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BACKGROUND: Acute kidney injury (AKI) is associated with high morbidity and mortality rates in the intensive care unit (ICU). In low- and middle-income countries (LMICs), epidemiological information about this condition is still scarce. Our main objective was to characterize its epidemiology, prognosis, and its treatment. METHODS: This multicenter prospective cohort study included 1466 patients from 35 ICUs during 6 months in Argentina in 2018. Risk factors and outcomes in patients with and without AKI, and between AKI on admission (AKIadm) and that developed during hospitalization (AKIhosp) were analyzed. RESULTS: AKI occurred in 61.3% of patients (900/1466); 72.6% were AKIadm and 27.3% AKIhosp. Risk factors were age, BMI, arterial hypertension, cardiovascular diseases, diabetes, SOFA, APACHE II, dehydration, sepsis, vasopressor use, radiocontrast, diuresis/h and mechanical ventilation. Independent predictors for AKI were sepsis, diabetes, dehydration, vasopressors on admission, APACHE II and radiocontrast use. Renal replacement therapies (RRT) requirement in AKI patients was 14.8%. Hospital mortality in AKI vs. non-AKI was 38.7% and 23.3% (p < 0.001); and in AKIadm vs. AKIhosp, 41.2% and 37.8% (p = 0.53). CONCLUSIONS: ICU-acquired AKI has high incidence, complications and mortality. Risk factors for AKI and RRT utilization were similar to those described in other epidemiological studies. AKIadm was more frequent than AKIhosp, but had equal prognosis.

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BACKGROUND: The gap between the nutrition education provided to medical students and the nutrition competencies and attitudes needed for physicians to provide adequate nutrition care is a global concern. There is no universally accepted benchmark on nutrition competencies for doctors. The objective of this study was to establish, by expert consensus, the objectives of undergraduate nutrition medial education, the nutrition core competencies, and strategies for curriculum development in medical nutrition education. METHODS: We administered a Delphi survey to systematically gather the opinion of a panel of Latin American experts in nutrition. The survey questionnaire was constructed considering scientific literature by using a 5-point Likert scale. Consensus was defined as >70% agreement on the importance of an item (Likert scale 4 and 5). RESULTS: A four-round Delphi survey was conducted for this research. In the second, third, and fourth rounds, we validated a total of 130 competencies by consensus, which were distributed into four different thematic areas: (1) basic nutrition concepts, (2) public nutrition and nutrition prevention throughout the life cycle, (3) nutrition status and disease, and (4) nutrition care process. CONCLUSION: The curricula for general physician education in medical school must include health promotion, prevention, and treatment of diseases related to nutrition. This goal can be reached by integrating ≤130 competencies into four different fundamental areas.

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RATIONALE: The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. METHODS: Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. RESULTS: A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0-150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students' average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients' health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. CONCLUSIONS: Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.

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RESUMEN Introducción: El distrés respiratorio en pacientes con SARS-CoV-2 plantea la necesidad de decúbito prono prolongado, ubicación que dificulta la realización del electrocardiograma (ECG) convencional, lo cual lleva a plantear su obtención en prono. Objetivos: Determinar los hallazgos electrocardiográficos en pacientes pronados, comparándolos con los obtenidos en posición supina Material y métodos: Fueron incluidos pacientes pronados por distrés. Se realizó ECG y se definieron los hallazgos más frecuentes y su comparación con la posición supina. Un valor de P menor de 0.05 se consideró significativo Resultados: en 302 pacientes pronados se observó: bajo voltaje en 232 (76,8%) pacientes, rotación antihoraria en 207 (68.5%), imagen QS en precordiales derechas en 198 (65.6%) y trastornos de la onda T en 193 (63.9%), arritmias supraventriculares en 134(44.4%), ventriculares en 59 (19,5%), y eventos isquémicos en 2 (0,7%) casos. Conclusión: Los hallazgos más frecuentes resultaron el bajo voltaje, la rotación antihoraria, el patrón QS en precordiales derechas y la reducción del voltaje de la onda P y el QRS.

ABSTRACT Background: Respiratory distress syndrome in patients with SARS CoV-2 poses the need for prolonged prone position. This hinders the performance of a conventional electrocardiogram (ECG), leading to consider the one obtained in prone position. Objective: The aim of this study was to determine the electrocardiographic findings in patients in prone position and compare them with those obtained in supine position. Methods: Patients in prone position due to respiratory distress syndrome were included in the study. An ECG was performed with definition of the most frequent findings which were compared with those observed in supine position. A p value <0.05 was considered statistically significant. Results: A total of 302 patients in prone position showed: low voltage in 232 patients (76.8%), counter-clockwise rotation in 207 (68.5%), QS image in right precordial leads in 198 (65.6%), T wave abnormalities in 193 (63.9%), supraventricular arrhythmias in 134 (44.4%), ventricular arrhythmias in 59 (19.5%), and ischemic events in 2 (0.7%) cases. Conclusions: The most frequent electrocardiographic findings were low voltage, counter-clockwise rotation, QS pattern in right precordial leads and reduced P wave and QRS complex voltage.

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La modulación de la respuesta inflamatoria e inmune en el paciente crítico ha sido objeto de múltiples investigaciones en la última década, debido a sus posibles efectos en el mantenimiento del funcionamiento del epitelio intestinal, del tejido linfoide asociado al intestino, mejora de la función de las células T, inhibición de factores pro-inflamatorios, disminución de la respuesta a la injuria, optimización de la cicatrización, mejora del balance nitrogenado y reducción de las complicaciones infecciosas y de la estancia hospitalaria. Por tal motivo, se realizó una revisión de la literatura del 2005 al 2016 a fin de evaluar la evidencia científica sobre el uso de inmunonutrientes (glutamina, arginina, ácidos grasos omega 3 y antioxidantes) en el paciente crítico. Aunque los primeros estudios han demostrado algunos beneficios clínicos, los estudios multicéntricos recientes no han logrado definir un beneficio consistente en términos de mortalidad o de otras medidas de resultado clínicas, por lo tanto, la evidencia actual muestra que la administración de inmunonutrientes no debe ser recomendada de forma rutinaria en el paciente crítico...

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Introducción: Los pacientes hospitalizados con riesgo nutricional (RN) o desnutrición (DNT) presentan complicaciones entre 2 y 20 veces más que los pacientes con estado nutricional (EN) normal. Muchos no cubren con la dieta hospitalaria los requerimientos calóricos y proteicos. Objetivos: Evaluar el EN de los pacientes internados y determinar el déficit calórico y proteico. Métodos: Estudio descriptivo y transversal en 135 pacientes elegidos por conglomerados. Se utilizó Valoración Global Subjetiva (VGS), índice de masa corporal (IMC), porcentaje de cambio de peso (PCP) y Recordatorio de 24hs. Resultados: El 38.5% de la muestra presentó RN o DNT moderada y el 17.1% DNT severa. El 49.5% de los pacientes con IMC normal, sobrepeso (SP) y obesidad (OB) tuvo pérdida peso, siendo severa en el 64.4%. El aporte calórico y proteico se adecuó a los requerimientos del paciente en el 45.2% y en el 63.7% respectivamente, sin embargo se registró déficit calórico en el 54.8% y déficit proteico en el 36.3% de la muestra. Con la administración del soporte nutricional (SN) se logró cubrir los requerimientos calóricos en más de la mitad de los pacientes con DNT y RN (92.3% y 66.6% respectivamente) Conclusión: El RN y la DNT hospitalaria sigue siendo un problema con elevada prevalencia. La pérdida exagerada de peso compromete el EN del paciente, siendo el PCP un indicador más útil que el IMC. El SN se indica cuando el paciente manifiesta un deterioro avanzado del EN, sin embargo se muestra que logró cubrir los requerimientos nutricionales en más de la mitad de pacientes con RN o DNT. Se propone trabajar sobre las causas que generan déficit de nutrientes y fomentar el uso del SN en quienes requieran apoyo nutricional, con el fin de que el tratamiento resulte eficaz y la recuperación del paciente sea lo más pronta posible.

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