Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study.

BACKGROUND: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. METHODS: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero (<1 N1 copies per mL), VIR-N1-Low (1-2747 N1 copies per mL), and VIR-N1-Storm (>2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. FINDINGS: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16-0·55; p<0·0001, compared with the VIR-N1-Storm group). 106 (26%) of 403 patients in the VIR-N1-Low group died within 90 days (OR for death 0·39, 95% CI 0·26-0·57; p<0·0001, compared with the VIR-N1-Storm group). INTERPRETATION: The presence of a so-called viral storm is associated with increased all-cause death in patients admitted to the intensive care unit with severe COVID-19. Preventing this viral storm could help to reduce poor outcomes. Viral storm could be an enrichment marker for treatment with antivirals or purification devices to remove viral components from the blood. FUNDING: Instituto de Salud Carlos III, Canadian Institutes of Health Research, Li Ka-Shing Foundation, Research Nova Scotia, and European Society of Clinical Microbiology and Infectious Diseases. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic: a matched analysis.

BACKGROUND: The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with coronavirus disease 2019 (COVID-19)-associated respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior noninvasive respiratory support on outcomes. METHODS: This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICUs) participating in the CIBERESUCICOVID project. The study period was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within the first 24 h of ICU admission. Propensity score matching was used to achieve a balance across baseline variables between the early intubation cohort and those patients who were intubated after the first 24 h of ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We performed sensitivity analyses to consider a different time-point (48 h from ICU admission) for early and delayed intubation. RESULTS: Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients were included in the analysis (307 for each group). In the unmatched population, there were no differences in mortality between the early and delayed groups. After propensity score matching, patients with delayed intubation presented higher hospital mortality (27.3% versus 37.1%; p=0.01), ICU mortality (25.7% versus 36.1%; p=0.007) and 90-day mortality (30.9% versus 40.2%; p=0.02) compared with the early intubation group. Very similar findings were observed when we used a 48-h time-point for early or delayed intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and 45% in the first, second, third and fourth waves, respectively; first versus second, third and fourth waves p<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving high-flow nasal cannula (HFNC) (n=294) who were intubated earlier. The subgroup of patients undergoing noninvasive ventilation (n=214) before intubation showed higher mortality when delayed intubation was set as that occurring after 48 h from ICU admission, but not when after 24 h. CONCLUSIONS: In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was associated with a higher risk of hospital mortality. The use of early intubation significantly decreased throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients who had received HFNC.

Translucency of a Dental Porcelain Mixed by Two Ceramic Slurry Methods: A Bayesian Comparison.

Background: The ceramics industry produces porcelain pastes using a controlled ratio of water and porcelain powder. Two methods are used to produce a dental porcelain paste: one-step mixing or incremental mixing. Objective: To evaluate the optical properties of a feldspathic dental ceramic using two different ceramic paste preparation methods using a Bayesian approach. Materials and Methods: Two groups of feldspathic porcelain discs, an incremental mixing group (n = 40) and a one-step mixing group (n = 40), were assessed. Groups were evaluated using spectrophotometry, and the translucency parameter (TP) of each sample was calculated. Surfaces were characterized by AFM and SEM. Statistical analysis was performed using a Bayesian approach. Results: Translucency parameter values of the incremental mixing group ranged from 1.65 to 3.41, while values for the one-step mixing group ranged from 3.62 to 5.74, this difference being statistically significant. The lowest roughness was obtained on the surface of discs in the one-step mixing group. Conclusions: Feldspathic porcelain with lower translucency and higher roughness was obtained using the incremental mixture method.

Low anti-SARS-CoV-2 S antibody levels predict increased mortality and dissemination of viral components in the blood of critical COVID-19 patients.

BACKGROUND: Anti-SARS-CoV-2 S antibodies prevent viral replication. Critically ill COVID-19 patients show viral material in plasma, associated with a dysregulated host response. If these antibodies influence survival and viral dissemination in ICU-COVID patients is unknown. PATIENTS/METHODS: We studied the impact of anti-SARS-CoV-2 S antibodies levels on survival, viral RNA-load in plasma, and N-antigenaemia in 92 COVID-19 patients over ICU admission. RESULTS: Frequency of N-antigenaemia was >2.5-fold higher in absence of antibodies. Antibodies correlated inversely with viral RNA-load in plasma, representing a protective factor against mortality (adjusted HR [CI 95%], p): (S IgM [AUC ≥ 60]: 0.44 [0.22; 0.88], 0.020); (S IgG [AUC ≥ 237]: 0.31 [0.16; 0.61], <0.001). Viral RNA-load in plasma and N-antigenaemia predicted increased mortality: (N1-viral load [≥2.156 copies/ml]: 2.25 [1.16; 4.36], 0.016); (N-antigenaemia: 2.45 [1.27; 4.69], 0.007). CONCLUSIONS: Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. Our findings support that these antibodies contribute to prevent systemic dissemination of SARS-CoV-2.

Cost effective reproduction number based strategies for reducing deaths from COVID-19.

In epidemiology, the effective reproduction number R e is used to characterize the growth rate of an epidemic outbreak. If R e > 1 , the epidemic worsens, and if R e < 1 , then it subsides and eventually dies out. In this paper, we investigate properties of R e for a modified SEIR model of COVID-19 in the city of Houston, TX USA, in which the population is divided into low-risk and high-risk subpopulations. The response of R e to two types of control measures (testing and distancing) applied to the two different subpopulations is characterized. A nonlinear cost model is used for control measures, to include the effects of diminishing returns. Lowest-cost control combinations for reducing instantaneous R e to a given value are computed. We propose three types of heuristic strategies for mitigating COVID-19 that are targeted at reducing R e , and we exhibit the tradeoffs between strategy implementation costs and number of deaths. We also consider two variants of each type of strategy: basic strategies, which consider only the effects of controls on R e , without regard to subpopulation; and high-risk prioritizing strategies, which maximize control of the high-risk subpopulation. Results showed that of the three heuristic strategy types, the most cost-effective involved setting a target value for R e and applying sufficient controls to attain that target value. This heuristic led to strategies that begin with strict distancing of the entire population, later followed by increased testing. Strategies that maximize control on high-risk individuals were less cost-effective than basic strategies that emphasize reduction of the rate of spreading of the disease. The model shows that delaying the start of control measures past a certain point greatly worsens strategy outcomes. We conclude that the effective reproduction can be a valuable real-time indicator in determining cost-effective control strategies.

Circulating microRNA profiles predict the severity of COVID-19 in hospitalized patients.

We aimed to examine the circulating microRNA (miRNA) profile of hospitalized COVID-19 patients and evaluate its potential as a source of biomarkers for the management of the disease. This was an observational and multicenter study that included 84 patients with a positive nasopharyngeal swab Polymerase chain reaction (PCR) test for SARS-CoV-2 recruited during the first pandemic wave in Spain (March-June 2020). Patients were stratified according to disease severity: hospitalized patients admitted to the clinical wards without requiring critical care and patients admitted to the intensive care unit (ICU). An additional study was completed including ICU nonsurvivors and survivors. Plasma miRNA profiling was performed using reverse transcription polymerase quantitative chain reaction (RT-qPCR). Predictive models were constructed using least absolute shrinkage and selection operator (LASSO) regression. Ten circulating miRNAs were dysregulated in ICU patients compared to ward patients. LASSO analysis identified a signature of three miRNAs (miR-148a-3p, miR-451a and miR-486-5p) that distinguishes between ICU and ward patients [AUC (95% CI) = 0.89 (0.81-0.97)]. Among critically ill patients, six miRNAs were downregulated between nonsurvivors and survivors. A signature based on two miRNAs (miR-192-5p and miR-323a-3p) differentiated ICU nonsurvivors from survivors [AUC (95% CI) = 0.80 (0.64-0.96)]. The discriminatory potential of the signature was higher than that observed for laboratory parameters such as leukocyte counts, C-reactive protein (CRP) or D-dimer [maximum AUC (95% CI) for these variables = 0.73 (0.55-0.92)]. miRNA levels were correlated with the duration of ICU stay. Specific circulating miRNA profiles are associated with the severity of COVID-19. Plasma miRNA signatures emerge as a novel tool to assist in the early prediction of vital status deterioration among ICU patients.

Intervención educativa sobre cáncer de mama / Educative Intervention about Breast Cancer

Introducción: El cáncer de mama es una proliferación maligna de las células epiteliales que revisten los conductos o lobulillos mamarios. Objetivo: Evaluar la efectividad de una intervención educativa sobre cáncer de mama. Métodos: Se realizó un estudio cuasi-experimental de intervención educativa sobre cáncer de mama en mujeres mayores de 30 años pertenecientes al consultorio 13 del Policlínico Pedro del Toro; de Holguín durante el 2018. La población de estudio la constituyó el total de mujeres adultas mayores de 30 años de edad, 124 pertenecientes al consultorio en estudio. La muestra quedó conformada por 80 pacientes, seleccionadas mediante el muestreo aleatorio simple. Resultados: En cuanto a las necesidades identificadas, las 80 pacientes (100 por ciento) expresaron la necesidad de conocer acerca de los factores de riesgo del cáncer de mama. Antes del programa educativo predominaron las mujeres con conocimientos inadecuados sobre prevención del cáncer de mama, autoexamen de mama y factores de riesgo (80 por ciento, 65 por ciento y 80 por ciento, respectivamente). Luego de la intervención aumentaron a suficientes: en el primer caso al 85 por ciento, en el segundo y tercero a 100 por ciento. La aplicación de dicho programa resultó efectiva en 68 féminas, para un 85 por ciento. Conclusiones: La intervención educativa fue efectiva, porque demostró un incremento en el nivel de conocimiento sobre la prevención, los factores de riesgo y el autoexamen de mama(AU)

Introduction: Breast cancer is a malignant growth of epithelial cells that line the ducts or breast lobules. Objective: To assess the effectiveness of an educative intervention about breast cancer. Methods: A quasiexperimental study of an educative intervention about breast cancer was carried out, during 2018, with women over 30 years belonging to the family medical office 13 of Pedro del Toro Polyclinic of Holguín. The study population was made up of all women aged over 30 years: 124 women, who belonged to the medical office under study. The sample was made up of 80 patients, selected by simple random sampling. Results: Regarding the identified needs, all the patients expressed the need to know about the risk factors for breast cancer. Before the educative program, women with inadequate knowledge of breast cancer prevention, breast self-examination, and risk factors predominated (80 percent, 65 percent, and 80 percent, respectively). After the intervention, this amount increased to enough: in the first case, it increased to 85 percent; in the second and third cases, it increased to 100 percent. The application of this program was effective in 68 women, accounting for 85 percent. Conclusions: The educative intervention was effective because it showed an increase in the level of knowledge about prevention, risk factors and breast self-examination(AU)

Viral RNA load in plasma is associated with critical illness and a dysregulated host response in COVID-19.

BACKGROUND: COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. METHODS: A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. RESULTS: The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183-12.968], 0.025), viral RNA load (N1) (1.962 [1.244-3.096], 0.004); viral RNA load (N2) (2.229 [1.382-3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). CONCLUSIONS: SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.

Transcriptomic depression of immunological synapse as a signature of ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia (VAP) is one of the most commonly encountered intensive care unit (ICU) acquired infections worldwide. The objective of the study was to identify the immune alteration occurring in patients suffering from VAP at the transcriptomic level and explore its potential use for clinical diagnoses of this disease. METHODS: We performed a prospective observational study in five medical ICUs. Immunological gene expression profiles in the blood of VAP patients were compared with those of controls by using whole transcriptome microarrays and droplet digital polymerase chain reaction (ddPCR) in the first 24 hours following diagnosis. RESULTS: VAP patients showed significantly lower expression levels of HLA-DOA, HLA-DMA, HLA-DMB, ICOS, ICOSLG, IL2RA, CD1, CD3, CD28 and CD40LG. The molecules coded by these genes participate of the immunological synapse. CD1C, CD40LG and ICOS showed the highest values of area under the receiver operating characteristic curve (AUROC) with a good balance between sensibility and specificity. CONCLUSIONS: Patients with VAP show a transcriptomic depression of genes participating of the immunological synapse. It takes a commonplace event, namely VAP, and highlights a quite significant underlying immune suppressive state. In effect this small study will change how we regard VAP, and proposes that we regard it as an infection in an immune compromised host, and that immunity has a central role for ICU acquired infections. This may in time change clinical practice, as it has profound implications for the role of protocolised care, or bundles, in the prevention of VAP. Quantifying the expression in blood of this genes using ddPCR could be a useful approach for the diagnosis of VAP.

Una nueva visión en la gestión de la logística de aprovisionamientos en la industria biotecnológica cubana / A new vision in the management of supply logistics in the cuban biotechnological industry

El objetivo de esta investigación es proponer una nueva metodología en la gestión logística de los aprovisionamientos para las industrias biotecnológicas cubanas que funcionan esencialmente con un ciclo completo de desempeño empresarial, desde la investigación básica de nuevos biofármacos, hasta llegar a la fabricación y comercialización de sus productos, donde la amplia y compleja gama de surtidos a suministrar en un contexto adverso para el país, conlleva a utilizar diferentes métodos de gestión de los aprovisionamientos en correspondencia con su destino y frecuencia de uso. De esta manera, se propone dividir las materias primas y materiales a proveer en: 1) insumos de proyectos, que emplean de forma esporádica pequeñas, pero múltiples variedades de mercancías 2) insumos de procesos, que se caracterizan por consumir altos volúmenes de productos, pero poco diversos, como sucede en las actividades de producción. Finalmente, se evalúa la implementación de este procedimiento en una de las entidades biotecnológicas de mayor prestigio en Cuba, el Centro de Inmunología Molecular, demostrando las ventajas y alcance de esta propuesta que permitió elevar la efectividad en la gestión de los aprovisionamientos, y de esta manera la eficiencia empresarial(AU)

The objective of this work is to propose a new methodology for the logistics management of supplies in Cuban biotechnological industries. They work essentially on a full cycle of enterprise performance, from basic research to the manufacture and marketing of new biopharmaceuticals products. The wide and complex range of supply requirements, in an adverse country-wide context, leads to the use of different methods for managing supplies, in accordance with their destination and frequency of use. We propose to divide the supplies and materials into two categories: 1) supplies for projects, for those that are highly varied, used sporadically and in small quantities, 2) process supplies, for those that are regularly used in large volumes -such as manufacture process-, and a relatively small variety of supply types. The implementation of this methodology is assessed in one of the most prestigious biotechnological entities in Cuba, the Molecular Immunology Center. The effectiveness in the management of supplies was increased, and therefore, business efficiency(AU)

Una nueva visión en la gestión de la logística de aprovisionamientos en la industria biotecnológica cubana / A new vision in the management of supply logistics in the cuban biotechnological industry

El objetivo de esta investigación es proponer una nueva metodología en la gestión logística de los aprovisionamientos para las industrias biotecnológicas cubanas que funcionan esencialmente con un ciclo completo de desempeño empresarial, desde la investigación básica de nuevos biofármacos, hasta llegar a la fabricación y comercialización de sus productos, donde la amplia y compleja gama de surtidos a suministrar en un contexto adverso para el país, conlleva a utilizar diferentes métodos de gestión de los aprovisionamientos en correspondencia con su destino y frecuencia de uso. De esta manera, se propone dividir las materias primas y materiales a proveer en: 1) insumos de proyectos, que emplean de forma esporádica pequeñas, pero múltiples variedades de mercancías 2) insumos de procesos, que se caracterizan por consumir altos volúmenes de productos, pero poco diversos, como sucede en las actividades de producción. Finalmente, se evalúa la implementación de este procedimiento en una de las entidades biotecnológicas de mayor prestigio en Cuba, el Centro de Inmunología Molecular, demostrando las ventajas y alcance de esta propuesta que permitió elevar la efectividad en la gestión de los aprovisionamientos, y de esta manera la eficiencia empresarial(AU)

The objective of this work is to propose a new methodology for the logistics management of supplies in Cuban biotechnological industries. They work essentially on a full cycle of enterprise performance, from basic research to the manufacture and marketing of new biopharmaceuticals products. The wide and complex range of supply requirements, in an adverse country-wide context, leads to the use of different methods for managing supplies, in accordance with their destination and frequency of use. We propose to divide the supplies and materials into two categories: 1) supplies for projects, for those that are highly varied, used sporadically and in small quantities, 2) process supplies, for those that are regularly used in large volumes -such as manufacture process-, and a relatively small variety of supply types. The implementation of this methodology is assessed in one of the most prestigious biotechnological entities in Cuba, the Molecular Immunology Center. The effectiveness in the management of supplies was increased, and therefore, business efficiency(AU)

Glucogénesis: caracterización clínica - patológica del primer caso descrito en Bolivia en un paciente pediátrico / Glycogen storage disease: first clinicopathologic pediatric case described in Bolivia

Las glucogenosis son enfermedades hereditarias del metabolismo del glucógeno. Se reconocen más de 12 tipos y afectan principalmente al hígado y al músculo, mismas que se clasifican según la enzima defectuosa y el órgano afectado. Presentamos el caso de un niño de 4 años y 6 meses con hepatomegalia importante, retardo del crecimiento pondoestatural, extremidades delgadas, facies con mejillas redondas. Sus exámenes laboratoriales revelaron: hipoglicemia, hiperlipidemia, hiperuricemia y sus estudios imagenológicos evidenciaron hepatomegalia difusa severa. El estudio histopatológico concluyó con glucogenosis, no pudiendo definirse el tipo, por la imposibilidad de realizar pruebas específicas de histoquímica en Bolivia. El paciente es seguido por consulta externa, bajo indicaciones dietéticas para prevenir complicaciones.

Glycogen storage diseases are inherited metabolic disorders of glycogen metabolism. There are over 12 types, they may affect primarily the liver and muscle. They are classified and the affected tissue. The case of a 4 y 6m old-male infant is presented, with growth retardation, thin limbs, rounded cheeks. Laboratory testing showed hypoglycemia, hyperlipidermia, hyperuricemia. Imagenoly testing showed severe diffuse hepatomegaly. Histopathology concluded in glycogen storage disease, the enzyme deficiency could not be established because of the unavailability of these test in Bolivia. The patient is followed by consult, diet therapy to prevent complications.

Disección espontánea de la arteria descendente anterior en una paciente hipertensa

Paciente mujer de 40 años, hipertensa, que cursó con infarto agudo de miocardio sr elevado, disfunción sistólica del ventrículo izquierdo y angina postinfarto. Se realizó una coronariografía, donde se evidenció una imagen compatible con disección espontánea de la arteria descendente anterior, y se implantó una prótesis endovascular (stent) convencional con éxito...

A 40 year-old woman hypertensive patient who developed an ST elevated acute myocardial infarction, left ventricle systolic dysfunction and postinfarction angina. Coronary angiography showed an image compatible with spontaneous dissection of the anterior descending artery, and a conventional stent was successfully implanted...

[Arterial blood gases in clinically healthy adults living at 3,350 meters of altitude]. / Gasometría arterial en adultos clínicamente sanos a 3350 metros de altitud.

OBJECTIVES: To determine the normal values of arterial blood gases in clinically healthy adults living at 3,350 meters of altitude. MATERIALS AND METHODS: The study was conducted in the Santiago district of Cusco, Peru at 3,350 meters of altitude with a sample of 118 subjects determined in a previous pilot study and selected by convenience sampling. The sample included individuals between 20-59 years old with no pulmonary, cardiovascular and hematological medical history, who practice sports less than 60 minutes per day, non smoking, have resided at least 5 years prior to the study in Cusco and were characterized through clinical examination by two internists and pulmonologists as "clinically healthy". The arterial blood gas collection was standardized for statistical analysis measures of central tendency and dispersion. Student's t-tests and analysis of variance, linear correlation and multiple linear regression were applied. RESULTS: Women comprised 57.6% of the sample. Respiratory rate averaged 16.2 per minute and BMI 24.8. The blood gas results were: pH 7.42 mEq/L; pO2 61.08 mm Hg; pCO 2 30.62 mm Hg; pAO 2 62.52 mm Hg; SO 2 91.13%; AaDO 0.0 mm Hg; Hto 44.22%; Hb 14.74 mg/dL; CaO2 18.18 vol%; HCO3 19.74 mmol/L; pO /FiO 290.79 and Anion Gap 20.99. Using linear regression, it was observed that each year from the age of 20, there was a decrease in pO (0.122 mm Hg), pAO (0.08 mm Hg), SO (0.05%), index pO /FiO (0.571 mm Hg) and an increase in pCO (0.056 mm Hg). CONCLUSIONS: The results found with respect to blood gases in this population are different from those residing at sea level and can be used to study other populations residing at a similar altitude.

Gasometría arterial en adultos clínicamente sanos a 3350 metros de altitud / Arterial blood gases in clinically healthy adults living at 3, 350 meters of altitude

Objetivo. Determinar los valores gasométricos arteriales de normalidad, en adultos clínicamente sanos que viven a 3350 metros de altitud. Materiales y métodos. Estudio realizado en Cusco, distrito de Santiago a 3350 m de altitud, se determinó una muestra de 118 sujetos mediante un estudio piloto previo, seleccionados por muestreo por conveniencia; las personas tenían entre 20-59 años de edad, sin antecedentes patológicos pulmonares, cardiovasculares o hematológicos, con práctica deportiva menor a 60 min/día, sin hábito tabáquico, residentes los 5 años previos al estudio en Cusco y catalogados como ôclínicamente sanosõ por dos médicos internistas y un neumólogo. La recolección gasométrica fue estandarizada, para el análisis estadístico se empleó medidas de tendencia central y dispersión, t de Student y análisis de varianza, correlación lineal y regresión lineal múltiple. Resultados. Las mujeres conformaron el 57,6% de la muestra; la frecuencia respiratoria fue 16,2 por minuto, y el IMC 24,8. Los resultados gasométricos fueron: pH=7,42mEq/L; pO2=61,08mmHg; pCO2=30,62mmHg; pAO2=62,52mmHg; SO2=91,13%; AaDO2=0,0mmHg; Hto 44,22%; Hb 14,74mg/dL; CaO2 18,18 vols/%; HCO3 19,74mmol/L; pO2/FiO2 290,79 y Anion Gap 20,99. Mediante regresión lineal, a partir de los 20 años de edad, por cada año cumplido, ôdisminuyenõ pO2 (0,122mmHg), pAO2 (0,08mmHg), SO2 (0,05%), índice pO2/FiO2 (0,571mmHg); e ôincrementaõ la pCO2 (0,056mmHg). Conclusiones. Los resultados hallados respecto a los parámetros gasométricos son diferentes a los del nivel de mar y pueden ser empleados en poblaciones que habitan a altitud semejante a la del estudio...

Objectives. To determine the normal values of arterial blood gases in clinically healthy adults living at 3,350 meters of altitude. Materials and methods. The study was conducted in the Santiago district of Cusco, Peru at 3,350 meters of altitude with a sample of 118 subjects determined in a previous pilot study and selected by convenience sampling. The sample included individuals between 20-59 years old with no pulmonary, cardiovascular and hematological medical history, who practice sports less than 60 minutes per day, non smoking, have resided at least 5 years prior to the study in Cusco and were characterized through clinical examination by two internists and pulmonologists as ôclinically healthyõ. The arterial blood gas collection was standardized for statistical analysis measures of central tendency and dispersion. StudentÆs t-tests and analysis of variance, linear correlation and multiple linear regression were applied. Results. Women comprised 57.6% of the sample. Respiratory rate averaged 16.2 per minute and BMI 24.8. The blood gas results were: pH 7.42 mEq/L; pO2 61.08 mm Hg; pCO2 30.62 mm Hg; pAO2 62.52 mm Hg; SO2 91.13%; AaDO2 0.0 mm Hg; Hto 44.22%; Hb 14.74 mg/dL; CaO2 18.18 vol%; HCO3 19.74 mmol/L; pO2/FiO2 290.79 and Anion Gap 20.99. Using linear regression, it was observed that each year from the age of 20, there was a decrease in pO2 (0.122 mm Hg), pAO2 (0.08 mm Hg), SO2 (0.05%), index pO2/FiO2 (0.571 mm Hg) and an increase in pCO2 (0.056 mm Hg). Conclusions. The results found with respect to blood gases in this population are different from those residing at sea level and can be used to study other populations residing at a similar altitude...

The economic burden of pediatric gastroenteritis to Bolivian families: a cross-sectional study of correlates of catastrophic cost and overall cost burden.

BACKGROUND: Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income). METHODS: From 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model). RESULTS: We determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child's first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]). CONCLUSIONS: Our analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.