Índice neutrófilo/linfocito como factor pronóstico de mortalidad en infarto agudo de miocardio. Hospital Belén de Trujillo 2012-2017

OBJETIVO: Evaluar si el índice neutrófilo/linfocito (INL) es un factor pronóstico de mortalidad en infarto agudo de miocardio. MATERIAL Y MÉTODOS: Estudio observacional, analítico, de pruebas diagnósticas. La población de estudio consistió en 73 pacientes con infarto agudo de miocardio ingresados en el Hospital Belén de Trujillo durante el período entre enero 2012 y noviembre 2017, quienes fueron divididos en dos grupos: grupo I (20 pacientes fallecidos) y grupo II (53 sobrevivientes). RESULTADOS: El INL promedio en los grupos I y II fueron 5,77 ± 3,72 y 7,48 ± 6,73, respectivamente (p>0,05). El área bajo la curva ROC fue de 0,56 (IC 95%: 0,41-0,71). El mejor punto de corte para el INL como predictor de mortalidad fue de 2,11 (sensibilidad: 90%, especificidad: 23%, VPP: 31%, VPN: 85%). La mortalidad en pacientes con INL elevado y no elevado fue de 31% y 14%, respectivamente (p>0,05). El sexo femenino y la edad ≥ 65 años fueron predictores de mortalidad intrahospitalaria (p: 0,0007 y 0,048, respectivamente). CONCLUSIONES: El INL no es de utilidad como factor pronóstico de mortalidad intrahospitalaria en infarto agudo de miocardio.OBJECTIVE: To assess whether the neutrophil-to-lymphocyte ratio (NLR) is a prognostic marker of mortality in acute myocardial infarction MATERIAL AND METHODS: Observational, analytical study of diagnostic tests. The study population consisted of 73 patients with acute myocardial infarction admitted to the Bethlehem Hospital of Trujillo during the period between January 2012 and November 2017, who were divided in 2 groups: group I (20 deceased patients) and group II (53 survivors). RESULTS: The mean NLR in groups I and II were 5.77 ± 3.72 and 7.48 ± 6.73, respectively (p>0.05). The area under the ROC curve was 0.56 (95%CI: 0.41-0.71). The best cut-off point for the NLR as a prognostic marker of mortality was 2.11 (sensitivity: 90%, specificity: 23%, PPV: 31%, NPV: 85%). Mortality rates in patients with elevated and non-elevated NLR were 31% and 14%, respectively (p>0.05). Female sex and age ≥ 65 years old were associated with in-hospital mortality (p<0.05 and p<0.001, respectively). CONCLUSIONS: The NLR is not useful as a prognostic marker of in-hospital mortality in acute myocardial infarction.Tesi

The CaFe Project: Optical FeII and Near-Infrared Ca II triplet emission in active galaxies. II. The driver(s) of the Ca II and Fe II and its potential use as a chemical clock

In this second paper in the series, we carefully analyze the observational properties of the optical FeII and NIR CaII triplet properties as well as the luminosity, black hole mass, and Eddington ratio in order to define the driving mechanism behind the properties of our sample. Most of the significant correlations are associated with CaII triplet. The CaII shows an inverse Baldwin effect, bringing out the particular behavior of this ion with respect to the other low-ionization lines such as H$\beta$. We also performed a Principal Component Analysis, where $\sim80\%$ of the variance can be explained by the first three principal components drawn from the FWHMs, luminosity, and equivalent widths. The first principal component is primarily driven by the combination of black hole mass and luminosity with a significance over $99.9\%$, which in turn is reflected in the strong correlation of the first eigenvector with the Eddington ratio. Since the observational correlations are better represented by the Eddington ratio, this could be the primary mechanism behind the relations observed in our CaII-FeII sample. Since the calcium belong to the $\alpha$-elements, the FeII/CaII flux ratio can be used as a chemical clock for determining the metal content in AGN and trace the evolution of the host galaxies. We confirm the negative enhancement of the ratio FeII/CaII by the Eddington ratio, suggesting a metal enrichment of the BLR in intermediate-$z$ with respect to low-$z$ objects. A larger sample, particularly at $z>2$, is needed to confirm the present results.Comment: 26 pages, 11 figures, 2 tables. Submitted to ApJ. Comments are welcom

High metal content of highly accreting quasars

We present an analysis of UV spectra of 13 quasars believed to belong to extreme Population A (xA) quasars, aimed at the estimation of the chemical abundances of the broad line emitting gas. Metallicity estimates for the broad line emitting gas of quasars are subject to a number of caveats, although present data suggest the possibility of an increase along the quasar main sequence along with prominence of optical Fe II emission. Extreme Population A sources with the strongest Fe II emission offer several advantages with respect to the quasar general population, as their optical and UV emission lines can be interpreted as the sum of a low-ionization component roughly at quasar rest frame (from virialized gas), plus a blueshifted excess (a disk wind), in different physical conditions. Specifically, in terms of ionization parameter, cloud density, metallicity and column density. Capitalizing on these results, we analyze the component at rest frame and the blueshifted one, exploiting the dependence (of several intensity line ratios on metallicity $Z$). We find that the validity of intensity line ratios as metallicity indicators depends on the physical conditions. We apply the measured diagnostic ratios to estimate the physical properties of sources such as density, ionization, and metallicity of the gas. Our results confirm that the two regions (the low-ionization component and the blue-shifted excess) of different dynamical conditions also show different physical conditions and suggest metallicity values that are high, and probably the highest along the quasar main sequence, with $Z \gtrsim 10 Z_{\odot}$. We found some evidence of an overabundance of Aluminium with respect to Carbon, possibly due to selective enrichment of the broad line emitting gas by supernova ejecta.Comment: 39 pages, will appear in Ap

Low- and high-z highly accreting quasars in the 4D Eigenvector 1 context

Highly accreting quasars are characterized by distinguishing properties in the 4D eigenvector 1 parameter space that make them easily recognizable over a broad range range of redshift and luminosity. The 4D eigenvector 1 approach allows us to define selection criteria that go beyond the restriction to Narrow Line Seyfert 1s identified at low redshift. These criteria are probably able to isolate sources with a defined physical structure i.e., a geometrically thick, optically thick advection-dominated accretion disk (a "slim" disk). We stress that the importance of highly accreting quasars goes beyond the understanding of the details of their physics: their Eddington ratio is expected to saturate toward values of order unity, making them possible cosmological probes.Comment: 21 pages, 7 figures. V2 contains small changes suggested by reader

What Is the Optimal Duration of Adjuvant Mitotane Therapy in Adrenocortical Carcinoma? An Unanswered Question

A relevant issue on the treatment of adrenocortical carcinoma (ACC) concerns the optimal duration of adjuvant mitotane treatment. We tried to address this question, assessing whether a correlation exists between the duration of adjuvant mitotane treatment and recurrence-free survival (RFS) of patients with ACC. We conducted a multicenter retrospective analysis on 154 ACC patients treated for ≥12 months with adjuvant mitotane after radical surgery and who were free of disease at the mitotane stop. During a median follow-up of 38 months, 19 patients (12.3%) experienced recurrence. We calculated the RFS after mitotane (RFSAM), from the landmark time-point of mitotane discontinuation, to overcome immortal time bias. We found a wide variability in the duration of adjuvant mitotane treatment among different centers and also among patients cared for at the same center, reflecting heterogeneous practice. We did not find any survival advantage in patients treated for longer than 24 months. Moreover, the relationship between treatment duration and the frequency of ACC recurrence was not linear after stratifying our patients in tertiles of length of adjuvant treatment. In conclusion, the present findings do not support the concept that extending adjuvant mitotane treatment over two years is beneficial for ACC patients with low to moderate risk of recurrence

Massive ionized outflows in quasars

The most luminous quasars in the Hamburg- ESO (HE) survey show, at a high prevalence, CIV λ1549 and [OIII]λλ4959,5007 emission line profiles with high-amplitude blueshifts which indicate outflows occurring over a wide range of spatial scales. We found evidence in favor of the nuclear origin of the outflows diagnosed by [OIII]λλ 4959,5007. The derived ionized gas mass, kinetic power, and radiation thrust are extremely high, and suggest widespread feedback on the host galaxies of very luminous quasars, at cosmic epochs between 2 and 6 Gyr from the Big Bang

Impacto prestacional y sanitario del financiamiento capitado en gestantes y niños menores de 5 años en perú, 2011-2014: Prestational and sanitary impact of financing capitated in gestants and children under 5 years old in peru, 2011-2014

Objective: To analyze the impact of the capital on the health of pregnant women and children under 5 years ofage affiliated to comprehensive health insurance in 3 pilot regions between 2011 and 2014. Methods: Study ofcounterfactual analysis of difference in differences. The pilot regions are Apurímac, Ayacucho and Huancavelica,while Amazonas, Cajamarca and Huánuco are controls. Indicators of acute diarrheal disease, acute respiratoryinfection and anemia in children, and of maternal death avoided in pregnant women were measured, andproduction indicators that include coverage of control of growth and development of the child and prenatalcontrol. Results: A negative impact was observed in acute diarrheal disease (-330) and maternal death prevented(-213), and positive in acute respiratory infections (1540), anemia (736) and the child's control and developmentrates and prenatal control - constant (9.5% and 7.8%). Only maternal death avoided was not significant (p =0.21). Conclusion: The expected impact of the capita agreement on acute diarrheal diseases is observed, but noton the other indicators because the capitated increased the opportunity of access and detection of morbidity,increasing the latter.Key words: Capitated; Payment mechanisms; Impact; Difference in differences; Health outcomes; Intermediaryoutcomes; Public insurance system. (source: MeSH NLM) DOI:&nbsp; 10.25176/RFMH.v18.n3.1583 &nbsp;Objetivo: Analizar el impacto del capitado en la salud de gestantes y niños menores de 5 años afiliados alseguro integral de salud en 3 regiones piloto entre 2011 y 2014. Métodos: Estudio de análisis contrafactual dediferencia en diferencias. Las regiones piloto son Apurímac, Ayacucho y Huancavelica, mientras que Amazonas,Cajamarca y Huánuco son controles. Se midieron indicadores de enfermedad diarreica aguda, infecciónrespiratoria aguda y anemias en niños, y de muerte materna evitada en gestantes, e indicadores de producciónque incluyen cobertura de control de crecimiento y desarrollo del niño y control prenatal. Resultados: Seobservó un impacto negativo en enfermedad diarreica aguda (-330) y muerte materna evitada (-213), y positivoen infecciones respiratorias agudas (1540), anemias (736) y los índices de control y desarrollo del niño y controlprenatal-gestante (9.5% y 7.8%). Sólo muerte materna evitada fue no significativa (p=0.21). Conclusión:Se observa impacto esperado del convenio cápita en las enfermedades diarreicas agudas, pero no en losdemás indicadores debido a que el capitado aumentó la oportunidad de acceso y detección de morbilidad,incrementando esta última.Palabras clave: Capitado; Mecanismos de pago; Impacto; Diferencia en diferencias; Resultados sanitarios; Resultadosintermedios; Sistema de aseguramiento público. (fuente: DeCS BIREME) DOI: 10.25176/RFMH.v18.n3.158

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