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Purpose Evaluate the associations of obesity and diabetes with the risk of mortality in critically ill patients infected with SARS-CoV-2. Materials and methods This cohort study included 115 adult patients admitted to the ICU with SARS-CoV-2 pneumonia. Anthropometric variables and biochemical (C-reactive protein, ferritin, leukocyte, neutrophils, and fibrinogen) were measured. Multivariate logistic regression analyses were used to investigate the associations. Results Mean age was 50.6 ± 11.2 years, 68.7% were male. Median BMI was 30.9 kg/m2. All patients had invasive mechanical ventilation. Patients with diabetes had increased risk of mortality with OR of 2.86 (CI 95% 1.1-7.4, p = 0.026); among those patients who, in addition to diabetes had obesity, the risk was de 3.17 (CI 95% 1.9-10.2, p = 0.038). Patients with obesity had 1.25 times greater risk of developing a severe SARS-CoV-2 infection (95% CI 1.09-1.46, p = 0.025). Negative correlation was observed between BMI and the PaO2/FiO2 ratio (r = -0.023, p

Measurement of intra-abdominal pressure (IAP) is realized with the Kron's method. However, this technique has drawbacks like an infusion of water into the bladder of the patient.The prove a new novel disposable sensor in the way to measure the IAP (DSIAP) this one addresses some limitations of the Kron method.The DSIAP was tested in vitro and clinical settings. The proposed technique was compared with Kron's method through Pearson correlation and Bland-Altman analysis. For in vitro tests, 159 measurements were taken performed by simulating the IAP in the bladder. For the clinical test, 20 pairs of measurements were made in patients with routine IAP monitoring in the intensive care unit.In vitro measurements showed a strong correlation between the DSIAP and the reference (r = 0.99, p-value2.2 × 10The results suggest that the proposed DSIAP showed a profile similar to pressure transducers already in clinical use while overcoming some limitations of the former.La medición de la presión intraabdominal (PIA) generalmente se realiza con el método de Kron, a pesar de presentar inconvenientes como la infusión de agua en la vejiga del paciente.Introducir un nuevo sensor desechable para medir la PIA (SDPIA) que aborda algunas limitaciones del método de Kron.Se probó el SDPIA en pruebas in vitro y clínicas. La técnica se contrastó con el método de Kron empleando la correlación de Pearson y el análisis de Bland-Altman. Para las pruebas in vitro se realizaron 159 mediciones simulando la PIA en la vejiga. Para las pruebas clínicas se realizaron 20 mediciones en pacientes con monitorización rutinaria de la PIA en la unidad de cuidados intensivos.En las mediciones in vitro se encontró una alta correlación (r = 0.99; p2.2 × 10Los resultados sugieren que el SDPIA propuesto muestra un desempeño similar al de los transductores de presión actualmente en uso clínico, mientras sobrelleva algunas limitaciones de estos últimos.

Preeclampsia, hemorrhage, and infection are the leading causes of maternal death in underdeveloped countries. Since several proteins associated with preeclampsia are known, we conducted a computational study which evaluated the commonness and potential functionality of intrinsic disorder of these proteins and also made an attempt to characterize their origin. The origin of the preeclampsia-related proteins was assessed with a supervised technique, a Polarity Index Method (PIM), which evaluates the electronegativity of proteins based solely on their sequence. The commonness of intrinsic disorder was evaluated using several disorder predictors from the PONDR family, the charge-hydropathy plot (CH-plot) and cumulative distribution function (CDF) analyses, and using the MobiDB web-based tool, whereas potential functionality of intrinsic disorder was studied with the D2P2 resource and ANCHOR predictor of disorder-based binding sites, and the STRING tool was used to build the interactivity networks of the preeclampsia-related proteins. Peculiarities of the PIM-derived polar profile of the group of preeclampsia-related proteins were then compared with profiles of a group of lipoproteins, antimicrobial peptides, angiogenesis-related proteins, and the intrinsically disordered proteins. Our results showed a high graphical correlation between preeclampsia proteins, lipoproteins, and the angiogenesis proteins. We also showed that many preeclampsia-related proteins contain numerous functional disordered regions. Therefore, these bioinformatics results led us to assume that the preeclampsia proteins are highly associated with the lipoproteins group, and that some preeclampsia-related proteins contain significant amounts of functional disorders.

Typhoid fever remains a serious public health problem. We have developed a vaccine from Salmonella enterica serovar typhi (S. typhi) outer-membrane proteins (OMPs) known as porins. A single subcutaneous dose of 10 microg of porins induced a five-fold (P = 0.05) seroconversion index consisting of IgM and IgG at 7 and 15 days after vaccination as well as the production of IgG1 and IgG2 isotypes. The porins-based vaccine induced a two-fold increase (P = 0.05) in bactericidal titres in volunteers, whom also developed a T-cell response characterized by the production of interferon-gamma (INF-gamma). Side effects after vaccination were mild and transient. The data showed that our S. typhi porins-based candidate vaccine is safe and immunogenic in healthy humans.

Symptoms of constrictive pericarditis may be nonspecific, misleading and may delay or lead to an incorrect diagnosis.We present the case of a 28-year-old male who was admitted to the hospital with progressive dyspnea, thoracic pain and a history of 25 kg of weight gain during the last 2 years. He was evaluated at another facility and his clinical presentation led to an erroneous diagnosis of primary hepatic disease (cirrhosis and portal hypertension). Physical examination showed that he was dyspneic, emaciated, had marked distention of his frontal cranial veins, diminished heart sounds, massive ascites and leg edema. Laboratory tests reported abnormal liver function tests and abdominal paracentesis chylous ascites. Electrocardiogram showed sinus rhythm with generalized low voltage and nonspecific repolarization changes. Heart size was normal on chest radiography. Doppler echocardiography reported bilateral atrial dilatation, a thickened pericardium and a short deceleration time of transmitral flow. A thickened and calcified pericardium was seen on CT scan. Pericardiectomy was performed. Spontaneous polyuria was observed during and after surgery with subsequent improvement of ascites and edema. The pericardium was found to be grossly thickened and inflamed.Clinician must be aware of the slow and progressive course of right ventricular failure, as well as to recognize constrictive pericarditis as a cause of chronic ascites.The hemodynamic aspects of the disease are of paramount importance for early diagnosis and opportune treatment.

Frequency of adrenal insufficiency in patients with tuberculosis varies from 0 to 58%; however, all published series excluded severely ill patients. Our objective was to investigate adrenal insufficiency with the low-dose cosyntropin test in patients with severe active tuberculosis.From two large university affiliated hospitals, 18 patients with tuberculosis and criteria of sepsis or severe sepsis according to SCCM/ACCP criteria, defined by the present authors as severe active tuberculosis, participated in the study. A low-dose ACTH test with 10 mg of ACTH was performed. After ACTH test, all patients received a stress dose of hydrocortisone (240 mg/day) during their entire hospitalization along with four antituberculous drugs. Abnormal response was considered when elevation of serum cortisol was7 microg/dl with respect to basal level, 60 min after ACTH administration.Adrenal insufficiency was found in seven patients (39%); no clinical or laboratory data were associated with the presence of abnormal adrenal response. Except in one patient with HIV infection, all the signs and symptoms improved after antituberculous and hydrocortisone treatment. The increment in serum cortisol value post-ACTH test was lower in patients with hypoalbuminemia.Adrenal insufficiency is frequent in severe active tuberculosis. The efficacy and security of supplemental steroid treatment in severe active tuberculosis should be established by a randomized clinical trial.

Positive end-expiratory pressure increases mean airway pressure (Paw) in patients with mechanical ventilation. We undertook this study to compare mean airway pressure (Paw) generated with static PEEP (sPEEP) vs. dynamic PEEP (dPEEP) at the same level of total PEEP (tPEEP) in the same patient with pressure-controlled mechanical ventilation (PC).We conducted a prospective clinical trial at the Intensive Care Unit of a university-affiliated hospital. Consecutive patients in PC with SaO290%; FiO250%; sPEEP of 4 cm H2O and inspiration-expiration ratio (I:E ratio) 1:2 were included in the study. After a basal period of time of 15 min, Paw was registered (phase one of the study protocol). In phase 2 with the ventilator settings constant, only the I:E ratio was switched to 2:1 to generate dPEEP, and after 15 min Paw and total PEEP (tPEEP) were registered (tPEEP=sPEEP+dPEEP). In phase 3, the I:E ratio was switched back to 1:2 substituting the dPEEP generated in the second phase of the study by sPEEP to maintain the same level of tPEEP of phase 2. After 15 min, Paw was again registered. Friedman and Wilcoxon's test were used, p value0.05 was considered statistically significant.Thirty eight patients were admitted to the study protocol, tPEEP was 4, 8 and 8 cm H2O and median of the Paw 8.7, 13.8, and 11.4 cm H2O, respectively, with a p value0.05 in the first, second and third phases of the study.During pressure control ventilation, mean airway pressure is affected by the level of total PEEP and its composition. Paw is higher when dynamic PEEP participates in the composition of total PEEP.

To evaluate cerebral blood flow (CBF) direction, speed, and shape of Doppler profile in patients with clinical criteria of brain death (BD).A total of 42 consecutive patients with clinical criteria for BD were included.After anemia, hypothermia and hypocapnia were ruled out; confirmatory electroencephalogram (EEG) and a complete transcranial Doppler ultrasonography (TCDU) profile of circle of Willis and basilar arteries were done in all patients. Patients continued with mechanical ventilation and support in the Intensive Care Unit.All EEG reported generalized theta and delta waves, which were associated with a TCDU profile showing small systolic peaks without diastolic wave. CBF velocities of10 cm/sec were recorded in all patients. Only four patients had reverberating flow. At follow-up, cardiac arrest occurred in all patients at a mean of 2 +/- 0.84 days.Patients with clinical criteria of BD frequently have slow wave neuronal electrical activity on EEG that anticipates cardiac arrest. In these patients, TCDU detects an early and severe drop in CFB that is incompatible with life. TCDU should be done when other confirmatory tests like EEG suggest some retention of brain function.

To evaluate the efficacy of early therapeutic plasmapheresis in severely affected patients with Guillain-Barré syndrome (GBS).Patients between 16 to 70 years of age, with GBS according to NINCDS criteria, in stageor = 3 of Huges severity score and with less than 7 days of onset of symptoms were admitted for therapeutic plasmapheresis. All patients completed a total of five sessions of plasma exchange every other day using 25% albumin and saline in a 1:1 proportion. Follow-up was performed for 6 months. Friedman and Wilcoxon tests were done to establish differences within groups.A total of 34 patients were admitted to the study. The time span between onset of symptoms and admission to the study was 4 days (median). Fourteen (41%) required mechanical ventilation. Clinical progression of the syndrome was observed during the first two sessions of plasma-pheresis. Improvement in motor function by Huges score was observed only after fourth session of plasma exchange (p0.05). Two patients did not improve, and one died.Clinical improvement in GBS during early therapeutic plasmapheresis occurs only after the fourth session of plasma exchange.

Objective: To demonstrate that pentoxifylline (PTX) and not placebo improves oxygen consumption (VO2) in critically ill patients with severe sepsis. Setting: Multidisciplinary intensive care unit in a university affiliated hospital. Design: A randomized, double blinded clinical trial comparing 300 mg of PTX administered in a 120 min iv infusion with an identically looking placebo. Patients: 13 patients (9 men and 4 women) average age 39 (24–62) years old received PTX, and 12 patients (5 men and 7 women) average age 38 (21–83) years old received placebo. All satisfied ACCP/SCCM criteria for severe sepsis. Measurements and interventions: Patients fulfilling criteria for severe sepsis were identified on admission, cardiac output, DO2 and VO2 were measured by thermodilution and standard oximetric technics after adequate volume replacement at baseline, 60 and 120 during infusion. F-test of analysis of variance was used to test hypothesis about differences of DO2 and VO2 by group, by time and for the interaction terms, a “p” value