Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry

Background and objective: Although recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients. Methods: We analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Patients were grouped according to whether treatment with IV NTG was started by EMS before ED admission (preED-NTG), during the ED stay (ED-NTG) or were untreated with IV NTG (no-NTG, control group). In-hospital, 30-day and 365-day all-cause mortality, prolonged hospitalization (>7 days) and 90-day post-discharge combined adverse events (ED revisit, hospitalization or death) were compared in EMS-NTG and ED-NTG respect to control group. Results: We included 8424 patients: preED-NTG = 292 (3.5%), ED-NTG = 1159 (13.8%) and no-NTG = 6973 (82.7%). preED-NTG group had the most severely decompensated cases of AHF (p < 0.001) but it had lower inhospital (OR = 0.724, 95%CI = 0.459-1.114), 30-day (HR = 0.818, 0.576-1.163) and 365-day mortality (HR = 0.692, 0.551-0.869) and 90-day post-discharge events (HR = 0.795, 0.643-0.984) than control group. ED-NTG group had mortalities similar to control group (in-hospital: OR = 1.164, 0.936-1.448; 30-day: HR = 0.980, 0.819-1.174; 365-day: HR = 0.929, 0.830-1.039) but significantly decreased 90-day post-discharge events (HR = 0.870, 0.780-0.970). Prolonged hospitalization rate did not differ among groups. Five different analyses confirmed these findings

Recomanacions de retorn d’activitat dels serveis de cardiologia en el procés de desconfinament per COVID-19

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Servei de cardiologia; Desconfinament; Mesures de proteccióCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Servicio de cardiología; Desconfinamiento; Medidas de protecciónCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Cardiology service; No confinement; Protection measuresAquest document recull les recomanacions de les societats científiques i professionals, per encàrrec del CatSalut i sota la coordinació del Pla Director de Malalties de l’Aparell Circulatori, pel retorn d’activitat de la pràctica clínica en els serveis de cardiologia en l’escenari actual de brot de COVID-19

Inhibidors de l’adenosina difosfat en pacients amb síndrome coronària aguda sense elevació del segment ST

Antiagregante plaquetario; Síndrome coronario agudo; InhibidoresAntigregant plaquetari; Síndrome coronària aguda; InhibidorsAntiplatelet drug; Acute coronary syndrome; InhibitorsAquest document conté les recomanacions d’ús dels antiagregants plaquetaris antagonistes dels receptors de l’adenosina difosfat (ADP) en pacients amb síndrome coronària aguda sense elevació persistent del segment ST (SCASEST). L’objectiu d’aquest document ha estat la generació de recomanacions d’ús per a clopidogrel, prasugrel i ticagrelor en pacients amb SCASEST, considerant els diferents escenaris clínics en els quals els pacients es poden trobar en funció del seu perfil de risc. Aquestes recomanacions estan adreçades a reduir la variabilitat en el maneig farmacològic d’aquests pacients i a homogeneïtzar els criteris d’ús de les tres alternatives antiagregants disponibles en el nostre entorn

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Introducció als sistemes Sacada

2003/200

Introducció als sistemes Sacada

2003/200

Reconstruction after pancreatic trauma by pancreaticogastrostomy

Introduction: Pancreatic lesions are very infrequent after closed abdominal trauma (5% of cases) with a complication rate that affects 30–40% of patients, and a mortality rate that can reach 39%. In our experience, closed abdominal traumatisms occurring at typical popular horse-riding festivals in our region constitute a high risk of pancreatic trauma. The purpose of the present paper is to raise awareness about our experience in the diagnosis and treatment of pancreatic lesions secondary to closed abdominal traumatism. Presentation of case: We present the clinical cases of two young patients who, after suffering blunt abdominal trauma secondary to the impact of a horse during the celebration of typical horse-riding festival, were diagnosed with pancreatic trauma type III. The treatment was surgical in both cases and consisted in performing a pancreaticogastric anastomosis with preservation of the distal pancreas and spleen. The postoperative period was uneventful and, at present, both patients are asymptomatic. Discussion: Signs and symptoms caused by pancreatic lesion are unspecific and difficult to objectify. With some limitations CT is the imaging test of choice for diagnosis and staging in the acute phase. The Wirsung section is indication for surgical treatment. The most extended surgical procedure in these cases is the resection of pancreatic body, tail, and spleen. Conclusion: The identification of a pancreatic injury after closed abdominal trauma requires a high suspicion based on the injury mechanism. A safer option may be the distal pancreatic preservation with pancreaticogastric anastomosis in grade III lesions with healthy pancreatic tissue

Starch-Based Biopolymer Reinforced with High Yield Fibers from Sugarcane Bagasse as a Technical and Environmentally Friendly Alternative to High Density Polyethylene

Greener composites, as alternatives to more common materials, should also achieve technical and economic feasibility to be commercially competitive. This study presents the results obtained from using a biodegradable starch-based matrix, and a natural fiber reinforcement coming from sugarcane bagasse, currently an agro-waste. The sugarcane bagasse biomass was treated to obtain four kinds of fibers with different morphological and chemical properties. The fibers were used to obtain composite materials, which were then tested for tensile properties. The results showed that some of the composites were suitable to replace high density polyethylene, from a technical and environmental point of view. The comparatively higher cost of the biobased matrices hinders the substitution, but the higher the fiber content, the lower the economic disadvantage. A micromechanical test and a sensitivity analysis showed that the fiber orientation had the highest impact on the tensile strength, followed by the fibers mean length and the quality of the interphase between the fibers and the matrix

Tensile Strength Assessment of Injection-Molded High Yield Sugarcane Bagasse-Reinforced Polypropylene

Sugarcane bagasse was treated to obtain sawdust, in addition to mechanical, thermomechanical, and chemical-thermomechanical pulps. The obtained fibers were used to obtain reinforced polypropylene composites prepared by injection molding. Coupling agent contents ranging from 2 to 10% w/w were added to the composite to obtain the highest tensile strength. All the composites included 30% w/w of reinforcing fibers. The tensile strength of the different sugarcane bagasse fiber composites were tested and discussed. The results were compared with that of other natural fiber- or glass fiber-reinforced polypropylene composites. Pulp-based composites showed higher tensile strength than sawdust-based composites. A micromechanical analysis showed the relationship of some micromechanical properties to the orientation angle, critical length, the intrinsic tensile strength, and the interfacial shear strength. The pulps showed similar intrinsic tensile strengths and were higher than that of sawdust. The properties of the sugarcane bagasse composites compared well with other natural fiber-reinforced composites