Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial.

Importance: Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been established. Objective: To determine if a peripheral perfusion-targeted resuscitation during early septic shock in adults is more effective than a lactate level-targeted resuscitation for reducing mortality. Design, Setting, and Participants: Multicenter, randomized trial conducted at 28 intensive care units in 5 countries. Four-hundred twenty-four patients with septic shock were included between March 2017 and March 2018. The last date of follow-up was June 12, 2018. Interventions: Patients were randomized to a step-by-step resuscitation protocol aimed at either normalizing capillary refill time (n = 212) or normalizing or decreasing lactate levels at rates greater than 20% per 2 hours (n = 212), during an 8-hour intervention period. Main Outcomes and Measures: The primary outcome was all-cause mortality at 28 days. Secondary outcomes were organ dysfunction at 72 hours after randomization, as assessed by Sequential Organ Failure Assessment (SOFA) score (range, 0 [best] to 24 [worst]); death within 90 days; mechanical ventilation-, renal replacement therapy-, and vasopressor-free days within 28 days; intensive care unit and hospital length of stay. Results: Among 424 patients randomized (mean age, 63 years; 226 [53%] women), 416 (98%) completed the trial. By day 28, 74 patients (34.9%) in the peripheral perfusion group and 92 patients (43.4%) in the lactate group had died (hazard ratio, 0.75 [95% CI, 0.55 to 1.02]; P = .06; risk difference, -8.5% [95% CI, -18.2% to 1.2%]). Peripheral perfusion-targeted resuscitation was associated with less organ dysfunction at 72 hours (mean SOFA score, 5.6 [SD, 4.3] vs 6.6 [SD, 4.7]; mean difference, -1.00 [95% CI, -1.97 to -0.02]; P = .045). There were no significant differences in the other 6 secondary outcomes. No protocol-related serious adverse reactions were confirmed. Conclusions and Relevance: Among patients with septic shock, a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality. Trial Registration: ClinicalTrials.gov Identifier: NCT03078712.

[Therapeutic monitoring of antibiotics: New methodologies: biosensors]. / Monitorización terapéutica de antibióticos: Nuevas metodologías: biosensores.

The pharmacokinetics of antibiotics, especially in severely ill patients, may be profoundly altered due to multiple pathophysiological changes. Recent studies have shown that empiric dosing recommendations for ICU patients are inadequate to effectively treat a broad range of susceptible organisms and need to be reconsidered. Therapeutic drug monitoring (TDM) is an important mean for optimizing drug utilization and doses for the purpose of improving the clinical effectiveness. However, it is very challenging to quantify plasma antibiotic concentrations in clinical situations as a routine practice, because of the high costs and complexities associated with advanced instrumental techniques. Currently there are not routine and low cost methods to determine the presence and concentration of ß-lactam antibiotics in plasma patients in a clinical setup. Indeed, such analytical methods are based on chromatographic techniques mainly used in research. Here we describe and comment different techniques, focusing on our preliminary experience using biosensors.

Emotional factors and self-efficacy in the psychological well-being of trainee teachers.

Introduction: The relationship among emotional intelligence, stress, and self-efficacy is a crucial factor in shaping psychological well-being. It has a significant impact on important areas such as health, academic and professional performance, and overall quality of life. Methods: Using a hierarchical approach, this study aimed to identify, the specific predictors of psychological well-being, including emotional intelligence, stress, resilience, burnout, and self-efficacy, among higher education students pursuing a bachelor's degree in education. We also examined gender differences among these predictors. This study involved 338 higher education students pursuing a primary education teaching degree. Results: The results obtained using the hierarchical regression analysis technique, indicated that the resilience measure, the burnout measure, and the factor of the teacher self-efficacy measure related to self-efficacy in coping with challenges and effectiveness in dealing with change in the educational context, significantly contributed to explaining psychological well-being in the total sample. Furthermore, the predictors of psychological well-being differed between male and female samples. Discussion: Finally, these findings are discussed in terms of their theoretical and practical implications for improving the training process of future teachers.

Building paths to success: a multilevel analysis of the effects of an emotional intelligence development program on the academic achievement of future teachers.

Introduction: The situation generated by the recent pandemic has had several effects on education, one of them being the necessary but hasty efforts of teachers and students to adapt to the demands of a virtual classroom environment. Thus, it is essential to promote the development of digital competencies in future teachers, enabling them to create effective learning situations in the digital medium. Moreover, the European university curriculum includes a set of specific competencies (specific to each degree) and a series of generic competencies, many of which are related to emotional intelligence. Our work emerges from these specific premises and the more general need to develop emotional skills and learning abilities in virtual environments for future educators. Methods: The sample comprised 240 students in higher education, pursuing a bachelor's degree in education at the University of Alicante, Spain (68.3% were female and average age of the participants was 19.43 years SD = 4.127). Using a quasi-experimental design with pretests, posttests, and a control group, we present the effects of an online program aimed at improving the emotional skills and academic achievement of future teachers in higher education. In this study, a 30-h emotional intelligence training program was implemented. Since the student sample was grouped into different classes, we analyzed, using a generalized linear mixed-effects model, whether students who took the program showed a significant improvement in their academic achievement at the end of their studies, compared to those who did not take it. Results: The findings show a significant improvement in the academic achievement at the end of the bachelor's degree studies of the students in the experimental group. Discussion: These results open up a field of possibilities for the implementation of this type of training using virtual environments, enabling interventions to enhance the emotional development of the teaching staff (and, subsequently, in their students), develop their teaching careers adequately, and employ the ideal strategies to address educational programs. Looking ahead, the integration of emotional development programs that incorporate emerging technology into university curricula could enhance the preparation of educators profoundly and create adaptable learning environments for contemporary students.

Analgesic effect of intra-articularly administered morphine, dexmedetomidine, or a morphine-dexmedetomidine combination immediately following stifle joint surgery in dogs.

OBJECTIVE: To compare the analgesic effects of intra-articularly administered saline (0.9% NaCl) solution, morphine, dexmedetomidine, and a morphine-dexmedetomidine combination in dogs undergoing stifle joint surgery for cranial cruciate ligament rupture. DESIGN: Randomized, controlled, clinical trial. ANIMALS: 44 dogs with cranial cruciate ligament rupture that underwent tibial tuberosity advancement (TTA) or tibial plateau leveling osteotomy (TPLO). PROCEDURES: Dogs received intra-articular injections of saline solution (0.2 mL/kg [0.09 mL/lb]), morphine (0.1 mg/kg [0.045 mg/lb]), dexmedetomidine (2.5 µg/kg [1.14 µg/lb]), or a combination of morphine (0.1 mg/kg) and dexmedetomidine (2.5 µg/kg). Intra-articular injections of the stifle joint were performed after completion of the corrective osteotomy procedure, just prior to skin closure. Signs of pain were assessed every 2 hours thereafter on the basis of mean behavioral and objective pain scores. Dogs with pain scores exceeding predetermined thresholds were given hydromorphone (0.05 mg/kg [0.023 mg/lb], SC) as rescue analgesia. RESULTS: Time to rescue analgesia did not significantly differ between dogs that underwent TTA versus TPLO. No significant difference in time to rescue analgesia was found among dogs receiving intra-articular injections of dexmedetomidine (median, 6 hours; range, 2 to 10 hours), morphine (median, 7 hours; range, 4 to 10 hours), or saline solution (median, 5 hours; range, 4 to 10 hours). However, time to rescue analgesia for dogs receiving intra-articular injection of the morphine-dexmedetomidine combination (median, 10 hours; range, 6 to 14 hours) was significantly longer than the time to rescue analgesia for other treatment groups. CONCLUSIONS AND CLINICAL RELEVANCE: Intra-articular administration of the morphine-dexmedetomidine combination provided longer-lasting postoperative analgesia, compared with either morphine or dexmedetomidine alone, in dogs undergoing TTA or TPLO.

Trends in hospitalizations and mortality from asthma in Costa Rica over a 12- to 15-year period.

BACKGROUND: Little is known about trends in morbidity and/or mortality due to asthma in Latin America. OBJECTIVE: To examine trends in hospitalizations and mortality due to asthma from 1997-2000 to 2011 in Costa Rica. METHODS: The rates of hospitalization due to asthma were calculated for each sex in 3 age groups from 1997 to 2011. The number of deaths due to asthma was first calculated for all groups and then for each sex in 3 age groups from 2000 to 2011. All analyses were conducted over the entire period and separately for the periods before and after a National Asthma Program (NAP) in 2003. Data also were available for prescriptions for beclomethasone since 2004. All analyses were conducted by using Epi Info. RESULTS: Substantial reductions were found in hospitalizations and deaths due to asthma in Costa Ricans (eg, from 25 deaths in 2000 to 5 deaths in 2011). Although, the percentage decrement in the rates of hospitalization for asthma in subjects <20 years old was similar before and after the NAP, the reduction in both deaths due to asthma and rates of asthma hospitalizations in older subjects were more pronounced after the NAP, when prescriptions for beclomethasone were also increased by approximately 129%. CONCLUSION: In Costa Rica, there was a marked decrement in hospitalizations and mortality due to asthma from 1997-2000 to 2011. In younger subjects, this is likely due to guidelines that, since 1988, recommend inhaled corticosteroids for persistent asthma. In older adults, the NAP probably enhanced reductions in hospitalizations and deaths due to asthma through inhaled corticosteroid use.

Hábitos alimentarios de la población urbana costarricense / Food habits of urban Costa Rican population

Resumen Objetivo: Es sabido que los malos hábitos alimentarios contribuyen a la aparición de enfermedades crónicas, como la obesidad y la diabetes mellitus, sin embargo, no existe información actualizada respecto a la alimentación de la población urbana en Costa Rica. El objetivo de este estudio fue analizar los hábitos alimentarios de la población costarricense incluida en el Estudio Latinoamericano de Nutrición y Salud (ELANS). Métodos: Se incluyó una muestra de 798 participantes entre 15 y 65 años del área urbana de Costa Rica. Se determinó el consumo diario promedio de alimentos y la frecuencia por tiempo de comida de acuerdo al sexo, el grupo de edad y el nivel socioeconómico. Resultados: Los grupos de alimentos más consumidos en el desayuno fueron café y panes, en la merienda de la mañana frutas, en la merienda de la tarde café y panes y en el almuerzo y la cena arroz blanco, bebidas con azúcar y leguminosas. Se determinaron algunas diferencias en los alimentos incluidos en los diferentes tiempos de comida entre hombres y mujeres, según el grupo de edad y el nivel socioeconómico de los participantes. Conclusión: Los hábitos alimentarios de la población costarricense se caracterizaron por ser poco variados, y poseer un alto consumo de café, panes, arroz blanco y bebidas con azúcar y un consumo insuficiente de leguminosas, frutas, vegetales no harinosos y pescado. Esta información puede ser utilizada para la implementación de programas nutricionales tendientes a mejor los hábitos de alimentación en el país.

Abstract Objective: It is known that poor eating habits contribute to the onset of chronic diseases, such as obesity and diabetes mellitus, among others, however there is no recent information regarding the diet of the urban population in Costa Rica. The objective of this study was to analyze the dietary habits of the Costa Rican population included in the Latin American Nutrition and Health Study (ELANS). Methods: A sample of 798 participants between 15 and 65 years of urban areas of Costa Rica was included. The average daily consumption of food and the frequency per meal time were determined according to sex, age group and socioeconomic level. Results: The most consumed food groups at breakfast were coffee and bread, in the morning snack fruits, in the afternoon snack coffee and bread and at lunch and dinner white rice, sweetened beverages and legumes. Some differences were determined in the foods included in the different meal times between according to sex, age group and socioeconomic status of the participants. Conclusion: The dietary habits of the Costa Rican population were characterized by having little variety, a high consumption of coffee, bread, white rice and sweetened beverages and insufficient consumption of legumes, fruits, non-starchy vegetables and fish. This information can be used for the implementation of nutritional programs aimed at improving eating habits in the country.

Effects of prenatal stress on conduction airway morphology / Efectos del estrés prenatal sobre la morfología de la vía aérea de conducción

SUMMARY: It is known that chronic gestational stress alters the pulmonary immune response predisposing to chronic pulmonary pathologies such as asthma, which occur with morphological alterations in both conduction and exchange airways. However, it is still unknown whether chronic gestational stress generates alterations in pulmonary morphology, specifically in the airway conduction, which predisposes to hyperreactivity or other alterations of the airway, in early postnatal stages. The aim of this work was to analyze the effects of prenatal stress on the development of pulmonary conduction airway. Eight pregnant females were randomly assigned to one control group and one group submitted to restriction of movement during the last gestational week. The offspring were sacrificed on postnatal days 0 (P0) and 14 (P14), extracting the lung to conduct a histomorphological analysis of the conduction airway. In P0 an increase in the peribronchiolar smooth muscle in stressed males was observed in the conduction airway in comparison to the control (p = 0.0002); no significant differences were observed in the female or in the P14 stage. Prenatal stress produces histomorphologic changes in the conduction airway in the offspring at early postnatal stages.

RESUMEN: Se sabe que el estrés crónico gestacional altera la respuesta inmune pulmonar, predisponiendo a patologías crónicas pulmonares como el asma, que cursan con alteraciones morfológicas tanto en la vía aérea de conducción como de intercambio. Sin embargo, se desconoce aún si el estrés crónico gestacional genera alteraciones en la morfología pulmonar, específicamente en la vía aérea de conducción, que predisponga a hiperreactividad u otras alteraciones de la vía aérea, en etapas postnatales tempranas. El objetivo de este trabajo consistió en analizar los efectos del estrés prenatal sobre el desarrollo de la vía aérea de conducción pulmonar. Ocho hembras preñadas fueron divididas aleatoriamente en un grupo control y otro grupo sometido a estrés por restricción de movimiento durante la última semana gestacional. Las crías fueron sacrificadas en los días postnatal 0 (P0) y 14 (P14), extrayendoles el pulmón para realizar un análisis histomorfológico de la vía aérea de conducción. En P0 se observó en la vía aérea de conducción un aumento en la musculatura lisa peribronquiolar en machos estresados en comparación al control (p=0,0002). No se observaron diferencias significativas en la crías hembra, ni en la etapa de P14. El estrés prenatal produce cambios histomorfológicos en la vía aérea de conducción en las crías de hembras estresadas, en etapas postnatales tempranas.

Maduración ósea vertebral en niños de 8 -14 años de la clínica del postgrado de ortodoncia de la Institución Universitaria Colegios de Colombia (UNICOC) sede Santiago de Cali / Vertebral bone maturation in children 8 -14 year-old at orthodontic clinics of University Colleges of Colombia (UNICOC) based in Cali

Objetivo: determinar los estadios de madu - ración ósea vertebral en los niños mestizos de 8-14 años pertenecientes a población Colombiana del Valle del Cauca. Materiales y métodos: La maduración ósea cervical es un método efectivo para determinar el pico de crecimiento pube - ral en niños, esto nos permite evaluar el momento ideal en el cual se debe iniciar el tratamiento ortopédico u ortodóntico. Se evaluaron 130 radiografías laterales de cráneo de niños mestizos de 8 a 14 años de las historias clínicas de la clínica del postgrado de ortodoncia de la Institución Universitaria Colegios de Colombia Cali, Utilizando el método de maduración ósea cervical modificado por Baccetti. Resultados: Se encontró que los niños y niñas en este rango de edad presentaron su pico de crecimiento puberal en el grupo de 12 a 14 años...(Au)

Objective: Determine the stages of ver - tebral bone maturation in children 8-14 year-old belonging to Colombian mestizo population at the Valle del Cauca. Materials and methods: Cervical bone ma - turation is an effective method to determine the pubertal growth spurting children, this allows to evaluate the ideal time to iniciate orthodontic or orthopedic treatment. In 130 lateral radiographs beloning to children 8 to14 year-old from records of the graduate orthodontic clinic of the university colle - ges of Cali Colombia were analized using cervical bone maturation according to the Baccetti modified method. Results: We found that children in this age range had their pubertal growth spurt at 12 to 14 year of age. Conclusion: The cervical bone maturation stage (CVS3) corresponding to the pubertal growth peak in the age group12 to14 year- old is reached first by the girls...(Au)

Evaluación del resultado de la terapia con puva en pacientes con estadios tempranos de micosis fungoides: seguimiento a 8 años / Eight years follow up of patients with early stage cutaneous T cell Lymphoma in treatment with psoralen plus UVA

Antecedentes: en la actualidad existen muy pocos datos en la literatura acerca de la evolución a largo plazo de los pacientes con micosis fungoides (MF) en tratamiento con PUVA. (fotoquimioterapia con radiación ultravioleta tipo A). Objetivos: Conocer las características epidemiológicas y clínicas de los pacientes con diagnóstico de MF en tratamiento con PUVA en el servicio de dermatología del CES-Sabaneta, y determinar qué impacto tiene la terapia de mantenimiento en la prevención de recaídas y en la sobrevida. Métodos: se realizó un estudio descriptivo y retrospectivo, con los pacientes con diagnóstico de MF desde abril de 1997 hasta junio de 2005.

Background: PUVA is considered first line therapy in early stages of mycosis fungoides. There are few reports in the literature about the long term follow up of these patients. Objective: to describe the epidemiology and clinical characteristics of patients with early stages of mycosis fungoides in PUVA therapy, in the Dermatologic Center CES-Sabaneta. We wanted to know the relationship between PUVA therapy and patient’s evolution, response to treatment, survival rates, relapse and adverse effects. Methods: a single center, retrospective, descriptive study was done. We included all patients with confirmed diagnosis of mycosis fungoides, who assisted PUVA therapy between April of 1997 and June of 2005.