Intake Characteristics as Predictors of Psychotherapy Outcome in a Practice Research Network in Argentina.

There are few studies exploring intake diagnostic characteristics as predictors of change in integrative naturalistic settings. The aim of this study is to explore baseline variables at the intake process and establish the predictive value of the individual trajectories of the patients. We recruited 259 patients undergoing an integrative psychotherapy network of psychotherapists from Buenos Aires, Argentina. Every therapist completed the intake form of each patient involved in the routine outcome monitoring. Thereafter step-wise regressions based on forward selection strategies were used, in order to identify meaningful baseline predictors of patients' clinical evolution, derived from the intake process. The selected predictors were social support network, subjective distress, the initial measure of clinical distress, unemployment, sociocultural status and reactance. When including those six variables in a multilevel model, the results indicate that social support network, subjective distress, and the initial measure of clinical distress were significant predictors of the trajectories of OQ-30, whereas unemployment, sociocultural status and reactance were not significant. The results regarding social support network are in line with the literature, while results of socioeconomic status (unemployment and sociocultural level) move in an opposite direction in comparison to the available evidence. Moreover, the mental health findings (initial OQ-30 and subjective distress) confirm the contradictory body of literature produced in this domain. Finally, reactance seems to be a significant predictor in previous study in contradiction of our results. Overall, this endeavor constitutes important but preliminary evidence to enhance the production of bottom-up science within practice research networks in the global south.

Delay Compensation in a Feeder-Conveyor System Using the Smith Predictor: A Case Study in an Iron Ore Processing Plant.

Conveyor belts serve as the primary mode of ore transportation in mineral processing plants. Feeders, comprised of shorter conveyors, regulate the material flow from silos to longer conveyor belts by adjusting their velocity. This velocity manipulation is facilitated by automatic controllers that gauge the material weight on the conveyor using scales. However, due to positioning constraints of these scales, a notable delay ensues between measurement and the adjustment of the feeder speed. This dead time poses a significant challenge in control design, aiming to prevent oscillations in material levels on the conveyor belt. This paper contributes in two key areas: firstly, through a simulation-based comparison of various control techniques addressing this issue across diverse scenarios; secondly, by implementing the Smith predictor solution in an operational plant and contrasting its performance with that of a single PID controller. Evaluation spans both the transient flow rate during step change setpoints and a month-long assessment. The experimental results reveal a notable increase in production by 355 t/h and a substantial reduction in flow rate oscillations on the conveyor belt, evidenced by a 55% decrease in the standard deviation.

Clinical predictors for mechanical ventilation assistance in Guillain-Barré syndrome.

Background: Guillain-Barré syndrome (GBS) frequently leads to respiratory failure and autonomic dysfunction, resulting in approximately one-third of patients requiring mechanical ventilation. Objective: This study aimed to identify clinical predictors for mechanical ventilation in patients with GBS. Methods: This research was conducted from 2010 to 2021 using registries from a tertiary hospital in an upper middle-income Latin American country. Participants were categorized into two groups based on their ventilation status. Demographic data were collected, and independent predictors of the need for mechanical ventilation were determined through multivariate logistic regression analysis. Results: Dysautonomic events occurred in 36% of the patients, with 17% requiring mechanical ventilation; the average duration of intubation was 1.16 ± 3.18 days. The multivariate analysis indicated that bulbar dysfunction significantly increased the likelihood of requiring mechanical ventilation by 19-fold (OR 18.67, 95% CI 5.85-59.42), followed by ophthalmoplegia, which increased the likelihood by sixfold (OR 5.68, 95% CI 1.28-25.19). Conclusion: Bulbar dysfunction, dysautonomia, and lower Medical Research Council (MRC) scores were significant predictors of the need for mechanical ventilation in hospitalized GBS patients. These findings support the need for close monitoring and early admission to the intensive care unit (ICU) admission for at-risk patients.

Factors Predicting Prolonged Mechanical Ventilation in Guillain-Barré Syndrome.

BACKGROUND: Up to 30% of patients with Guillain-Barré syndrome require mechanical ventilation and 5% die due to acute complications of mechanical ventilation. There is a considerable group of patients that will need prolonged mechanical ventilation (considered as >14 days) and should be considered for early tracheostomy. The objective of this study is to identify risk factors for prolonged mechanical ventilation. METHODS: We prospectively analyzed patients with Guillain-Barré diagnosis with versus without prolonged mechanical ventilation. We considered clinical and electrophysiological characteristics and analyzed factors associated with prolonged mechanical ventilation. RESULTS: Three hundred and three patients were included; 29% required mechanical ventilation. When comparing the groups, patients with prolonged invasive mechanical ventilation (IMV) have a lower score on the Medical Research Council score (19.5 ± 16.2 vs 27.4 ± 17.5, p = 0.03) and a higher frequency of dysautonomia (42.3% vs 19.4%, p = 0.037), as well as lower amplitudes of the distal compound muscle action potential (CMAP) of the median nerve [0.37 (RIQ 0.07-2.25) vs. 3.9 (RIQ1.2-6.4), p = <0.001] and ulnar nerve [0.37 (RIQ0.0-3.72) vs 1.5 (RIQ0.3-6.6), p = <0.001], and higher frequency of severe axonal damage in these nerves (distal CMAP ≤ 1.0 mV). Through binary logistic regression, severe axonal degeneration of the median nerve is an independent risk factor for prolonged IMV OR 4.9 (95%CI 1.1-21.5) p = 0.03, AUC of 0.774, (95%CI 0.66-0.88), p = < 0.001. CONCLUSIONS: Severe median nerve damage is an independent risk factor for prolonged mechanical ventilation.

Las apolipoproteínas como marcadores predictivos de riesgo metabólico-vascular en pediatría / Apolipoproteins as predictive markers of metabolic-vascular risk in pediatrics

Introducción: La búsqueda de nuevos marcadores predictivos, en la estratificación de riesgos metabólicos-vasculares, es de vital importancia en la prevención, diagnóstico y tratamiento oportuno de enfermedades cardiometabólicas, al considerar que el proceso aterosclerótico se inicia desde la infancia. La revisión documental se realizó entre marzo y julio del 2022, consultadas las bases de datos PubMed/Medline, SciElo, Scopus y el Google académico como puerta de entrada de la información sobre el tema. Se revisaron 33 artículos originales en el período 2012-2021 en idioma inglés y español, referenciados 29 y los términos clave para la búsqueda fueron, riesgo metabólico-vascular, apolipoproteínas A1 y B100, marcadores predictores de riesgo metabólico-vascular, niñez, adolescencia. Objetivo: Analizar la importancia de las apolipoproteínas como marcadores predictores del riesgo metabólico- vascular pediátrico. Desarrollo: Las apolipoproteínas han surgido como una alternativa muy viable, particularmente la determinación de ApoB 100 y ApoA 1, que expresan el equilibrio entre la actividad aterogénica y la antiaterogénica y están presentes desde las edades tempranas de la vida. El diagnóstico temprano de estos marcadores, permitirá aplicar intervenciones precoces para propiciar cambios a estilos de vidas saludables, así como tratamientos preventivos que impidan las complicaciones de la enfermedad cardiometabólica. Conclusiones: Al considerar que el proceso aterosclerótico se inicia en edades tempranas, las apolipoproteínas constituyen marcadores en la predicción del riesgo metabólico-vascular, su determinación permite la identificación, estratificación del riesgo y propuesta de estrategias preventivas desde las edades pediátricas(AU)

Introduction: The search for new predictive markers, in the stratification of metabolic-vascular risks, is of vital importance in the prevention, diagnosis and timely treatment of cardiometabolic diseases, considering that the atherosclerotic process begins in childhood. The documentary review was carried out between March and July 2022, consulting the PubMed/Medline, SciElo, Scopus and Google Scholar databases as a gateway to information on the topic. 33 original articles were reviewed in the period 2012-2021 in English and Spanish, 29 were referenced and the key terms for the search were, metabolic-vascular risk, apolipoproteins A1 and B100, markers predictive of metabolic-vascular risk, childhood adolescence. Objective: To analyze the importance of apolipoproteins as predictive markers of pediatric metabolic-vascular risk. Development: Apolipoproteins have emerged as a very viable alternative, particularly the determination of ApoB 100 and ApoA 1, which express the balance between atherogenic and antiatherogenic activity and are present from the early ages of life. Early diagnosis of these markers will allow for early interventions to promote changes to healthy lifestyles, as well as preventive treatments that prevent complications of cardiometabolic disease. Conclusions: Considering that the atherosclerotic process begins at an early age, apolipoproteins constitute markers in the prediction of metabolic-vascular risk, their determination allows the identification, risk stratification and proposal of preventive strategies from pediatric ages(AU)

Medición de la fuerza muscular en adultos como predictor de extubación en Unidades de Cuidados Intensivos. Revisión narrativa / Measurement of muscular strength in adults as a predicator of extubation in intensive care units. Narrative review

Resumen: Introducción: uno de los principales efectos de la ventilación mecánica invasiva es la lesión de los músculos respiratorios, específicamente, sobre el diafragma en el que pueden ocurrir alteraciones estructurales y funcionales que modifican parcial o totalmente su función. Durante la ventilación mecánica se produce un proceso de atrofia por desuso de dicho músculo. Por ello la utilidad clínica de la medición de la fuerza muscular diafragmática es importante para conocer si el paciente tiene la capacidad de activar los mecanismos protectores de la vía aérea para lograr la extubación exitosa y el retiro del ventilador mecánico en el menor tiempo posible. Objetivos: describir la medición de la fuerza muscular como predictor de la extubación en las unidades de cuidados intensivos. Material y métodos: se realizó una revisión de la literatura, entre 2011 y 2022. Resultados: los pacientes que son sometidos a ventilación mecánica invasiva prolongada generalmente desarrollan una afección muscular diafragmática, lo que se convierte en una problemática para el proceso de extubación temprana, por lo cual es vital conocer los métodos de medición de fuerza muscular como predictor de extubación.

Abstract: Introduction: one of the main effects of invasive mechanical ventilation is injury to the respiratory muscles, specifically the diaphragm. In which structural and functional alterations can occur that partially or totally modify its function. During mechanical ventilation, a process of disuse atrophy of said muscle occurs. Therefore, the clinical utility of measuring diaphragmatic muscle strength is important to know if the patient has the ability to activate the protective mechanisms of the airway to achieve successful extubation and removal of the mechanical ventilator in the shortest time possible. Objective: describe the measurement of muscle strength as a predictor of extubation in intensive care units. Material and methods: a literature review was carried out, carried out between 2011 and 2022. Results: patients who are subjected to prolonged mechanical ventilation generally develop a diaphragmatic muscle disorder, becoming a problem for the weaning, for it is important know the methods of measuring muscle strength.

Predicting the Outcome of ICU Patients with COVID-19 Requires the Inclusion of All Influencing Factors.

How to cite this article: de Almeida AG, Scorza FA, Finsterer J. Predicting the Outcome of ICU Patients with COVID-19 Requires the Inclusion of all Influencing Factors. Indian J Crit Care Med 2023;27(11):845-846.

Correlation between ischemic stroke topography and female urinary incontinence.

AIM: To investigate the association between ischemic stroke topography and the onset of urinary incontinence (UI); to evaluate predictors of post-stroke UI in women. METHOD: We prospectively followed up a cohort of women with ischemic stroke confirmed by clinical and computed tomography (CT) or magnetic resonance imaging (MRI) scans findings. Participants were subjected to interview, clinical evaluation, and urodynamic study if needed at 6 months post-stroke and divided in continent and incontinent groups. Non-parametric tests compared the baseline characteristics among the groups and determined association between post-stroke UI and the brain sites of injury. Logistic regression analysis determined predictors of post-stroke UI. Significance level at 5 % was set. RESULTS: 162 S-women were included: 128 (79 %) continent and 34 (21 %) incontinent. Frontal lobe lesions were higher in the incontinent group (82.9 % versus 51.2 %, p = 0.001); lesions in the parietal lobe and the left cerebral hemisphere were higher in the continent group (40.9 % versus 20 %, p = 0.023; and 61.4 % versus 40 %, p = 0.024, respectively). Frontal lobe injury [RR 3.68 (CI 1.2-11.2)], body mass index (BMI) [RR1.16 (CI 1.062-1.266)] and number of vaginal deliveries [RR 1.358 (CI 1.163-1.585)] are risk factors for post-stroke UI. Left parietal lobe injury is less likely to occur in continent women after 6 months [RR 0.168 (CI 0.029-0.981; p = 0.048)]. CONCLUSION: There is a correlation between the topography of the ischemic stroke and the onset of UI. Frontal lobe lesion, BMI and number of vaginal deliveries are predictors of post-stroke UI.

Predictors of long-term healing for endorectal advancement flap for anorectal fistulas

Introduction: Anorectal fistulas are some of the commonest surgical proctologic disorders treated by surgeons. Despite the recent introduction of various sphincter preserving techniques, the search for the optimal operation continues. The purpose of this study was to determine the predictors of long-term healing for the endorectal advancement flap. Methods: A retrospective review of a single surgeon experience with the endorectal advancement flap for anorectal fistulas over an 18-year period. The impact of various patient and fistula related factors were analyzed for their impact on the primary endpoint of long-term fistula healing. Results: 87 patients underwent endorectal advancement flap (Male/Female 42.5/57.5%). Median age was 41 years. Sixty-nine patients (79.3%) had anal fistula while 18 patients had rectal fistula (20.7%). An anterior based fistula was noted in 45 patients (51.7%). The most common etiology was cryptoglandular disease (87.4%). The median operative time was 75minutes (range 36-250). Postoperative septic complications were noted in 4 patients (4.6%). Fistula healing was documented in 80 patients (93%). During a median follow-up of 4 months (range 1-38, 1 patient lost to follow-up), recurrence was noted in 8 patients (9.3%), yielding an overall long-term success rate of 83.7%. The long-term healing rate was higher in patients with fistulas from cryptoglandular etiology (86.6%) compared to fistulas from other etiologies (63.6%) [p = 0.027]. Conclusions: The endorectal advancement is associated with a high healing rate, a low postoperative septic complication rate, and infrequent risk for recurrence. Long-term healing without recurrence is achieved more frequently in patients with cryptoglandular etiology of the fistula compared to patients with non-cryptoglandular etiology. (AU)

Disentangling the contributions of biotic and abiotic predictors in the niche and the species distribution model of Trypanosoma cruzi, etiological agent of Chagas disease.

The potential benefits of incorporating biotic, as well as abiotic, predictors in niche and species distribution models (SDMs), as well as how to achieve this, is still debated, with their interpretability and explanatory potential being particularly questioned. It is therefore important to stress test modelling methodologies that include biotic factors against use cases where there is ample knowledge of the potential biotic component of the niche. Relatively well studied and important vector-borne diseases offer just such an opportunity, where knowledge of the agents involved in the transmission cycle -vectors and hosts- can serve to calibrate and test the niche model and corresponding SDM. Here, we study the contributions of biotic -14 vectors, 459 potential hosts- and abiotic -258 climatic categories- predictors to the explanatory and predictive features of the niche and corresponding SDM for the etiological agent of Chagas disease, Trypanosoma cruzi, in Mexico. Using an established spatial data mining technique, we generate biotic, abiotic and biotic+abiotic niche and SDM models. We test our models by comparing predictions of the most important probable hosts of Chagas disease with a previously published list of confirmed hosts. We quantify, compare, and contrast the individual and total contributions of predictors to the niche and distribution of Chagas disease in Mexico. We assess the relative predictive potential of these variables to model performance, showing that models that include relevant biotic niche variables lead to more predictive, more ecologically realistic SDMs. Our research illustrates a useful general procedure for identifying and ranking potential biotic interactions and for assessing the relative importance of biotic and abiotic predictors. We conclude that the inclusion of both abiotic and biotic predictors in SDMs not only provides more predictive and accurate models but also models that are more understandable and explainable from an ecological niche perspective.

Asociación entre índice neutrófilo/linfocito como biomarcador de mortalidad en pacientes con quemaduras mayores durante el periodo del 01 de febrero de 2020 al 28 de enero de 2022 / Association between neutrophil/lymphocyte ratio as a biomarker of mortality in patientswith major burns during the period February 1, 2020 to January 28, 2022 / Associação entre a relação neutrófilo/linfócito como biomarcador de mortalidade empacientes com grandes queimaduras no período de 1º de fevereiro de 2020 a 28 de janeiro de 2022

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Abstract: Introduction: burns are a serious public health problem, with several studies estimating that more than 11 million people were affected by burn injuries with approximately 300,000 deaths worldwide. Studies showed that the main causes of death were inhalation injuries, infection, and metabolic and hemodynamic complications ending in multi-organ failure. It has been shown that the increase in the systemic inflammatory response, whose parameters can be easily obtained, can be useful and directly related to poor prognosis. Several clinical studies indicate that the ratio of neutrophils to lymphocytes, an indicator of systemic inflammatory response, can signify the presence of inflammation in some diseases such as diabetes, coronary artery disease, cholangitis, rheumatoid arthritis, and recently COVID-19. Objective: to know the association between the neutrophil lymphocyte index as a biomarker of mortality in patients with major burns. Material and methods: an observational, retrospective, descriptive, longitudinal study will be carried out: with a user population of the National Center for Research and Attention to Burned Patients (CENIAQ) of the Luis Guillermo Ibarra Ibarra National Rehabilitation Institute. A review of the clinical records of the patients treated in the period will be carried out during the period from February 1, 2020 to February 28, 2022, the data of admission and discharge will be taken into account, as well as initial laboratory studies. The information will be recorded in an Excel spreadsheet to be later analyzed in the SPSS software, the results will be obtained and finally their analysis will be carried out. Results: in the analyzed population we found that the average age is 40 years, it was also found that the most affected gender in this population corresponds to the male gender with 81.2%. It was also found that, within the diagnoses of the population studied, fire burn was the one that most affected the population, this being 67.1% of all diagnoses. However, in this study no significant difference was found in the neutrophil lymphocyte index with respect to the type of burn. In our analysis, the neutrophil lymphocyte index was included as a biochemical predictor of mortality, since high levels of this index at admission are associated with increased mortality. In our population, a significant difference was found between the groups with a fatal clinical outcome and those who recovered, which is why it can be considered as a predictor of mortality in these patients since they presented a p value < 0.023, data that is consistent with what is reported in the international literature where the Neutrophil lymphocyte index value can be used as a predictor of mortality. Conclusions: an association was found between the elevation of the neutrophil/lynphocyte ratio and mortality in patients with severe burns.

Resumo: Introdução: as queimaduras são um grave problema de saúde pública, onde estima-se em diversos estudos que mais de 11 milhões de pessoas foram acometidas por queimaduras com aproximadamente 300.000 mortes em todo o mundo. Estudos mostraram que as principais causas de morte foram lesões inalatórias, infecções e complicações metabólicas e hemodinâmicas que culminaram em falência de múltiplos órgãos. Tem sido demonstrado que o aumento da resposta inflamatória sistêmica, cujos parâmetros podem ser facilmente obtidos, pode ser útil e estar diretamente relacionado ao mau prognóstico. Vários estudos clínicos indicam que a proporção de neutrófilos para linfócitos, um indicador de resposta inflamatória sistêmica, pode significar a presença de inflamação em algumas doenças como diabetes, doença arterial coronariana, colangite, artrite reumatóide e recentemente COVID-19. Objetivo: conhecer a associação entre o índice neutrófilo-linfócito como biomarcador de mortalidade em pacientes com grandes queimaduras. Material e métodos: será realizado um estudo observacional, descritivo, retrospectivo, longitudinal: com a população usuária do Centro Nacional de Pesquisa e Atenção ao Paciente Queimado (CENIAQ), do Instituto Nacional de Reabilitação Luis Guillermo Ibarra Ibarra. Realizaremos uma revisão dos prontuários clínicos dos pacientes atendidos no período de 1º de fevereiro de 2020 a 28 de fevereiro de 2022, serão levados em consideração os dados de admissão e alta, bem como os estudos laboratoriais iniciais. As informações serão registradas em planilha Excel para posteriormente serem analisadas no software SPSS, serão obtidos os resultados e por fim será realizada a análise. Resultados: na população analisada verificamos que a média de idade é de 40 anos, constatou-se também que o gênero mais acometido nesta população corresponde ao gênero masculino com 81.2%. Constatou-se também que, dentro dos diagnósticos da população estudada, a queimadura por fogo foi o que mais afetou a população, sendo este 67.1% do total de diagnósticos. No entanto, neste estudo não foi encontrada diferença significativa no índice neutrófilo-linfócito em relação ao tipo de queimadura. Em nossa análise, foram incluídos o índice neutrófilo-linfócito como preditor bioquímico de mortalidade, uma vez que altos níveis desse índice na admissão estão associados a aumento da mortalidade. Em nossa população, foi encontrada diferença significativa entre os grupos com desfecho clínico fatal e os recuperados, motivo pelo qual pode ser considerado como preditor de mortalidade nesses pacientes, pois apresentaram valor de p < 0.023, dado compatível com o relatado em a literatura internacional onde o valor do índice neutrófilo-linfócito pode ser utilizado como preditor de mortalidade. Conclusões: encontrou-se associação entre a elevação do índice neutrófilo/linfócito e mortalidade em pacientes com queimaduras graves.

Assessment of Predictors of Infection in Primary Knee and Hip Arthroplasty: A Case-control Study.

Objective This study assesses risk factors for periprosthetic joint infection after elective primary total knee or hip arthroplasty. Methods The study included 706 medical records of patients undergoing elective primary total hip or knee arthroplasty from January to December 2018. We used a multivariate analysis of infection predictors through a logistic regression model. The R software performed all statistical analysis. Results The prevalence of infection in the sample was 2.0% (14 cases). Most patients were women (79.6%), with an afflicted right side (50.6%), and underwent a total knee arthroplasty (61.3%). Significant risk factors ( p < 0.05) for infection included surgical time greater than 120 minutes ( p = 0.009) and a history of diabetes ( p = 0.025). Conclusion The risk of infection after elective primary total knee or hip arthroplasty is higher when the surgical procedure is lengthy (over 120 minutes), or the patient has a history of diabetes mellitus. Level of Evidence IIIB, retrospective, case-control study.

Assessment of Predictors of Infection in Primary Knee and Hip Arthroplasty: A Case-control Study / Avaliação de fatores preditores de infecção na artroplastia primária de joelho e quadril: Um estudo caso-controle

Abstract Objective This study assesses risk factors for periprosthetic joint infection after elective primary total knee or hip arthroplasty. Methods The study included 706 medical records of patients undergoing elective primary total hip or knee arthroplasty from January to December 2018. We used a multivariate analysis of infection predictors through a logistic regression model. The R software performed all statistical analysis. Results The prevalence of infection in the sample was 2.0% (14 cases). Most patients were women (79.6%), with an afflicted right side (50.6%), and underwent a total knee arthroplasty (61.3%). Significant risk factors (p< 0.05) for infection included surgical time greater than 120 minutes (p= 0.009) and a history of diabetes (p= 0.025). Conclusion The risk of infection after elective primary total knee or hip arthroplasty is higher when the surgical procedure is lengthy (over 120 minutes), or the patient has a history of diabetes mellitus. Level of EvidenceIIIB, retrospective, case-control study.

Resumo Objetivo Avaliar os fatores de risco para infecção articular periprotética após procedimento cirúrgico eletivo de artroplastia primária total de joelho ou quadril. Métodos Incluem-se no estudo 706 prontuários de pacientes que foram submetidos a artroplastia total primária eletiva de quadril ou joelho entre os meses de janeiro e dezembro de 2018. Utilizou-se a análise multivariada dos fatores preditores de infecção por meio de um modelo de regressão logística. Toda a análise estatística foi realizada no software R. Resultados A prevalência de infecção de toda a amostra foi de 2,0% (14 casos). A amostra contou com a maioria do gênero feminino (79,6%), com o lado direito afetado (50,6%) e predomínio da artroplastia total de joelho (61,3%). Os fatores de risco significativos (p< 0,05) para a infecção foram: tempo cirúrgico maior do que 120 minutos (p= 0,009) e diagnóstico prévio de diabetes (p= 0,025). Conclusão Artroplastias totais primárias eletivas de joelho ou quadril possuem maior risco de infecção quando ocorre um tempo prolongado do procedimento cirúrgico (acima de 120 minutos) e quando o paciente possui diagnóstico prévio de diabetes mellitus. Nível de EvidênciaIIIB, estudo retrospectivo caso-controle.

Sociodemographic and Personal Predictors of Exclusive Breastfeeding in Pregnant Mexican Women Using Public Health Services.

Exclusive breastfeeding (EBF) is a cost-effective healthy behavior for the mother-child dyad. Globally, rates of EBF are low. Little research has been conducted on the joint role of modifiable and nonmodifiable variables in pregnant women's decision-making. The aim was to develop and test a model that used personal and sociodemographic factors to predict whether pregnant women who use public healthcare services plan to breastfeed. In a nonprobabilistic sample of 728 pregnant Mexican women, self-efficacy, the planned behavior theory constructs, and the intention to breastfeed (BFI) were measured. A total 60% of the sample was randomly chosen to develop a predictive multivariate logistic regression model. The model was validated in the remaining 40%. Women in the highest tertiles of attitudes and self-efficacy had fourfold increased chances of having a high BFI (OR 4.2, 95% CI [2.4, 7.4]). Working was associated with a decreased intention to exclusively breastfeed (OR 0.61, 95% CI [0.37, 0.98]). The model predicted BFI with a sensitivity of 38.3% and specificity of 82.2%. While personal variables predict the BFI, working decreases women's chances of breastfeeding. The results can be utilized to develop primary prevention strategies to help mothers who use public health services to breastfeed.

Curating the gnomAD database: Report of novel variants in the thyroid peroxidase gene using in silico bioinformatics algorithms and a literature review.

Thyroid peroxidase (TPO) is a membrane-bound glycoprotein located at the apical side of the thyroid follicular cells that catalyzes both iodination and coupling of iodotyrosine residues within the thyroglobulin molecule, leading to the synthesis of thyroid hormone. Variants in TPO cause congenital hypothyroidism (CH) by iodide organification defect and are commonly inherited in an autosomal recessive fashion. In the present work, we report a detailed population analysis and bioinformatic prediction of the TPO variants indexed in the Genome Aggregation Database (gnomAD) v2.1.1. The proportion of missense cysteine variants and nonsense, frameshift, and splice acceptor/donor variants were analyzed in each ethnic group (European (Non-Finnish), European (Finnish), African/African Americans, Latino/Admixed American, East Asian, South Asian, Ashkenazi Jewish, Other). The results showed a clear predominance of frameshift variants in the East Asian (82%) and European (Finnish) (75%) population, whereas the splice site variants predominate in African/African Americans (99.46%), Other (96%), Latino/Admixed American (94%), South Asian (86%), European (Non-Finnish) (56%) and Ashkenazi Jewish (56%) populations. The analysis of the distribution of the variants indexed in gnomAD v2.1.1 database revealed that most missense variants identified in the An peroxidase domain map in exon 8, followed by exons 11, 7 and 9, and finally in descending order by exons 10, 6, 12 and 5. In total, 183 novel TPO variants were described (13 missense cysteine's variants, 158 missense variants involving the An peroxidase domain and 12 splicing acceptor or donor sites variants) which were not reported in the literature and that would have deleterious effects on prediction programs. In the gnomAD v2.1.1 population, the estimated prevalence of heterozygous carriers of the potentially damaging variants was 1:77. In conclusion, we provide an updated and curated reference source of new TPO variants for application in clinical diagnosis and genetic counseling. Also, this work contributes to elucidating the molecular basis of CH associated with TPO defects.

Clinical characteristics and mortality predictors of patients with cancer hospitalized by COVID-19 in a pediatric third-level referral center.

Background: More than 135 million COVID-19 cases (coronavirus disease 2019) have been reported worldwide until today, with over 2.9 million deaths. Several studies have demonstrated that disease severity is lower in the pediatric population than in adults; however, differences are described in patients with chronic diseases, including oncological patients. Current world literature suggests patients with comorbidities, including cancer, have an increased risk of unfortunate outcomes. Therefore, our objective was to describe the clinical characteristics and epidemiological factors associated with mortality in a cohort of pediatric cancer patients hospitalized for COVID-19. Methods: This is a retrospective, descriptive study of the cases of patients with cancer hospitalized for COVID-19. A total of 40 pediatrics were included in the analysis. Data from pediatric patients with COVID-19 included clinical and epidemiological records, laboratory, imaging studies, COVID-19 diagnostic methods, and medical treatment. Results: Of the 40 pediatric patients admitted with cancer with a confirmed diagnosis of COVID-19, 42.5% were solid tumors, 40% leukemias, and 17.5% lymphomas. The clinical parameters associated with mortality were stage IV tumor (p = 0.029) and intubation (p < 0.001). The biochemical factors associated with lower survival were thrombocytopenia under 25,000 cells/mm3 (p < 0.001), D-dimer over 1 µg/ml (p = 0.003), clinical malnutrition (p = 0.023), and disseminated intravascular coagulation (p = 0.03). Conclusion: Our findings showed that the fever was the most frequent symptom, and the clinical parameters associated with mortality were stage IV tumor, intubation, saturation percentage, RDW, platelets, creatinine, ALT, D-dimer, ferritin, and FiO2 percentage. The thrombocytopenia, D-dimer, nutritional status, and disseminated intravascular coagulation were significantly associated with lower survival.

Predictores de potenciales reacciones adversas e interacciones medicamentosas en pacientes post accidente cerebrovascular en Perú

Objetivo Identificar los predictores clínicos y farmacoterapéuticos asociados a los niveles de severidad de las reacciones adversas (RAM) e interacciones medicamentosas (IM) en pacientes hospitalizados post accidente cerebrovascular. Métodos Estudio analítico, predictivo y transversal mediante el modelo de regresión lineal múltiple. Los niveles de severidad de las potenciales reacciones adversas e interacciones medicamentosas se evaluaron mediante Drugs.com. Resultados De la evaluación de 992 prescripciones médicas de 55 (56,7%) pacientes mujeres y 42 (43,3%) varones post accidente cerebrovascular isquémico 62 (63,9%) y hemorrágico 35 (36,1%), se identificó un total de 11 790±46,8 potenciales reacciones adversas y 1 034±9,8 interacciones medicamentosas. La hipertensión arterial se asoció a las reacciones adversas graves y moderadas, en tanto que la neumonía intrahospitalaria y alcalosis metabólica a reacciones adversas leves y moderadas. La alcalosis metabólica se asoció a las interacciones medicamentosas moderadas y leves. Los predictores farmacoterapéuticos como la prescripción en polifarmacia y el uso de antibióticos se relacionaron con reacciones adversas graves, moderadas y leves; los antidiabéticos se relacionaron con interacciones medicamentosas graves, moderadas y los fármacos para terapia cardiaca con interacciones medicamentosas leves. Conclusiones Las variables clínicas como factores de riesgo cardiovascular, presencia de comorbilidades que exacerban las enfermedades crónicas no trasmisibles, los signos y síntomas de alarma, el mayor tiempo de estancia hospitalaria y la prescripción en polifarmacia fueron predictores de mayor frecuencia de reacciones adversas e interacciones medicamentosas graves y moderadas que requieren especial vigilancia y estudio individualizado.

Objective To identify clinical and pharmacotherapeutic predictors associated with severity levels of adverse reactions and drug-drug interactions in post-stroke hospita-lized patients. Methods Analytic, predictive, cross-sectional study using multiple linear regression modeling. Severity levels of potential adverse reactions and drug-drug interactions were assessed using Drugs.com. Results From the evaluation of 992 medical prescriptions of 55 (56.7%) female and 42 (43.3%) male patients post ischemic stroke 62(63.9%) and hemorrhagic stroke 35 (36.1%); a total of 11 790±46.8 potential adverse reactions and 1 034±9.8 drug-drug interactions were identified; arterial hypertension was associated with severe and moderate adverse reactions; while in-hospital pneumonia and metabolic alkalosis with mild and moderate adverse reactions. While metabolic alkalosis was associated with moderate and mild drug-drug interactions. Pharmacotherapeutic predictors such as polypharmacy prescription and antibiotic use were related to moderate and mild severe adverse reactions; antidiabetic drugs were related to moderate and severe drug-drug interactions and cardiac therapy drugs were related to mild drug-drug interactions. Conclusions Clinical variables such as cardiovascular risk factors, presence of comorbidities that exacerbate chronic noncommunicable diseases, alarm signs and symptoms, longer hospital stay, as well as polypharmacy prescriptions, were predictors of a higher frequency of severe and moderate adverse reactions and drug-drug interactions, which require special vigilance and individualized study.

Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review / Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

OBJETIVO: O transtorno de estresse pós-traumático (TEPT) é um transtorno altamente prevalente e incapacitante. Mesmo quando tratado com uma intervenção de primeira linha, terapia cognitivo-comportamental (TCC), 45% dos pacientes continuam sofrendo desse transtorno. Portanto, conhecer os fatores que podem prever quem responderá à TCC seria de grande valor no tratamento desses pacientes. Por esse motivo, revisamos sistematicamente a literatura para identificar as variáveis que poderiam predizer a resposta à TCC em pacientes que sofrem de TEPT. MÉTODOS: Seguindo as diretrizes do PRISMA 2020, pesquisamos em banco de dados eletrônico como ISI Web of Science, Scopus, PsycINFO, MEDLINE e PTSDpubs até novembro de 2021. Dois autores conduziram independentemente a seleção do estudo e a extração de dados. Estudos que examinaram possíveis preditores de resposta à terapia, com amostra de adultos (18-65 anos) de ambos os sexos, com e sem comorbidades, foram considerados elegíveis. As características dos estudos foram sintetizadas em uma tabela. O risco de viés foi avaliado pela ferramenta de avaliação de qualidade de risco de viés da Cochrane. RESULTADOS: Vinte e oito estudos envolvendo 15 variáveis foram selecionados. Desses, oito mostraram baixo risco de viés, 19 mostraram algumas preocupações e um mostrou alto risco potencial de viés. A relação terapêutica foi a única variável considerada um preditor de boa resposta à terapia. Todas as outras variáveis apresentaram resultados conflitantes. CONCLUSÕES: A variável mais promissora, embora muito fraca cientificamente, é a relação terapêutica. Ensaios clínicos randomizados adicionais devem ser conduzidos para esclarecer o papel dessa variável como um preditor de resposta da TCC em pacientes com TEPT.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. METHODS: Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. RESULTS: Twenty- -eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. CONCLUSIONS: The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.

Mean Platelet Volume as a Predictor of COVID-19 Severity: A Prospective Cohort Study in the Highlands of Peru.

INTRODUCTION: Although 80% of symptomatic individuals with COVID-19 develop mild forms, it is the severe (15%) and critical (5%) forms that have the greatest impact in the hospital setting. Recognizing markers that can predict severe forms is essential, especially in high-altitude populations. METHODS: We conducted a prospective cohort study at 3200 masl (meters above sea level) in a city in Peru to determine if MPV (mean platelet volume) level is a predictor of COVID-19 severity. Patients with mild/moderate disease were enrolled and followed for 21 days or until the development of severe disease (primary outcome). A bivariate analysis was used to identify variables associated with severe disease. A ROC analysis determined the best MPV (mean platelet count) cut-off to predict COVID-19 severity, and then, a multiple regression analysis was performed. RESULTS: 64 patients were enrolled. The median age was 48.5 years (IQT 39-64.5) and the proportion of women was 51.6%, the most frequent symptoms were chest pain (73%), fever (71%), and dyspnea (67%). The median time to develop a severe form from the onset of symptoms was 11 days (IQT 10.5-13). The most common radiographic phase on CT scan (computed tomography) was progressive (60.38%). We observed that an MPV of more than 10.15 fL in the first week of disease predicted severity regardless of age and sex at high altitudes. CONCLUSIONS: MPV in the first week of the disease may predict severity in patients diagnosed with COVID-19 at high altitudes; however, we need prospective studies with a larger population and at a different altitude, levels to confirm these findings.