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Background\\nTo better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study.\\nMethods\\nThis is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1–2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort.\\nResults\\nOf the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1–Q3, 7–21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample.\\nConclusions\\nMost patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality.

Purpose Current reports on acute kidney injury (AKI) in the intensive care unit (ICU) show wide variation in occurrence rate and are limited by study biases such as use of incomplete AKI definition, selected cohorts, or retrospective design. Our aim was to prospectively investigate the occurrence and outcomes of AKI in ICU patients. Methods The Acute Kidney Injury–Epidemiologic Prospective Investigation (AKI-EPI) study was an international cross-sectional study performed in 97 centers on patients during the first week of ICU admission. We measured AKI by Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and outcomes at hospital discharge. Results A total of 1032 ICU patients out of 1802 [57.3 %; 95 % confidence interval (CI) 55.0–59.6] had AKI. Increasing AKI severity was associated with hospital mortality when adjusted for other variables; odds ratio of stage 1 = 1.679 (95 % CI 0.890–3.169; p  = 0.109), stage 2 = 2.945 (95 % CI 1.382–6.276; p  = 0.005), and stage 3 = 6.884 (95 % CI 3.876–12.228; p  < 0.001). Risk-adjusted rates of AKI and mortality were similar across the world. Patients developing AKI had worse kidney function at hospital discharge with estimated glomerular filtration rate less than 60 mL/min/1.73 m 2 in 47.7 % (95 % CI 43.6–51.7) versus 14.8 % (95 % CI 11.9–18.2) in those without AKI, p  < 0.001. Conclusions This is the first multinational cross-sectional study on the epidemiology of AKI in ICU patients using the complete KDIGO criteria. We found that AKI occurred in more than half of ICU patients. Increasing AKI severity was associated with increased mortality, and AKI patients had worse renal function at the time of hospital discharge. Adjusted risks for AKI and mortality were similar across different continents and regions.

In a randomized trial involving previously untreated patients with metastatic intermediate- or poor-risk renal-cell cancer, nivolumab plus ipilimumab was associated with higher response rates, longer overall survival, and greater improvement in quality of life than sunitinib.

Propósito. El objetivo de esta revisión es la de conocer en el contexto actual el uso de los numerosos epónimos del hipertiroidismo del siglo XIX, y la de describir la historia correspondiente. Contenidos.  Usando las palabras clave en varias bases de datos, encontramos información entre 2012-2022. Posteriormente narramos la historia de hechos y personajes involucrados en las primeras observaciones sobre el bocio exoftálmico hipertiroideo. Contribuciones. La utilización de los epónimos del hipertiroidismo se ha reducido notoriamente, y la tendencia actual es la de usar palabras descriptivas y un sistema de códigos que permite explicar más claramente la enfermedad que afecta a un paciente dado, cuando se trata de enviar una cuenta de cobro.

In Parkinson’s disease (PD) there is a selective degeneration of neuromelanin-containing neurons, especially substantia nigra dopaminergic neurons. In humans, neuromelanin accumulates with age, the latter being the main risk factor for PD. The contribution of neuromelanin to PD pathogenesis remains unknown because, unlike humans, common laboratory animals lack neuromelanin. Synthesis of peripheral melanins is mediated by tyrosinase, an enzyme also present at low levels in the brain. Here we report that overexpression of human tyrosinase in rat substantia nigra results in age-dependent production of human-like neuromelanin within nigral dopaminergic neurons, up to levels reached in elderly humans. In these animals, intracellular neuromelanin accumulation above a specific threshold is associated to an age-dependent PD phenotype, including hypokinesia, Lewy body-like formation and nigrostriatal neurodegeneration. Enhancing lysosomal proteostasis reduces intracellular neuromelanin and prevents neurodegeneration in tyrosinase-overexpressing animals. Our results suggest that intracellular neuromelanin levels may set the threshold for the initiation of PD. It is unclear if neuromelanin plays a role in Parkinson’s disease pathogenesis since common laboratory animals lack this pigment. Authors show here that overexpression of human tyrosinase in the substantia nigra of rats resulted in an age-dependent production of human-like neuromelanin within nigral dopaminergic neurons and is associated with a Parkinson’s disease phenotype when allowed to accumulate above a specific threshold.

How do migrants in transit through Mexico interpret and manage the injuries and diseases they experience on their route? We argue that migrants in transit attempt to minimise their ill-health while at the same time engaging in health practices to keep moving to arrive at their destination. Through ethnographic research in migrant shelters in Mexico, we examine the reasons migrants give to minimise their injuries: 1) they believe pain is contingent to transit; 2) their tolerance to pain is informed by how they tolerated pain and disease in Central America; and 3) they choose temporary pain to avoid falling into more serious crises. At the same time, however, migrants are engaging in preventative care, self-medicating, in-group care, and accessing safe medical services in Mexico. We show the importance of noticing how different forms of suffering are naturalised while crossing Mexico and how the social sources of suffering are obscured.  Resumen:              “Poco dolor” y resistencia: narrativas y prácticas de salud entre migrantes en tránsito por México ¿Qué hacen las personas migrantes en tránsito por México para interpretar y lidiar con las heridas que experimentan a lo largo de la ruta? Sugerimos que las personas en tránsito intentan minimizar el impacto de sus heridas en la ruta mientras se intentan curar al moverse. Utilizamos investigación etnográfica para sugerir que las personas migrantes minimizan sus problemas porque: 1) creen que el dolor es parte de migrar; 2) aprendieron a tolerarlo en Centroamérica; y 3) prefieren aguantarlo en vez de caer en crisis más graves. Al mismo tiempo, las personas migrantes también hacen lo posible por cuidarse mediante medidas preventivas, tomando medicamentos, cuidándose entre sí y utilizando servicios de salud. Mostramos cómo algunos tipos de sufrimiento son invisibilizados y naturalizados cuando las personas migran, y cómo las fuentes sociales del sufrimiento se vuelven invisibles.

Sustainable strategies to manage infectious diseases in threatened wildlife are still lacking despite considerable concern over the global increase in emerging infectious diseases of wildlife and their potential to drive populations to extinction. Selective culling of infected individuals will often be the most feasible option to control infectious disease in a threatened wildlife host, but has seldom been implemented or evaluated as a management tool for the conservation of threatened species. The Tasmanian devil ( Sarcophilus harrisii) is threatened with extinction by an infectious cancer, devil facial tumor disease (DFTD). We assess the success of an adaptive management trial involving selective culling of infected Tasmanian devils to control DFTD. Demographic and epidemiological parameters indicative of disease progression and impact were compared between the management site and a comparable unmanaged control site. Selective culling of infected individuals neither slowed rate of disease progression nor reduced population-level impacts of this debilitating disease. Culling mortality simply compensated for disease mortality in this system. Failure of selective culling to impede DFTD progress and reduce its impacts in the managed population was attributed to DFTD's frequency-dependent nature, its long latent period and high degree of infectivity, and the presence of a cryptic hidden disease reservoir or continual immigration of diseased individuals. We suggest that increasing the current removal rate and focusing removal efforts prior to the breeding season are options worth pursuing for future management of DFTD in this population. On the basis of our experience, we suggest that disease-management programs for threatened wildlife populations be developed on the principles of adaptive management and utilize a wide variety of strategies with regular reviews and adaptation of strategies undertaken as new information is obtained.

Objectives The COVID-19 pandemic is having an unprecedented detrimental impact on mental health in people around the world. It is important therefore to explore factors that may buffer or accentuate the risk of mental health problems in this context. Given that compassion has numerous benefits for mental health, emotion regulation, and social relationships, this study examines the buffering effects of different flows of compassion (for self, for others, from others) against the impact of perceived threat of COVID-19 on depression, anxiety, and stress, and social safeness. Methods The study was conducted in a sample of 4057 adult participants from the general community population, collected across 21 countries from Europe, Middle East, North America, South America, Asia, and Oceania. Participants completed self-report measures of perceived threat of COVID-19, compassion (for self, for others, from others), depression, anxiety, stress, and social safeness. Results Perceived threat of COVID-19 was associated with higher scores in depression, anxiety, and stress, and lower scores in social safeness. Self-compassion and compassion from others were associated with lower psychological distress and higher social safeness. Compassion for others was associated with lower depressive symptoms. Self-compassion moderated the relationship between perceived threat of COVID-19 on depression, anxiety, and stress, whereas compassion from others moderated the effects of fears of contracting COVID-19 on social safeness. These effects were consistent across all countries. Conclusions Our findings highlight the universal protective role of compassion, in particular self-compassion and compassion from others, in promoting resilience by buffering against the harmful effects of the COVID-19 pandemic on mental health and social safeness.

White-nose syndrome (WNS) is a fatal disease of bats that hibernate. The etiologic agent of WNS is the fungus Geomyces destructans, which infects the skin and wing membranes. Over 1 million bats in six species in eastern North America have died from WNS since 2006, and as a result several species of bats may become endangered or extinct. Information is lacking on the pathogenesis of G. destructans and WNS, WNS transmission and maintenance, individual and site factors that contribute to the probability of an outbreak of WNS, and spatial dynamics of WNS spread in North America. We considered how descriptive and analytical epidemiology could be used to fill these information gaps, including a four-step (modified) outbreak investigation, application of a set of criteria (Hill's) for assessing causation, compartment models of disease dynamics, and spatial modeling. We cataloged and critiqued adaptive-management options that have been either previously proposed for WNS or were helpful in addressing other emerging diseases of wild animals. These include an ongoing program of prospective surveillance of bats and hibernacula for WNS, treatment of individual bats, increasing population resistance to WNS (through vaccines, immunomodulators, or other methods), improving probability of survival from starvation and dehydration associated with WNS, modifying hibernacula environments to eliminate G. destructans, culling individuals or populations, controlling anthropogenic spread of WNS, conserving genetic diversity of bats, and educating the public about bats and bat conservation issues associated with WNS. El síndrome de nariz blanca (SNB) es una enfermedad fatal en murciélagos que invernan. El agente etiológico del SNB es el hongo Geomyces destructans, que infecta la piel y las membranas alares. Desde 2006 más de 1 millón de murciélagos de 6 especies han muerto de SNB, y como consecuencia varias especies de murciélagos pueden estar en peligro o extintas. Se carece de información de la patogénesis de G. destructans y SNB, la transmisión y mantenimiento de SNB, los factores individuales y de sitio que contribuyen a la probabilidad de una epidemia de SNB y de la dinámica espacial de la dispersión de SNB en Norte América. Consideramos cómo la epidemiología descriptiva y analítica podrían contribuir a llenar esos vacíos de información, incluyendo una investigación de la epidemia, aplicación de un conjunto de criterios (de Hill) para evaluar las causas, modelos de compartimiento de la dinámica de la enfermedad y modelado espacial. Clasificamos y criticamos las opciones de manejo adaptativo que se han propuesto anteriormente para SNB o que fueron útiles para atender otras enfermedades emergentes en animales silvestres. Estas incluyen un programa de vigilancia prospectiva de murciélagos y sus sitios de hibernación para detectar SNB, tratamiento de murciélagos individuales, incremento de la resistencia a SNB (mediante vacunas, inmunomoduladores u otros métodos), incremento de la probabilidad de supervivencia a la inanición o la deshidratación asociadas con SNB, modificación de los ambientes de hibernación para eliminar G. destructans, sacrificio de individuos o poblaciones, control de la dispersión antropogénica de SNB, conservación de la diversidad genética de murciélagos y campañas para educar al público sobre murciélagos y temas de conservación asociados con SNB.

Introduction: Chagas disease is an infectious disease caused by the parasitism process of the protozoan Trypanosoma cruzi. Given its potential for chronicity, nursing care in the health care of patients with Chagas disease will provide an improvement in quality of life and the prognosis of the disease. Objective: Review scientific knowledge about nursing care for individuals with Chagas disease. Material and Methods: descriptive and exploratory research, carried out with two independent reviewers using high sensitivity criteria in databases and gray literature sources between June and July 2022. Results: The review identified 12 relevant publications that emphasized health care, education, relationships, disease prevention and health promotion. The most frequent and diverse nursing diagnoses were related to the Activity/Rest, Health Promotion and Coping/Stress domains. Discussion: To meet the care needs of Chagas disease, it is essential to ensure nursing care that recognizes individualities, highlighting the importance of creating tools that facilitate the nursing process. The main points highlighted were related to the health education process, longitudinal monitoring, healthy lifestyle habits, general nursing care during hospitalization and the use of nursing diagnoses. Conclusion: the need for comprehensive nursing care that meets the main needs of individuals with Chagas disease is emphasized, considering their unique circumstances. Developing tools to support the nursing process is essential to improve the results of care for this population.