Aplicabilidad clínica de los índices pronósticos, PROFUND y PROFUNCTION

An 83-year-old woman with a history of hypertension, grade II obesity, dyslipidemia and paranoid schizophrenia with limited life due to polyarthrosis and basic psychiatric pathology who enter by episode of hydropic decompensation in the context of severe acute anemization. After carrying out a comprehensive assessment together with the calculation of the PROFUND index and PROFUNCTION index, a personalized action plan adapted to the patient was carried out by consensus with her family.Se presenta el caso de una mujer de 83 años con antecedentes de hipertensión arterial, obesidad grado II, dislipemia y esquizofrenia paranoide, con vida limitada por poliartrosis y patología psiquiátrica de base. Ingresó por episodio de descompensación hidrópica en contexto de anemización aguda grave. Tras realización de una valoración integral, junto con el cálculo de los índices PROFUND y PROFUNCTION, se llevó a cabo, consensuado con sus familiares, un plan de acción personalizado adaptado a la paciente

Estimating the Prevalence of Cardiac Amyloidosis in Old Patients with Heart Failure—Barriers and Opportunities for Improvement: The PREVAMIC Study

Background: Cardiac amyloidosis (CA) could be a common cause of heart failure (HF). The objective of the study was to estimate the prevalence of CA in patients with HF. Methods: Observational, prospective, and multicenter study involving 30 Spanish hospitals. A total of 453 patients >= 65 years with HF and an interventricular septum or posterior wall thickness > 12 mm were included. All patients underwent a Tc-99m-DPD/PYP/HMDP scintigraphy and monoclonal bands were studied, following the current criteria for non-invasive diagnosis. In inconclusive cases, biopsies were performed. Results: The vast majority of CA were diagnosed non-invasively. The prevalence was 20.1%. Most of the CA were transthyretin (ATTR-CM, 84.6%), with a minority of cardiac light-chain amyloidosis (AL-CM, 2.2%). The remaining (13.2%) was untyped. The prevalence was significantly higher in men (60.1% vs 39.9%, p = 0.019). Of the patients with CA, 26.5% had a left ventricular ejection fraction less than 50%. Conclusions: CA was the cause of HF in one out of five patients and should be screened in the elderly with HF and myocardial thickening, regardless of sex and LVEF. Few transthyretin-gene-sequencing studies were performed in older patients. In many patients, it was not possible to determine the amyloid subtype

Metachronic malignant transformation of small bowel and rectal endometriosis in the same patient

BACKGROUND: Malignant transformation of intestinal endometriosis is a rare event with an unknown rate of incidence. Metachronous progression of endometriosis to adenocarcinoma from two distant intestinal foci happening in the same patient has not been previously reported. CASE PRESENTATION: We describe a case of metachronic transformation of ileal and rectal endometriosis into an adenocarcinoma occurring in a 45-year-old female without macroscopic pelvic involvement of her endometriosis. First, a right colectomy was performed due to intestinal obstruction by an ileal mass. Pathological examination revealed an ileal endometrioid adenocarcinoma and contiguous microscopic endometriotic foci. Twenty months later, a rectal mass was discovered. An endoscopic biopsy revealed an adenocarcinoma. En bloc anterior rectum resection, hysterectomy and bilateral salpingectomy were performed. A second endometrioid adenocarcinoma arising from a focus of endometriosis within the wall of the rectum was diagnosed. CONCLUSION: Intestinal endometriosis should be considered a premalignant condition in premenopausal women

Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry

Objectives: Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients. Methods: Variables associated with all-cause mortality and readmission for HF during 9 months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups. Results: We evaluated 1551 patients, 82 years and 56% women. Using HR strata of < 70 and ≥ 70 bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP ≥ 140, 120–140 and < 120 mm Hg, mortality rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HR < 70 bpm and SBP ≥ 140 mm Hg (n = 176; low-risk), HR < 70 and SBP < 140 + HR ≥ 70 and SBP < 120 (n = 1089; moderate-risk) and HR ≥ 70 and SBP < 120 (n = 286; high-risk) we found mortality rates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93–3.99, p = 0.077) and 4.32 (95% CI: 2.04–9.14, p < 0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors. Conclusions: The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

“ADHERENCE TO THE MEDITERRANEAN DIET IN MEDICAL STUDENTS”

Abstract Objective The protective effect of the Mediterranean Diet (MeDi) is undisputed. However, adherence to MeDi has decreased in recent years, particularly in young people. The aim of this study was to evaluate adherence to MeDi in medical students and to assess the influence of knowledge acquisition as well as other factors on dietary compliance. Design A cross-sectional study was conducted on medical students. The data were obtained through anonymous surveys that collected demographic characteristics, medical history, alcohol and tobacco consumption, physical activity and adherence to MeDi – using 14-point Mediterranean Diet Adherence Score (MEDAS)-. Adherence to MeDi and related factors were evaluated by univariate and multivariable analysis. Participants Medical students from the first to the sixth year of the 2018-2019 academic year. Setting The study was conducted at the university of Las Palmas de Gran Canaria. Results Of 589 respondents (73% women) mean aged 22 years (range 18 to 39), 58.9% showed good adherence to MeDi. Adherence was significantly associated with age (p=0.017) but not with sex or the presence of comorbidities. Independently, adherence to MeDi was higher in last academic courses (OR=2.1; 95% CI=1.3-3.2; p=0.001), in those who consumed alcohol more frequently (OR=1.5; 95% CI=1.0-2.1; p=0.039) and in those who practiced more exercise (OR=1.5; 95% CI=1.2-1.9; p<0.001). Conclusions Half of all medical students did not have a good adherence to MeDi. Adherence was higher at older age, in higher academic years and related to greater physical activity. It would be convenient to quantify dietary knowledge as well as implement nutritional educational programs, favoring a healthy lifestyle