Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 ± 5.2 mm vs 19.9 ± 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 +/- 20.6% vs 93.6 +/- 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 +/- 5.2 mm vs 19.9 +/- 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

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

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

Agroecology and sustainability in the Didactic Garden of the Faculty of Education -CFP of the Complutense University of Madrid

Con este proyecto se pretende potenciar el uso de los espacios verdes de la UCM, en especial el Huerto Didáctico de la Facultad de Educación, para trabajar con el alumnado de Magisterio la alimentación saludable y sostenibleDepto. de Didáctica de las Ciencias Experimentales , Sociales y MatemáticasDepto. de Didáctica de las Lenguas, Artes y Educación FísicaFac. de EducaciónFALSEsubmitte

Informe elaborado desde la Plataforma Temática Interdisciplinar Salud Global/Global Health del CSIC

Informe elaborado desde la Plataforma Temática Interdisciplinar Salud Global/Global Health del CSIC.-- Coordinadores: M.Victoria Moreno-Arribas y Jesús Marco de Lucas.La pandemia COVID-19, causada por el coronavirus SARS-CoV-2, se ha convertido durante este último año en una de las peores amenazas para la historia de la humanidad. Su impacto en todo el planeta ha planteado un desafío sin precedentes para la sociedad. El CSIC tomó la iniciativa en marzo de 2020 con el lanzamiento de la Plataforma Salud Global, orientada a buscar soluciones desde la ciencia ante la pandemia, y ha canalizado este esfuerzo contando desde el primer momento con el trabajo coordinado e ininterrumpido de nuestros investigadores y con el apoyo de la sociedad en su conjunto. La plataforma ha movilizado y coordina a más de 300 grupos de investigación de más de 90 centros del CSIC, en seis temáticas de trabajo, que tratan de cubrir con un enfoque interdisciplinar todos los aspectos de la pandemia: Prevención, Enfermedad, Contención y Diagnóstico, Tratamiento y Vacunas, Impacto social, y Comunicación. Gracias al apoyo recibido a través de nuestro ministerio, convocatorias y donaciones directas de entidades públicas y privadas, y de particulares, a quienes queremos agradecer la confianza depositada, el CSIC desarrolla más de 100 proyectos de investigación, que abarcan desde el desarrollo de antivirales, anticuerpos y antiinflamatorios, la monitorización de la transmisión, el estudio del genoma del virus y el impacto de las mutaciones, las características del microbioma intestinal y la genética de los pacientes, su respuesta inmune a la infección y a la vacunación, hasta la fabricación y puesta en el mercado de mascarillas, sistemas de diagnóstico y contención del virus, así como estudios realizados sobre la percepción social de las medidas, especialmente sobre el impacto en residencias de mayores. Los tres proyectos de desarrollo de vacunas que lidera el CSIC arrancaron también al comienzo de la pandemia, como una apuesta estratégica para demostrar la capacidad de desarrollar de principio a fin una vacuna propia en España. Los proyectos de investigación han dado lugar por el momento a más de 800 resultados de investigación, más de 150 artículos en revistas de alto impacto, más de 180 resultados de transferencia protegidos, un máster propio, así como numerosos informes y guías científicas, y múltiples acciones de comunicación, divulgación y educación. Este documento tiene como objetivo difundir desde un enfoque global las principales investigaciones a nivel mundial, y las respuestas y soluciones basadas en proyectos en los dominios en que los grupos de investigación del CSIC son expertos. En estos intensos meses de trabajo, la plataforma Salud Global se ha convertido en una estructura estable de cooperación científica dimensionada a las expectativas cambiantes que ha demandado esta brutal pandemia. Su consolidación, reforzando su estructura y mecanismos de coordinación, en particular el enlace con el sector clínico, nos prepara para hacer frente a los nuevos desafíos y oportunidades, y el desarrollo de iniciativas con empresas en nuestro país, tan necesario para configurar una respuesta ante esta y futuras pandemias.1. ACTUACIONES EN PREVENCIÓN. 1.1. Modelos de predicción. 1.2. Origen y ecología del virus SARS-CoV-2, emergencia de nuevos virus. 1.3. Apps de seguimiento: Llegar a tiempo para frenar nuevos brotes. 1.4. Movilidad: incidencia y propagación de la enfermedad. 1.5. Proyectos en la temática PREVENCIÓN que se desarrollan en el CSIC.-- 2. ACTUACIONES SOBRE LA ENFERMEDAD Y LA CONEXIÓN CON LA CLÍNICA. 2.1. Entendiendo la enfermedad: dónde, cómo, cuándo y quién transmite el SARS-CoV-2. Presintomáticos, sintomáticos, y asintomáticos. Transmisión en personas asintomáticas. 2.2. Epidemiología genómica para rastrear la transmisión. 2.3. Genética del virus, evolución de la pandemia y respuesta ante la enfermedad. 2.4. Población infantil. COVID-19 y los niños. 2.5. Gravedad de la enfermedad. Factores de riesgo. Nuevos síntomas y secuelas. 2.6. Genética humana y otros factores en fase de estudio y su conexión con la gravedad de la enfermedad. 2.7. Inmunidad y respuesta inflamatoria ante el SARS-CoV-2. 2.8. Proyectos en la temática ENFERMEDAD que se desarrollan en el CSIC.-- 3. ACTUACIONES EN CONTENCIÓN Y DIAGNÓSTICO. 3.1. Conociendo cómo se trasmite el virus y los protocolos de desinfección. 3.2. Protección específica de las mucosas frente a la entrada del SARS-CoV-2. 3.3. Proyectos en la temática TRANSMISIÓN Y CONTENCIÓN que se desarrollan en el CSIC. 3.4. El papel del diagnóstico frente a la pandemia. 3.5. Proyectos en la temática DIAGNÓSTICO que se desarrollan en el CSIC.-- 4. ACTUACIONES EN TRATAMIENTO Y VACUNAS. 4.1. Tratamiento: el esfuerzo desde la investigación para curar la Covid-19. 4.2. Vacunas. 4.3. Proyectos en la temática TRATAMIENTO que se desarrollan en el CSIC.-- 5. IMPACTO GLOBAL DE LA PANDEMIA. 5.1. Residencias de ancianos. 5.2. Covid-19 y efectos en la salud mental. 5.3. Habitabilidad 5.4. El trabajo después de la COVID-19. 5.5. Publicación científica urgente: los cambios en la comunicación científica. 5.6. Proyectos en la temática IMPACTO GLOBAL que se desarrollan en el CSIC.-- 6. TRANSFERENCIA EN TIEMPOS COVID-19.-- 7. DIVULGACIÓN Y COMUNICACIÓN. 7.1. ExpoCovid, Exposición itinerante: ¿Qué sabemos hoy del SARS-CoV-2?Peer reviewe

Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry

International audienceImportance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE).Objective: To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT.Design, setting, and participants: This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection.Main outcomes and measures: Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE.Results: A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%).Conclusions and relevance: Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT