Quiz Ref ID Acute respiratory distress syndrome (ARDS) is a common clinical problem among critically ill patients and is associated with high mortality and limited long-term quality of life.^1,2 The functional lung size is decreased in ARDS, since many lung units become poorly or nonaerated due to collapse, flooding, or consolidation.³ This places patients at increased risk of ventilator-induced lung injury due both to overdistention of aerated lung units and cyclic opening and closing of small airways and alveoli (atelectrauma).^4- 6

Odds ratios (OR) significantly overestimate associations between risk factors and common outcomes. The estimation of relative risks (RR) or prevalence ratios (PR) has represented a statistical challenge in multivariate analysis and, furthermore, some researchers do not have access to the available methods. Objective: To propose and evaluate a new method for estimating RR and PR by logistic regression.

Community integration in dengue control requires assessments of knowledge, attitudes and practices (KAPs), which can vary widely according to demographic and educational factors. We aimed to describe and compare the KAPs according to level of education in municipalities in the Caribbean region of Colombia. A survey was administered from October to December 2015, including families selected through probabilistic sampling in eleven municipalities. The analysis focused on the comparative description of the responses according to level of education. The KAP prevalence ratios (PR) according to education were estimated using Poisson regression (robust), including age and sex as adjustment variables. Out of 1057 participants, 1054 (99.7%) surveys were available for analysis, including 614 (58.3%) who had a high school level of education or higher and 440 (41.7%) who had a lower level of education (not high school graduates). The high school graduates showed a higher frequency of correct answers in relation to knowledge about dengue symptoms and transmission. On the other hand, graduates showed a higher probability of practices and attitudes that favor dengue control, including not storing water in containers (PR: 2.2; 95% Confidence Interval [CI]: 1.42–3.43), attend community meetings (PR: 1.33; 95% CI: 1.07–1.65), educate family members and neighbors in prevention measures (PR: 1.35; 95% CI: 1.15–1.59). Level of education could be a key determinant of knowledge of the disease and its transmission, as well as attitudes and practices, especially those that involve the integration of community efforts for dengue control.

Objective: To determine the effect of doxycycline treatment on cytokine levels, including tumor necrosis factor (TNF) and interleukin 6 (IL-6), and mortality in dengue patients at high risk of complication. Methods: A group of dengue hemorrhagic fever patients (n=231) were randomized to receive either standard supportive care or supportive care in addition to oral doxycycline twice daily for 7 days. Dengue virus infection was confirmed by PCR using multiple primers. Serum samples were obtained at days 0, 3, 5 and 7 and tested for levels of TNF and IL-6. Results: Doxycycline-treated group presented a 46% lower mortality than that observed in the untreated group (11.2% [13/116] vs 20.9% [24/115], respectively, p=0.05). Moreover, administration of doxycycline resulted in a significant (p<0.01) decrease in levels of TNF and IL-6 versus controls in the tests performed during follow-up (day 3, 5 and 7). Patients who died in both groups possessed significantly (p<0.01) higher levels of TNF and IL-6 compared to those who survived at all-time points. Conclusion: The above findings suggest that doxycycline can provide a clinical benefit to dengue patients at high risk of complications. This effect could be mediated by decreasing pro-inflammatory cytokine levels.

We evaluated biochemical alterations as predictors of dengue hemorrhagic fever (DHF). Patients with confirmed infection with dengue virus were prospectively evaluated for the first seven days of disease to determine their final clinical outcome. Serum samples taken 48–96 hours after onset of fever were used for biochemical tests. Of 199 patients, 30 developed DHF. Cases of DHF had higher levels of lactate dehydrogenase (LDH), creatine kinase (CK), and aspartate aminotransferase, and lower levels of albumin, total cholesterol, and triglycerides. Multivariate analysis showed that early alterations of CK (hazard ratio [HR] = 6.98, 95% confidence interval [CI] = 2.34–20.85, P = 0.001), LDH (HR = 3.19, 95% CI = 1.01–10.12, P < 0.05), and albumin (HR = 2.54, 95% CI = 1.09–5.92, P = 0.03) were associated with DHF. Triglyceride levels > 160 mg/dL were negatively associated with developing DHF (HR = 0.07, 95% CI = 0.01–0.59, P = 0.01). Early alterations of biochemical markers can predict DHF in patients with acute fever caused by dengue.