Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries : Analysis from the RIETE registry

publishersversionPeer reviewe

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Estudio de los desplazamientos necesarios para el colapso de arcos de fábrica en la educación

The aim is to show the use of models in teaching the beaviour of masonry structures in architecture, when the focus is on the movements more than in the stresses, forces and resitance. The fact that in masonry building structures collapses occurs in many cases due to the displacements of supports more than resistance failure, make necessary to familiarize students with the movements necessary for the collapse to occur. Students need to identify patrons of cracs that append when different types of movements appear and, how much movement displacements have to increase. Students make models of arches, identify loads that act and explain the way is in equilibrium. Then they test the arch movin one of the supports in differents directions. This way they can draw the “limit movements” of the support before the collapse append, getting a deeper knowledge of arches beaviour.El trabajo que se presenta es el resultado del proyecto de innovación educativa IE1819.0306 seleccionado y financiado por la UPM en la convocatoria 2018-2019

Evolution and current situation of the age at first lambing in Rasa Aragonesa ewes

En ovino, los retrasos en la edad al primer parto dan lugar a periodos improductivos que conllevan una disminución de la vida productiva del animal y un aumento del intervalo generacional, con sus consecuentes pérdidas económicas. Entre los ganaderos no existe una postura única en cuanto a la edad óptima a la que hay que cubrir por primera vez las corderas, en muchos casos por temor a que su estado fisiológico no sea todavía el adecuado y pueda repercutir negativamente en su vida productiva. El peso es uno de los factores más determinantes, ya que la pubertad no aparece hasta que el animal no ha alcanzado un peso vivo y condición corporal adecuados (Foster et al., 1985). En Rasa Aragonesa suele producirse alrededor de los 7-8 meses de edad, aunque puede variar en función de la disponibilidad de alimentos ligada al manejo en la ganaderla. La media de edad al primer parto de los rebaños pertenecientes al programa de selección de UPRAGrupo Pastores en 2015 (19,5 meses; Jurado y Jiménez, 2016) muestra que todavía se está muy lejos del óptimo teórico que se podría alcanzar en esta raza. A pesar de su gran repercusión en la vida productiva del animal, en los últimos años no se le ha prestado la suficiente atención y la mayor parte de los esfuerzos se han dedicado a mejorar otros caracteres como la prolificidad. En este sentido, UPRA-Grupo Pastores viene desarrollando desde 1994 un programa de selección por prolificidad en Rasa Aragonesa. En dicho programa se registran los partos de todos sus animales, contando en la actualidad con más de 2 millones de registros acumulados. Es necesario analizar la evolución de los últimos años y la situación actual de la edad al primer parto en Rasa Aragonesa con vistas a la posible toma de decisiones, lo que constituye el objetivo del presente trabajo.In sheep, delays in the age at first lambing (AFL) give rise to unproductive periods and a decrease in productiva lite. Despite its proven influence on economic profitability, in the Rasa Aragonesa sheep breed the efforts in the last years to improve it have been scarce. The aim of this study was to analyze the evolution of !he las! years and !he curren! state of !he AFL in Rasa Aragonesa ewes far possible luture decision making. Far this purpose 191, 114 fist lambing records from 327 farms were analyzed using the GLM procedure (SAS). Mean AFL during all !he studied period (1997-2013) was 19.8 months, too far from optimal in this breed. A decrease of AFL through !he years was found (-5.6 days/year; P<0.0001). The month of lambing demonstrated an effect on AFL (P<0.0001), so that autumn and winter-born lambs showed the lowest AFL values. The proliftc BMP15 genotype, present in several farms, also gives rise to a slight reduction of AFL (-5 days, P<0.01). The significan! effect of farm on AFL (P<0.0001), with differences up to 421 days, reveals importan! management differences, and therefore, !he great capacity far improvement of AFL in future.Financiado con fondos FEDER a través de POCTEFA (Proyecto PIRINNOVI EFA103/15) y CDTI (Proyecto 101-20160426).Publishe