Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Prospective, Multicenter Cohort Study From Colombia, 2018-2022.

OBJECTIVES: High driving pressure (DP, ratio of tidal volume (Vt) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality. DESIGN: Multicenter, prospective study conducted between February 2018 and December 2022. SETTING: Twelve tertiary care PICUs in Colombia. PATIENTS: One hundred eighty-four intubated children with moderate to severe PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H2O, p < 0.01). Of note, children with a Vt less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H2O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H2O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02). CONCLUSIONS: In children with moderate to severe PARDS, a DP greater than 15 cm H2O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.

Dependencia en adultos mayores con enfermedad de Alzheimer en el Hospital Civil de Tepic, Nayarit, México / Dependence in Aged Adults Suffering from Alzheimer Disease at Tepic Civil Hospital, Nayarit, México

Introducción: El mundo ha experimentado un proceso de cambio que implica múltiples transiciones, como la demográfica y epidemiológica. En México, la prevalencia de las enfermedades demenciales como el Alzheimer tiene una tendencia al aumento, de ahí que sea necesario estudiar y analizar sus repercusiones en la población. Objetivo: Determinar el grado de dependencia en adultos mayores con enfermedad de Alzheimer en un hospital de segundo nivel en Nayarit, México. Métodos: Estudio descriptivo, corte transversal y enfoque cuantitativo. Se aplicó el índice de Barthel para evaluar las actividades básicas de la vida diaria a 29 cuidadores principales de los pacientes registrados en la base de datos del hospital. Las variables elegidas fueron: sexo, edad, municipio y grado de dependencia. El análisis de los datos se realizó mediante el programa SPSS de IBM versión 20. Resultados: La edad media fue de 79 años; el 62,1 por ciento fueron mujeres y el 37,9 por ciento hombres; el municipio con mayor número de pacientes fue Tepic (44,8 por ciento); con respecto al grado de dependencia, la independencia fue la más frecuente (27,6 por ciento), seguido de dependencia total (24,1 por ciento). Se evidenció correlación entre defunciones y grado de dependencia con un nivel de significancia por debajo de 0,000 (error α). Conclusiones. En Nayarit existe dependencia en los adultos mayores con enfermedad de Alzheimer. Los cuidadores primarios reciben poca o ninguna capacitación para el cuidado de estos pacientes. El subdiagnóstico de esta enfermedad de alguna manera favorece la dependencia, pues no se orienta o no se otorgan las medidas básicas terapéuticas a la familia para el apoyo del enfermo, esto a su vez es de especial interés debido a que existe una correlación estrecha entre defunción y dependencia(AU)

Introduction: The world has undergone a process of change that involves multiple transitions, such as demographic and epidemiological. In Mexico, the prevalence of dementia diseases such as Alzheimer's has an increasing trend, hence it is necessary to study and to analyze its impact on the population. Objective: To determine the degree of dependence in aged adults with Alzheimer's disease in a second-level hospital in Nayarit, Mexico. Methods: This is a descriptive study with cross-sectional and quantitative approach. The Barthel index was applied to assess the basic activities of daily living to 29 main caregivers of the patients registered in the hospital database. The variables chosen were sex, age, municipality and degree of dependency. Data analysis was performed using the IBM SPSS version 20 program. Results: The mean age was 79 years; 62.1percent were women and 37.9percent men; the municipality with the highest number of patients was Tepic (44.8percent). Regarding the degree of dependence, independence was the most frequent (27.6percent), followed by total dependence (24.1percent). Correlation between deaths and degree of dependence was evidenced with a level of significance below 0.000 (α error). Conclusions: In Nayarit there is dependence in aged adults suffering from Alzheimer's disease. Primary caregivers receive little or no training in caring for these patients. The underdiagnoses of this disease in some way favors dependence, since the family is not guided or the basic therapeutic measures are not given to support the patient, this in turn is of special interest because there is close correlation between deaths and dependency(AU)

Retreatment of 6 ceramic restorations in a single session - the application of Er:YAG laser and CAD/CAM technology: an 1 year follow up clinical evaluation / Retratamento de 6 restaurações de cerâmica em uma única sessão ­ Utilizando o Laser ER: YAG e a tecnologia CAD/CAM com Acompanhamento de 1 ano

Background: To present the benefits of high power lasers (Er: YAG and Nd: YAG) over the use of the high speed turbine for the extraction of ceramics restorations, without damaging the surfaces of the teeth; being a relatively easier and faster procedure without the use of anesthetic agents, and the preparation of the ceramic restorations and cementing in the single session; with a follow-up of 1 year. Objective: The benefits of lasers over high-speed turbine mechanical instrumentation for crown removal encompass efficient restoration recovery without damage to tooth surfaces; and a relatively easier and faster procedure without the use of anesthetic agents. Methods: The Er: YAG laser (no contact; 3.2-4.0 W, 20 Hz) was used to extract the porcelain prosthesis, followed by a gingivectomy with the Nd: YAG laser on tooth 12 to improve the gingival contour. The dental surfaces where the ceramic prosthesis will be cemented were scanned. Then, CAD / CAM technology was used to make the ceramic veneers that were cemented in the same session. Results: The efficacy the Er:YAG laser energy was observed by the decreased of the time to remove all-ceramic materials through ablation of bonding cements, reducing working time by 75% compared to a high-speed turbine. Conclusions: An Er: YAG laser can safely remove lithium disilicate crowns with the settings used in this study. Laser-assisted removal of all ceramic PDFs is a promising treatment protocol. The use of the Nd: YAG (2.0 W power, short 20Hz, 320 µm optical fiber, in contact) laser allowed gingivoplasty to be performed, automatically cauterizing avoiding post-operative bleeding, and facilitating the preparation of ceramic restorations the same day. The use of high-power lasers and the use of accompanying CAD / CAM technology allowed this clinical case to be completed in a single visit without the use of temporary restorations, achieving absolute patient satisfaction. (AU)

Antecedentes: Apresentar os benefícios dos lasers de alta potência (Er: YAG e Nd:YAG) sobre o uso da turbina de alta velocidade para a remoção de restaurações cerâmicas, sem danificar as superfícies dos dentes; sendo um procedimento relativamente mais fácil e rápido evitando o uso de agentes anestésicos, conseguindo fazer o preparo das restaurações de cerâmica e cimentação em uma única sessão; com seguimento de 1 ano. Objetivo: Os benefícios dos lasers sobre a instrumentação mecânica com turbina de alta velocidade para a remoção da coroa abrangem a recuperação eficiente da restauração sem danos às superfícies dos dentes; e um procedimento relativamente mais fácil e rápido sem o uso de agentes anestésicos. Métodos: O laser Er: YAG (sem contato; 3,2-4,0 W, 20 Hz) foi utilizado para remover a prótese de porcelana, seguido de gengivectomia com o laser Nd: YAG no dente 12 para melhorar o contorno gengival. As superfícies dentais onde a prótese de cerâmica será cimentada foram escaneadas. Em seguida, a tecnologia CAD / CAM foi utilizada para confeccionar as facetas de cerâmicas que foram cimentadas na mesma sessão. Resultados: A eficácia da energia do laser Er: YAG foi observada pela diminuição do tempo na remoção dos materiais cerâmicos por meio da ablação dos cimentos de ligação, reduzindo o tempo de trabalho em 75% em relação a uma turbina de alta velocidade. Conclusão: Um laser Er: YAG pode remover com segurança as coroas de dissilicato de lítio com as configurações usadas neste estudo. A remoção assistida por laser de todos os PDFs de cerâmica é um protocolo de tratamento promissor. O uso do laser Nd: YAG (2,0 W potência, curta 20Hz, 320 µm fibra ótica, em contato) permitiu a realização da gengivoplastia, cauterizando automaticamente evitando sangramento pós-operatório e facilitando o preparo das restaurações cerâmicas no mesmo dia. O uso de lasers de alta potência e o uso da tecnologia CAD / CAM que o acompanha permitiram que este caso clínico fosse concluído em uma única visita, sem o uso de restaurações temporárias, alcançando a satisfação absoluta do paciente (AU)