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High flow nasal cannula (HFNC) is frequently used in patients with acute respiratory failure, but there is limited evidence regarding predictors of therapeutic failure. The objective of this study was to assess diaphragmatic ultrasound criteria as predictors of failure to HFNC, defined as the need for orotracheal intubation or death.Prospective cohort study including adult patients consecutively admitted to the critical care unit, from July 24 to October 20, 2020, with respiratory failure secondary to SARS-CoV-2 pneumonia who required HFNC. After 12 hours of HFNC initiation we measured ROX index (ratio of SpOIn total, 41 patients were analyzed, 25 succeeded and 16 failed HFNC therapy. At 12 hours, patients who succeeded HFNC therapy presented higher ROX index in supine position (9.8 [9.1-15.6] versus 5.4 [3.9-6.8], P .01), and higher PaODiaphragmatic contraction speed by ultrasound emerges as a diagnostic complement to clinical tools to predict HFNC success. Future studies should confirm these results.

An inventory of the total population of isolated rural villages of the most affected Ecuadorian Andean provinces by endemic goiter was made. In each of these villages iodine content in urine, salt and water was determined. It was conclusive that the chronic iodine deficiency is sine qua non condition for the endemic; but the severity of the endemic; but the severity of the endemic doesn’t have relationship with the magnitude of the lack, rather due to the intercourse of socio-economic and biological intercurrent deficitary factors. Even with the iodine deficiency and the intercourse of the communities located more than 3,500 m, adove sea level, did not present goiter with endemic characteristics. The severity of the endemic was determined to be correlated with: incidence of nodular goiters, in the general population in the first two decades of life, presence of big goiters, incidence of goiters mean in the relation to that in woman. All of wich is epidemiologically related to the incidence of defects that would begin appearing in endemic form in a community, and in accord to the severity would follow the following order of appearing in the endemic form in a community, and in accord to the severity would follow the following order od appearance: motor abnormalities, mental deficiency, deafmutism, deafness and mutism. Finally, a familiar tendency was clearly demonstrated so that a cretin child would be born, and no relationship, on familial level, between incidence and type of goiter and the appearance.