Differences in the yield of the implantable loop recorder between secondary and tertiary centers

Background: The implantable loop recorder (ILR) is a useful tool for diagnosis of syncope or palpitations. Its easy use and safety have extended its use to secondary hospitals (those without an Electrophysiology Lab). The aim of the study was to compare results between secondary and tertiary hospitals. Methods: National prospective and multicenter registry of patients with an ILR inserted for clinical reasons. Data were collected in an online database. The follow-up ended when the first diagnostic clinical event occurred, or 1 year after implantation. Data were analyzed according to the center of reference; hospitals with Electrophysiology Lab were considered Tertiary Hospi­tals, while those hospitals without a lab were considered Secondary Hospitals. Results: Seven hundred and forty-three patients (413 [55.6%] men; 65 ± 16 year-old): 655 (88.2%) from Tertiary Centers (TC) and 88 (11.8%) from Secondary Centers (SC). No differences in clinical characteristics between both groups were found. The electrophysi­ologic study and the tilt table test were conducted more frequently in Tertiary Centers. Fol­low-up was conducted for 680 (91.5%) patients: 91% in TC and 94% in SC. There was a higher rate of final diagnosis among SC patients (55.4% vs. 30.8%; p < 0.001). Tertiary Hospital patients showed a trend towards a higher rate of neurally mediated events (20% vs. 4%), while bradyarrhythmias were more frequent in SC (74% vs. 60%; p = 0.055). The rate of deaths and adverse events was similar in both populations. Conclusions: Patients with an ILR in SC and TC have differences in terms of the use of complementary tests, but not in clinical characteristics. There was a higher rate of diagnosis in Secondary Hospital patients.

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Modelo de evaluación al proyecto de la Fundación Comunitaria Morelense I.A.P.

Licenciatura en Intervención Educativ

Polimorfismos de los genes ACTN3 y ACE y su relación con el rendimiento deportivo en deportes individuales: Una revisión sistemática

Los polimorfismos de los genes ACTN3 y ACE relacionados al rendimiento deportivo son causa de polémica debido a quienes se inclinan por las diferencias entre el origen étnico y el estado atlético. Sin embargo, aunque lo anterior es objeto de debate a través de la genética se conoce que los beneficios potenciales del alelo R + I recaen en el rendimiento anaerobio y los portadores del alelo X + D en el rendimiento aerobio, indicativos de que biológicamente el genotipo RX + DD + II es la clave en el excelente desempeño de los atletas con capacidades físicas similares y torna importantes tanto a los fenotipos de potencia como a los de resistencia. El objetivo de este artículo fue seleccionar y describir los estudios que sustentan la asociación del genotipo de los genes ACTN3 y ACE con el rendimiento de los atletas de deportes individuales, considerados de élite por su alto desempeño deportivo. Se revisaron 1,153 artículos sobre el tema y solo 13 fueron incluidos en la investigación. Los resultados obtenidos indican que los deportistas con el genotipo RR/RX + ID/DD destacan en velocidad/potencia y con el genotipo XX + II en resistencia. En conclusión, es posible que exista una estructura genética específica y asociada a los polimorfismos de los genes ACTN3 y ACE que les permite estar predispuestos a un alto nivel de rendimiento anaeróbico y/o aeróbic

Stent liberador de rapamicina en el tratamiento de lesiones coronarias con alto riesgo de reestenosis: seguimiento clínico a 6 meses de los primeros 100 pacientes

Introducción y objetivos. Los stents con rapamicina han demostrado reducir drásticamente la reestenosis en lesiones con un riesgo reestenótico entre ligero y moderado. No existen estudios amplios que evalúen su comportamiento en contextos lesionales de alto riesgo. Nos planteamos conocer el posible impacto de su empleo en este tipo de lesiones. Pacientes y método. Se incluyó a pacientes consecutivos con indicación de angioplastia con alguna lesión que reuniera al menos una de las siguientes características: a) reestenosis intra-stent; b) difusa (> 20 mm); c) vaso pequeño (= 2,5 mm), y d) oclusión total. Resultados. Entre junio y diciembre de 2002 se incluyó a 100 pacientes (61 ± 11 años; un 84% varones; un 21% diabéticos) que tenían 154 lesiones tratadas (un 34% difusas, un 36% en un vaso pequeño, un 20% reestenosis intra-stent y un 20% oclusiones). Se implantaron 1,6 ± 0,7 stents/paciente, con un diámetro de 2,74 ± 0,26 mm, una longitud de 21 ± 8,5 mm y una longitud total stent/paciente de 33 ± 16 mm. Se obtuvo un éxito inmediato en el 98%. Se produjeron 2 infartos sin onda Q (2%) tras el procedimiento. No hubo ningún caso de trombosis agudas ni subagudas. Durante el seguimiento de 8,5 ± 2 meses (rango, 6-12 meses) se produjeron 2 trombosis tardías (2%), a los 3 y 7 meses, una de las cuales ocasionó un infarto. Se efectuó revascularización de la lesión tratada en 3 casos (3%), 2 de los cuales correspondieron a las trombosis tardías. Conclusiones. La utilización de stents con rapamicina en lesiones de alto riesgo para reestenosis fue segura y la necesidad de nueva revascularización en el seguimiento fue notablemente baja

Estimation of the full shape of the crystalline lens in-vivo from OCT images using eigenlenses

19 pags., 9 figs., 5 tabs.Quantifying the full 3-D shape of the human crystalline lens is important for improving intraocular lens power or sizing calculations in treatments of cataract and presbyopia. In a previous work we described a novel method for the representation of the full shape of the ex vivo crystalline lens called eigenlenses, which proved more compact and accurate than compared state-of-the art methods of crystalline lens shape quantification. Here we demonstrate the use of eigenlenses to estimate the full shape of the crystalline lens in vivo from optical coherence tomography images, where only the information visible through the pupil is available. We compare the performance of eigenlenses with previous methods of full crystalline lens shape estimation, and demonstrate an improvement in repeatability, robustness and use of computational resources. We found that eigenlenses can be used to describe efficiently the crystalline lens full shape changes with accommodation and refractive error.HORIZON EUROPE European Research Council (IMCUSTOMEYE H2020-ICT-2017 Ref. 779960;); European Research Council (SILKEYE H2020-ERC-571 2018-ADG Ref.833106); Ministerio de Ciencia e Innovación (PID2020-115191RB-I00); Narodowa Agencja Wymiany Akademickiej (ULAM 2020/1/00176); Fundacja narzecz Nauki Polskiej (MAB/2019/12); L’Oréal-UNESCO “For Women in Science”; Ministerio de Ciencia, Innovación y Universidades (IJC2018-037508-I, Juan de la Cierva-Incorporation); Research to Prevent Blindness (Bascom Palmer Eye Institute, Flaum Eye Institute); National Institutes of Health (NIE P30EY 001319); Unrestricted Funds Research to Prevent Blindness, NY; National Institutes of Health (R01EY021834); National Institutes of Health (P30EY014801); Florida Lions Eye Bank and Beauty of Sight Foundation; Hyderabad Eye Research Foundation