BackgroundEvaluation of the microcirculation in critically ill patients is usually done by means of indirect parameters. The aim of our study was to evaluate the functional state of the microcirculation by direct visualization of sublingual microcirculation using Sidestream Dark Field Imaging, to determine the correlation between these findings and other parameters that are commonly used in the clinical practice and to assess the applicability of the systematic use of this technique in critically ill children.MethodsA prospective observational study was carried out in a Pediatric Intensive Care Unit (PICU) of a tertiary referral hospital. All patients admitted to the PICU during a three-month period were included in the study after obtaining the informed consent from the patient. Systematic evaluation of sublingual microcirculation was done in these patients (Total Vessel Density, Proportion of Perfused Vessels, Perfused Vessel Density, De Backer Score, Microvascular Flow Index, Heterogeneity Index) within the first day of admission (T1) and between the second and third day of admission (T2). Other clinical, hemodynamic, and biochemical parameters were measured and registered simultaneously. When the evaluation of the microcirculation was not feasible, the reason was registered. Descriptive analysis of our findings are expressed as means, medians, standard deviations and interquartile ranges. Mann–Whitney-Wilcoxon and Fisher tests were used to compare variables between patients with and without evaluation of the microcirculation. Pearson Correlation Coefficient (ρ) was used to evaluate the correlation between microcirculatory parameters and other clinical parameters.ResultsOne hundred fine patients were included during the study period. Evaluation of the microcirculation was feasible in 18 patients (17.1%). 95.2% of them were intubated. The main reason for not evaluating microcirculation was the presence of respiratory difficulty or the absence of collaboration (95.1% on T1 and 68.9% on T2). Evaluated patients had a higher prevalence of intubation and ECMO at admission (72.2% vs. 14.9% and 16.6% vs. 1.1%, respectively), and longer median duration of mechanical ventilation (0 vs. 6.5 days), vasoactive drugs (0 vs. 3.5 days) and length of stay (3 vs. 16.5 days) than non-evaluated patients. There was a moderate correlation between microcirculatory parameters and systolic arterial pressure, central venous pressure, serum lactate and other biochemical parameters used for motoring critically ill children.ConclusionsSystematic evaluation of microcirculation in critically ill children is not feasible in the unstable critically ill patient, but it is feasible in stable critically ill children. Microcirculatory parameters show a moderate correlation with other parameters that are usually monitored in critically ill children.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0837-5) contains supplementary material, which is available to authorized users.
This paper attempts to contribute to the ongoing debate on the historical roots of the high economic inequality of contemporary Iberian America. Our approach, which is basically empirical, departs from the mainstream scholarship. We show new data on wages and heights in several viceroyalties that (1) suggest relatively medium-to-high levels of material welfare among the commoners in Bourbon Hispanic America; and (2) allow us to build indexes of economic inequality. An international comparison of those indexes casts some doubts on the widely accepted view that Viceroyal America's economy was exclusively based on extremely unequal or extractive Keywords: anthropometrics, colonialism, inequality, wages, Hispanic American economic history RESUMENEste trabajo pretende contribuir al debate sobre las causas histó ricas de la alta desigualdad econó mica en la Iberoamérica contemporá nea y lo hace en forma bá sicamente empírica, lo que es bastante inusual. En él se muestran nuevos datos sobre salarios y estaturas de varios virreinatos que: (1) sugieren niveles de bienestar material relativamente medios o altos para grupos no privilegiados de la Hispanoamérica borbó nica; y (2) permiten la construcció n de índices de desigualdad econó mica. La comparació n internacional de esos índices arroja dudas sobre la verosimilitud del ampliamente extendido supuesto de que la economía de la América españ ola se basada exclusivamente en instituciones extremadamente desiguales o extractivas, que ha sido popularizada por los influyentes trabajos de Engerman y Sokoloff y Acemoglu et al.
The impact on fungal growth and mycotoxin formation of interactions between fumonisin‐producing isolates of Fusarium moniliforme and F proliferatum and a zearalenone (ZEA)‐ and deoxynivalenol (DON)‐producing isolate of F graminearum inoculated together on irradiated maize at 15 and 25 °C and at 0.98, 0.95 and 0.93 aw was studied. The presence of F graminearum decreased the fungal populations (CFU g−1 grain) of F moniliforme and F proliferatum under almost all conditions tested. In the presence of F moniliforme, CFUs of F graminearum increased significantly at 25 °C, especially at 0.93 and 0.95 aw, while the presence of F proliferatum caused them to increase at 15 °C. The presence of F graminearum always inhibited FB1 production, except at 25 °C and 0.98 aw where it increased. However, the observed differences were not statistically significant. There was no effect of fungal interaction on ZEA production by F graminearum; however, when paired with F moniliforme and F proliferatum, DON production by F graminearum was significantly stimulated, especially at 0.98 aw. © 2000 Society of Chemical Industry
There is considerable variation in the management of ventilation of children in cardiac arrest, and international recommendations are not being followed in a high percentage of cases.
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