Search

Currently the whole world is going through a health contingency due to the COVID-19 disease, a situation that has triggered countless changes in different sectors of society. Among the various problems derived from this situation are the negative effects on the economy, since the condition in which the different economic agents find themselves is not favorable. Companies in all countries have been suffering the consequences within their life cycle, some of them having to close permanently and others looking for strategies not to die, or simply trying to survive. In Mexico, certain organizations analyze the damage that has affected the national economy, however, the information found in the different documents shows generalized data, and these effects cannot be identified locally. As a consequence, the objective of this study was to analyze the Micro and Small Enterprises (MSEs) in Atlacomulco, Mexico. For which, an instrument was developed with the indicators of the survey on the Economic Impact Generated by COVID-19 in Companies (ECOVID-IE) (INEGI, 2020). The study was made up of a sample of 40 MSEs from the study area, the main results show that the MSEs considered have been strongly affected.

The Neolithic Revolution narrative associates early-mid Holocene domestications with the development of agriculture that fueled the rise of late Holocene civilizations. This narrative continues to be influential, even though it has been deconstructed by archaeologists and geneticists in its homeland. To further disentangle domestication from reliance on food production systems, such as agriculture, we revisit definitions of domestication and food production systems, review the late Pleistocene–early Holocene archaeobotanical record, and quantify the use, management and domestication of Neotropical plants to provide insights about the past. Neotropical plant domestication relies on common human behaviors (selection, accumulation and caring) within agroecological systems that focus on individual plants, rather than populations—as is typical of agriculture. The early archaeobotanical record includes numerous perennial and annual species, many of which later became domesticated. Some of this evidence identifies dispersal with probable cultivation, suggesting incipient domestication by 10,000 years ago. Since the Pleistocene, more than 6500, 1206 and 6261 native plant species have been used in Mesoamerica, the Central Andes and lowland South America, respectively. At least 1555, 428 and 742 are managed outside and inside food production systems, and at least 1148, 428 and 600 are cultivated, respectively, suggesting at least incipient domestication. Full native domesticates are more numerous in Mesoamerica (251) than the Andes (124) and the lowlands (45). This synthesis reveals that domestication is more common in the Neotropics than previously recognized and started much earlier than reliance on food production systems. Hundreds of ethnic groups had, and some still have, alternative strategies that do involve domestication, although they do not rely principally on food production systems, such as agriculture.

Lansbury et al. recently reported in this journal that 7% of hospitalized COVID-19 patients had a bacterial co-infection. This proportion increased to 14% in studies that only included patients who required admission to the intensive care unit (ICU)1Louise Lansbury Benjamin Lim Vadsala Baskaran Shen Lim Wei Co-infections in people with COVID-19: a systematic review and meta-analysis.J Infect. 2020; 81: 266-275https://doi.org/10.1016/j.jinf.2020.05.046Abstract Full Text Full Text PDF Scopus (14) Google Scholar. ICU admission is a risk factor for hospital-acquired infections and nosocomial infections by multidrug-resistant (MDR) bacteria 2Jean-Louis Vincent Jordi Rello John Marshall Eliezer Silva Antonio Anzueto Martin Claude D. et al. International study of the prevalence and outcomes of infection in intensive care units.JAMA. 2009; 302: 2323-2329https://doi.org/10.1001/jama.2009.1754Crossref Scopus (1775) Google Scholar,3Hui Ang Xuan Sun Risk factors for multidrug-resistant Gram-negative bacteria infection in intensive care units: A meta-analysis.Int J Nurs Pract. 2018; 24: e12644https://doi.org/10.1111/ijn.12644Crossref Scopus (6) Google Scholar. Here, we report our findings of a retrospective cohort study to asses the incidence of co-infections, ICU-acquired infections and their relation to mortality in patients with COVID-19.

Joubert syndrome is a rare neurological manifestation usually present in late infancy or early childhood with characteristic episodes of abnormal breathing pattern along with the neurological and other systemic involvement.We report a case of confirmed Joubert syndrome present in the immediate neonatal period with isolated spells of oxygen desaturations not accompanied by the classically described breathing pattern and absent neurological symptoms causing delay in the diagnosis. Isolated oxygen desaturation episodes could be a presenting manifestation of Joubert syndrome in a neonatal period.

In accordance with the recommendations of, amongst others, the Surviving Sepsis Campaign and the recently published European treatment guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), in the event of a patient with such infections, empirical antibiotic treatment must be appropriate and administered as early as possible. The aim of this manuscript is to update treatment protocols by reviewing recently published studies on the treatment of nosocomial pneumonia in the critically ill patients that require invasive respiratory support and patients with HAP from hospital wards that require invasive mechanical ventilation. An interdisciplinary group of experts, comprising specialists in anaesthesia and resuscitation and in intensive care medicine, updated the epidemiology and antimicrobial resistance and established clinical management priorities based on patients’ risk factors. Implementation of rapid diagnostic microbiological techniques available and the new antibiotics recently added to the therapeutic arsenal has been reviewed and updated. After analysis of the categories outlined, some recommendations were suggested, and an algorithm to update empirical and targeted treatment in critically ill patients has also been designed. These aspects are key to improve VAP outcomes because of the severity of patients and possible acquisition of multidrug-resistant organisms (MDROs).

A narrative review from a multidisciplinary task force of experts in critical care medicine and clinical mycology was carried out. The multi drug-resistant species Candida auris has emerged simultaneously on several continents, causing hospital outbreaks, especially in critically ill patients. Although there are not enough data to support the routine use of continuous antibiotic prophylaxis in patients subjected to extracorporeal membrane oxygenator, a clear increase of invasive fungal infection (IFI) has been described with the use of this device. Possible IFI treatment failures could be related with suboptimal antifungal concentrations despite dose adjustment. Invasive aspergillosis has become an important life-threating infection in intensive care unit related with new risk factors described. IFI remain important problem in critical patients due to the appearance of new risk factors, new species, and resistance increase. Multidisciplinary packages of measures designed to reduce IFI incidence and improve diagnostics tools may reduce the high mortality associated.

This study aimed to assess the efficacy of ceftolozane-tazobactam (C/T) for treating infections due to Pseudomonas aeruginosa (P. aeruginosa) in critically ill patients.A multicenter, retrospective and observational study was conducted in critically ill patients receiving different C/T dosages and antibiotic combinations for P. aeruginosa infections. Demographic data, localisation and severity of infection, clinical and microbiological outcome, and mortality were evaluated.Ninety-five patients received C/T for P. aeruginosa serious infections. The main infections were nosocomial pneumonia (56.2%), intra-abdominal infection (10.5%), tracheobronchitis (8.4%), and urinary tract infection (6.3%). Most infections were complicated with sepsis (49.5%) or septic shock (45.3%), and bacteraemia (10.5%). Forty-six episodes were treated with high-dose C/T (3 g every 8 hours) and 38 episodes were treated with standard dosage (1.5 g every 8 hours). Almost half (44.2%) of the patients were treated with C/T monotherapy, and the remaining group received combination therapy with other antibiotics. Sixty-eight (71.6%) patients presented a favourable clinical response. Microbiological eradication was documented in 42.1% (40/95) of the episodes. The global ICU mortality was 36.5%. Univariate analysis showed that 30-day mortality was significantly associated (P0.05) with Charlson Index at ICU admission and the need of life-supporting therapies.C/T appeared to be an effective therapy for severe infections due to P. aeruginosa in critically ill patients. Mortality was mainly related to the severity of the infection. No benefit was observed with high-dose C/T or combination therapy with other antibiotics.

Background and objective The impact of pandemic influenza A (H1N1)v infection is still unknown but it is associated with a high case-fatality rate. Methods This was a prospective, observational, multicentre study conducted in 144 Spanish intensive care units. Demographic and clinical data were reviewed for all cases of pandemic influenza A (H1N1)v infection reported from 23 June 2009 through 11 February 2010 and confirmed by reverse transcriptase PCR assay. Results Out of 872 cases reported by statewide surveillance, data for the first 131 deceased patients were analysed. Thirty-seven patients (28.2%) died within the first 14 days. The median age of these patients was 46 years (interquartile range 35-58) and 60.3% were male. Twenty-eight patients (21.4%) did not present with any comorbidities on admission. Forty-six per cent of patients were reported to be obese and 22 (16.8%) had COPD. The vast majority of the patients (72.5%) had viral pneumonia; 95.4% of these had bilateral patchy alveolar opacities (predominantly basal), affecting three or four quadrants. One hundred and fifteen patients (87.8%) developed multi-organ dysfunction syndrome. Ninety-seven patients (74%) required vasopressor drugs, 37 (27.2%) received renal replacement therapy, and 47 (35.1%) received intravenous corticosteroids on admission to the intensive care unit. Only 68 patients (51.9%) received empirical antiviral treatment. Conclusions One-third of patients with pandemic influenza A (H1N1)v infection died within the first two weeks and these were young patients, with rapidly progressive viral pneumonia as the primary cause of admission. Obese patients were at high risk but one in four patients did not present with any risk factors on admission. Only half the patients received empirical antiviral therapy and this was administered late.

Purpose Information about healthcare-associated pneumonia (HCAP) in critically ill patients is scarce. Methods This prospective study compared clinical presentation, outcomes, microbial etiology, and treatment of HCAP, community-acquired pneumonia (CAP), and immunocompromised patients (ICP) with severe pneumonia admitted to 34 Spanish ICUs. Results A total of 726 patients with pneumonia (449 CAP, 133 HCAP, and 144 ICP) were recruited during 1 year from April 2011. HCAP patients had more comorbidities and worse clinical status (Barthel score). HCAP and ICP patients needed mechanical ventilation and tracheotomy more frequently than CAP patients. Streptococcus pneumoniae was the most frequent pathogen in all three groups (CAP, 34.2 %; HCAP, 19.5 %; ICP, 23.4 %; p = 0.001). The overall incidence of Gram-negative pathogens, methicillin-resistant Staphylococcus aureus (MRSA), and Pseudomonas aeruginosa was low, but higher in HCAP and ICP patients than CAP. Empirical treatment was in line with CAP guidelines in 73.5 % of patients with CAP, in 45.5 % of those with HCAP, and in 40 % of those with ICP. The incidence of inappropriate empirical antibiotic therapy was 6.5 % in CAP, 14.4 % in HCAP, and 21.8 % in ICP (p

Background The Peruvian Andean region is a main center of plant domestication of the world. There, several tuber species were domesticated and the area lodges one of the most important reservoirs of their varieties and wild relatives. It is also the setting of traditional cultures using and conserving them. However, crop genetic erosion has been reported in the region since several decades ago; therefore, understanding factors influencing both loss and maintenance of crop variation is relevant to design conservation policies. Previous researches have examined factors influencing agrobiodiversity conservation in the region but additional case studies are recognized to be still necessary for a deeper understanding of causes of genetic erosion and for policy design to prevent and remedy it. Our study focused on analyzing (1) variation in richness of traditional varieties of tubers cultivated among households, (2) changes in varieties richness occurred in four consecutive agricultural cycles, and (3) ecological, social, and cultural factors influencing loss and conservation of varieties. Methods Richness of farmer varieties of tuber species cultivated by 28 peasant households was monitored in communities of Cajamarca and Huánuco, Peru during four consecutive agricultural cycles (from 2001 to 2005). In-depth interviews were conducted with 12 of the households with higher reputation as conservationists, in order to document farmers' perception of tubers qualities in ecological, social, economic, technological and culinary aspects and how these influence their decisions of conservation priorities. Traditional varieties were identified according to their local names, which were then confronted among farmers and with scientific catalogues in order to identify synonyms. Based on the information documented, indexes of ecological and socio-cultural factors affecting agricultural practices were designed, and their linear correlations and multivariate relations with varieties richness managed per household were analyzed in order to explore factors with higher influence on conservation of crop variation. Results A total of 1483 and 507 farmer varieties of tuber species were found in the whole sample and period studied in Huánuco and Cajamarca, respectively. Significantly more varieties managed per household per year were recorded in Huánuco (146.39 ± 12.02) than in Cajamarca (44.55 ± 9.26), and marked differences in number of varieties per year were documented among households within each region (78.25 to 246.50 in Huánuco, 7.50 to 144.00 in Cajamarca). Correlation and multivariate analyses identified that the extent of agricultural area managed by households, cultural identity, practicing of traditional agricultural techniques, and level of self-sufficiency, are meaningful factors influencing higher varieties richness maintained by households. Yield and culinary attributes were considered by people as main features for selecting and deciding which varieties are priorities for conservation. Conclusions Maintenance and promotion of indigenous Andean culture is crucial for ensuring conservation of both traditional agroecological systems and agrobiodiversity. Policies supporting Andean culture (through educational, cultural and economic programs) are therefore directly connected with conservation of traditional farmer varieties. Promotion of seed availability and interchange are effective actions for maintaining and developing diversity, but using and valuing native tubers at regional, national and international levels are fundamental motivations to enhance policies and processes in this direction.

Received 8 October 2010; returned 9 November 2010; revised 2 December 2010; accepted 6 December 2010Objectives: The impact of oseltamivir on mortality in critically ill patients with 2009 pandemic influenza A(2009 H1N1) is not clear. The main objective of this study was to investigate the relationship between thetiming of antiviral administration and intensive care unit (ICU) outcomes.Methods: Prospective, observational study of a cohort of ICU patients with confirmed 2009 H1N1 infection.Clinical data, treatment and outcome were compared between patients receiving early treatment (ET) withoseltamivir, initiated within 2 days, and patients administered late treatment (LT), initiated after this timepoint.Multivariate analysis and propensity score were used to determine the effect of oseltamivir on ICU mortality.Results: Six hundred and fifty-seven patients were enrolled. Four hundred and four (61.5%) patients requiredmechanical ventilation (MV; mortality 32.6%). Among them, 385 received effective antiviral therapy andwere included in the study group. All patients received oseltamivir for a median duration of 10 days (interquar-tile range 8–14 days). Seventy-nine (20.5%) ET patients were compared with 306 LT patients. The two groupswere comparable in terms of main clinical variables. ICU length of stay (22.7+16.7 versus 18.4+14.2 days;P¼0.03), hospital length of stay (34.0+20.3 versus 27.2+18.2 days; P¼0.001) and MV days (17.4+15.2versus 14.0+12.4; P¼0.04) were higher in the LT group. ICU mortality was also higher in LT (34.3%) than inET (21.5%; OR¼1.9; 95% CI 1.06–3.41). A multivariate model identified ET (OR¼0.44; 95% CI 0.21–0.87) asan independent variable associated with reduced ICU mortality. These results were confirmed by propensityscore analysis (OR¼0.44; 95% CI 0.22–0.90; P,0.001).Conclusions: Our findings suggest that early oseltamivir administration was associated with favourableoutcomes among critically ill ventilated patients with 2009 H1N1 virus infection.Keywords: antiviral treatment, prognosis, pneumonia

Objective: A large proportion of patients infected with 2009 infl uenza A(H1N1) (A[H1N1]) are obese. Obesity has been proposed as a risk factor infl uencing outcome in these patients. However, its role remains unclear. We evaluate the outcome of patients who are obese and infected with A(H1N1) in the ICU, determining whether obesity is a risk factor for mortality. Methods: This was a prospective, observational, and multicenter study performed in 144 ICUs in Spain. Data were obtained from the Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Espanola de Medicina Intensiva, Critica y Unidades Coronarias (GTEI/SEMICYUC) registry. Adult patients with A(H1N1) that was confi rmed by real-time polymerase chain reaction were included in the analysis. Patients who were obese (BMI . 30) were compared with patients who were nonobese. Cox regression analysis was used to determine adjusted mortality. Differences of P , .05 were considered signifi cant. Results: In January 2010, the GTEI/SEMICYUC registry had complete records for 416 patients. One hundred and fi fty patients (36.1%) were obese, of whom 67 (44.7%) were morbidly obese (BMI . 40). Mechanical ventilation (MV) was more frequently applied in patients who were obese (64% vs 52.4%, P , .01) Patients with obesity remained on MV longer than patients who were nonobese (6.5 6 10.3 days vs 9.3 6 9.7 days, P 5 .02), had longer ICU length of stay (10.8 6 12.1 days vs 13.7 6 11.7 days, P 5 .03), and had longer hospitalization (18.2 6 14.6 days vs 22.2 6 16.5 days, P 5 .02). Mortality adjusted by severity and potential confounders identifi ed that obesity was not signifi cantly associated with ICU mortality (hazard ratio, 1.1; 95% CI, 0.69-1.75; P 5 .68). Conclusions: In our cohort, patients who were obese and infected with A(H1N1) did not have increased mortality. However, there was an association between obesity and higher ICU resource consumption.

In critically ill patients sudden changes in glomerular filtration rate (GFR) are not instantly followed by parallel changes in serum creatinine. The aim of the present study was to analyze the utility of serum cystatin C as a marker of renal function in these patients. Serum creatinine, serum cystatin C and 24-hour creatinine clearance (CCr) were determined in 50 critically ill patients (age 21–86 years; mean Acute Physiology and Chronic Health Evaluation II score 20 ± 9). They did not have chronic renal failure but were at risk for developing renal dysfunction. Serum cystatin C was measured using particle enhanced immunonephelometry. Twenty-four-hour body surface adjusted CCr was used as a control because it is the 'gold standard' for determining GFR. Serum creatinine, serum cystatin C and CCr (mean ± standard deviation [range]) were 1.00 ± 0.85 mg/dl (0.40–5.61 mg/dl), 1.19 ± 0.79 mg/l (0.49–4.70 mg/l), and 92.74 ± 52.74 ml/min per 1.73 m2 (8.17–233.21 ml/min per 1.73 m2), respectively. Our data showed that serum cystatin C correlated better with GFR than did creatinine (1/cystatin C versus CCr: r = 0.832, P < 0.001; 1/creatinine versus CCr: r = 0.426, P = 0.002). Cystatin C was diagnostically superior to creatinine (area under the curve [AUC] for cystatin C 0.927, 95% confidence interval 86.1–99.4; AUC for creatinine 0.694, 95% confidence interval 54.1–84.6). Half of the patients had acute renal dysfunction. Only five (20%) of these 25 patients had elevated serum creatinine, whereas 76% had elevated serum cystatin C levels (P = 0.032). Cystatin C is an accurate marker of subtle changes in GFR, and it may be superior to creatinine when assessing this parameter in clinical practice in critically ill patients.

Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009 -2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the bi-nominal distributions of the true (+) and true (-) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT < 0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT < 0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock. (C) 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.