Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study.

BACKGROUND: The awake prone positioning strategy for patients with acute respiratory distress syndrome is a safe, simple and cost-effective technique used to improve hypoxaemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease 2019 (COVID-19) who underwent awake prone positioning during hospitalisation. METHODS: In this retrospective, multicentre observational study conducted between 1 May 2020 and 12 June 2020 in 27 hospitals in Mexico and Ecuador, nonintubated patients with COVID-19 managed with awake prone or awake supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding. RESULTS: 827 nonintubated patients with COVID-19 in the awake prone (n=505) and awake supine (n=322) groups were included for analysis. Fewer patients in the awake prone group required endotracheal intubation (23.6% versus 40.4%) or died (19.8% versus 37.3%). Awake prone positioning was a protective factor for intubation even after multivariable adjustment (OR 0.35, 95% CI 0.24-0.52; p<0.0001, E=2.12), which prevailed after propensity score analysis (OR 0.41, 95% CI 0.27-0.62; p<0.0001, E=1.86) and mortality (adjusted OR 0.38, 95% CI 0.26-0.55; p<0.0001, E=2.03). The main variables associated with intubation among awake prone patients were increasing age, lower baseline peripheral arterial oxygen saturation/inspiratory oxygen fraction ratio (P aO2 /F IO2 ) and management with a nonrebreather mask. CONCLUSIONS: Awake prone positioning in hospitalised nonintubated patients with COVID-19 is associated with a lower risk of intubation and mortality.

A case report of atypical preeclampsia with severity criteria for hydatidiform complete mole.

Preeclampsia is defined as elevation of blood pressure and any of the following severity criteria: proteinuria, thrombocytopenia, elevation of creatinine in the absence of another renal pathology, elevation of transaminases, pulmonary edema, or neurological symptoms. However, after 20 weeks of gestation in a previously normotensive patient, cases of preeclampsia associated with molar pregnancy have been described in patients at less than 20 weeks of gestation. A 26-year-old woman, at 14.1 weeks of gestation was admitted to the lower extremities with facial edema, holocranial headache, nausea, epigastralgia, phosphenes, and photophobia, with a double-length uterine fundus for gestational age and ultrasonography. Obstetricians who showed images of snowflakes without fetuses and annexes had multiple thecal-lutein cysts. Atypical preeclampsia was identified using the severity data for complete hydatidiform moles. Given the possibility of serious complications that may endanger the life of the maternal-fetal binomial, atypical forms of preeclampsia should be suspected.

Effects of home confinement on physical activity, nutrition, and sleep quality during the COVID-19 outbreak in amateur and elite athletes.

Introduction: Despite the progress in the management of the pandemic caused by COVID-19, it is necessary to continue exploring and explaining how this situation affected the athlete population around the world to improve their circumstances and reduce the negative impact of changes in their lifestyle conditions that were necessitated due to the pandemic. The aim of this study was to analyze the moderating influence of physical activity (PA) and dietary habits on the impact of the COVID-19 pandemic experience on sleep quality in elite and amateur athletes. Materials and methods: A total of 1,420 elite (40.1%) and amateur (59.9%) athletes (41% women; 59% men) from 14 different countries participated in a cross-sectional design study. Data were collected using a battery of questionnaires that identified sociodemographic data, sleep quality index, PA levels, dietary habits, and the athletes' perception of their experience during the COVID-19 pandemic. Means and standard deviations were calculated for each variable. The analysis of variances and the correlation between variables were carried out with non-parametric statistics. A simple moderation effect was calculated to analyze the interaction between PA or dietary habits on the perception of the COVID-19 experience effect on sleep quality in elite and amateur athletes. Results: The PA level of elite athletes was higher than amateur athletes during COVID-19 (p < 0.001). However, the PA level of both categories of athletes was lower during COVID-19 than pre-COVID-19 (p < 0.01). In addition, amateurs had a higher diet quality than elite athletes during the pandemic (p = 0.014). The perception of the COVID-19 experience as controllable was significantly higher (p = 0.020) among elite athletes. In addition, two moderating effects had significant interactions. For amateur athletes, the PA level moderated the effect of controllable COVID-19 experience on sleep quality [F (3,777) = 3.05; p = 0.028], while for elite athletes, the same effect was moderated by dietary habits [F (3,506) = 4.47, p = 0.004]. Conclusion: Elite athletes had different lifestyle behaviors compared to amateurs during the COVID-19 lockdown. Furthermore, the relevance of maintaining high levels of PA for amateurs and good quality dietary habits by elite athletes was noted by the moderating effect that both variables had on the influence of the controllable experience during the COVID-19 pandemic on sleep quality.

Canine distemper in neotropical procyonids: Molecular evidence, humoral immune response and epidemiology.

Canine Distemper Virus (CDV) can produce a fatal multisystem disease in carnivores and other mammals and is an important threat for wildlife conservation. However, integrative and comparative studies in wild carnivores are scarce and some areas of the world lack of genetic studies. We explore the dynamic of host-CDV in a procyonid community during an outbreak. This study reports for the first time an index case occurred in a common raccoon (Procyon lotor) and for which a complete CDV diagnosis was performed. The long-term epidemiological analysis in two sympatric populations of common raccoons and white-nosed coatis (Nasua narica) was achieved through seroneutralization, RT-PCR and direct immunofluorescence assays. Additionally, hematologic analyses were performed and phylogenetic reconstruction of CDV was done using molecular data from this study. Overall prevalence for white-nosed coatis was 19.6 % and for common raccoons was 25.3 % by seroneutralization, and 13.3 % and 17.3 % by RT-PCR. Antibodies titer average for white-nosed coatis was 1:512 and 1:156 for common raccoons. Significant difference in prevalence between white-nosed coatis and common raccoons was detected during one season (summer 2013). White-nosed coatis showed differences in erythrocytes and monocytes counts between positives and negative animals. A 100 % similarity was found between CDV of white-nosed coati and CDV of common raccoon and is a new CDV sequence not previously described; this sequence is close to Asian and European lineage. An endemic state of distemper in both species was observed but showed different dynamics over time per host species. Differences in cellular and humoral responses were also detected between procyonids. The evidence found here may have serious implications for CDV understanding in wild carnivores, it reveals clear differences in the response over time to the same CDV strain, in two close related carnivore species.

Rat aorta relaxation induced by the venom of Poecilotheria regalis involves the activation of the NO/cGMP pathway.

Spider venoms are widely recognized as a new emerging source of potential research tools, pesticides, drug leads, and therapeutic agents. Some studies suggest that these venoms may contain interesting vasodilator compounds with potential therapeutic applications. In the present study, the vasodilator activity of the venom of Poecilotheria regalis was evaluated in isolated rat aortic rings. This venom induced an endothelium-dependent vasodilation [EC50 value was 5.52 (4.18-7.32) µg protein/ml with an Emax = 103.4 ±â€¯3.8%]. While the percentage of vasodilation induced by the venom was significantly diminished in the presence of a nitric oxide synthase inhibitor (L-NAME), it remained unaltered in the presence of suramin, a P2-purinergic receptor antagonist. Moreover, the vasodilator activity of the venom was not affected after boiling bath incubation, but was significantly decreased under reducing conditions. Additionally, venom composition was analyzed by reverse-phase chromatography and MALDI-TOF mass spectrometry, and two fractions were obtained, referred to as peptidic and non-peptidic fractions. Interestingly, both fractions induced vasodilation in isolated rat aortic rings. The results of this study showed that the venom of P. regalis induces a concentration-dependent vasodilation in rat aorta that was endothelium-dependent and involves the activation of NO/cGMP pathway. These results suggest that the venom contains a combination of both peptidic and non-peptidic vasodilator components. This study provides pharmacological data that suggest that P. regalis venom may be an important source of peptidic and non-peptidic vasodilator compounds.

Ultrasonido Point-Of-Care (POCUS) durante la reanimación cardiopulmonar para el diagnóstico de causas reversibles de arresto cardiaco / Point-Of-Care ultrasound (POCUS) during cardiopulmonary resuscitation for the diagnosis of reversible causes of cardiac arrest / Ultrassonografia Point-of-Care (POCUS) durante a reanimação cardiopulmonar para o diagnóstico de causas reversíveis de parada cardíaca

Resumen: La ultrasonografía enfocada al paciente crítico o «ultrasonido Point-Of-Care¼ (POCUS) es una herramienta utilizada en la cabecera del paciente en distintas áreas de la medicina crítica y servicios de emergencias debido a su practicidad y a que provee gran información de forma rápida y no invasiva para realizar diagnósticos y abordajes terapéuticos. El arresto cardiaco (AC) es una situación crítica que requiere una adecuada reanimación cardiopulmonar (RCP) y en la que es crucial la identificación de la etiología para realizar una intervención rápida y lograr la resolución de la misma, particularmente en el escenario de una actividad eléctrica sin pulso (AESP) en la que la ecografía cobra vital importancia. La implementación de protocolos de reanimación cardiopulmonar apoyados de un abordaje ultrasonográfico es factible y de gran utilidad para la identificación etiológica del AC y la resolución de causas específicas.

Abstract: Ultrasound focused on the critical patient or «Point-Of-Care ultrasound¼ (POCUS) is a tool used at the patient's bedside in different areas of critical medicine and emergency services due to its practicality as it provides great information quickly and non-invasive for diagnostic and therapeutic approaches. Cardiac arrest (CA) is a critical situation that requires adequate cardiopulmonary resuscitation (CPR), and in which the identification of the etiology is crucial to carry out a rapid intervention and achieve its resolution, particularly in the setting of a pulseless electrical activity (AESP) in which ultrasound is of vital importance. The implementation of cardiopulmonary resuscitation protocols supported by an ultrasound approach is feasible and of great utility for the etiological identification of CA and the resolution of specific causes.

Resumo: A ultrassonografia focada em pacientes críticos ou «Point-Of-Care ultra-som¼ (POCUS) é uma ferramenta utilizada à beira do leito do paciente em diferentes áreas da medicina crítica e serviços de emergência devido à sua praticidade e ao fato de fornecer uma grande quantidade de informações rapidamente e não invasivo para abordagens diagnósticas e terapêuticas. A parada cardíaca (PC) é uma situação crítica que requer uma adequada ressuscitação cardiopulmonar (RCP) e na qual a identificação da etiologia é crucial para a rápida intervenção e resolução, particularmente no cenário de uma atividade elétrica sem pulso (AESP) em qual o ultra-som é de vital importância. A implementação de protocolos de ressuscitação cardiopulmonar apoiados por uma abordagem ultrassonográfica é viável e muito útil para a identificação etiológica do RAC e resolução de causas específicas.

Protocolo de manejo para la infección por COVID-19 / Management protocol for COVID-19 / Protocolo de tratamento para a infecção por COVID-19

Resumen: El 31 de diciembre de 2019 se reportaron en Wuhan, China los primeros casos de neumonía de origen desconocido, más tarde identificado como nuevo Coronavirus (2019-nCoV o COVID-19), genéticamente distinto de otros coronavirus como SARS-CoV y MERS-CoV, oficialmente identificado como SARS-CoV-2. En marzo de 2020, la Organización Mundial de la Salud (OMS) declaró alerta de pandemia por esta enfermedad, que ha infectado a miles de personas como consecuencia de afección pulmonar por síndrome de distrés respiratorio agudo (SDRA), por lo que es prioridad conocer el abordaje de manejo para el COVID-19.

Abstract: On December 31, 2019, the first cases of pneumonia of unknown origin were reported in Wuhan, China, later identified as a new Coronavirus (2019-nCoV or COVID-19), genetically distinct from other coronaviruses such as SARS-CoV and MERS-CoV, officially identified as SARS-CoV-2. In March 2020, the World Health Organization (WHO) declared a pandemic alert for this disease, which has infected thousands of people, as a consequence of pulmonary affection due to acute respiratory distress syndrome (ARDS), making it a priority to know the management approach for COVID-19.

Resumo: Em 31 de dezembro de 2019, os primeiros casos de pneumonia de origem desconhecida foram relatados em Wuhan, China, posteriormente identificado como um novo Coronavírus (2019-nCoV ou COVID-19), geneticamente diferente de outros coronavírus, como SARS-CoV e MERS-CoV , oficialmente identificado como SARS-CoV-2. Em março de 2020, a Organização Mundial da Saúde (OMS) declarou um alerta de pandemia para esta doença, que infectou milhares de pessoas, como consequência de uma doença pulmonar devido à síndrome do desconforto respiratório agudo (SDRA), tornando-se uma prioridade conhecer a abordagem de gerenciamento do COVID-19.

Caracterización el virus el Distemper (moquillo canino) en cultivos celulares, aislado de animales clínicamente enfermos / Caracterization of Distemper Virus in cell culture

Se estudió el comportamiento del virus del Distemper Canino (VDC) en cultivos celulares primarios y de líneas. Se emplearon diversos VDC, aislados de encéfalos provenientes de perros que murieron mostrando una sintomatología nerviosa; histológicamente, dichos encéfalos presentaron cuerpos de inclusión y reacción positiva por inmunofluorescencia (IF) al emplear un conjugado anti-DVC. Cada muestra se inoculó en células VERO y Cultivo Primario de Riñón de perro (CRP) para evaluar la capacidad de: a) producir efectos citopáticos (ECP),b) reaccionar frente a un conjugado fluorescente anti-DVC, c) hemoaglutinar glóbulos rojos de diversas especies en diferentes condiciones y d) hemoadsorber glóbulos rojos. Los resultados mostraron que: a) no hubo diferencia alguna entre emplear células VERO y CRP, observándose cambios citopáticos que permitieron diferenciar un cultivo infectado de uno no infectado con virus vacunal, b) el 88 por ciento de las muestras conservó su antigenisidad, pues resultó positivo en la prueba de IF, observándose la mayor intensidad de fluorescencia específica a las 48 horas postinfección, c) el 58 por ciento de las muestras mostró hemoadsorción y d) ninguna muestra, incluyendo los testigos, fue capaz de hemoaglutinar. No fue posible, con base en los resultados, establecer diferencias entre los virus "de campo" y los vacunales.