Maniac Episode Induced by Thyrotoxicosis: Case Report

Objetivo: Presentamos el caso de un paciente de 65 años con diagnóstico de episodio maniaco inducido por tirotoxicosis, quien presentó síntomas neuropsiquiátricos asociados a hiporexia, pérdida de peso, diarrea y palpitaciones, como elementos clave para la sospecha clínica y el diagnóstico oportuno con el fin de disminuir la morbilidad y mortalidad del paciente. Descripción del caso: Paciente masculino de 65 años de edad con antecedente de episodio maniaco; desde los 45 años con sospecha de TAB, con falla terapéutica a múltiples antipsicóticos. Ingresó al servicio de urgencias con síntomas psicóticos y  afectivos maneiformes, hiporexia, pérdida de peso, diarrea y palpitaciones. Con laboratorios que mostraron una TSH baja, y anticuerpos antiperoxidasa tiroidea elevados. Recibió quetiapina 600 mgs/día, ácido valpróico 750 mgs/día, complementando con metimazol 30 mgs/día y propranolol 80 mgs/día, resolviendo sus síntomas neuropsiquiátricos rápidamente. Conclusiones: Un episodio maneiforme puede ser causado por tirotoxicosis. La psicosis y los síntomas del estado de ánimo secundarios al hipertiroidismo son raros en la práctica clínica, lo cual causa que pasen inadvertidos, por lo cual el conocimiento de esta alteración genera un manejo oportuno de pacientes reduciendo el gasto de los recursos del sistema de salud y mejorando la calidad de vida de la persona.Objective: We present the case of a 65-year-old patient diagnosed with a manic episode induced by thyrotoxicosis, who presented neuropsychiatric symptoms associated with hyporexia, weight loss, diarrhea and palpitations, as key elements for clinical suspicion and timely diagnosis in order to reduce patient morbidity and mortality. Description of the case: A 65-year-old male patient with a history of manic episode; since the age of 45 with suspected BAD, with therapeutic failure to multiple antipsychotics. He was admitted to the emergency department with maneiform psychotic and affective symptoms, hyporexia, weight loss, diarrhea, and palpitations. With laboratories that showed a low TSH, and elevated anti-thyroid peroxidase antibodies. He received quetiapine 600 mg/day, valproic acid 750 mg/day, supplemented with methimazole 30 mg/day and propranolol 80 mg/day, resolving his neuropsychiatric symptoms rapidly. Conclusions: A maneiform episode may be caused by thyrotoxicosis. Psychosis and mood symptoms secondary to hyperthyroidism are rare in clinical practice, which causes them to go unnoticed, therefore, knowledge of this alteration generates timely management of patients, reducing the expenditure of health system resources. and improving the quality of life of the perso

Improving Cr (VI) Extraction through Electrodialysis

A laboratory study has been carried out to determine the feasibility of in situ remediation of chromium (VI) contaminated soil using electrodialysis. In a classic setup, this technique implies the application of a low intensity direct current to the soil, which is separated from the electrode compartments by ion-exchange membranes. If the pollutants are ionic compounds, they can be forced to migrate to the oppositely charged electrode by electro-migration. Membranes selectively impede the flow of ions in the electrode compartments back to the soil. If a metal species is naturally present as an anion, mobilization from the soil at alkaline pH can be realized and, at the same time, the mobilization of other metal cations that occur at low pH can be minimized. Experiments have been carried out with clayey soils (kaolinite clay and soil clay mixtures) that have been characterized and then contaminated by mixing with a potassium dichromate solution for several days. Initial Cr (VI) content ranges from 500 to 4000 mg/kg. Treatment tests were carried out in an acrylic laboratory cells consisting of a central soil compartment and two electrode compartments located at both ends of the column. Dimensionally stable titanium electrodes coated with mixed metal oxides were placed in the electrode compartments. 0.01M Na2SO4 electrolytes were recirculated through them from two 1-liter deposits using a peristaltic pump. Two commercial ion exchange membranes separated the anolyte and catholyte compartments from the soil in the standard configuration. A programmable DC: power supply was connected to the electrodes and a computer for data acquisition.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. The authors acknowledge the financial support from the "Plan Propio de Investigación de la Universidad de Málaga" with project numbers PPIT.UMA.D1; PPIT.UMA.B1.2017/20 and PPIT.UMA.B5.2018/17. This work has also received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 778045

El conocimiento profesional específico de los docentes de lengua castellana y matemáticas, asociado a las categorías de escritura y fracción: estudio de caso múltiple

El objetivo principal del proyecto es comprender e interpretar el conocimiento profesional específico que han construido los profesores de lengua castellana y matemáticas en relación con las categorías escritura y fracción respectivamente. Al proponer el análisis de categorías específicas enseñadas por el profesor, se indagó sobre el conocimiento que éste posee sobre ellas para explicitarlo y hacerlo visible; así mismo, se pretendió cuestionar y redefinir la intención de llevar a la escuela la lógica de las disciplinas científicas, demostrando que en este lugar se producen otros conocimientos epistemológicamente diferenciados, donde se involucran saberes académicos, saberes basados en la experiencia, guiones y rutinas y teorías implícitas, los cuáles en conjunto constituyen el conocimiento construido por el profesor.Universidad de San Buenaventura, sede Bogot

Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy

Background and aimsDespite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN.MethodsAdult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores).ResultsOf a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053–1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098–1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057–1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001–1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210–0.687, p = 0.016) was associated with lower need of PN.ConclusionA higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction.Clinical trial registrationClinicalTrials.gov: NCT03634943

Enfrentando los riesgos socionaturales

El objetivo del libro es comprender la magnitud de los Riesgos Socionaturales en México y Latinoamérica, para comprender el peligro que existe por algún tipo de desastre, ya sea inundaciones, sismos, remoción en masa, entre otros, además conocer qué medidas preventivas, correctivas y de contingencias existen para estar atentos ante alguna señal que la naturaleza esté enviando y así evitar alguna catástrofe. El libro se enfoca en los aspectos básicos de análisis de los peligros, escenarios de riesgo, vulnerabilidad y resiliencia, importantes para la gestión prospectiva o preventiva

Memoria del segundo simposium sobre historia, sociedad y cultura de México y América Latina

La presente obra reúne 20 ponencias de las 27 que se presentaron en el “Segundo simposium sobre historia, sociedad y cultura de México y América Latina”, realizado el 8 y 9 de noviembre de 2006, en el Centro de Investigación en Ciencias Sociales y Humanidades (CICSyH) de la Universidad Autónoma del Estado de México (UAEM), en Toluca, Estado de México

The SADDEN DEATH Study: Results from a Pilot Study in Non-ICU COVID-19 Spanish Patients

Introduction: The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. Methods: In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. Results: In total, 324 deceased patients were included. Median age was 82 years (IQR 76–87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0–8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. Conclusions: This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group