Derrame pleural paraneumónico: valor diagnóstico y pronóstico de la determinación de biomarcadores de respuesta inflamatoria en líquido pleural

La incidencia de las infecciones pleurales ha aumentado en las últimas décadas. Su diagnóstico puede ser difícil de establecer, y su manejo tiene claras implicaciones en la morbimortalidad de los pacientes. Dada la rentabilidad diagnóstica y pronóstica de los biomarcadores de respuesta inflamatoria en las neumonías, se analizan las mediciones de parámetros inflamatorios (procalcitonina, proteína C reactiva, interleuquina-6 y factor de necrosis tumoral alfa) en pacientes con diferentes tipos de derrame pleural, para valorar su utilidad para diagnosticar los derrames infecciosos, diferenciar entre los distintos subgrupos de estos, predecir la necesidad de drenaje torácico, e identificar potenciales factores asociados que puedan modificar sus concentraciones en el líquido pleural. Se diseñan modelos predictivos para dar respuesta a estas cuestiones, facilitando así su aplicación en la práctica clínica diaria

Interleukin 27 could be useful in the diagnosis of tuberculous pleural effusions

BACKGROUND: The diagnosis of tuberculous pleural effusion (TBPE) has some limitations. We studied the efficacy of interleukin-27 (IL-27) in the diagnosis of TBPE. METHODS: We measured IL-27, adenosine deaminase (ADA), ADA-2, interferon-gamma (IFNgamma), and the ADA.IL-27 and ADA-2.IL-27 products in all the pleural effusion fluids. The diagnostic yield of IL-27 was evaluated with receiver operating characteristic curves. RESULTS: Of 431 pleural effusions, 70 were tuberculous, 146 were neoplastic, 58 were parapneumonic, 28 were empyemas, 88 were transudates, and 41 were other types. With a cutoff point of 0.55 ng/mL, IL-27 had a sensitivity of 91.4% and a specificity of 85.1%, which were significantly less than ADA, ADA-2, IFNgamma, ADA.IL-27, or ADA-2.IL-27. The area under the receiver operating characteristic curve for IL-27 (0.963) was also significantly lower than that for the other markers, except for IFNgamma. However, IL-27 improved the sensitivity of ADA and ADA-2 through ADA.IL-27 and ADA-2.IL-27 products (100% for both). CONCLUSIONS: IL-27 is less efficient than ADA and ADA-2 in the diagnosis of TBPE. However, ADA.IL-27 and ADA-2.IL-27 improve the diagnostic sensitivity of ADA and ADA-2, and thus could be useful in situations of high clinical suspicion and low ADA level. A value above the cutoff point of the latter is practically diagnostic of TBPE

Apparent auxetic to non-auxetic crossover driven by Co2+ redistribution in CoFe2O4 thin films

Oxide spinels of general formula AB2O4 (A = Mg2+, Fe2+; B = Al3+, Cr3+, etc.) constitute one of the most abundant crystalline structures in mineralogy. In this structure, cations distribute among octahedral and tetrahedral sites, according to their size and the crystal-field stabilization energy. The cationic arrangement determines the mechanical, magnetic, and transport properties of the spinel and can be influenced by external parameters like temperature, pressure, or epitaxial stress in the case of thin films. Here, we report a progressive change in the sign of the Poisson ratio, ν, in thin films of CoFe2O4, defining a smooth crossover from auxetic (ν 0) behavior in response to epitaxial stress and temperature. Microstructural and magnetization studies, as well as ab initio calculations, demonstrate that such unusual elastic response is actually due to a progressive redistribution of Co2+ among the octahedral and tetrahedral sites of the spinel structure. The results presented in this work clarify a long standing controversy about the magnetic and elastic properties of Co-ferrites and are of general applicability for understanding the stress-relaxation mechanism in complex crystalline structures.This work has received financial support from Ministerio de Economía y Competitividad (Spain) under Project No. MAT2016-80762-R and MAT2017-82970-C2-R, Xunta de Galicia (Centro singular de investigación de Galicia accreditation 2016-2019, No. ED431G/09), the European Union (European Regional Development Fund-ERDF), and the European Commission through the Horizon H2020 funding by H2020-MSCA-RISE-2016-Project No. 734187–SPICOLOST. I.L.d.P. and B.R.-M. thank the funding under the ESTEEM2 project and the researchers L.A. Rodríguez and E. Snoeck for preliminary Lorentz Microscopy (L.M.) and electron holography (EH) studies in CoFe2O4 samples synthesized by PAD method performed at CEMES (Toulouse)S

El deporte femenino, ese gran desconocido

Actas de la Jornada "El deporte femenino, ese gran desconocido" celebrada el 26 de septiembre de 2018 en la Universidad Carlos III de Madrid

Development and validation of a clinical score to estimate progression to severe or critical state in Covid-19 pneumonia hospitalized patients

The prognosis of a patient with Covid-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. A retrospective study was performed of patients admitted with Covid-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, analytical, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. During the study period 1,152 patients presented with Covid-19 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 hours of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤5%, 6-25%, and >25% exhibited disease progression, respectively. A simple risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis.Carlos III Health Institute, Spain, Ministry of Economy and Competitiveness (SPAIN) and the European Regional Development Fund (FEDER)Instituto de Salud Carlos II

Plan gallego de hospitalización a domicilio. Estrategia HADO 2019-2023

Documento estratéxico que pretende potenciar e consolidar a hospitalización a domicilio como un modelo asistencial do Servizo Galego de Saúde e garantir o seu desenvolvemento nos próximos seis anos, establecendo criterios homoxéneos de atención coa finalidade de normalizar os modelos asistenciais, carteira de servizos e fluxos de traballo para asegurar una asistencia sanitaria de calidadeDocumento estratégico que pretende potenciar y consolidar la hospitalización a domicilio como un modelo asistencial del Servicio Gallego de Salud y garantizar su desarrollo en los próximos seis años, estableciendo criterios homogéneos de atención con la finalidad de normalizar los modelos asistenciales, cartera de servicios y flujos de trabajo para asegurar una asistencia sanitaria de calida

Fusobacterium Nucleatum Empyema: An Atypical Presentation

A 40-year-old man presented to the emergency room and was evaluated in the internal medicine department for unexplained weight loss, asthenia, anorexia and night sweats over the previous 2 months. After a loculated pleural effusion was identified on thoracic computed tomography, purulent fluid was drained from the lung and Fusobacterium nucleatum was isolated. The patient was successfully treated for 27 days with amoxicillin-clavulanic acid. This was an atypical presentation of a common micro-organism implicated in lung infections