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A Respiratory Therapist-Driven High-Flow Nasal Cannula Liberation Protocol at High Altitude.
(SAGE Publications, 2026-08-26) Vásquez Hoyos, Pablo; Villa Rosero, Yinna M.; Jaramillo-Bustamante, Juan C.; Gómez Lund, Oscar; Carvajal, Cristóbal; Díaz, Franco; González-Dambrauskas, Sebastián; Caporal, Paula; Jabornisky, Roberto; Serra, Alberto; Monteverde-Fernandez, Nicolás
Background: High-flow nasal cannula (HFNC) liberation strategies in pediatric intensive care often transition patients directly from HFNC to room air. At high altitude, oxygen requirements may persist after flow-dependent respiratory support is no longer needed. We evaluated the association between a protocolized, respiratory therapist-driven HFNC liberation strategy and time to successful liberation from high-flow support in children with acute respiratory failure. Methods: We conducted a retrospective cohort study using prospectively collected LARed Network registry data from a tertiary PICU in Bogotá, Colombia (2,600 m altitude). In September 2022, the unit implemented an HFNC liberation strategy designed to separate persistent oxygen requirement from ongoing need for high-flow support. The primary analysis included the first HFNC episode per PICU admission from March 2018 to March 2025. The primary outcome was time to successful HFNC liberation. Kaplan-Meier curves and multivariable Cox regression were used; gamma log-link models were used for sensitivity analyses, including a prespecified bronchiolitis subgroup. Results: We included 1,086 PICU admissions, 627 before and 459 after implementation. Median HFNC duration decreased from 59.8 h (interquartile ranges [IQR] 34.7-91.4) to 53.1 h (IQR 32.3-80.5, P = .01). Kaplan-Meier analysis showed earlier HFNC liberation after implementation (log-rank P < .01). Implementation was associated with earlier liberation in adjusted Cox regression (hazard ratio 1.17, 95% CI 1.03-1.34, P = .02). PICU stay decreased from 4.7 days (IQR 3.2-6.9) to 4.0 days (IQR 2.9-5.8, P < .01). In bronchiolitis, implementation was associated with an 18.2% relative reduction in HFNC duration (95% CI 7.7-27.5%, P < .01). Conclusions: In a high-altitude PICU, a respiratory therapist-driven HFNC liberation strategy was associated with earlier liberation from high-flow support. A strategy that preserves oxygen delivery while testing tolerance of minimal flow may be useful in high-altitude settings
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Role of nutritional interventions to reduce cardiometabolic disease burden in the community.
(Wolters Kluwer Health, 2026-06-08) López-Arana, Sandra; Rincón-Cervera, Miguel Ángel; Pereyra-González, Isabel
Purpose of review: Cardiovascular disease (CVD) is the leading global cause of death and disability, with most disability-adjusted life-years linked to modifiable risk factors. Nutrition is a scalable intervention that influences multiple cardiometabolic pathways. This review is timely because recent scientific statements and global policy frameworks highlight the need to prioritize dietary strategies in community settings to reduce CVD burden and promote equity. Recent findings: Community-based nutritional interventions in urban settings, neighborhoods and workplaces effectively reach underserved populations by leveraging trust and cultural relevance. Dietary patterns such as the Mediterranean and DASH diets have demonstrated improvements in blood pressure, lipid profiles, and inflammation. New approaches, including intermittent fasting and the EAT-Lancet reference diet, broaden prevention options. Policy actions such as taxes, nutrition labeling, and healthier procurement standards are recognized by the WHO as cost-effective measures. Summary: Community-based nutritional interventions reduce cardiometabolic risk and promote equity. Strategies include fiscal policies, healthier food environments, education, digital tools, and "Food Is Medicine" programs. Their success relies on cultural adaptation and stakeholder engagement. Evidence supports their capacity to shift norms, improve diets, and sustain long-term reductions in CVD burden.
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Adenovirus Versus Respiratory Syncytial Virus in Children With Severe Viral Acute Respiratory Failure: A Multicenter Latin American Cohort.
(Wolters Kluwer Health, 2026-08-26) Barajas-Romero, Juan Sebastián; Reyes-Téllez, Mario Andrés; Jaramillo-Bustamante, Juan Camilo; Gómez-Lund, Oscar; Decía, Mónica; Monteverde-Fernández, Nicolás; Serra, Jesús Alberto; Caporal, Paula; Lasso-Palomino, Rubén; Zemanate Zuñiga, Eliana; Martínez, Javier; Menta, Soledad; Martínez-Arroyo, Luis; Herrera-Salazar, Hernán; Castro-Zamorano, Francisca; Carvajal, Cristóbal; Jabornisky, Roberto; Cruces, Pablo; Díaz, Franco; González-Dambrauskas, Sebastián; Vásquez-Hoyos, Pablo
Background: Respiratory syncytial virus (RSV) commonly causes severe lower respiratory tract disease. Adenovirus is detected less often, but severe pneumonia may occur. The pediatric intensive care unit (PICU) course associated with adenovirus detection compared with RSV-only detection is not well defined. Methods: We studied clinician-tested, virus-positive PICU admissions of children aged 1 month to 18 years from 37 PICUs in 7 Latin American countries (2017-2025). Children with RSV and/or adenovirus detection who used respiratory support were grouped as RSV-only, adenovirus-only or RSV-adenovirus codetection. The primary outcome was PICU death or worse functional status at discharge. Adjusted associations were estimated with logistic regression; Firth penalization was used for mortality. Results: Among 3196 PICU admissions, 2859 had RSV-only, 257 adenovirus-only and 80 codetection. PICU mortality was 12/257 (4.7%) in adenovirus-only, 13/2859 (0.5%) in RSV-only and 2/80 (2.5%) in codetection. Compared with RSV-only detection, adenovirus-only detection was associated with mortality [adjusted odds ratio (OR): 10.56; 95% confidence interval (CI): 4.57-24.43] and with PICU death or worse functional status at discharge [21/222 (9.5%) vs 45/2308 (1.9%); adjusted OR: 6.57; 95% CI: 3.59-12.03]. Among nonsurvivors, the median PICU day of death was 3 (IQR: 2-6) with adenovirus-only detection and 8 (IQR: 3-9) with RSV-only detection. Conclusions: In this multicenter Latin American PICU cohort, adenovirus-only detection was associated with a higher-risk acute course than RSV-only detection, including higher mortality and worse functional status at PICU discharge.
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Identification of a HOMA-IR cut-off point for cardiometabolic risk and modifiable risk factors in peruvian adolescents
(PLOS oNE, 0026-10-07) Curi-Quinto, Katherine; Vasquez, Fabian; Abad, Melissa; Lazarte, Fabiola; Penny, Mary; del Valle-Mendoza, Juana
Background: Although HOMA-IR is widely used to assess insulin resistance, reported cut-off values vary substantially across population, particularly during adolescence. The aim of this study was to determine the distribution of HOMA-IR values. identify a HOMA-IR cut-off associated with metabolic syndrome (MS), and assess modifiable risk factors of IR in a longitudinal cohort of Peruvian adolescents. Methods: We performed a secondary data analysis from a longitudinal adolescent’s study. A sample of 371 adolescents (14.5±0.1 years old) from low- medium socioeconomic status. ROC curve analysis was used to identify the specific cut-off point to classify IR using the sensitivity and specificity values in comparison with the MS. Multiple logistic regression analysis including diet, physical activity and body composition from adolescence, excess weight during infancy and family history of non-chronic disease was included to identify risk factors (FHCD) associated with IR. Results: The HOMA-IR was 3.29 (SD 1.71) with no differences by sex. We identified 3.9 for HOMA-IR as the cut-off point with sensitivity (72.4%) and specificity (75.4%) for predicting MS. IR was present in 28.6% (95% CI 24.2;33.4%); 84% had at least one cardiometabolic risk factor and low HDL and abdominal obesity were the most prevalent (62 and 35%, respectively). Adolescents with higher fat mass index (OR 16.03, 95% CI 6.79 to 37.86), and those physically inactive (OR 2.08 95% CI 1.06 to 4.07) were more likely to have IR. No association was found with diet, excess weight at infancy and FHCD. Conclusions: A cut-offs point of 3.9 for HOMA-IR allows to identify adolescents with high metabolic risk. Strategies to promote lower FMI and improve the physical activity levels could reduce the risk of IR in adolescents.
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Distribución de estilos de aprendizaje y su relación con variables sociodemográficas y académicas en estudiantes de Odontología: estudio transversal
(Universidad de Murcia, 2026-07-08) García, Pax; Moya Rivera, Patricia
Introducción: La comprensión de los estilos de aprendizaje en estudiantes de ciencias de la salud constituye una herramienta relevante para orientar la reflexión pedagógica y reconocer la diversidad de formas de aprender. En odontología, la formación transita desde etapas teóricas hacia escenarios clínicos de creciente complejidad, por lo que resulta pertinente analizar cómo estas preferencias se distribuyen a lo largo de la trayectoria formativa. Objetivo: Analizar la distribución de los estilos de aprendizaje en estudiantes de Odontología de una universidad privada de Santiago de Chile durante el año 2025, considerando su relación con género, edad y año académico cursado. Métodos: Estudio transversal. Participaron 177 estudiantes de primero a quinto año (tasa de respuesta: 53,8%). Se aplicó el Cuestionario Honey-Alonso de Estilos de Aprendizaje (CHAEA). La consistencia interna se evaluó mediante alfa de Cronbach (α=0,592–0,729). Se utilizaron pruebas no paramétricas para comparaciones según género y año académico, correlación de Spearman para edad y análisis post-hoc con corrección de Bonferroni. Se estimaron tamaños del efecto mediante eta cuadrado (η²). Resultados: El estilo teórico fue el más frecuente (33,9%), seguido del reflexivo (28,8%), pragmático (19,2%) y activo (18,1%). No se observaron diferencias significativas en la distribución de los estilos predominantes según genero (p=0,051), sí entre años académicos en los cuatro estilos (p<0,001), con tamaños del efecto grandes (η²=0,14–0,33). Las mayores diferencias se concentraron entre tercero y cuarto año, coincidiendo con el inicio del ciclo clínico. El estilo pragmático mostró correlación positiva moderada con la edad (r=0,526; p<0,001) y el teórico una correlación negativa moderada (r=- 0,432; p<0,001). Conclusión: Los estilos de aprendizaje difieren según la etapa formativa de los estudiantes de odontología, observándose mayores diferencias entre cursos preclínicos y clínicos. Aunque el diseño no permite establecer cambios a lo largo del tiempo, los hallazgos respaldan la necesidad de implementar estrategias pedagógicas diversificadas y coherentes con las distintas etapas de formación.