi-modal way of interacting (speech and a touch screen interface), have been designed for cognitive stimulation based on the items of the mini-mental state examination. The results of the user's performance are stored in a cloud database and can be reviewed by therapists through a web interface that also allows them to establish customized therapy plans for each user. The platform has been tested and validated, first using adult people and then deployed to an elder care facility where the robot has been interacting with users for a long period of time. The results and feedback received have shown that the robot can help to keep the users physically and mentally active as well as establish an emotional link between the user and the robot.

Characterization of ocular biometric parameters in Colombian candidates for cataract surgery / Caracterización de los parámetros biométricos oculares de pacientes colombianos candidatos a cirugía de catarata

Abstract Introduction: Intraocular lens (IOL) power calculation, based on ocular biometry, is a determinant for the success of cataract surgery. Objectives: To characterize the ocular biometric parameters of Colombian patients over 40 years of age who are candidates for cataract surgery and to determine the prevalence of the 9 clinical conditions proposed by Holladay according to the interaction between axial length (AL) and anterior chamber depth (ACD). Materials and methods: Analytical cross-sectional study. The ocular biometry results of 781 patients (831 eyes) who were going to be taken to cataract surgery between January 2014 and January 2015 in Medellín, Colombia, were reviewed. After applying exclusion criteria, 716 eyes were included for analysis. Data on age, sex, AL, keratometry (flat keratometry (K1) and steep keratometry (K2)), ACD and white-to-white distance were collected. Results are presented using descriptive statistics. Results: Most eyes were from women (62.3%). The mean values of AL, K1 and ACD were 23.37±1.51mm, 43.52±2.06 and 3.03mm±0.41, respectively. Mean AL in men was 23.62±1.37mm, and in women, 23.21±1.67mm. The highest mean AL was observed in patients <50 years old (23.84±2.41) and the lowest in patients ≥80 years old (22.96±1.03 mm). Regarding eye size according to their AL, 90.5% were normal, 4.89% long, and 4.61% short. Conclusions: 85% of the participants had normal biometric parameters. For the remaining 15%, it is necessary to take some precautions when calculating IOL power, such as using fourth-generation formulas like Holladay 2 in long eyes, because the same refractive behavior will not be obtained using traditional prediction formulas in these patients. Furthermore, according to the Holladay classification, excluding normal eyes, the most frequent eyes were those with myopia and axial hyperopia.

Resumen Introducción. El cálculo del poder del lente intraocular (LIO), basado en la biometría ocular, es un factor determinante del éxito en la cirugía de catarata. Objetivos. Caracterizar los parámetros biométricos oculares de pacientes colombianos mayores de 40 años candidatos a cirugía de catarata y determinar la prevalencia de las 9 condiciones clínicas propuestas por Holladay según la interacción entre longitud axial (LA) y profundidad de la cámara anterior (ACD). Materiales y métodos. Estudio transversal analítico. Se revisaron los resultados de biometría ocular de 781 pacientes (831 ojos) que iban a ser sometidos a cirugía de cataratas entre enero de 2014 y enero de 2015 en Medellín, Colombia. Luego de aplicar los criterios de exclusión, se incluyeron 716 ojos para análisis. Se recolectaron datos sobre edad, sexo, LA, queratometría (queratometría más plana (K1), queratometría más curva (K2)), ACD y distancia blanco-blanco. Los resultados se presentan mediante estadística descriptiva. Resultados. La mayoría de ojos eran de mujeres (62.3%). Las medias de LA, K1 y ACD fueron 23.37±1.51mm, 43.52±2.06 y 3.03±0.41mm, respectivamente. La media de LA en hombres fue 23.62±1.37mm, y en mujeres, 23.21±1.67mm. La media más alta de LA se observó en pacientes <50 años (23.84±2.41mm) y la más baja en aquellos ≥80 años (22.96±1.03mm). Respecto al tamaño de los ojos según su LA, 90.5% fueron normales; 4.89%, largos, y 4.61%, cortos. Conclusiones. 85% de los participantes tuvo parámetros biométricos normales. Para el 15% restante es necesario tomar precauciones al calcular el poder del LIO, tales como el uso de fórmulas de cuarta generación como la Holladay 2 en ojos largos, pues en estos pacientes no se obtendrá el mismo comportamiento refractivo con las fórmulas de predicción tradicionales. Además, según la clasificación de Holladay, excluyendo a los ojos normales, los ojos más frecuentes fueron aquellos con miopía e hipermetropía axial.

Access to Palliative Care for Critically Ill Cancer Patients in Mexico.

OBJECTIVE: To determine the outcomes of hospitalized cancer patients requiring intensive care unit (ICU) intervention and receiving palliative care. MATERIALS AND METHODS: An observational retrospective study was completed at a single academic critical care unit in Mexico City. All hospitalized cancer patients who were evaluated by the intensive care team to assess need for ICU were included between January and December 2018. RESULTS: During the study period, the ICU group made 408 assessments of critically ill cancer patients in noncritical hospitalized areas. In total, 24.2% (99/408) of the patients in this population were consulted by the palliative care team. Of the patients evaluated, 46.5% (190/408) had advanced stage, but only 28.4% were receiving care by the palliative care team. The only risk factor for hospital mortality in the multivariate analysis was the quick Sequential Organ Failure Assessment (qSOFA) score at the time of the consultation by the ICU group (HR = 2.10, 95% CI = 1.34-3.29, p = 0.001). The median time between palliative care consultation and death was 3 days (IQR = 2-22). A total of 63% (37/58) of patients who were discharged from the hospital died during follow-up. The median follow-up time was 55 days (95% CI = 26.9-83.0). The overall mortality rate for the entire group during hospitalization and after hospital discharge was 80.8% (80/99). CONCLUSION: Fewer than 3 out of 10 hospitalized cancer patients requiring admission to the ICU were evaluated by the palliative care team despite having incurable cancer. The qSOFA score of patients at the time of the ICU consultation was the only risk factor for mortality during hospitalization. Future research efforts in Mexico should focus on earlier integration of palliation care with usual oncology care in incurable cancer patients.

Generalized equation of state for fluids: From molecular liquids to colloidal dispersions.

In this work, a new parameterization for the Statistical Association Fluid Theory for potentials of Variable Range (SAFT-VR) is coupled to the discrete potential theory to represent the thermodynamic properties of several fluids, ranging from molecular liquids to colloidal-like dispersions. In this way, this version of the SAFT-VR approach can be straightforwardly applied to any kind of either simple or complex fluid. In particular, two interaction potentials, namely, the Lennard-Jones and the hard-core attractive Yukawa potentials, are discretized to study the vapor-liquid equilibrium properties of both molecular and complex liquids, respectively. Our results are assessed with Monte Carlo computer simulations and available and accurate theoretical results based on the self-consistent Ornstein-Zernike approximation.

A Case of Fatal Rhino-Orbital Mucormycosis Associated With New Onset Diabetic Ketoacidosis and COVID-19.

Mucormycosis is an invasive fungal infection, often acute and extremely severe, occurring in patients with an underlying condition. Coinfection in patients with coronavirus disease 2019 (COVID-19) has been reported, often bacterial. A 24-year-old female is presented with acute fatal rhino-orbital mucormycosis and COVID-19. We report one of the first cases of rhino-orbital mucormycosis and COVID-19. With this case, we highlight the importance of considering mycotic coinfection in COVID-19 patients with diabetes.

Association of fever and antipyretic treatment with progressive organ dysfunction in sepsis: Prospective cohort.

INTRODUCTION: Whether fever and antipyretic treatment are related to progression of organ dysfunction (POD) in sepsis is currently not known. OBJECTIVE: To evaluate the association of fever and antipyretic treatment with POD in sepsis. METHODS: Prospective cohort study of patients with sepsis. Maximum axillary temperature (T° Max), antipyretic drugs total dose and daily SOFA score were recorded. POD was defined as an increase ≥ 1 point on the SOFA score. A multivariate logistic regression model was used to evaluate the studied association. RESULTS: 305 patients were included: 163 were women (53.4%), with a SOFA score of 8 points (6-11); 130 participants (42.62%) had T° Max ≥ 38°C, and 76 (24.9%), POD. Mortality in patients with fever was 26.2% vs. 20% (p = 0.21), and with POD, 73.7% vs. 5.7% (p = 0.01). T° Max ≥ 39°C had an OR of 4.96 (95% CI = 1.97-12.47, p = 0.01); and the use of antipyretics, an OR of 1.04 (95% CI: 0.58-1.86, p = 0.88). CONCLUSIONS: An axillary T° Max ≥ 39°C is a risk factor for POD in sepsis. The use of antipyretics was not associated with POD.

INTRODUCCIÓN: No se conoce si la fiebre y el tratamiento antipirético se relacionan con progresión de la disfunción orgánica (PDO) en sepsis. OBJETIVO: Evaluar la asociación de la fiebre y el tratamiento antipirético con la PDO en sepsis. MÉTODOS: Estudio de cohorte prospectiva de pacientes con sepsis. Se registró temperatura axilar máxima (T° máx.), dosis total de fármacos antipiréticos y puntuación diaria de la escala SOFA. La PDO se definió como el incremento de SOFA ≥ 1 punto. Se utilizó un modelo de regresión logística multivariado para evaluar la asociación estudiada. RESULTADOS: Se incluyeron 305 pacientes: 163 mujeres (53.4 %) con puntuación SOFA de ocho puntos (6-11); 130 participantes (42.62 %) presentaron T° máx. ≥ 38 °C y 76 (24.9 %), PDO. La mortalidad en los pacientes con fiebre fue de 26.2 % versus 20 % sin fiebre (p = 0.21) y con PDO, de 73.7 % versus 5.7 % (p = 0.01). La T° máx. ≥ 39°C tuvo RM = 4.96 (IC 95 % = 1.97-12.47, p = 0.01) y el uso de antipiréticos, RM = 1.04 (IC 95 % = 0.58-1.86, p = 0.88). CONCLUSIONES: La T° máx. axilar ≥ 39°C es un factor de riesgo para PDO en sepsis. El uso de antipiréticos no se asoció a PDO.

Acute Stress in Health Workers during Two Consecutive Epidemic Waves of COVID-19.

The COVID-19 pandemic has provoked generalized uncertainty around the world, with health workers experiencing anxiety, depression, burnout, insomnia, and stress. Although the effects of the pandemic on mental health may change as it evolves, the majority of reports have been web-based, cross-sectional studies. We performed a study assessing acute stress in frontline health workers during two consecutive epidemic waves. After screening for trait anxiety/depression and dissociative experiences, we evaluated changes in acute stress, considering resilience, state anxiety, burnout, depersonalization/derealization symptoms, and quality of sleep as cofactors. During the first epidemic wave (April 2020), health workers reported acute stress related to COVID-19, which was related to state anxiety. After the first epidemic wave, acute stress decreased, with no increase during the second epidemic wave (December 2020), and further decreased when vaccination started. During the follow-up (April 2020 to February 2021), the acute stress score was related to bad quality of sleep. However, acute stress, state anxiety, and burnout were all related to trait anxiety/depression, while the resilience score was invariant through time. Overall, the results emphasize the relevance of mental health screening before, during, and after an epidemic wave of infections, in order to enable coping during successive sanitary crises.

Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study.

BACKGROUND: As of June 15, 2020, a cumulative total of 7,823,289 confirmed cases of COVID-19 have been reported across 216 countries and territories worldwide. However, there is little information on the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to intensive care units (ICUs) in Latin America. The present study evaluated the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to ICUs in Mexico. METHODS: This was a multicenter observational study that included 164 critically ill patients with laboratory-confirmed COVID-19 who were admitted to 10 ICUs in Mexico, from April 1 to April 30, 2020. Demographic data, comorbid conditions, clinical presentation, treatment, and outcomes were collected and analyzed. The date of final follow-up was June 4, 2020. RESULTS: A total of 164 patients with severe COVID-19 were included in this study. The mean age of patients was 57.3 years (SD 13.7), 114 (69.5%) were men, and 6.0% were healthcare workers. Comorbid conditions were common in patients with critical COVID-19: 38.4% of patients had hypertension and 32.3% had diabetes. Compared to survivors, nonsurvivors were older and more likely to have diabetes, hypertension or other conditions. Patients presented to the hospital a median of 7 days (IQR 4.5-9) after symptom onset. The most common presenting symptoms were shortness of breath, fever, dry cough, and myalgias. One hundred percent of patients received invasive mechanical ventilation for a median time of 11 days (IQR 6-14). A total of 139 of 164 patients (89.4%) received vasopressors, and 24 patients (14.6%) received renal replacement therapy during hospitalization. Eighty-five (51.8%) patients died at or before 30 days, with a median survival of 25 days. Age (OR, 1.05; 95% CI, 1.02-1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003-1.012; p<0.001) were associated with a higher risk of in-hospital death. ICU length of stay was associated with reduced in-hospital mortality risk (OR, 0.89; 95% CI, 0.84-0.94; p<0.001). CONCLUSIONS: This observational study of critically ill patients with laboratory-confirmed COVID-19 who were admitted to the ICU in Mexico demonstrated that age and C-reactive protein level upon ICU admission were associated with in-hospital mortality, and the overall hospital mortality rate was high. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04336345.

Burnout, depersonalization, and anxiety contribute to post-traumatic stress in frontline health workers at COVID-19 patient care, a follow-up study.

INTRODUCTION: We designed a follow-up study of frontline health workers at COVID-19 patient care, within the same working conditions, to assess the influence of their general characteristics and pre-existing anxiety/depression/dissociative symptoms and resilience on the development of symptoms of post-traumatic stress disorder (PTSD), while monitoring their quality of sleep, depersonalization/derealization symptoms, acute stress, state anxiety, and burnout. METHODS: In a Hospital reconfigured to address the surge of patients with COVID-19, 204 frontline health workers accepted to participate. They completed validated questionnaires to assess mental health: before, during, and after the peak of inpatient admissions. After each evaluation, a psychiatrist reviewed the questionnaires, using the accepted criteria for each instrument. Correlations were assessed using multivariable and multivariate analyses, with a significance level of .05. RESULTS: Compared to men, women reporting pre-existing anxiety were more prone to acute stress; and younger age was related to both pre-existent common psychological symptoms and less resilience. Overall the evaluations, sleep quality was bad on the majority of participants, with an increase during the epidemic crisis, while persistent burnout had influence on state anxiety, acute stress, and symptoms of depersonalization/derealization. PTSD symptoms were related to pre-existent anxiety/depression and dissociative symptoms, as well as to acute stress and acute anxiety, and negatively related to resilience. CONCLUSIONS: Pre-existent anxiety/depression, dissociative symptoms, and coexisting acute anxiety and acute stress contribute to PTSD symptoms. During an infectious outbreak, psychological screening could provide valuable information to prevent or mitigate against adverse psychological reactions by frontline healthcare workers caring for patients.