71 research outputs found
COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study
Mortality rates for COVID-19 have declined over time in the general population, but data in patients with hematologic malignancies are contradictory. We identified independent prognostic factors for COVID-19 severity and survival in unvaccinated patients with hematologic malignancies, compared mortality rates over time and versus non-cancer inpatients, and investigated post COVID-19 condition. Data were analyzed from 1166 consecutive, eligible patients with hematologic malignancies from the population-based HEMATO-MADRID registry, Spain, with COVID-19 prior to vaccination roll-out, stratified into early (FebruaryâJune 2020; n = 769 (66%)) and later (July 2020âFebruary 2021; n = 397 (34%)) cohorts. Propensity-score matched non-cancer patients were identified from the SEMI-COVID registry. A lower proportion of patients were hospitalized in the later waves (54.2%) compared to the earlier (88.6%), OR 0.15, 95%CI 0.11â0.20. The proportion of hospitalized patients admitted to the ICU was higher in the later cohort (103/215, 47.9%) compared with the early cohort (170/681, 25.0%, 2.77; 2.01â3.82). The reduced 30-day mortality between early and later cohorts of non-cancer inpatients (29.6% vs. 12.6%, OR 0.34; 0.22â0.53) was not paralleled in inpatients with hematologic malignancies (32.3% vs. 34.8%, OR 1.12; 0.81â1.5). Among evaluable patients, 27.3% had post COVID-19 condition. These findings will help inform evidence-based preventive and therapeutic strategies for patients with hematologic malignancies and COVID-19 diagnosis.Depto. de MedicinaFac. de MedicinaTRUEFundaciĂłn Madrileña de HematologĂa y HemoterapiaFundaciĂłn Leucemia y LinfomaAsociaciĂłn Madrileña de HematologĂa y Hemoterapiapu
Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters.
Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs).
Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001).
Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio
Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study
Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ℠0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe
Ahora / Ara
La cinquena ediciĂł del microrelatari per lâeradicaciĂł de la violĂšncia contra les dones de lâInstitut Universitari dâEstudis Feministes i de GĂšnere «PurificaciĂłn Escribano» de la Universitat Jaume I vol ser una declaraciĂł dâesperança. Aquest Ă©s el moment en el qual les dones (i els homes) hem de fer un pas endavant i eliminar la violĂšncia sistĂšmica contra les dones. Ara Ă©s el moment de denunciar el masclisme i els micromasclismes començant a construir una societat mĂ©s igualitĂ ria.
Cadascun dels relats del llibre Ă©s una denĂșncia i una declaraciĂł que ens encamina cap a un mĂłn millor
Mar Menor: una laguna singular y sensible. EvaluaciĂłn cientĂfica de su estado.
Este libro recopila las aportaciones que equipos de investigaciĂłn de la Universidad de Murcia, Universidad PolitĂ©cnica de Cartagena, Instituto GeolĂłgico-Minero de España, Universidad de Alicante, el Instituto Español de OceanografĂa y otros organismos hicieron en las Jornadas CientĂficas del Mar Menor, celebradas en diciembre de 2014.La informaciĂłn recogida en este libro se estructura en dos grandes bloques, uno de BiologĂa y EcologĂa del Mar Menor (capĂtulos 1 al 8) y otro de Condiciones fisicoquĂmicas e impacto de actividades humanas en la laguna (capĂtulos 9 al 14). El primer bloque resume buena parte de los estudios ecolĂłgicos realizados en el Mar Menor, que han servido para mejorar su conocimiento y tambiĂ©n para cambiar antiguas asunciones sobre la naturaleza y el funcionamiento de estos ecosistemas lagunares (CapĂtulo 1). El segundo capĂtulo muestra que esta laguna alberga en zonas someras de su perĂmetro hĂĄbitats fundamentales para mantener y conservar tanto especies migratorias como residentes, que es necesario conocer para paliar el impacto de las actividades humanas que les afectan. En este sentido la reducciĂłn de la carga de nutrientes y contaminantes orgĂĄnicos e inorgĂĄnicos que fluyen hacia el Mar Menor puede ayudar a preservar la laguna en mejores condiciones, bien sea tratando las escorrentĂas (plantas de tratamiento, humedales artificiales u otras tĂ©cnicas) y recuperar este agua para uso agrĂcola o evitar su descarga en la laguna (CapĂtulo 3). Estas actuaciones serĂĄn clave para la conservaciĂłn de especies emblemĂĄticas como el caballito de mar (CapĂtulo 4) y reducir el impacto de las proliferaciones masivas de medusas que se producen en la laguna desde 1993 (CapĂtulo 5). En este mismo sentido los cambios acaecidos en la laguna han favorecido la incursiĂłn de invertebrados marinos alĂłctonos (CapĂtulo 6) y han afectado a la respuesta de la dinĂĄmica poblacional de las aves acuĂĄticas a distintas escalas (CapĂtulo 7). Para completar este bloque se ofrece una perspectiva histĂłrica de la importancia que ha tenido la investigaciĂłn sobre acuicultura realizada en esta laguna, que ha servido de base para su gran desarrollo actual (CapĂtulo 8).
El segundo bloque se inicia con una evaluaciĂłn del origen y evoluciĂłn del Mar Menor desde el punto de vista geolĂłgico, y evidencia su vulnerabilidad ante el deterioro que puede sufrir la desapariciĂłn de la barrera de cierre y/o su colmataciĂłn (CapĂtulo 9). En el CapĂtulo 10 se describe la relevancia que tiene la interacciĂłn de los acuĂferos del Campo de Cartagena con la laguna, que se produce no sĂłlo a nivel superficial sino tambiĂ©n subterrĂĄneo. Esta interacciĂłn permite el acceso de nutrientes a la laguna, a pesar de la cierta capacidad de depuraciĂłn de los humedales que le circundan, y tambiĂ©n de metales traza por los aportes de residuos mineros (CapĂtulo 11). De hecho los metales traza estĂĄn presentes en los sedimentos de la laguna, y su distribuciĂłn se ha caracterizado en la columna sedimentaria relacionĂĄndola con la granulometrĂa y el contenido de materia orgĂĄnica del sedimento (CapĂtulo 12). Posteriormente se describe la entrada de diversos contaminantes orgĂĄnicos, incluyendo pesticidas y fĂĄrmacos a travĂ©s de la rambla del AlbujĂłn, y su distribuciĂłn estacional en agua y sedimento de la laguna (CapĂtulo 13). Este segundo bloque finaliza con el CapĂtulo 14 en el que se describe la bioacumulaciĂłn de hidrocarburos aromĂĄticos policĂclicos, pesticidas y fĂĄrmacos en moluscos y peces del Mar Menor, asĂ como los efectos biolĂłgicos que la carga contaminante que accede a travĂ©s de la rambla del AlbujĂłn produce en los organismos que allĂ habitan. El libro concluye con un breve epĂlogo redactado por los editores de este libro
Mar Menor: una laguna singular y sensible. EvaluaciĂłn cientĂfica de su estado.
Este libro recopila las aportaciones que equipos de investigaciĂłn de la Universidad de Murcia, Universidad PolitĂ©cnica de Cartagena, Instituto GeolĂłgico-Minero de España, Universidad de Alicante, el Instituto Español de OceanografĂa y otros organismos hicieron en las Jornadas CientĂficas del Mar Menor, celebradas en diciembre de 2014.La informaciĂłn recogida en este libro se estructura en dos grandes bloques, uno de BiologĂa y EcologĂa del Mar Menor (capĂtulos 1 al 8) y otro de Condiciones fisicoquĂmicas e impacto de actividades humanas en la laguna (capĂtulos 9 al 14). El primer bloque resume buena parte de los estudios ecolĂłgicos realizados en el Mar Menor, que han servido para mejorar su conocimiento y tambiĂ©n para cambiar antiguas asunciones sobre la naturaleza y el funcionamiento de estos ecosistemas lagunares (CapĂtulo 1). El segundo capĂtulo muestra que esta laguna alberga en zonas someras de su perĂmetro hĂĄbitats fundamentales para mantener y conservar tanto especies migratorias como residentes, que es necesario conocer para paliar el impacto de las actividades humanas que les afectan. En este sentido la reducciĂłn de la carga de nutrientes y contaminantes orgĂĄnicos e inorgĂĄnicos que fluyen hacia el Mar Menor puede ayudar a preservar la laguna en mejores condiciones, bien sea tratando las escorrentĂas (plantas de tratamiento, humedales artificiales u otras tĂ©cnicas) y recuperar este agua para uso agrĂcola o evitar su descarga en la laguna (CapĂtulo 3). Estas actuaciones serĂĄn clave para la conservaciĂłn de especies emblemĂĄticas como el caballito de mar (CapĂtulo 4) y reducir el impacto de las proliferaciones masivas de medusas que se producen en la laguna desde 1993 (CapĂtulo 5). En este mismo sentido los cambios acaecidos en la laguna han favorecido la incursiĂłn de invertebrados marinos alĂłctonos (CapĂtulo 6) y han afectado a la respuesta de la dinĂĄmica poblacional de las aves acuĂĄticas a distintas escalas (CapĂtulo 7). Para completar este bloque se ofrece una perspectiva histĂłrica de la importancia que ha tenido la investigaciĂłn sobre acuicultura realizada en esta laguna, que ha servido de base para su gran desarrollo actual (CapĂtulo 8).
El segundo bloque se inicia con una evaluaciĂłn del origen y evoluciĂłn del Mar Menor desde el punto de vista geolĂłgico, y evidencia su vulnerabilidad ante el deterioro que puede sufrir la desapariciĂłn de la barrera de cierre y/o su colmataciĂłn (CapĂtulo 9). En el CapĂtulo 10 se describe la relevancia que tiene la interacciĂłn de los acuĂferos del Campo de Cartagena con la laguna, que se produce no sĂłlo a nivel superficial sino tambiĂ©n subterrĂĄneo. Esta interacciĂłn permite el acceso de nutrientes a la laguna, a pesar de la cierta capacidad de depuraciĂłn de los humedales que le circundan, y tambiĂ©n de metales traza por los aportes de residuos mineros (CapĂtulo 11). De hecho los metales traza estĂĄn presentes en los sedimentos de la laguna, y su distribuciĂłn se ha caracterizado en la columna sedimentaria relacionĂĄndola con la granulometrĂa y el contenido de materia orgĂĄnica del sedimento (CapĂtulo 12). Posteriormente se describe la entrada de diversos contaminantes orgĂĄnicos, incluyendo pesticidas y fĂĄrmacos a travĂ©s de la rambla del AlbujĂłn, y su distribuciĂłn estacional en agua y sedimento de la laguna (CapĂtulo 13). Este segundo bloque finaliza con el CapĂtulo 14 en el que se describe la bioacumulaciĂłn de hidrocarburos aromĂĄticos policĂclicos, pesticidas y fĂĄrmacos en moluscos y peces del Mar Menor, asĂ como los efectos biolĂłgicos que la carga contaminante que accede a travĂ©s de la rambla del AlbujĂłn produce en los organismos que allĂ habitan. El libro concluye con un breve epĂlogo redactado por los editores de este libro.VersiĂłn del edito
All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ć2010
Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection
Ciencia OdontolĂłgica 2.0
Libro que muestra avances de la InvestigaciĂłn OdontolĂłgica en MĂ©xicoEs para los integrantes de la Red de InvestigaciĂłn en EstomatologĂa (RIE) una enorme alegrĂa presentar el segundo de una serie de 6 libros sobre casos clĂnicos, revisiones de la literatura e investigaciones. La RIE estĂĄ integrada por cuerpos acadĂ©micos de la UAEH, UAEM, UAC y UdeG
COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Background:
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms.
Methods:
International, prospective observational study of 60â109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms.
Results:
âTypicalâ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (â€â18 years: 69, 48, 23; 85%), older adults (â„â70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each Pâ<â0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country.
Interpretation:
This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men
Why It Is Not Always Anxiety: A Tough Diagnosis of Stiff Person Syndrome
Anxiety disorder is a commonly used diagnosis that may mask underlying conditions. Stiff person syndrome (SPS) is a rare neuroimmunological disorder characterized by progressive rigidity and painful muscle spasms affecting axial and lower extremity musculature. These episodes can be triggered by sudden movement, noise, or emotional stress, which may present as a psychiatric condition. We report the case of a 30-year-old female who presented with recurrent panic attacks with multiple prior hospital admissions for anxiety, rigidity, and difficulty in walking. Previous electroencephalogram (EEG) and brain and cervical spine magnetic resonance imaging (MRI) were unremarkable. She was empirically treated with diazepam and beta-blockers for SPS, which was confirmed by positive glutamic acid decarboxylase (GAD) antibodies. The patientâs symptoms became refractory to benzodiazepines and required steroids with intravenous immunoglobulin (IVIG). Her rigidity subsequently responded to plasmapheresis. In SPS, antibodies in the cerebrospinal fluid (CSF) most commonly target the GAD antigen on gamma-aminobutyric acid (GABA) neurons. The goal of treatment is to ameliorate symptoms and improve quality of life. Our case of SPS was masked as generalized anxiety disorder for at least six years since onset of symptoms. The criteria for both diagnoses may overlap as seen in this patient
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