Efficiency and Safety of CyberKnife Robotic Radiosurgery in the Multimodal Management of Patients with Acromegaly

Objective: To analyze, in a cohort of acromegalic patients, the results of the efficiency and safety of radiosurgery (CyberKnife), as well as the prognostic factors associated with disease remission. Material and methods: Observational, retrospective, longitudinal, and analytical study that included acromegalic patients with persistent biochemical activity after initial medical–surgical treatment, who received treatment with CyberKnife radiosurgery. GH and IGF-1 levels at baseline after one year and at the end of follow-up were evaluated. Results: 57 patients were included, with a median follow-up of four years (IQR, 2–7.2 years). The biochemical remission rate was 45.6%, 33.33% achieved biochemical control, and 12.28% attained biochemical cure at the end of follow-up. A progressive and statistically significant decrease was observed in the comparison of the concentrations of IGF-1, IFG-1 x ULN, and baseline GH at one year and at the end of follow-up. Both cavernous sinus invasion and elevated baseline IGF-1 x ULN concentrations were associated with an increased risk of biochemical non-remission. Conclusion: Radiosurgery (CyberKnife) is a safe and effective technique in the adjuvant treatment of GH-producing tumors. Elevated levels of IGF x ULN before radiosurgery and invasion of the cavernous sinus by the tumor could be predictors of biochemical non-remission of acromegaly

Risk Factors Associated with Mortality among Patients with COVID-19: Analysis of a Cohort of 1213 Patients in a Tertiary Healthcare Center

The presence of cardio-metabolic and respiratory comorbidities, immunosuppression, and chronic kidney disease have been associated with an increase in mortality from COVID-19. The objective of this study is to establish the risk factors associated with 30-day mortality in a cohort of hospitalized patients with COVID-19. This paper conducts a retrospective and analytical study of patients hospitalized for COVID-19 in a tertiary care center. A Cox proportional hazard analysis was performed to estimate the association of comorbidities with 30-day mortality. A total of 1215 patients with a median age of 59 years were included. In the adjusted Cox proportional hazards regression model, hypothyroidism, D-dimer ≥ 0.8 μg/mL, LHD ≥ 430 IU/L, CRP ≥ 4.83 ng/mL, and triglycerides ≥ 214 mg/dL were associated with an increased risk of death. The presence of a history of hypothyroidism and biomarkers (D-dimer, lactic dehydrogenase, CRP, and triglycerides) were associated with an increase in mortality in the studied cohort

Groundwater Prospecting Using a Multi-Technique Framework in the Lower Casas Grandes Basin, Chihuahua, México

Groundwater is a strategic resource for economic development, social justice, environmental sustainability, and water governance. The lower Casas Grandes River Basin, located in the state of Chihuahua, México, is in a semi-arid region with increasing groundwater demand and regional challenges such as drought and depletion of aquifers. Even though there is official information about the availability of groundwater, a comprehensive aquifer characterization requiring an interdisciplinary investigation using a diverse suite of tools and multiple data sources has yet to be carried out. This study presents a multi-technique framework to evaluate potential sites to drill for groundwater resources and reduce the risk of unsuccessful drilling. The main components of the methodology include wellhead leveling correction with a differential global positioning survey to define piezometric levels, principal component analysis using LANDSAT-8 images, application of geospatial tools, geophysics analysis using time domain electromagnetic surveys (TDES) and vertical electric soundings (VES), and structural geohydrology to define aquifer characteristics. The results showed that using the proposed framework steps improved the possibility of identifying subsurface layers with lower resistivity values that could be related to groundwater. Low resistivity values (35 Ohm-m) were found at depths from 50 to 85 m at sites where the regional static water level reached a depth of 245 m, indicating the potential location of a shallow groundwater resource at a site where the intersection of a fracture trace was identified. This procedure can be used in other regions in the world where limited information is available for groundwater exploration, thus reducing the risk of drilling dry wells in complex hydrogeological environments