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Differentially methylated regions (DMRs) can be used as head and neck squamous cell carcinoma (HNSCC) diagnostic, prognostic and therapeutic targets in precision medicine workflows. DNA from 21 HNSCC and 10 healthy oral tissue samples was hybridized to a genome-wide tiling array to identify DMRs in a discovery cohort. Downstream analyses identified differences in promoter DNA methylation patterns in oral, laryngeal and oropharyngeal anatomical regions associated with tumor differentiation, nodal involvement and survival. Genome-wide DMR analysis showed 2,565 DMRs common to the three subsites. A total of 738 DMRs were unique to laryngeal cancer (n=7), 889 DMRs were unique to oral cavity cancer (n=10) and 363 DMRs were unique to pharyngeal cancer (n=6). Based on the genome-wide analysis and a Gene Ontology analysis, 10 candidate genes were selected to test for prognostic value and association with clinicopathological features. TIMP3 was associated with tumor differentiation in oral cavity cancer (P=0.039), DAPK1 was associated with nodal involvement in pharyngeal cancer (P=0.017) and PAX1 was associated with tumor differentiation in laryngeal cancer (P=0.040). A total of five candidate genes were selected, DAPK1, CDH1, PAX1, CALCA and TIMP3, for a prevalence study in a larger validation cohort: Oral cavity cancer samples (n=42), pharyngeal cancer tissues (n=25) and laryngeal cancer samples (n=52). PAX1 hypermethylation differed across HNSCC anatomic subsites (P=0.029), and was predominantly detected in laryngeal cancer. Kaplan-Meier survival analysis (P=0.043) and Cox regression analysis of overall survival (P=0.001) showed that DAPK1 methylation is associated with better prognosis in HNSCC. The findings of the present study showed that the HNSCC subsites oral cavity, pharynx and larynx display substantial differences in aberrant DNA methylation patterns, which may serve as prognostic biomarkers and therapeutic targets.
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BACKGROUND: Food and agricultural wastes constitute a rich source of functional ingredients for the food, pharmaceutical, and cosmetic industries. In this context, by-products from the red variety of Solanum betaceum fruits (chilto) from Northwestern Argentina are suitable sources for pectin extraction. METHODS: In this study, pectin from the peels of red chilto fruits was extracted and characterized. RESULTS: The recovery yield of red chilto peel pectin was about 24%, and it was co-extracted with 40.0 mg phenolic compounds, 6.5 mg anthocyanins, and 4.7 g proteins per 100 g of pectin. The pectin obtained from red chilto showed proper technological functionality displaying water and oil holding capacities of 4.2 and 2.0%, respectively, an emulsifying capacity of 83%, emulsion stability of 87.5%, foaming capacity of 21.1%, and foaming stability of 79.1%. The pectin displayed antioxidant activity with the ability to scavenge ABTS radical, superoxide anion, and H2O2. The polysaccharide exhibited in vitro hypoglycemic potential and inhibited the α-amylase enzyme, retarded glucose diffusion, and improved the cellular uptake of glucose in a Saccharomyces cerevisiae model. The extract was non-toxic on acute toxicity tests. CONCLUSIONS: Red chilto pectin showed potential as a new and safe functional ingredient for the design of foods, health products, and cosmetics.
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The Colombian Pacific coast is an amazing natural region, immersed in one of the most unknown biodiversity hotspots in the world. An expedition carried out in the north of this area, at the Jardín Botánico del Pacífico (JBP) in Bahía Solano, Chocó, focused on studying the diversity of the mygalomorph spider fauna, allowed us to discover four new species included in the families Halonoproctidae and Theraphosidae. The trapdoor species Ummidiasolanasp. nov., and the theraphosids species Euthycaeluscunampiasp. nov. (Schismatothelinae), Melloinapacificasp. nov. (Glabropelmatinae), and Neischnocolusmecanasp. nov. (Theraphosinae) are illustrated, diagnosed, and described in detail. Photographs of somatic features and copulatory organs and a distribution map are provided. Morphological, taxonomical, and biogeographical aspects are discussed for each species. All these taxonomic novelties represent the first records of these genera for the region, expanding the range of geographic distribution of each of them. This work constitutes the first effort focused on characterizing the community of Mygalomorphae species in the Chocó Biogeographic Region.
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OBJECTIVE: To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. METHODS: We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. RESULTS: A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. CONCLUSIONS: The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage.
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The fruit supply chain generates large amounts of waste that are often used as animal feed and in the production of both composts and fertilizers and biogas (anaerobic digestion). Since these types of procedures imply high economic costs related to drying, storage, and transport processes, more efficient and environmentally friendly utilization and recycling of this kind of waste are becoming significant for governments and industries. However, improper waste disposal increases the burden on the environment. Many of these fruit wastes, such as Solanum betaceum fruit waste, viz., peels, seeds, and pomace, could be considered potent bio-resource materials for several applications in the food and non-food industries due to their richness in valuable compounds. The basic composition of Solanum betaceum fruits seed has a high content of protein (20%), fiber (around 25%), sugar (11-20%) and low lipid content (0.4%), while S. betaceum peel has a low content of sugar (2-9%), protein (8-10%) and lipid (0.2-0.8%) and high fiber content (23%). Regarding the phytochemicals, the wastes have a high level of phenolics (0.2-0.6%) and pigments such as anthocyanins (0.06%). The inherent bioactive compounds of waste can be used as natural ingredients for foods, cosmetics, medicines, and the production of packaging materials production. Along this line, the present review covers all possible approaches for the valorization of S.betaceum waste in the food and non-food sectors.
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Sulfhemoglobin (SulfHb) is formed by hemoglobin (Hb) oxidation by sulfur compounds. Sulfhemoglobinemia is mainly associated with drugs or intestinal bacterial overgrowth. Patients present with central cyanosis, an abnormal pulse oximetry and normal arterial oxygen partial pressure. These features are shared with methemoglobinemia (MetHb) whose diagnosis requires an arterial co-oximetry. Depending on the device used, SulfHb may produce interference with this technique. We report two females aged 31 and 43 years, consulting at the emergency room with cyanosis. Both had a history of acute and chronic, high dose zopiclone ingestion. Pulse oximetry showed desaturation but with normal arterial oxygen partial pressure. Cardiac and pulmonary diseases were ruled out. Co-oximetry in two different analyzers showed interference or normal MetHb percentages. No other complications ensued, and cyanosis decreased over days. Since MetHb was discarded among other causes of cyanosis in a compatible clinical context, the diagnosis of sulfhemoglobinemia was made. The confirmatory method is not available in Chile. The presence of SulfHb is difficult to diagnose, confirmatory tests are not readily available, and it frequently interferes with arterial co-oximetry. This is attributed to a similar absorbance peak of both pigments in arterial blood. Venous co-oximetry can be useful in this context. SulfHb is a self-limited condition in most cases, however it must be differentiated from methemoglobinemia to avoid inappropriate treatments like methylene blue.
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Humanos , Feminino , Sulfemoglobinemia/complicações , Metemoglobinemia/diagnóstico , Metemoglobinemia/induzido quimicamente , Oxigênio , Oximetria/efeitos adversos , Cianose/complicaçõesRESUMO
BACKGROUND: The Ziziphus mistol fruit (vulgar name mistol) is used in northwestern Argentina in traditional food and beverage preparations and popular medicines for liver and respiratory disorders. AIMS: The aim of this research was to evaluate the hypoglycemic and anti-inflammatory activity in pulp powders and sub-products (skin and seeds) of mistol fruit, along with their toxicity. METHODS: Powders from mistol seeds, pulp, and skin were obtained. Antioxidant capacity and inhibitory activity against key enzymes involved in metabolic syndrome were determined by in vitro assays. RESULTS: The mistol powders obtained from the different fruit parts reduced glucose bioaccessibility. Before and after simulated gastroduodenal digestion, the polyphenol-enriched extracts (PEE) obtained from mistol powders increased glucose uptake by yeast cells and inhibited the pivotal enzymes of the inflammatory pathway (cyclooxygenase-2, lipooxygenase-1, and phospholipase A2). The analyzed mistol powders did not show acute toxicity or genotoxicity in model organisms and cell cultures. CONCLUSIONS: These results evince the potentiality of both the pulp from Z. mistol fruits and residual biomass (seeds and skin) to obtain biofunctional powders to use as supplements for metabolic disorders associated with chronic diseases.
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Resumen Objetivo: Determinar la validez de contenido de un protocolo con recomendaciones para la aplicación del instrumento WHOQOL-BREF, en la evaluación de la calidad de vida en mujeres con cáncer de mama. Materiales y métodos: Estudio descriptivo, observacional, tipo validación de instrumentos. El proceso se desarrolló en 3 fases, incluyendo validación de contenido con la participación de expertos en las áreas de oncología, psicología, trabajo social, y enfermería; valorando la claridad, coherencia, pertinencia, y suficiencia del protocolo. Se determinó el grado de acuerdo entre los evaluadores con el índice RwG. Resultados: El protocolo obtuvo puntajes promedios superiores a 9,0 en todos los ítems, la mayoría con índices RwG mayor a 0,5. Por su parte, los evaluadores adicionaron recomendaciones claves como acompañamiento permanente durante la aplicación de la encuesta e incluir pausas activas, por la extensión del instrumento. Conclusiones: Se presenta un protocolo para mejorar la aplicación del instrumento WHOQOL-BREF en población con cáncer de mama.
Abstract Objective: To determine content validity of a protocol with the recommendations for the application of the WHOQOL-BREF instrument to assess the quality of life of women with breast cancer. Materials and methods: This is a descriptive, observational, and type validation of instruments study. The process was developed in 3 phases, including content validation with the participation of experts in the oncology, psychology, social work, and nursing fields that assessed the clarity, coherence, relevance, and sufficiency of the protocol. The degree of agreement between the evaluators was determined using the rWG index. Results: The protocol obtained mean scores higher than 9.0 in all items, the majority with rWG indices greater than 0.5. The evaluators added key recommendations such as permanent accompany during the application of the survey and active pauses inclusion due to the instrument extension. Conclusions: A protocol is presented to improve the application of the WHOQOL-BREF instrument in populations that suffer from breast cancer.
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INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic revealed a worldwide lack of effective molecular surveillance networks at local, state, and national levels, which are essential to identify, monitor, and limit viral community spread. SARS-CoV-2 variants of concern (VOCs) such as Alpha and Omicron, which show increased transmissibility and immune evasion, rapidly became dominant VOCs worldwide. Our objective was to develop an evidenced-based genomic surveillance algorithm, combining reverse transcription polymerase chain reaction (RT-PCR) and sequencing technologies to quickly identify highly contagious VOCs, before cases accumulate exponentially. METHODS: Deidentified data were obtained from 508,969 patients tested for coronavirus disease 2019 (COVID-19) with the TaqPath COVID-19 RT-PCR Combo Kit (ThermoFisher) in four CLIA-certified clinical laboratories in Puerto Rico (n = 86,639) and in three CLIA-certified clinical laboratories in the United States (n = 422,330). RESULTS: TaqPath data revealed a frequency of S Gene Target Failure (SGTF) > 47% for the last week of March 2021 in both, Puerto Rico and US laboratories. The monthly frequency of SGTF in Puerto Rico steadily increased exponentially from 4% in November 2020 to 47% in March 2021. The weekly SGTF rate in US samples was high (>8%) from late December to early January and then also increased exponentially through April (48%). The exponential increase in SGFT prevalence in Puerto Rico was concurrent with a sharp increase in VOCs among all SARS-CoV-2 sequences from Puerto Rico uploaded to Global Influenza Surveillance and Response System (GISAID) (n = 461). Alpha variant frequency increased from <1% in the last week of January 2021 to 51.5% of viral sequences from Puerto Rico collected in the last week of March 2021. CONCLUSIONS: According to the proposed evidence-based algorithm, approximately 50% of all SGTF patients should be managed with VOCs self-quarantine and contact tracing protocols, while WGS confirms their lineage in genomic surveillance laboratories. Our results suggest this workflow is useful for tracking VOCs with SGTF.
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COVID-19 , SARS-CoV-2 , Sequência de Bases , COVID-19/diagnóstico , COVID-19/epidemiologia , Humanos , Medicina de Precisão , SARS-CoV-2/genética , Estados Unidos/epidemiologiaRESUMO
Resumen Durante la pandemia por SARS-CoV-2 hubo un marcado requerimiento de camas de cuidados críticos, insumos y profesionales entrenados para asistir a pacientes con insuficiencia respiratoria grave. La Sociedad Argentina de Terapia Intensiva (SATI) diseñó un estudio para caracterizar estos aspectos en las Unidades de Cuidados Intensivos (UCIs). Estudio multicéntrico, de cohorte prospectiva; las UCIs participantes completaron un formulario al final del estudio (31/10/2020) sobre características hospitalarias, número de camas de áreas críticas pre- e intra-pandemia, incorporación de profesionales, insumos y recursos tecnológicos, y carga de trabajo. Participaron 58 UCIs; 28(48%) de Provincia de Buenos Aires, 22(38%) de Ciudad Autónoma de Bue nos Aires, 10(17%) de otras; 31(53%) UCIs pertenecían al sector público; 23(47%) al privado-seguridad social. En 35/58(60%) hospitales las camas de cuidados críticos aumentaron de 902 a 1575(75%); 37% en UCI y 63% principalmente en Unidad Coronaria y Emergencias-shock room. En 41/55(75%) UCIs se incorporó personal: 27(49%) médicos/as (70% intensivistas), 36(65%) enfermeros/as, 28(51%) kinesiólogos/as, 20(36%) personal de limpieza, y 1(2%) otros/as; 96% de las UCIS reportaron disponer de respiradores suficientes, y 95%, insumos y EPP suficientes. De todos los pacientes en ventilación mecánica invasiva, 55% [43-64] presentaron COVID-19. Se requirió oxigenoterapia como soporte no invasivo en 14% [8-24] de los ingresos por COVID-19. Se registró una importante expansión de las áreas críticas operativas, secundariamente al aumento de camas, personal, y adecuada disponibilidad de respiradores e insumos esenciales. La carga de la enfermedad crítica por COVID-19 fue intensa, constituyendo más de la mitad de los pacientes en ventilación mecánica.
Abstract During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies and trained professionals to assist patients with severe respiratory failure. The Argentine Society of Intensive Care (SATI) designed a study to characterize these aspects in intensive care units (ICUs). Multicenter, prospective cohort study; the participating ICUs completed a form at the end of the study (31/10/2020) on hospital characteristics, number of beds in pre- and intra-pandemic critical areas, incorporation of professionals, technological resources, and workload. Fifty-eight ICUs participated; 28(48%) were located in Buenos Aires Province, 22(38%) in Buenos Aires Autonomous City and 10 (17%) in other provinces; 31 (53%) of UCIs belonged to the public sector; 23 (47%) to the private-social security. In 35/58 (60%) of the hospitals critical care beds increased from 902 to 1575 (75%), 37% in ICU and 63% mainly in Coronary Care Unit and Emergency-shock room. In 41/55 (75%) UCIs, staff were incorporated: 27(49%) physicians (70% intensivists), 36 (65%) nurses, 28 (51%) respiratory therapists, 20(36%) cleaning staff, and 1(2%) others. A 96% of the ICUS reported having sufficient ventilators and 95% enough sup plies and PPE. Of all patients on invasive mechanical ventilation, 55% [43-64] had COVID-19. Oxygen therapy was required as noninvasive support in 14% [8-24] of COVID-19 admissions. There was a significant expansion of critical operational areas, secondary to the increase in beds, staff, and adequate availability of ventilators and essential supplies. The burden of critical illness from COVID-19 was intense, with more than half of patients on mechanical ventilation.
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OBJECTIVE: To compare gas exchange indices behavior by using liberal versus conservative oxygenation targets in patients with moderate to severe acute respiratory distress syndrome secondary to COVID-19 under invasive mechanical ventilation. We also assessed the influence of high FiO2 on respiratory system mechanics. METHODS: We prospectively included consecutive patients aged over 18 years old with a diagnosis of COVID-19 and moderate-severe acute respiratory distress syndrome. For each patient, we randomly applied two FiO2 protocols to achieve SpO2 88% - 92% or 96%. We assessed oxygenation indices and respiratory system mechanics. RESULTS: We enrolled 15 patients. All the oxygenation indices were significantly affected by the FiO2 strategy (p < 0.05) selected. The PaO2/FiO2 deteriorated, PA-aO2 increased and Pa/AO2 decreased significantly when using FiO2 to achieve SpO2 96%. Conversely, the functional shunt fraction was reduced. Respiratory mechanics were not affected by the FiO2 strategy. CONCLUSION: A strategy aimed at liberal oxygenation targets significantly deteriorated gas exchange indices, except for functional shunt, in COVID-19-related acute respiratory distress syndrome. The respiratory system mechanics were not altered by the FiO2 strategy.Clinical Trials Register: NCT04486729.
OBJETIVO: Comparar o comportamento dos índices de troca gasosa conforme o uso de alvos de oxigenação liberais em comparação a conservadores em pacientes com síndrome do desconforto respiratório agudo moderada a grave secundária à COVID-19 e em uso de ventilação mecânica; avaliar a influência da FiO2 elevada na mecânica do sistema respiratório. MÉTODOS: Foram incluídos prospectivamente pacientes consecutivos com idades acima de 18 anos, diagnóstico de COVID-19 e síndrome do desconforto respiratório agudo moderada e grave. Para cada paciente, aplicou-se aleatoriamente dois protocolos de FiO2 para obter SpO2 de 88% a 92% ou 96%. Avaliaram-se os índices de oxigenação e a mecânica do sistema respiratório. RESULTADOS: Foram incluídos 15 pacientes. Todos seus índices foram significantemente afetados pela estratégia de FiO2 (p < 0,05). A proporção PaO2/FiO2 deteriorou, o PA-aO2 aumentou e o Pa/AO2 diminuiu significantemente com a utilização de FiO2 para obter SpO2 96%. Opostamente, a fração de shunt funcional foi reduzida. A mecânica respiratória não foi afetada pela estratégia de FiO2. CONCLUSÃO: Uma estratégia com alvos liberais de oxigenação deteriorou significantemente os índices de troca gasosa, com exceção do shunt funcional, em pacientes com síndrome do desconforto respiratório agudo relacionada à COVID-19. A mecânica do sistema respiratório não foi alterada pela estratégia de FiO2.Registro Clinical Trials: NCT04486729.
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COVID-19 , Síndrome do Desconforto Respiratório , Adulto , Gasometria , Humanos , Pessoa de Meia-Idade , Saturação de Oxigênio , Síndrome do Desconforto Respiratório/terapia , SARS-CoV-2RESUMO
During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies and trained professionals to assist patients with severe respiratory failure. The Argentine Society of Intensive Care (SATI) designed a study to characterize these aspects in intensive care units (ICUs). Multicenter, prospective cohort study; the participating ICUs completed a form at the end of the study (31/10/2020) on hospital characteristics, number of beds in pre- and intra-pandemic critical areas, incorporation of professionals, technological resources, and workload. Fifty-eight ICUs participated; 28(48%) were located in Buenos Aires Province, 22(38%) in Buenos Aires Autonomous City and 10 (17%) in other provinces; 31 (53%) of UCIs belonged to the public sector; 23 (47%) to the private-social security. In 35/58 (60%) of the hospitals critical care beds increased from 902 to 1575 (75%), 37% in ICU and 63% mainly in Coronary Care Unit and Emergency-shock room. In 41/55 (75%) UCIs, staff were incorporated: 27(49%) physicians (70% intensivists), 36 (65%) nurses, 28 (51%) respiratory therapists, 20(36%) cleaning staff, and 1(2%) others. A 96% of the ICUS reported having sufficient ventilators and 95% enough supplies and PPE. Of all patients on invasive mechanical ventilation, 55% [43-64] had COVID-19. Oxygen therapy was required as noninvasive support in 14% [8-24] of COVID-19 admissions. There was a significant expansion of critical operational areas, secondary to the increase in beds, staff, and adequate availability of ventilators and essential supplies. The burden of critical illness from COVID-19 was intense, with more than half of patients on mechanical ventilation.
Durante la pandemia por SARS-CoV-2 hubo un marcado requerimiento de camas de cuidados críticos, insumos y profesionales entrenados para asistir a pacientes con insuficiencia respiratoria grave. La Sociedad Argentina de Terapia Intensiva (SATI) diseñó un estudio para caracterizar estos aspectos en las Unidades de Cuidados Intensivos (UCIs). Estudio multicéntrico, de cohorte prospectiva; las UCIs participantes completaron un formulario al final del estudio (31/10/2020) sobre características hospitalarias, número de camas de áreas críticas pre- e intra-pandemia, incorporación de profesionales, insumos y recursos tecnológicos, y carga de trabajo. Participaron 58 UCIs; 28(48%) de Provincia de Buenos Aires, 22(38%) de Ciudad Autónoma de Buenos Aires, 10(17%) de otras; 31(53%) UCIs pertenecían al sector público; 23(47%) al privado-seguridad social. En 35/58(60%) hospitales las camas de cuidados críticos aumentaron de 902 a 1575(75%); 37% en UCI y 63% principalmente en Unidad Coronaria y Emergencias-shock room. En 41/55(75%) UCIs se incorporó personal: 27(49%) médicos/as (70% intensivistas), 36(65%) enfermeros/as, 28(51%) kinesiólogos/as, 20(36%) personal de limpieza, y 1(2%) otros/as; 96% de las UCIS reportaron disponer de respiradores suficientes, y 95%, insumos y EPP suficientes. De todos los pacientes en ventilación mecánica invasiva, 55% [43-64] presentaron COVID-19. Se requirió oxigenoterapia como soporte no invasivo en 14% [8-24] de los ingresos por COVID-19. Se registró una importante expansión de las áreas críticas operativas, secundariamente al aumento de camas, personal, y adecuada disponibilidad de respiradores e insumos esenciales. La carga de la enfermedad crítica por COVID-19 fue intensa, constituyendo más de la mitad de los pacientes en ventilación mecánica.
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COVID-19 , Pandemias , Argentina/epidemiologia , Cuidados Críticos , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , Respiração Artificial , SARS-CoV-2 , Recursos HumanosRESUMO
Sulfhemoglobin (SulfHb) is formed by hemoglobin (Hb) oxidation by sulfur compounds. Sulfhemoglobinemia is mainly associated with drugs or intestinal bacterial overgrowth. Patients present with central cyanosis, an abnormal pulse oximetry and normal arterial oxygen partial pressure. These features are shared with methemoglobinemia (MetHb) whose diagnosis requires an arterial co-oximetry. Depending on the device used, SulfHb may produce interference with this technique. We report two females aged 31 and 43 years, consulting at the emergency room with cyanosis. Both had a history of acute and chronic, high dose zopiclone ingestion. Pulse oximetry showed desaturation but with normal arterial oxygen partial pressure. Cardiac and pulmonary diseases were ruled out. Co-oximetry in two different analyzers showed interference or normal MetHb percentages. No other complications ensued, and cyanosis decreased over days. Since MetHb was discarded among other causes of cyanosis in a compatible clinical context, the diagnosis of sulfhemoglobinemia was made. The confirmatory method is not available in Chile. The presence of SulfHb is difficult to diagnose, confirmatory tests are not readily available, and it frequently interferes with arterial co-oximetry. This is attributed to a similar absorbance peak of both pigments in arterial blood. Venous co-oximetry can be useful in this context. SulfHb is a self-limited condition in most cases, however it must be differentiated from methemoglobinemia to avoid inappropriate treatments like methylene blue.
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Metemoglobinemia , Sulfemoglobinemia , Feminino , Humanos , Metemoglobinemia/induzido quimicamente , Metemoglobinemia/diagnóstico , Sulfemoglobinemia/complicações , Oximetria/efeitos adversos , Cianose/complicações , OxigênioRESUMO
RESUMO Objetivo: Comparar o comportamento dos índices de troca gasosa conforme o uso de alvos de oxigenação liberais em comparação a conservadores em pacientes com síndrome do desconforto respiratório agudo moderada a grave secundária à COVID-19 e em uso de ventilação mecânica; avaliar a influência da FiO2 elevada na mecânica do sistema respiratório. Métodos: Foram incluídos prospectivamente pacientes consecutivos com idades acima de 18 anos, diagnóstico de COVID-19 e síndrome do desconforto respiratório agudo moderada e grave. Para cada paciente, aplicou-se aleatoriamente dois protocolos de FiO2 para obter SpO2 de 88% a 92% ou 96%. Avaliaram-se os índices de oxigenação e a mecânica do sistema respiratório. Resultados: Foram incluídos 15 pacientes. Todos seus índices foram significantemente afetados pela estratégia de FiO2 (p < 0,05). A proporção PaO2/FiO2 deteriorou, o PA-aO2 aumentou e o Pa/AO2 diminuiu significantemente com a utilização de FiO2 para obter SpO2 96%. Opostamente, a fração de shunt funcional foi reduzida. A mecânica respiratória não foi afetada pela estratégia de FiO2. Conclusão: Uma estratégia com alvos liberais de oxigenação deteriorou significantemente os índices de troca gasosa, com exceção do shunt funcional, em pacientes com síndrome do desconforto respiratório agudo relacionada à COVID-19. A mecânica do sistema respiratório não foi alterada pela estratégia de FiO2. Registro Clinical Trials: NCT04486729.
ABSTRACT Objective: To compare gas exchange indices behavior by using liberal versus conservative oxygenation targets in patients with moderate to severe acute respiratory distress syndrome secondary to COVID-19 under invasive mechanical ventilation. We also assessed the influence of high FiO2 on respiratory system mechanics. Methods: We prospectively included consecutive patients aged over 18 years old with a diagnosis of COVID-19 and moderate-severe acute respiratory distress syndrome. For each patient, we randomly applied two FiO2 protocols to achieve SpO2 88% - 92% or 96%. We assessed oxygenation indices and respiratory system mechanics. Results: We enrolled 15 patients. All the oxygenation indices were significantly affected by the FiO2 strategy (p < 0.05) selected. The PaO2/FiO2 deteriorated, PA-aO2 increased and Pa/AO2 decreased significantly when using FiO2 to achieve SpO2 96%. Conversely, the functional shunt fraction was reduced. Respiratory mechanics were not affected by the FiO2 strategy. Conclusion: A strategy aimed at liberal oxygenation targets significantly deteriorated gas exchange indices, except for functional shunt, in COVID-19-related acute respiratory distress syndrome. The respiratory system mechanics were not altered by the FiO2 strategy. Clinical Trials Register: NCT04486729.
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Humanos , Adulto , Pessoa de Meia-Idade , COVID-19 , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Gasometria , SARS-CoV-2RESUMO
Background: Dietary strategies, including the use of probiotics as preventive agents that modulate the gut microbiota and regulate the function of adipose tissue, are suitable tools for the prevention or amelioration of obesity and its comorbidities. We aimed to evaluate the effect of lactic acid bacteria (LAB) with different adipo- and immuno-modulatory capacities on metabolic and immunological parameters and intestinal composition microbiota in high-fat-diet-induced in mice fed a high-fat diet Methods: Balb/c weaning male mice were fed a standard (SD) or high-fat diet (HFD) with or without supplementation with Limosilactobacillus fermentum CRL1446 (CRL1446), Lactococcus lactis CRL1434 (CRL1434), or Lacticaseibacillus casei CRL431 (CRL431) for 45 days. Biochemical and immunological parameters, white-adipose tissue histology, gut microbiota composition, and ex vivo cellular functionality (adipocytes and macrophages) were evaluated in SD and HFD mice. Results: CRL1446 and CRL1434 administration, unlike CRL431, induced significant changes in the body and adipose tissue weights and the size of adipocytes. Also, these strains caused a decrease in plasmatic glucose, cholesterol, triglycerides, leptin, TNF-α, IL-6 levels, and an increase of IL-10. The CRL1446 and CRL1434 obese adipocyte in ex vivo functionality assays showed, after LPS stimulus, a reduction in leptin secretion compared to obese control, while with CRL431, no change was observed. In macrophages from obese mice fed with CRL1446 and CRL1434, after LPS stimulus, lower levels of MCP-1, TNF-α, IL-6 compared to obese control were observed. In contrast, CRL431 did not induce modification of cytokine values. Regarding gut microbiota, all strain administration caused a decrease in Firmicutes/Bacteroidetes index and diversity. As well as, related to genus results, all strains increased, mainly the genera Alistipes, Dorea, Barnesiella, and Clostridium XIVa. CRL1446 induced a higher increase in the Lactobacillus genus during the study period. Conclusions: The tested probiotic strains differentially modulated the intestinal microbiota and metabolic/immunological parameters in high-fat-diet-induced obese mice. These results suggest that CRL1446 and CRL1434 strains could be used as adjuvant probiotics strains for nutritional treatment to obesity and overweight. At the same time, the CRL431 strain could be more beneficial in pathologies that require regulation of the immune system.
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BACKGROUND: Although COVID-19 has greatly affected many low-income and middle-income countries, detailed information about patients admitted to the intensive care unit (ICU) is still scarce. Our aim was to examine ventilation characteristics and outcomes in invasively ventilated patients with COVID-19 in Argentina, an upper middle-income country. METHODS: In this prospective, multicentre cohort study (SATICOVID), we enrolled patients aged 18 years or older with RT-PCR-confirmed COVID-19 who were on invasive mechanical ventilation and admitted to one of 63 ICUs in Argentina. Patient demographics and clinical, laboratory, and general management variables were collected on day 1 (ICU admission); physiological respiratory and ventilation variables were collected on days 1, 3, and 7. The primary outcome was all-cause in-hospital mortality. All patients were followed until death in hospital or hospital discharge, whichever occurred first. Secondary outcomes were ICU mortality, identification of independent predictors of mortality, duration of invasive mechanical ventilation, and patterns of change in physiological respiratory and mechanical ventilation variables. The study is registered with ClinicalTrials.gov, NCT04611269, and is complete. FINDINGS: Between March 20, 2020, and Oct 31, 2020, we enrolled 1909 invasively ventilated patients with COVID-19, with a median age of 62 years [IQR 52-70]. 1294 (67·8%) were men, hypertension and obesity were the main comorbidities, and 939 (49·2%) patients required vasopressors. Lung-protective ventilation was widely used and median duration of ventilation was 13 days (IQR 7-22). Median tidal volume was 6·1 mL/kg predicted bodyweight (IQR 6·0-7·0) on day 1, and the value increased significantly up to day 7; positive end-expiratory pressure was 10 cm H2O (8-12) on day 1, with a slight but significant decrease to day 7. Ratio of partial pressure of arterial oxygen (PaO2) to fractional inspired oxygen (FiO2) was 160 (IQR 111-218), respiratory system compliance 36 mL/cm H2O (29-44), driving pressure 12 cm H2O (10-14), and FiO2 0·60 (0·45-0·80) on day 1. Acute respiratory distress syndrome developed in 1672 (87·6%) of patients; 1176 (61·6%) received prone positioning. In-hospital mortality was 57·7% (1101/1909 patients) and ICU mortality was 57·0% (1088/1909 patients); 462 (43·8%) patients died of refractory hypoxaemia, frequently overlapping with septic shock (n=174). Cox regression identified age (hazard ratio 1·02 [95% CI 1·01-1·03]), Charlson score (1·16 [1·11-1·23]), endotracheal intubation outside of the ICU (ie, before ICU admission; 1·37 [1·10-1·71]), vasopressor use on day 1 (1·29 [1·07-1·55]), D-dimer concentration (1·02 [1·01-1·03]), PaO2/FiO2 on day 1 (0·998 [0·997-0·999]), arterial pH on day 1 (1·01 [1·00-1·01]), driving pressure on day 1 (1·05 [1·03-1·08]), acute kidney injury (1·66 [1·36-2·03]), and month of admission (1·10 [1·03-1·18]) as independent predictors of mortality. INTERPRETATION: In patients with COVID-19 who required invasive mechanical ventilation, lung-protective ventilation was widely used but mortality was high. Predictors of mortality in our study broadly agreed with those identified in studies of invasively ventilated patients in high-income countries. The sustained burden of COVID-19 on scarce health-care personnel might have contributed to high mortality over the course of our study in Argentina. These data might help to identify points for improvement in the management of patients in middle-income countries and elsewhere. FUNDING: None. TRANSLATION: For the Spanish translation of the Summary see Supplementary Materials section.
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COVID-19/terapia , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/terapia , Adulto , Idoso , Argentina/epidemiologia , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/mortalidade , Teste de Ácido Nucleico para COVID-19 , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial/métodos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/virologia , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Volume de Ventilação Pulmonar , Resultado do Tratamento , Adulto JovemRESUMO
The "red chilto" (Solanum betaceum Cav) is a native fruit from the Yungas forest of Argentina. Red chilto is a neglected and underutilized native species (NUS). The objective of this work was to evaluate the potentiality of pulp, seed and skin from "red chilto" as a functional food ingredient to add value to a native resource of Argentine Yungas to promote sustainable integral use of it. The powders have low carbohydrate and sodium content and are a source of vitamin C, phenolic acids (rosmarinic acid and caffeoylquinic acid), anthocyanins, condensed tannins, carotenoids, potassium, and fiber. The phenolics of chilto powders showed, before and after simulated gastroduodenal digestion, antioxidant activity (ABTSâ¢+; H2O2; O2 â¢; HOâ¢) and were able to inhibit enzymes related to metabolic syndrome, such as α-glucosidase, α-amylase and lipase. Chilto powder showed hypoglycemic effect by increasing glucose adsorption, decreasing glucose diffusion rate and by promoting glucose transport across the cell membrane. These results suggest the potential of Argentinean "red chilto" fruits as functional food ingredients or dietary supplements to prevent metabolic syndrome principally by its antioxidant, hypoglycemic and hypolipemic effects.
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El desarrollo motor es un proceso continuo y multidimensional del ciclo vital del ser humano. Para el profesor de educación física se hace esencial buscar instrumentos que permitan medir el desarrollo motor para una intervención intencionada que permita alcanzar un desarrollo apropiado a la edad de cada estudiante. El objetivo de este estudio es identificar los test de desarrollo motor aplicados en Chile entre 2014-2018. Se realizó una revisión sistemática de artículos científicos que aplicaron test de desarrollo motor, entre los años 2014-2018. La búsqueda de artículos se realizó en las bases de datos "Ebsco", "Dialnet" y "Scielo". Las palabras claves en la búsqueda fueron, desarrollo motor y test desarrollo motor, en los idiomas español, inglés y portugués. Se obtuvo un total de 9 artículos que cumplieron los criterios de inclusión. Los resultados mostraron que se han utilizado 4 test de desarrollo motor en el periodo declarado. En conclusión, el test más utilizado en Chile es el TGMD-2 el cual es ampliamente recomendado y validado en el contexto chileno; y cuyo propósito se basa en la identificación de los niveles de ejecución (bajo o superior) del desarrollo motor grueso en los niños según la edad cronológica
Motor development is a continuous and multidimensional process of the human being life cycle. For the physical education teacher it is essential to look for instruments that allow measuring the motor development for an intentional intervention that allows achieving an appropriate development at the age of each student. The objective of this study is to identify the motor development test applied in Chile between 2014-2018. A systematic review of scientific articles that applied motor development tests was carried out between 2014-2018. The search for articles was carried out in the "Ebsco", "Dialnet" and "Scielo" databases. The keywords in the search were; motor development and motor development test, in the Spanish, English and Portuguese languages. Nine articles were obtained that met the inclusion criteria. The results showed that four motor development tests have been used in the declared period. In conclusion, the most used test in Chile is TGMD-2 which is widely recommended and validated in the Chilean context; and whose purpose is based on the identification of the performance levels (lower or higher) of gross motor development in children according to chronological age
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Humanos , Educação Física e Treinamento , Estudantes , Desenvolvimento Infantil/fisiologia , Atividade Motora/fisiologia , Desenvolvimento Humano/fisiologiaRESUMO
The present study aimed at investigating the lactic fermentation of cactus pear (Opuntia ficus-indica) fruit juice with the autochthonous and potentially probiotic strain Lactobacillus plantarum S-811. L. plantarum S-811 was able to quickly acidify the juice with a decrease in the pH from 5.5 to 3.7 and a production of 5.06 g l-1 of lactic acid. Fermentation of cactus pear juice led to conservation of its health-promoting properties and it markedly promoted antioxidant mechanisms in yeast cells, showing in a Saccharomyces cerevisiae model a protective effect of up to 11 times against H2O2 (4 mM), compared to yeasts not supplemented with the fermented juice. Administration of fermented juice to obese mice caused a significant decrease in the body weight gain and ameliorated the insulin resistance, hyperglycemia, and hyperlipemia that characterize obesity. These results reveal the potential of the cactus pear juice fermented with L. plantarum S-811 as a functional beverage for the prevention of obesity and related pathologies.