RESUMO
BACKGROUND: The use of rosuvastatin plus colchicine and emtricitabine/tenofovir in hospitalized patients with SARS-CoV-2 disease (COVID-19) has not been assessed. The objective of this study was to assess the effectiveness and safety of rosuvastatin plus colchicine, emtricitabine/tenofovir, and their combined use in these patients. METHODS: This was a randomized, controlled, open-label, multicentre, parallel, pragmatic study conducted in six referral hospitals in Bogotá, Colombia. The study enrolled hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 complicated with pneumonia, not on chronic treatment with the study medications, and with no contraindications for their use. Patients were assigned 1:1:1:1. 1) emtricitabine with tenofovir disoproxil fumarate (FTC/TDF, 200/300 mg given orally for 10 days); 2) colchicine plus rosuvastatin (COLCH+ROSU, 0.5 mg and 40 mg given orally for 14 days); 3) emtricitabine with tenofovir disoproxil plus colchicine and rosuvastatin at the same doses and for the same period of time (FTC/TDF+COLCH+ROSU); or 4) the Colombian consensus standard of care, including a corticosteroid (SOC). The primary endpoint was 28-day all-cause mortality. A modified intention-to-treat analysis was used together with a usefulness analysis to determine which could be the best treatment. The trial was registered at ClinicalTrials.gov: NCT04359095. FINDINGS: Out of 994 candidates considered between August 2020 and March 2021, 649 (65.3%) patients agreed to participate and were enrolled in this study; among them, 633 (97.5%) were included in the analysis. The mean age was 55.4 years (SD ± 12.8 years), and 428 (68%) were men; 28-day mortality was significantly lower in the FTC/TDF+COLCH+ROSUV group than in the SOC group, 10.7% (17/159) vs. 17.4% (28/161) (hazard ratio [HR] 0.53; 95% CI 0.29 to 0.96). Mortality in the FTC/TDF group was 13.8% (22/160, HR 0.68, 95% CI 0.39 to 1.20) and 14.4% in the COLCH+ROSU group (22/153) (HR 0.78, 95% CI 0.44 to 1.36). A lower need for invasive mechanical ventilation was observed in the FTC/TDF+COLCH+ROSUV group than in the SOC group (risk difference [RD] - 0.08, 95% CI 0.11 to 0.04). Three patients presented severe adverse events, one severe diarrhoea in the COLCH+ROSU and one in the FTC/TDF+COLCH+ROSU group and one general exanthema in the FTC/TDF group. INTERPRETATION: The combined use of FTC/TDF+COLCH+ROSU reduces the risk of 28-day mortality and the need for invasive mechanical ventilation in hospitalized patients with pulmonary compromise from COVID-19. More randomized controlled trials are needed to compare the effectiveness and cost of treatment with this combination versus other drugs that have been shown to reduce mortality from SARS-CoV-2 infection and its usefulness in patients with chronic statin use.
RESUMO
En México, no existe una adecuada regulación legal de la práctica profesional de la neuropsicología, a pesar de que existen pautas a nivel internacional donde se estipula que el profesional debe tener una formación teórica-práctica sobre neurociencias, psicología clínica y psicometría, además de destreza en habilidades clínicas y formulación de programas de intervención sólidamente fundamentados en estudios empíricos. Por lo tanto, es necesario que los profesionistas estén capacitados para desarrollar su labor, pues de lo contrario estaría atentando contra derechos fundamentales del ser humano. Por lo que las autoridades en materia de salud mental, al tener facultades suficientes para actualizar y legalizar en relación con la práctica clínica, deberán implementar medidas más específicas y rígidas en cuanto a los requisitos que deben reunir los profesionales en materia de neuropsicología. Finalmente, se debe impulsar el consenso entre las asociaciones, universidades y profesionales del campo, para establecer vías de comunicación que tenga como objetivo la regulación y reconocimiento de la profesionalización en neuropsicología clínica.
In Mexico, there is a lack of legal regulation of the professional practice of neuropsychology, even though there are international guidelines on the practice of neuropsychology which stipulate to have theoretical-practical training in neuroscience, clinical psychology and psychometrics, as well as skills in clinical and formulation of intervention programs solidly based on empirical studies. Therefore, it is a necessity that the professionals are properly trained, because otherwise it would be attacking the fundamental rights of the human being. Thus, the mental health authorities should update and legalize in relation to clinical practice more specific measures on the requirements to practice clinical neuropsychology. Finally, consensus among associations, universities, and professionals in the field should be encouraged to establish a communication that aims to regulate and recognize the practice in clinical neuropsychology.
Assuntos
Humanos , Neuropsicologia/legislação & jurisprudência , Neuropsicologia/ética , Prática Profissional , MéxicoRESUMO
AIMS: To evaluate and compare the association of four potential insulin resistance (IR) biomarkers (pigment-epithelium-derived factor [PEDF], retinol-binding-protein-4 [RBP-4], chitinase-3-like protein 1 [YKL-40] and brain-derived neurotrophic factor [BDNF]) with objective measures of IR. METHODS: We studied 81 subjects with different metabolic profiles. All participants underwent a 5-point OGTT with calculation of multiple IR indexes. A subgroup of 21 participants additionally underwent a hyperinsulinemic-euglycemic clamp. IR was defined as belonging to the highest quartile of incremental area under the insulin curve (iAUCins), or to the lowest quartile of the insulin sensitivity index (ISI). RESULTS: PEDF was associated with adiposity variables. PEDF and RBP4 increased linearly across quartiles of iAUCins (for PEDF p-trend=0.029; for RBP-4 p-trend=0.053). YKL-40 and BDNF were not associated with any adiposity or IR variable. PEDF and RBP-4 levels identified individuals with IR by the iAUCins definition: A PEDF cutoff of 11.9ng/mL had 60% sensitivity and 68% specificity, while a RBP-4 cutoff of 71.6ng/mL had 70% sensitivity and 57% specificity. In multiple regression analyses simultaneously including clinical variables and the studied biomarkers, only BMI, PEDF and RBP-4 remained significant predictors of IR. CONCLUSIONS: Plasma PEDF and RBP4 identified IR in subjects with no prior diagnosis of diabetes.
Assuntos
Biomarcadores/sangue , Fator Neurotrófico Derivado do Encéfalo/sangue , Proteína 1 Semelhante à Quitinase-3/sangue , Técnicas de Diagnóstico Endócrino , Proteínas do Olho/sangue , Resistência à Insulina , Fatores de Crescimento Neural/sangue , Proteínas Plasmáticas de Ligação ao Retinol/análise , Serpinas/sangue , Adulto , Idoso , Feminino , Técnica Clamp de Glucose , Intolerância à Glucose/sangue , Intolerância à Glucose/complicações , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Obesidade/metabolismo , Estado Pré-Diabético/sangue , Estado Pré-Diabético/complicações , Estado Pré-Diabético/diagnóstico , Proteínas Plasmáticas de Ligação ao Retinol/metabolismoRESUMO
Urinary tract infections (UTIs) account for 20-50% of all hospital-acquired infections occurring in the intensive care unit (ICU). In some reports UTI was found to be more frequent than hospital-acquired pneumonia and intravascular device bacteremia, with a greater incidence in developing countries. The risk factors associated with the appearance of UTI include the severity of illness at the time of admission to the ICU, female status, prolonged urinary catheterization or a longer ICU stay and poor urinary catheter management - mainly disconnection of the closed system. about the present study offers data on the epidemiology of UTI in the ICU, the identified risk factors, etiology, diagnosis, impact upon morbidity and mortality, and the measures to prevent its appearance.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Sistema Urinário/microbiologia , Estado Terminal , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/terapia , Humanos , Fatores de Risco , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapiaRESUMO
Tigecycline is a broad spectrum antibiotic having activity against multiresistant isolates. In vitro susceptibility testing is difficult to perform with the use of traditional microbiological techniques. The aim of this study was to evaluate the disk diffusion test with three different Mueller-Hinton agar brands, and the Vitek 2 automated system in comparison with the standard broth microdilution method against 200 gram-negative isolates (Escherichia coil, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens and Acinetobacter baumannii). Among Enterobacteriaceae, the Becton Dickinson agar had the lowest rate of minor (32.5%) and major errors (3.8%). No very major errors were found. For A. baumanni, the rate of minor and major errors was lower. A high rate of agreement (94%) was found between the broth microdilution method and the Vitek 2 system. Our results show that there are important differences between agars used for the disk diffusion test, and that Vitek 2 is a valid tool for susceptibility testing in clinical laboratories.
Assuntos
Antibacterianos/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Minociclina/análogos & derivados , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Humanos , Testes de Sensibilidade Microbiana/instrumentação , Testes de Sensibilidade Microbiana/métodos , Minociclina/farmacologia , TigeciclinaRESUMO
Patient care in an intensive care unit (ICU) is associated with an increased risk of developing nosocomial infections. Bacteremia is responsible for a great number of cases, 23% of which have attributable mortality in developed countries and can affect up to 52% of ICU patients. The main cause of mortality is inadequate and inappropriate antimicrobial empirical therapy. The incorrect use of antimicrobials is a major risk for identifying multidrug resistant microorganisms, thereby involving increased morbidity, mortality and costs. Implementing several surveillance systems and becoming acquainted with resistance patterns represent a valuable tool for identifying, preventing and treating this infectious complication. There is paucity of data regarding antimicrobial resistance in bacteremic patients in Latin America, and the available data reveals a worrying scenario.
Assuntos
Anti-Infecciosos/uso terapêutico , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana , Prescrição Inadequada , Humanos , Unidades de Terapia Intensiva , América LatinaRESUMO
El cambio climático puede afectar la distribución y frecuencia de las garrapatas en diferentes partes del mundo. No obstante, existen otros factores que también explican los cambios en la incidencia de las enfermedades transmitidas por garrapatas como:la explosión demográfica, las condiciones socioeconómicas, los cambios del paisaje y el comercio internacional. Se presentan los conceptos básicos del cambio climático enmarcados en un contexto biológico y epidemiológico. Se ha documentado que la tasa de transmisión de microorganismos es más alta con ciclos de vida más rápidos de las garrapatas. Se señalan los principales factores que podrían estar involucrados en los cambios poblacionales y geográficos de las garrapatas. Las actividades antrópicas podrían tener una influencia más determinante y profunda sobre la distribución degarrapatas, en comparación con el cambio climático. Se presentan las principales estrategias diseñadas para controlar su expansión geográfica y estacional. Si bien los planes de control en animales de producción requieren el uso de acaricidas de síntesis química, la inclusión de varias estrategias integradas dentro de un plan de manejo se presenta como una alternativa efectiva y sostenible.
The climatic change could be affect the frequency and distribution of the vector populations,like ticks, in many different places around the world, nowadays. Nevertheless, there is a number of factors explaining changes in the incidences of vector-borne diseases,e.g., rapid growth of human population, socio-economic conditions, changes of landscape, and international trading. I am presenting basic concepts about changes of the climate in a biological and epidemiological context. It has been documented that microorganisms transmission rates are higher with shorter life cycles of ticks. I amhereby presenting the main strategies designed to limit migration and abundance of tick populations. Although tick control within farm animals uses chemical acaricides,several strategies could be added by an integrated pest management program. It posesan effective and sustainable alternative.
Assuntos
Animais , Aquecimento Global , Mudança Climática , Ácaros e CarrapatosRESUMO
Patient care in an intensive care unit (ICU) is associated with an increased risk of developing nosocomial infections. Bacteremia is responsible for a great number of cases, 23% of which have attributable mortality in developed countries and can affect up to 52% of ICU patients. The main cause of mortality is inadequate and inappropriate antimicrobial empirical therapy. The incorrect use of antimicrobials is a major risk for identifying multidrug resistant microorganisms, thereby involving increased morbidity, mortality and costs. Implementing several surveillance systems and becoming acquainted with resistance patterns represent a valuable tool for identifying, preventing and treating this infectious complication. There is paucity of data regarding antimicrobial resistance in bacteremic patients in Latin America, and the available data reveals a worrying scenario.
El manejo médico en la unidad de cuidado intensivo (UCI) se asocia con un mayor riesgo de infecciones intrahospitalarias. Las bacteriemias tienen una alta frecuencia en dichas unidades, se presentan hasta en el 52% de los pacientes allí asistidos y en los países desarrollados se les atribuye una mortalidad del 23%, que se debe fundamentalmente al uso de tratamiento empírico inadecuado o inapropiado. El uso incorrecto de los antimicrobianos es uno de los principales factores de riesgo para el desarrollo de la resistencia bacteriana, que conlleva la selección de microorganismos multirresistentes, el aumento de la morbilidad y la mortalidad y el incremento en los días de estancia hospitalaria y del costo por hospitalización. La implementación de diferentes sistemas de vigilancia y el conocimiento de la variabilidad en la resistencia a los antimicrobianos constituyen valiosas herramientas para identificar y prevenir la resistencia a los antibióticos y para orientar la terapéutica. En América Latina disponemos de pocos datos sobre las tasas de resistencia y aquellos disponibles muestran un panorama preocupante.
Assuntos
Humanos , Anti-Infecciosos/uso terapêutico , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana , Prescrição Inadequada , Unidades de Terapia Intensiva , América LatinaRESUMO
The objectives were to evaluate the effect of high linear somatic cell counts (LNSCC > or =4.5) during early lactation on reproductive performance and to estimate their association with the risk of abortion in a population of central-southern Chilean dairy cattle. The analysis included records from a population of 157 farms and considered 1,127,405 test-day records including 101,944 lactations that began between 1997 and 2006. After data edits, the analyses of calving to first service and calving to conception intervals consisted of 88,633 and 70,877 lactations, respectively. Once controlling for significant variables, time to first breeding was 21.8 d longer in cows with at least 1 high LNSCC before the first breeding compared with controls. Cows with at least 1 high LNSCC before the fertile breeding had an increment in time to conception of 48.7 d and required, on average, 0.49 more services to conceive. The odds of conception at first service in cows with a high LNSCC within 30 d before [after] breeding were 0.85 (0.81 to 0.89; 95% confidence interval ) [0.82 (0.78 to 0.87; 95% confidence interval)] times the odds of conception for cows without a high LNSCC during that period. The Cox proportional hazard model indicated that after correction by calving year, lactation number, and milk yield standardized to 305 d, the risk of pregnancy decreased by 44% if a high LNSCC occurred before breeding. Cows registering a high LNSCC during the first 90 d of gestation had an increased risk of abortion, being 1.22 (1.07 to 1.35; 95% confidence interval) times more likely to abort than nonaffected cows. It is concluded that subclinical mastitis, measured as LNSCC >/=4.5, had a significant effect on reproductive performance in Chilean dairy cattle.