21 research outputs found
Kidney disease in primary anti-phospholipid antibody syndrome
APS is an autoimmune disease defined by the presence of arterial or venous thrombotic events and/or pregnancy morbidity in patients who test positive for aPL. APS can be isolated (primary APS) or associated with other autoimmune diseases. The kidney is a major target organ in APS, and renal thrombosis can occur at any level within the vasculature of the kidney (renal arteries, intrarenal vasculature and renal veins). Histological findings vary widely, including ischaemic glomeruli and thrombotic lesions without glomerular or arterial immune deposits on immunofluorescence. Renal involvement in patients with definite APS is treated with long-term anticoagulants as warfarin, but new treatments are being tried. The aim of this article is to review the links between primary APS and kidney disease
Multiple approaches at admission based on lung ultrasound and biomarkers improves risk identification in COVID-19 patients
Background: Risk stratification of COVID-19 patients is fundamental to improving prognosis and selecting the right treatment. We hypothesized that a combination of lung ultrasound (LUZ-score), biomarkers (sST2), and clinical models (PANDEMYC score) could be useful to improve risk stratification. Methods: This was a prospective cohort study designed to analyze the prognostic value of lung ultrasound, sST2, and PANDEMYC score in COVID-19 patients. The primary endpoint was in-hospital death and/or admission to the intensive care unit. The total length of hospital stay, increase of oxygen flow, or escalated medical treatment during the first 72 h were secondary endpoints. Results: a total of 144 patients were included; the mean age was 57.5 ± 12.78 years. The median PANDEMYC score was 243 (52), the median LUZ-score was 21 (10), and the median sST2 was 53.1 ng/mL (30.9). Soluble ST2 showed the best predictive capacity for the primary endpoint (AUC = 0.764 (0.658â0.871); p = 0.001), towards the PANDEMYC score (AUC = 0.762 (0.655â0.870); p = 0.001) and LUZ-score (AUC = 0.749 (0.596â0.901); p = 0.002). Taken together, these three tools significantly improved the risk capacity (AUC = 0.840 (0.727â0.953); p = 0.001). Conclusions: The PANDEMYC score, lung ultrasound, and sST2 concentrations upon admission for COVID-19 are independent predictors of intra-hospital death and/or the need for admission to the ICU for mechanical ventilation. The combination of these predictive tools improves the predictive power compared to each one separately. The use of decision trees, based on multivariate models, could be useful in clinical practice. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/)
ComparaciĂłn de los Ăndices PROFUND y PALIAR en pacientes pluripatolĂłgicos con enfermedad crĂłnica no oncolĂłgica en fase avanzada
Background and objective: To compare the discrimination power of PROFUND and PALIAR indexes for predicting mortality in polypathological patients with advanced non-oncologic chronic disease. Material and methods: Prospective multicentre cohort study. We included polypathological patients with advanced non-oncologic chronic disease, who were admitted to internal medicine departments between July 1 st and December 31th, 2014. Data was collected from each patient on age, sex, categories of polypathology, advanced disease, comorbidity, functional and cognitive assessment, terminal illness symptoms, need for caregiver, hospitalisation in the past three and 12 months and number of drugs. We calculated the PROFUND and PALIAR indexes and conducted a 12-month follow-up. We assessed mortality with the Kaplan-Meier survival curves and the discrimination of indexes with the ROC curves. Results: We included 213 patients with a mean (standard deviation) age of 83.0 (7.0) years, 106 (49.8%) of whom were female. Mortality at six months was 40.4% and at 12 months 50.2%. Deceased patients scored higher scores on the PROFUND [11.2(4.2) vs 8.5(3.9); P <.001] and PALIAR [6.7 (4.6) vs 3.6(3.1); p < 0, 001] indexes. The discrimination of PALIAR index at six months (under the curve area 0.734 95%CI 0.665-0.803) was higher than of PROFUND, and there was no difference at 12 months. Conclusions: In polypathological patients with advanced non-oncologic chronic disease, the PALIAR index had better discrimination power than PROFUND index at 66 months and there were no differences at 12 months
Multi-messenger observations of a binary neutron star merger
On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transientâs position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta
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Dietary αâLinolenic Acid, Marine Ïâ3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvenciĂłn con DIeta MEDiterrĂĄnea (PREDIMED) Study
Background: Epidemiological evidence suggests a cardioprotective role of αâlinolenic acid (ALA), a plantâderived Ïâ3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine Ïâ3 fatty acids (longâchain nâ3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to allâcause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for longâchain nâ3 polyunsaturated fatty acids (â„500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvenciĂłn con DIeta MEDiterrĂĄnea (PREDIMED) trial. Multivariableâadjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9ây followâup, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56â0.92) for allâcause mortality and 0.95 (95% CI 0.58â1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for longâchain nâ3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67â1.05) for allâcause mortality, 0.61 (95% CI 0.39â0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29â0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22â1.01) for sudden cardiac death. The highest reduction in allâcause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45â0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to allâcause mortality, whereas protection from cardiac mortality is limited to fishâderived longâchain nâ3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639
Sindrome de Forrestier Rosler Querol
Se trata de un varĂłn de 67 años de edad con antecedentes de hipertensiĂłn arterial, dislipemia y cardiopatĂa isquĂ©mica. Ingresa por cuadro de afasia motora y sĂndrome vertiginoso asociado, confirmĂĄndose ictus isquĂ©mico en territorio de arteria cerebral media izquierda. Se solicitĂł una tomografĂa computarizada con angiografĂa que mostrĂł como hallazgo casual una calcificaciĂłn del ligamento vertebral longitudinal anterior sin compromiso de la vĂa aĂ©rea (fig. 1a y b), corte similar en sujeto normal. Dicha imagen se comprobĂł tambiĂ©n en la radiografĂa simple de columna cervical con hiperostosis marcada en cara anterior de C4-C7 (fig. 2a y b), corte similar en sujeto sano
Bilateral bronchopneumonia due to Rothia mucilaginosa [Bronconeumonia bilateral por Rothia mucilaginosa]
Rothia mucilaginosa (R. mucilaginosa), antiguamente denominada Stomatococcus mucilaginosus, es un coco Gram positivo capsulado, anaerobio facultativo, que forma parte de la flora orofarĂngea normal y raramente se considera patĂłgeno en pacientes inmunocompetentes, aunque puede producir, de forma poco habitual, infecciones graves como bacteriemias, endocarditis e infecciones respiratorias: neumonĂas, empiemas pleurales o sobreinfecciĂłn de bronquiectasias. Presentamos el caso de un varĂłn de 74 años diagnosticado de neumonĂa basal derecha de evoluciĂłn tĂłrpida con mala respuesta inicial a diversos antibiĂłticos, con empeoramiento clĂnico y radiolĂłgico y apariciĂłn de bronconeumonia bilateral con imĂĄgenes pseudonodulares. En 3 cultivos de esputos y en broncoaspirado se aislĂł R. mucilaginosa en cultivo puro. Finalmente fue tratado con Linezolid con buena respuesta clĂnica y normalizaciĂłn de la radiografĂa de tĂłrax, comprobando la desapariciĂłn de R. mucilaginosa en posteriores cultivos de esputos. Existen pocos casos documentados de neumonĂa por R. mucilaginosa por lo que consideramos de interĂ©s presentar este caso.
Rothia mucilaginosa (R. mucilaginosa), formerly named Stomatococcus mucilaginosus, is a facultatively anaerobic, encapsulated gram-positive coccus, which forms part of the normal oropharyngeal and is rarely considered to be a pathogen in immunocompetent patients, although it can produce, on rare occasions, serious infections like bacteremia, endocarditis and respiratory infections; such as pneumonia, pleural empyema or superinfection of bronchiectasis. We present the case of a 74-year-old male diagnosed with right basal pneumonia of torpid evolution with poor initial response to different antibiotics, with clinical and radiological worsening and the appearance of bilateral bronchopneumonia with pseudonodular images. R. mucilaginosa in pure culture was isolated in three sputum cultures and in bronchial suction. The patient was finally treated with Linezolid with good clinical response and normalisation of the thorax radiography, confirming the disappearance of R. mucilaginosa in subsequent sputum cultures. As there are few documented cases of pneumonia due to R. mucilaginosa, we believe that presenting this case will be of interest
Active deformation and seismogenic characterizaton of secondary faults in the Alboran Sea constrained by high-resolution bathymetry and seismic data
Recent advances in seafloor and subsurface imaging allow accurately mapping and characterizing the kinematic pattern and the style of deformation of submarine faults with unprecedented detail to better assess seismic and tsunami hazards in coastal areas. The Alboran Sea is a Neogene basin generated by crustal extension associated with the subduction in the Gibraltar Arc. At present, several fault systems absorb part of the strain related to the NW-SE convergence (4-5.5 mm/yr) between the African and Eurasian plates. Consequently, the Alboran Sea shows a significant seismic activity. New high-resolution bathymetric and seismic data reveal the presence of poorly known pervasive fault systems in the central part of the Alboran Sea, the Averroes Fault (AF) and the North Averroes Faults (NAFs). These are secondary fault systems located between two large active faults, the Carboneras and Yusuf/Alboran Ridge faults, and represent a hitherto unrecognized seismogenic potential. The WNW-ESE trending AF and NAFs, which may have evolved since the Lower Pliocene (4.57 Ma), are subvertical right-lateral strike-slip active faults since: a) are offsetting the Quaternary sedimentary units and deforming the seafloor; and b) produce a right-lateral displacement of the northwestern margin of the Alboran Channel and across the Adra Ridge North. Given that the AF and NAFs have formed in a continental crust and that are located in a zone surrounded by some of the main active faults in the Alboran Sea, we postulate that these fault systems have been developed into a distributed dextral strike-slip shear zone with the local bulk shear striking approximately N90Âș. Considering their surface length they could generate earthquakes with magnitudes (Mw) between 6.3 and 7.2, but reaching 7.6 when AF and Yusuf Fault are linked. The high resolution bathymetry map has allowed us measuring lateral offsets produced by the AF and NAFs. Assuming that these displacements have been accumulated during the last 4.57 Ma, the calculated lateral slip rate for AF is approximately1.5 mm/yr and range between 0.2 and 0.4 mm/yr for the NAFs. Our results evidence the importance of the kinematic and seismogenic characterization of secondary fault systems to better comprehend earthquake and tsunami hazards