Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients

Background: Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients.Methods: Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.Results: In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, DC-statistic = 0.019; 95% confidence interval 0.001–0.037). Use of renin–angiotensin–aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors.Conclusions: Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality

Diverse Large HIV-1 Non-subtype B Clusters Are Spreading Among Men Who Have Sex With Men in Spain

In Western Europe, the HIV-1 epidemic among men who have sex with men (MSM) is dominated by subtype B. However, recently, other genetic forms have been reported to circulate in this population, as evidenced by their grouping in clusters predominantly comprising European individuals. Here we describe four large HIV-1 non-subtype B clusters spreading among MSM in Spain. Samples were collected in 9 regions. A pol fragment was amplified from plasma RNA or blood-extracted DNA. Phylogenetic analyses were performed via maximum likelihood, including database sequences of the same genetic forms as the identified clusters. Times and locations of the most recent common ancestors (MRCA) of clusters were estimated with a Bayesian method. Five large non-subtype B clusters associated with MSM were identified. The largest one, of F1 subtype, was reported previously. The other four were of CRF02_AG (CRF02_1; n = 115) and subtypes A1 (A1_1; n = 66), F1 (F1_3; n = 36), and C (C_7; n = 17). Most individuals belonging to them had been diagnosed of HIV-1 infection in the last 10 years. Each cluster comprised viruses from 3 to 8 Spanish regions and also comprised or was related to viruses from other countries: CRF02_1 comprised a Japanese subcluster and viruses from 8 other countries from Western Europe, Asia, and South America; A1_1 comprised viruses from Portugal, United Kingom, and United States, and was related to the A1 strain circulating in Greece, Albania and Cyprus; F1_3 was related to viruses from Romania; and C_7 comprised viruses from Portugal and was related to a virus from Mozambique. A subcluster within CRF02_1 was associated with heterosexual transmission. Near full-length genomes of each cluster were of uniform genetic form. Times of MRCAs of CRF02_1, A1_1, F1_3, and C_7 were estimated around 1986, 1989, 2013, and 1983, respectively. MRCA locations for CRF02_1 and A1_1 were uncertain (however initial expansions in Spain in Madrid and Vigo, respectively, were estimated) and were most probable in Bilbao, Spain, for F1_3 and Portugal for C_7. These results show that the HIV-1 epidemic among MSM in Spain is becoming increasingly diverse through the expansion of diverse non-subtype B clusters, comprising or related to viruses circulating in other countries

Estado de la Insuficiencia Mitral en Europa. Papel diagnóstico del orificio regurgitante

Los objetivos de este trabajo son: 1) Determinar la prevalencia de insuficiencia mitral (IM) en una cohorte de pacientes consecutivos referidos para una ecocardiografía; 2) determinar la distribución de IM primaria y secundaria; 3) Analizar con qué frecuencia los pacientes con IM significativa satisfacen los criterios anatómicos para el implante de MitraClip y 4) determinar el punto de corte óptimo del orificio regurgitante (ORE). Métodos Se han incluido prospectivamente todos los pacientes remitidos para la realización de una ecocardiografía en los hospitales participantes durante el periodo de reclutamiento. Los estudios ecocardiográficos de acuerdo a un protocolo previamente establecido. La IM se clasificó en primaria, secundaria o mixta y se describió su gravedad y su etiología. El orificio regurgitante se midió empleando el método PISA. El subgrupo de pacientes con IM de grado mayor que leve de nuestro centro fue seguido durante tres años. Resultados Finalmente se incluyeron un total de 63 463 estudios ecocardiográficos realizados en 19 centros europeos. Se describió IM de cualquier grado en 15 501 pacientes. En el 78,7% de los casos, la IM fue leve, en el 15,5% moderada y en el 5,9% grave. Entre los estudios con insuficiencia moderada o grave, el 55 % fue primaria, el 30% secundaria y en el 14% ambos mecanismos estuvieron presentes. La forma más frecuente de insuficiencia mitral primaria fue la degenerativa (60%). En lo que respecta a la insuficiencia mitral secundara, la etiología más frecuente fue la isquémica (51%). Se realizó seguimiento a tres años de 115 pacientes con IM primaria y 71 pacientes con IM secundaria. El punto de corte óptimo de orificio regurgitante para predecir un evento combinado de muerte cardiovascular e ingresos por insuficiencia cardiaca fue de 45mm2 en la IM primaria y 21mm2 en la secundaria. Conclusiones Se trata del mayor estudio ecocardiográfico hasta la fecha que analiza la prevalencia y distribución etiológica de la IM en Europa. La IM significativa podría estar presente hasta en el 5% de los estudios realizados con indicación clínica. Aunque la aplicabilidad del MitraClip está limitada por la morfología valvular, en este trabajo, hasta el 70% de los pacientes con IM secundaria presentaban una morfología adecuada para el procedimiento. Un orificio regurgitante de al menos 45mm2 en la IM primaria y de al menos 20mm2 en la IM secundaria está independientemente asociado con un incremento significativo del riesgo de muerte cardiovascular y hospitalización por insuficiencia cardiaca

Overview of mitral regurgitation in Europe: results from the European Registry of mitral regurgitation (EuMiClip)

Aims To determine the prevalence of mitral regurgitation (MR) in a large cohort of consecutive patients undergoing clinically indicated echocardiography and to examine the distribution of primary and secondary MR. Methods and results All patients undergoing an echocardiographic study in 19 European centres within a 3-month period were prospectively included. MR assessment was performed as recommended by the European Association of Cardiovascular Imaging (EACVI). MR was classified according to mechanism as primary or secondary and aetiologies were reported. A total of 63 463 consecutive echocardiographic studies were reviewed. Any degree of MR was described in 15 501 patients. Concomitant valve disease of at least moderate grade was present in 28.5% of patients, being tricuspid regurgitation the most prevalent. In the subgroup of moderate and severe MR (n = 3309), 55% of patients had primary MR and 30% secondary MR. Both mechanisms were described in 14% of the studies. According to Carpentier's classification, 26.7% of MR were classified as I, 19.9% of MR as II, 22.4% of MR as IIIa, and 31.1% of MR as IIIb. Conclusion To date, this is the largest echocardiography-based study to analyse the prevalence and aetiology distribution of MR in Europe. The burden of secondary MR was higher than previously described, representing 30% of patients with significant MR. In our environment, degenerative disease is the most common aetiology of primary MR (60%), whereas ischaemic is the most common aetiology of secondary MR (51%). Up to 70% of patients with severe primary MR may have a Class I indication for surgery. However, the optimal therapeutic approach for secondary MR remains uncertain

Diez propuestas didácticas para el conocimiento del noroeste murciano en la Enseñanza Secundaria Obligatoria

Documento que recoge un total de diez propuestas diseñadas con encuadres curriculares, materiales de apoyo, valoraciones didácticas y un soporte justificativo y documental. Contempla aspectos significativos y relevantes de la realidad del noroeste murciano, incluyendo propuestas de visitas o desplazamientos a algun municipio de los que integran la comarca, recogiendo sesiones de trabajo previo en el aula. Los objetivos que se persiguen con este trabajo son promover la dinamización educativa del ámbito mediante modelos de actuación que supongan la concreción y el desarrollo de actividades adecuadas para el conocimiento del noroeste murciano y aportar al profesorado de la zona los recursos pedagógicos y documentales que puedan contribuir a la mejora de sus prácticas docentes y de la dinamización educativa. Como objetivo complementario pretende contribuir a la tarea social y colectiva de profundización y arraigo en la pertenecia a una determinada comarca natural a través del mayor conocimiento de la misma.MurciaES

El huerto como recurso para educación ambiental

Se propone acercar la naturaleza a los alumnos con el fin de educar de acuerdo con el entorno, y que conozcan los problemas ecológicos de la comunidad y de la localidad donde viven. Sus objetivos son crear un huerto escolar, desarrollar técnicas instrumentales, saber apreciar la naturaleza y favorecer la integración de los alumnos. Desarrolla contenidos sobre aprovechamiento didáctico del huerto, cultivos útiles para la naturaleza, condiciones de un huerto escolar, vocabulario, ciclo biológico de las plantas, taxonomía y clasificación, plantas autónomas de la zona, educación ambiental, educación en actitudes y valores, y técnicas de cultivo y cuidado de plantas. Esta experiencia es valorada por el alumnado de modo positivo porque les permite ampliar su conocimiento y estar más en contacto con el campo.Madrid (Comunidad Autónoma). Consejería de Educación y CulturaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES