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Effect of polymerised type I collagen on hyperinflammation of adult outpatients with symptomatic COVID-19.
Méndez-Flores, S, Priego-Ranero, Á, Azamar-Llamas, D, Olvera-Prado, H, Rivas-Redonda, KI, Ochoa-Hein, E, Perez-Ortiz, A, Rendón-Macías, ME, Rojas-Castañeda, E, Urbina-Terán, S, et al
Clinical and translational medicine. 2022;(3):e763
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2.
A Risk Score to Predict Admission to the Intensive Care Unit in Patients with COVID-19: the ABC-GOALS score.
Mejía-Vilet, JM, Córdova-Sánchez, BM, Fernández-Camargo, DA, Méndez-Pérez, RA, Morales-Buenrostro, LE, Hernández-Gilsoul, T
Salud publica de Mexico. 2020;(1, ene-feb):1-11
Abstract
OBJECTIVE To develop a score to predict the need for ICU admission in COVID-19. METHODS We assessed patients admitted to a COVID-19 center in Mexico. Patients were segregated into a group that required ICU admission, and a group that never required ICU admission. By logistic regression, we derived predictive models including clinical, laboratory, and imaging findings. The ABC-GOALS was constructed and compared to other scores. RESULTS We included 329 and 240 patients in the development and validation cohorts, respectively. One-hundred-fifteen patients from each cohort required ICU admission. The clinical (ABC-GOALSc), clinical+laboratory (ABC-GOALScl), clinical+laboratory+image (ABC-GOALSclx) models area under the curve were 0.79 (95%CI=0.74-0.83) and 0.77 (95%CI=0.71-0.83), 0.86 (95%CI=0.82-0.90) and 0.87 (95%CI=0.83-0.92), 0.88 (95%CI=0.84-0.92) and 0.86 (95%CI=0.81-0.90), in the development and validation cohorts, respectively. The ABC-GOALScl and ABC-GOALSclx outperformed other COVID-19 and pneumonia predictive scores. CONCLUSION ABC-GOALS is a tool to timely predict the need for admission to ICU in COVID-19.
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Noninvasive ventilation: education and training. A narrative analysis and an international consensus document.
Karim, HMR, Burns, KEA, Ciobanu, LD, El-Khatib, M, Nicolini, A, Vargas, N, Hernández-Gilsoul, T, Skoczyński, S, Falcone, VA, Arnal, JM, et al
Advances in respiratory medicine. 2019;(1):36-45
Abstract
Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries.
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Mortality in adult patients with fluid overload evaluated by BIVA upon admission to the emergency department.
Kammar-García, A, Pérez-Morales, Z, Castillo-Martinez, L, Villanueva-Juárez, JL, Bernal-Ceballos, F, Rocha-González, HI, Remolina-Schlig, M, Hernández-Gilsoul, T
Postgraduate medical journal. 2018;(1113):386-391
Abstract
PURPOSE OF THE STUDY The aim of this study was to investigate the association of fluid overload, measured by bioelectrical impedance vector analysis (BIVA) and also by accumulated fluid balance, with 30-day mortality rates in patients admitted to the emergency department (ED). DESIGN We conducted a prospective observational study of fluid overload using BIVA, taking measures using a multiple-frequency whole-body tetrapolar equipment. Accumulated fluid balances were obtained at 24, 48 and 72 hours from ED admission and its association with 30-day mortality. PATIENTS 109 patients admitted to the ED classified as fluid overloaded by both methods. RESULTS According to BIVA, 71.6% (n=78) of patients had fluid overload on ED admission. These patients were older and had higher Sequential Organ Failure Assessment scores. During a median follow-up period of 30 days, 32.1% (n=25) of patients with fluid overload evaluated by BIVA died versus none with normovolaemia (p=0.001). There was no statistically significant difference in mortality between patients with and without fluid overload as assessed by accumulated fluid balance (p=0.81). CONCLUSIONS Fluid overload on admission evaluated by BIVA was significantly related to mortality in patients admitted to the ED.
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Influenza A (H1N1pdm09)-Related Critical Illness and Mortality in Mexico and Canada, 2014.
Dominguez-Cherit, G, De la Torre, A, Rishu, A, Pinto, R, Ñamendys-Silva, SA, Camacho-Ortiz, A, Silva-Medina, MA, Hernández-Cárdenas, C, Martínez-Franco, M, Quesada-Sánchez, A, et al
Critical care medicine. 2016;(10):1861-70
Abstract
OBJECTIVES The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. DESIGN Observational study and a survey of available healthcare setting resources. SETTING Twenty-one hospitals, 13 in Mexico and eight in Canada. PATIENTS Critically ill patients with confirmed H1N1pdm09 during 2013-2014 influenza season. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median PaO2-to-FIO2 ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H2O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting PaO2-to-FIO2 ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80-0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10-2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02-27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. CONCLUSIONS Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.