Effect of the modified snorkel mask as noninvasive ventilatory support in patients with acute hypoxemic respiratory failure due to COVID-19.

Background: The shortage of mechanical ventilators during the COVID-19 pandemic led doctors to use alternative noninvasive ventilation systems, including a modified snorkel mask. Data on the use of the modified snorkel mask is limited. Purpose: The study aims to describe the effect and clinical characteristics of patients with COVID-19 treated with a snorkel mask and to investigate the factors associated with the failure to use noninvasive ventilation with a snorkel mask. Methods: In this retrospective observational study, adult patients with COVID-19 who were treated with a snorkel mask at Daniel Alcides Carrion Hospital of Huancayo-Perú were selected. Results: Of the 390 patients included, 158 (20.5%) received noninvasive ventilation with a snorkel, 84 (53.2%) patients were discharged alive without intubation, and the mortality rate was 22%. In the control group that received standard treatment, 129 patients (55.6%) failed (i.e., deceased or admitted to a mechanical ventilator). The mortality rate was 33.2%. ROX index < 4.8, consolidation-type tomographic pattern, and the presence of complications, such as bacterial pneumonia or thromboembolism, were independently associated with a higher risk of noninvasive ventilation failure with snorkels. Conclusions: Using the snorkel system resulted in an absolute mortality reduction of 11%, and recovery increased by 15% compared to the standard treatment system. Therefore, this device can be used as an acceptable alternative in the absence of mechanical ventilators.

Exceso de grasa visceral asociado a severidad de COVID-19, cuantificado por bioimpedancia / Excess visceral fat associated with severity of COVID-19 quantified by bioimpedance

Hay dos tipos principales de tejido adiposo; el subcutáneo, que es menos activo metabólicamente, y el tejido adiposo visceral, que secreta constantemente citocinas inflamatorias y está relacionado a enfermedades metabólicas y cardiovasculares. Nuestro objetivo fue identificar la asociación entre el exceso de grasa visceral y la severidad de enfermedad en pacientes con COVID-19. Se realizó un estudio observacional analítico que incluyó a pacientes con COVID-19 admitidos al Hospital Carrión de Huancayo, Perú. Se utilizó la balanza de bioimpedancia para cuantificar la composición corporal, la variable dependiente fue la severidad de enfermedad. Se utilizó el análisis de regresión logística para determinar la asociación de la grasa visceral y otros parámetros antropométricos con severidad de enfermedad. Se analizaron a 120 personas con COVID-19, la edad promedio fue 50 años, el sexo masculino fue 60%. De acuerdo a los valores de la composición corporal emitidos por el equipo de bioimpedancia: La grasa visceral > 15Kg (OR 7,31; p = 0,001); la grasa corporal total > 35% (OR 5,58; p = 0,009) y el exceso de peso > 20Kg (OR 6,96; p = 0,011) fueron los parámetros asociados a enfermedad severa por COVID-19. La relación positiva entre el perímetro abdominal y la cantidad de grasa visceral fue significativo (p = 0,01). En la composición corporal, el exceso de grasa visceral es el mayor parámetro asociado a enfermedad severa por COVID-19(AU)

There are two main types of adipose tissue; the subcutaneous, which is less metabolically active, and the visceral adipose tissue, which constantly secretes inflammatory cytokines and is related to metabolic and cardiovascular diseases. Our objetive was to identify the association between the excess of visceral fat and disease severity in COVID-19 patients. An analytical observational study was carried out which included patients with COVID-19 admitted to the Carrión Hospital in Huancayo, Peru. The bioimpedance balance was used to quantify the body composition; the dependent variable was the severity of the disease. A logistic regression analysis was used to determine the association of visceral fat and other anthropometric parameters with the severity of the disease. Out of 120 people with COVID-19 were analyzed, the average age was 50 years, the male sex was 60%. According to the body composition values issued by the bioimpedance team: Visceral fat> 15Kg (OR 7.31; p = 0.001); Total body fat> 35% (OR 5.58; p = 0.009) and excess weight> 20Kg (OR 6.96; p = 0.011) were the parameters associated with severe disease due to COVID-19. The positive relationship between abdominal circumference and the amount of visceral fat was significant (p = 0.01). In body composition, excess visceral fat is the main parameter associated with severe COVID-19 disease(AU)

Sexual Behavior of Men Who Have Sex with Men and Its Relationship to Sexually Transmitted Infections during an Outbreak of the Human Monkeypox Virus.

BACKGROUND: There is a high frequency of monkeypox (MPOX) and sexually transmitted infections (STIs) in men who have sex with men (MSM). AIM: To identify the sexual behavior of MSM during the MPOX infection period. METHODS: We conducted an observational study of cases and controls were carried out. RESULTS: A total of 171 participants were considered, two heterosexual male controls (MSW) were included for each case of MSM with a consecutive selection of people who attended the STI prevention and control center from January to July 2022. The results revealed that the mean number of sexual partners reported in the last year was higher in cases (4.2) compared to controls 1.9 (p < 0.05). The related conditions for MSM to acquire some type of STI were sexual intercourse under the influence of alcohol (OR 2.42; 95% CI: 1.11-3.96), forgetting to use a protection method (condom) (OR 3.16; 95%: 1.73-7.48) and sexual intercourse with casual couples (OR 1.4; 95% CI: 1.01-2.16). CONCLUSION: Our findings demonstrated a link between the sexual behavior of men who have sex with men and the high prevalence of sexually transmitted infections during the human monkeypox virus outbreak.

Comparación clínica y laboratorial de la fiebre amarilla severa versus dengue grave en Perú / Clinical and laboratory differences between severe yellow fever and severe dengue in emergency patients

En los centros de Emergencia con poco apoyo de laboratorio, es difícil diferenciar a los pacientes con dengue grave y fiebre amarilla severa. El objetivo fue comparar el perfil clínico y de laboratorio de los pacientes con dengue grave y fiebre amarilla severa en Urgencias. Se realizó un estudio observacional retrospectivo de pacientes con diagnóstico confirmado de dengue y fiebre amarilla en el período 2018 a 2020 atendidos en la Unidad de Emergencia del Hospital Carrión, Huancayo-Perú. Se evaluaron un total de 35 pacientes, 11 pacientes (31,4%) fueron diagnosticados con fiebre amarilla severa y 24 pacientes (68,5%) con dengue grave. La media de los resultados de laboratorio con fiebre amarilla severa fueron bilirrubina indirecta 4,7 ml/dL, aspartato transaminasa 4463 UI/L, transaminasa aminotransferasa 4329 UI/L, creatinina 4,9 mg/dl. En pacientes con dengue grave el hematocrito promedio fue 51,8, hemoglobina 17,6 g/dl, plaquetas 24 × 103/mm. En pacientes con síndrome ictérico-febril la presencia de bradicardia, bilirrubina indirecta elevada y transaminasas muy elevadas debe hacer sospechar de fiebre amarilla; mientras que los pacientes que acuden por ascitis, derrame pleural, aumento de hematocrito y deficiencia de plaquetas, se debe tratar como dengue grave sobre todo en Unidades de Emergencia con poco apoyo de laboratorio(AU)

In Emergency centers with little laboratory support, differentiating patients with dengue and yellow fever is difficult. The Aim was to compare the clinical and laboratory profile of patients with severe dengue and severe yellow fever in the Emergency unit. We conducted a retrospective observational study of patients with a confirmed diagnosis of dengue and yellow fever in the period 2018 to 2020 treated in the Emergency Unit of the Carrión hospital, Huancayo-Peru. A total of 35 patients were evaluated, 11 patients (31.4%) were diagnosed with severe yellow fever and 24 patients (68.5%) with severe dengue. The mean laboratory results in patients with severe yellow fever were indirect bilirubin 4.7 ml/dL, aspartate transaminase 4463 IU/L, transaminase aminotransferase 4329 IU/L, creatinine 4.9 mg / dl. In patients with severe dengue were hematocrit 51.8, hemoglobin 17.6 g / dl, platelets 24 × 103 / mm. In patients with syndrome jaundice and fever the presence of bradycardia, elevated indirect bilirubin, and very elevated transaminases should be suspicious for yellow fever; while in patients who come for ascites, pleural effusion, increased hematocrit and platelet deficiency, it should be treated as severe dengue especially in Emergency Units with little laboratory support(AU)