Síndrome antifosfolípido primario con hemorragia alveolar refractaria e insuficiencia mitral severa: reporte de un caso y revisión de la literatura

The antiphospholipid syndrome (APS) is a hematological disorder that presents a state of hypercoagulability of autoimmune origin, characterized by thrombotic venous and / or arterial thrombosis, recurrent fetal loss and antiphospholipid antibodies presence. Another manifestation of this disease is diffuse alveolar hemorrhage, clinical entity that may occur with adult respiratory distress syndrome, respiratory failure and high mortality. Among its causes, we find lupus erythematosus, Behcet’s disease, microscopic polyarteritis, cryoglobulinemia vasculitis, Goodpasture’s syndrome, and granulomatous vasculitis. The differential diagnosis in a patient with severe valvular disease secondary to APS is a clinical challenge. We report a case of a 31- year-old woman, diagnosed with primary antiphospholipid syndrome with severe mitral regurgitation, who presented three episodes of diffuse alveolar hemorrhage, refractory to medical management. The case is discussed and a literature review is performed.El síndrome antifosfolípido (SAF)es un trastorno hematológico que cursa con un estado de hipercoagulabilidad de origen autoinmune, caracterizado por fenómenos trombóticos venosos o arteriales, pérdidas fetales recurrentes y presencia de anticuerpos antifosfolípidos. Otra manifestación de esta patología es la hemorragia alveolar difusa (HAD), entidad clínica que puede cursar con síndrome de dificultad respiratoria del adulto, falla ventilatoria y alta mortalidad. Entre sus causas se encuentran lupus eritematoso, enfermedad de Behcet, poliarteritis microscópica, vasculitis por crioglobulinemia, síndrome de Goodpasture y vasculitis granulomatosa. El diagnóstico diferencial en un paciente con enfermedad valvular severa secundaria aSAF es un reto clínico.Reportamos el caso de una mujer de 31 años con diagnóstico de SAF primario con insuficiencia mitral severa, quien presento 3 episodios de HAD refractaria al manejo médico. Se discute el caso y realizamos una revisión de la literatura

Implementation of risk stratification scales in the diagnosis of acute coronary syndromes

Introducción El dolor torácico es uno de los principales motivos de consulta en el servicio de urgencias. Diferentes escalas de riesgo han sido evaluadas en los pacientes con dolor torácico. El objetivo del presente estudio es comparar el desempeño diagnóstico de las escalas de riesgo en los pacientes con dolor torácico y sospecha de síndrome coronario agudo. Métodos Estudio de pruebas diagnósticas que incluyó pacientes mayores de 18 años con dolor torácico y sospecha de síndrome coronario agudo. El estándar de referencia fue alguna prueba de estratificación coronaria invasiva o no invasiva y la prueba índice la constituyó la puntuación de las escalas de riesgo TIMI, GRACE, CARdiac, Florencia, Sanchis y HEART. Se calcularon las características operativas para diferentes puntos de corte y se compararon las áreas bajo la curva ROC. Resultados Se incluyeron 249 pacientes, 143 (57,4%) fueron de sexo masculino, 65,3 años de edad media; 73 (29,3%) fueron anginas inestables, 79 (31,7%) presentaron infartos agudos de miocardio sin elevación del ST y a 97 (39%) se les descartó la enfermedad coronaria. Las escalas HEART y TIMI mostraron el mejor rendimiento diagnóstico con un área bajo la curva de 0,75 (IC del 95% 0,69-0,81) y 0,71 (IC del 95% 0,65-0,77). Las áreas bajo la curva de Florencia, CARdiac, GRACE, y Sanchis fueron 0,64 (IC 95% 0,57-0,71), 0,63 (IC 95% 0,57-0,69), 0,62 (IC 95% 0,55-0,69), y 0,62 (IC 95% 0,55-0,69), respectivamente. Conclusiones En una población de pacientes con alta probabilidad para el síndrome coronario agudo, las escalas HEART y TIMI mostraron una mayor capacidad para discriminar el diagnóstico del síndrome coronario agudo.Introduction Chest pain is one of the main reasons for consultation in the emergency room. Several risk scales have been assessed in patients with chest pain. The motivation of this study is to compare the diagnostic performance of risk scales in patients with chest pain and suspicion of acute coronary syndrome. Methods Study of diagnostic tests that included patients over the age of 18 with chest pain and suspicion of acute coronary syndrome. The reference standard was an invasive or noninvasive coronary stratification test and the index test consisted of the score in risk scales TIMI, GRACE, CARdiac, Florencia, Sanchis and HEART. Operative characteristics for different cut points were calculated and the areas under the ROC curve were compared. Results The study included 249 patients, of whom 143 (57.4%) were male, average age was 65.3 years; 73 (29.3%) were unstable anginas; 79 (31.7%) showed acute myocardial infarctions without ST elevation and for 97 (39%) coronary disease was ruled out. HEART and TIMI scales revealed the best diagnostic performance with a low area under the curve of 0.75 (CI of 95% 0.69-0.81) and 0.71 (CI of 95% 0.65-0.77). Areas under the curve for Florencia, CARdiac, GRACE, and Sanchis were 0,64 (CI 95% 0.57-0.71), 0.63 (CI 95% 0.57-0.69), 0.62 (CI 95% 0.55-0.69), and 0.62 (CI 95% 0.55-0.69), respectively. Conclusions In a patient population with high probability for acute coronary syndrome, HEART and TIMI scales showed a greater ability to discriminate the diagnosis of acute coronary syndrome

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe

MUSiC : a model-unspecific search for new physics in proton-proton collisions at root s=13TeV

Results of the Model Unspecific Search in CMS (MUSiC), using proton-proton collision data recorded at the LHC at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb(-1), are presented. The MUSiC analysis searches for anomalies that could be signatures of physics beyond the standard model. The analysis is based on the comparison of observed data with the standard model prediction, as determined from simulation, in several hundred final states and multiple kinematic distributions. Events containing at least one electron or muon are classified based on their final state topology, and an automated search algorithm surveys the observed data for deviations from the prediction. The sensitivity of the search is validated using multiple methods. No significant deviations from the predictions have been observed. For a wide range of final state topologies, agreement is found between the data and the standard model simulation. This analysis complements dedicated search analyses by significantly expanding the range of final states covered using a model independent approach with the largest data set to date to probe phase space regions beyond the reach of previous general searches.Peer reviewe

Measurement of prompt open-charm production cross sections in proton-proton collisions at root s=13 TeV

The production cross sections for prompt open-charm mesons in proton-proton collisions at a center-of-mass energy of 13TeV are reported. The measurement is performed using a data sample collected by the CMS experiment corresponding to an integrated luminosity of 29 nb(-1). The differential production cross sections of the D*(+/-), D-+/-, and D-0 ((D) over bar (0)) mesons are presented in ranges of transverse momentum and pseudorapidity 4 < p(T) < 100 GeV and vertical bar eta vertical bar < 2.1, respectively. The results are compared to several theoretical calculations and to previous measurements.Peer reviewe

Combined searches for the production of supersymmetric top quark partners in proton-proton collisions at root s=13 TeV

A combination of searches for top squark pair production using proton-proton collision data at a center-of-mass energy of 13 TeV at the CERN LHC, corresponding to an integrated luminosity of 137 fb(-1) collected by the CMS experiment, is presented. Signatures with at least 2 jets and large missing transverse momentum are categorized into events with 0, 1, or 2 leptons. New results for regions of parameter space where the kinematical properties of top squark pair production and top quark pair production are very similar are presented. Depending on themodel, the combined result excludes a top squarkmass up to 1325 GeV for amassless neutralino, and a neutralinomass up to 700 GeV for a top squarkmass of 1150 GeV. Top squarks with masses from 145 to 295 GeV, for neutralino masses from 0 to 100 GeV, with a mass difference between the top squark and the neutralino in a window of 30 GeV around the mass of the top quark, are excluded for the first time with CMS data. The results of theses searches are also interpreted in an alternative signal model of dark matter production via a spin-0 mediator in association with a top quark pair. Upper limits are set on the cross section for mediator particle masses of up to 420 GeV

Probing effective field theory operators in the associated production of top quarks with a Z boson in multilepton final states at root s=13 TeV

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Measurement of B-c(2S)(+) and B-c*(2S)(+) cross section ratios in proton-proton collisions at root s=13 TeV

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Measurement of the azimuthal anisotropy of Y(1S) and Y(2S) mesons in PbPb collisions at root s(NN)=5.02 TeV

The second-order Fourier coefficients (v(2)) characterizing the azimuthal distributions of Y(1S) and Y(2S) mesons produced in PbPb collisions at root s(NN) = 5.02 TeV are studied. The Y mesons are reconstructed in their dimuon decay channel, as measured by the CMS detector. The collected data set corresponds to an integrated luminosity of 1.7 nb(-1). The scalar product method is used to extract the v2 coefficients of the azimuthal distributions. Results are reported for the rapidity range vertical bar y vertical bar < 2.4, in the transverse momentum interval 0 < pT < 50 GeV/c, and in three centrality ranges of 10-30%, 30-50% and 50-90%. In contrast to the J/psi mesons, the measured v(2) values for the Y mesons are found to be consistent with zero. (C) 2021 The Author(s). Published by Elsevier B.V.Peer reviewe