Drug deprescription-withdrawal risk, prevention, and treatment

In most cases, a sudden interruption of most medications has no major consequences. There are well-recognized therapies that, when withheld, can either lead to the reappearance of the symptoms they were controlling or to signs or symptoms of withdrawal. In this article, we present a table including medications that when interrupted can produce withdrawal syndromes, the signs and symptoms of the withdrawal syndrome, the time to onset and resolution of the syndrome, information regarding alternative delivery options for the drug/s when the oral route is not possible, as well as prevention and therapy

Recurring pleural effusion secondary to walled-off pancreatic necrosis

Recurring, exudative, lymphocytic-predominant pleural effusions have not been previously reported in association with walled-off pancreatic necrosis. We present a case of chronic pancreatitis complicated by a large pancreatic fluid collection and recurrent pleural effusion. Endoscopic drainage of the walled-off pancreatic necrosis was the definitive treatment for both fluid collections

HEART and TIMI Scores Predict Severe Coronary Atherosclerosis in Patients With End-Stage Renal Disease

Objectives History, EKG, age, risk factors, and troponin (HEART) and thrombolysis in myocardial infarction (TIMI) risk calculators have been validated to predict the risk of subsequent acute coronary syndromes and in some studies, severe coronary atherosclerosis in patients with a concerning clinical history. Their performance in patients with end-stage renal disease (ESRD), a population with a high pretest probability for the condition, is unknown. We aimed to determine whether HEART and TIMI scores can predict severe coronary atherosclerosis in patients with end-stage renal disease (ESRD). Methods A single-center retrospective cohort of admitted patients aged 18 years or older with ESRD on dialysis who underwent coronary angiography during admission (November 2010 to December 2017) was retrospectively reviewed. The outcome of coronary angiography was compared with the calculated HEART and TIMI scores at the time of presentation. Receiver operating characteristics and logistic regression models were used to determine optimal score cutoffs, score usefulness, and associations between outcomes, scores, and patient characteristics. Results Among 231 patient encounters, the mean HEART and TIMI scores were 6±2 and 3±1 points, respectively. Patients with diabetes mellitus, those 65 years old and older, and those reported to have angina pectoris were more likely to show severe coronary artery disease (CAD) lesions. Optimal score cutoffs for determining severe coronary lesions were between six and seven (area under the curve (AUC)=0.754, confidence interval (CI): 0.682-0.826) and between three and four (AUC=0.716, CI: 0.640-0.792) for the HEART and TIMI scores, respectively. Conclusion Similar to the general population, HEART and TIMI scores can predict severe coronary atherosclerosis in the complex ESRD population

Short proofs of the Kneser-Lovász coloring principle

We prove that propositional translations of the Kneser–Lovász theorem have polynomial size extended Frege proofs and quasi-polynomial size Frege proofs for all fixed values of k. We present a new counting-based combinatorial proof of the K neser–Lovász theorem based on the Hilton–Milner theorem; this avoids the topological arguments of prior proofs for all but finitely many base cases. We introduce new “truncated Tucker lemma” principles, which are miniaturizations of the octahedral Tucker lemma. The truncated Tucker lemma implies the Kneser–Lovász theorem. We show that the k=1 case of the truncated Tucker lemma has polynomial size extended Frege proofs.Peer ReviewedPostprint (author's final draft

Zamba by you: possible stridulation during courtship in a spider with bridal veil (Ctenidae)

Guasuctenus longipes es una araña asociada a ambientes de quebrada. El objetivo de este estudio fue explorar la existencia de estructuras estridulatorias y emisión de sonido. Se describe el raspador y la lira en los palpos de los machos. Al tratarse de una especie nocturna, sugerimos que el canal acústico es preponderante para el encuentro de los sexos.Guasuctenus longipes is a spider associated with stream environments. The objective of this study was to explore the presence of stridulatory organs and sound emission. Scraper and ridges on the pedipalps of males were described. As it is a nocturnal species, we suggest that the acoustic channel is preponderant for the meeting of the sexes

The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities

This paper collates the pathological findings from initial published autopsy reports on 23 patients with coronavirus disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with a diffuse alveolar damage component, coupled with microvascular involvement with intra- and extravascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles. Major pulmonary thromboemboli with pulmonary infarcts and/or hemorrhage occurred in 5 of the 23 patients. Two of the Houston cases had interstitial pneumonia with diffuse alveolar damage pattern. One of the Houston cases had multiple bilateral segmental pulmonary thromboemboli with infarcts and hemorrhages coupled with, in nonhemorrhagic areas, a distinctive interstitial lymphocytic pneumonitis with intra-alveolar fibrin deposits and no hyaline membranes, possibly representing a transition form to acute fibrinous and organizing pneumonia. Multifocal acute injury of cardiac myocytes was frequently observed. Lymphocytic myocarditis was reported in 1 case. In addition to major pulmonary pathology, the 3 Houston cases had evidence of lymphocytic pericarditis, multifocal acute injury of cardiomyocytes without inflammatory cellular infiltrates, depletion of splenic white pulp, focal hepatocellular degeneration and rare glomerular capillary thrombosis. Each had evidence of chronic cardiac disease: hypertensive left ventricular hypertrophy (420 g heart), dilated cardiomyopathy (1070 g heart), and hypertrophic cardiomyopathy (670 g heart). All 3 subjects were obese (BMIs of 33.8, 51.65, and 35.2 Kg/

Influenza Vaccination for the Prevention of Cardiovascular Disease in the Americas: Consensus document of the Inter-American Society of Cardiology and the Word Heart Federation

Background Cardiovascular mortality is decreasing but remains the leading cause of death world-wide. Respiratory infections such as influenza significantly contribute to morbidity and mortality in patients with cardiovascular disease. Despite of proven benefits, influenza vaccination is not fully implemented, especially in Latin America. Objective The aim was to develop a regional consensus with recommendations regarding influenza vaccination and cardiovascular disease. Methods A multidisciplinary team composed by experts in the management and prevention of cardiovascular disease from the Americas, convened by the Inter-American Society of Cardiology (IASC) and the World Heart Federation (WHF), participated in the process and the formulation of statements. The modified RAND/UCLA methodology was used. This document was supported by a grant from the WHF. Results An extensive literature search was divided into seven questions, and a total of 23 conclusions and 29 recommendations were achieved. There was no disagreement among experts in the conclusions or recommendations. Conclusions There is a strong correlation between influenza and cardiovascular events. Influenza vaccination is not only safe and a proven strategy to reduce cardiovascular events, but it is also cost saving. We found several barriers for its global implementation and potential strategies to overcome them

Female and juvenile burrow-digging in Allocosa brasiliensis, a South American sand-dwelling wolf spider

Allocosa brasiliensis is a sand-dwelling wolf spider that constructs burrows along the coasts of rivers, lakes and the Atlantic Ocean in Argentina, Brazil and Uruguay. This species shows a reversal in typical sex roles in spiders: females wander searching for males and initiate courtship, while both females and males are selective when taking mating decisions. Females prefer to mate with males that show long burrows. As burrow digging in the sand seems to be an energetically expensive activity, we would expect differences in burrow characteristics according to developmental stage and selection pressures. Our aim was to describe female and juvenile digging behavior in A. brasiliensis and report burrow dimensions, comparing the results with data available for males of this species. We placed each individual (n = 30 of each category) in glass cages with sand as substrate and recorded burrow construction under laboratory conditions. Only five females and nine juveniles constructed burrows after 72 hours. Burrow dimensions did not show significant differences between females or juveniles, but burrow length was markedly lower that reports for males of this species. Burrow digging was stereotyped both in females and juveniles, following a sequence of behavioral units repeated in a cycle. Digging behavior would be highly conserved in A. brasiliensis. However, variations in burrow digging behavior and final burrow dimensions would reflect differences in strategies according to sex and stage.Fil: de Simone, Gabriel Alejandro. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Biodiversidad y Biología Experimental; Argentina. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Biodiversidad y Biologia Experimental y Aplicada; ArgentinaFil: Aisenberg, Anita Diana. Inst. Investigaciones Biológicas Clemente Estable;Fil: Peretti, Alfredo Vicente. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Cordoba. Instituto de Diversidad y Ecologia Animal; Argentin