Is erythrocyte size a strategy to avoid hypoxia in Wiegmann’s Torquate Lizards (Sceloporus torquatus)? Field evidence

This study examined changes in certain hematological parameters in a reptilian model naturally exposed to altitude-associated hypoxia. Four populations of the Mexican lizard Sceloporus torquatus Wiegmann, 1828 (Wiegmann’s Torquate Lizard) from different altitudes were sampled to evaluate erythrocyte count (Erc), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), and erythrocyte size (Ers). Blood was also assayed to determine hemoglobin ([Hb]), glucose, lactate, and electrolyte concentrations. Erc was performed using a Neubauer hemocytometer. Hct was calculated as percentage of packed cell volume by centrifuging blood samples. [Hb] was determined using a Bausch and Lomb Spectronic colorimeter. MCHC was calculated with the formula 100 × [Hb]/Hct. Ers was calculated from blood smear microphotographs analyzed with the Sigma Scan Pro software. Values of serum electrolytes (sodium (Na+), potassium (K+), and calcium (Ca2+)), pH, glucose, and lactate from blood samples were obtained through a blood electrolyte analyzer. Highland populations of S. torquatus exhibited a significant increase in Erc, Hct, Ers, and [Hb]. In contrast, MCHC showed no correlation with altitude. Additionally, significant differences in lactate, Na+, K+, and Ca2+ were observed in highland populations. In general, we found that most hematological parameters were significantly different among lizard populations from different altitudes. This is the first study to report changes in Ers in relation to altitude, which could be a physiological response to hypoxia.CONACYT 17872

Relationship between ABO Blood Group Distribution and COVID-19 Infection in Patients Admitted to the ICU: A Multicenter Observational Spanish Study

ABO blood-group system; Coronavirus infections; Multivariate analysis.Sistema de grups sanguinis ABO; Infeccions per coronavirus; Anàlisi multivariantSistema de grupos sanguíneos ABO; Infecciones por coronavirus; Análisis multivariableSince the beginning of the COVID-19 pandemic in December 2019, a relationship between the ABO blood group type and the novel coronavirus SARS-CoV-2, the etiological agent of COVID-19, has been reported, noting that individuals with the O blood group are the least likely to be infected. Spain is one of the most badly affected countries worldwide, with high rates of patients diagnosed, hospitalized, and deceased due to COVID-19 infection. The present study aimed to analyze the possible relationship of ABO in COVID-19 patients hospitalized in different Spanish centers during the first wave of the COVID-19 pandemic, for which the ABO group was available. Physicians from the transfusion services of different Spanish hospitals, who have developed a multicenter retrospective observational study, were invited to participate voluntarily in the research and 12,115 patients with COVID-19 infection were admitted to the nine participating hospitals. The blood group was known in 1399 cases (11.5%), of which 365 (26.1%) were admitted to the ICU. Regarding the distribution of ABO blood groups, a significant increase in the non-O blood groups and reduction for the O blood group was observed in patients hospitalized due to COVID-19, compared to the reference general population. Among the patients admitted to the ICU, after multivariate analysis, adjusted for the rest of the confounding variables, patients with the O blood group presented a significantly lower risk for admission to the ICU. We conclude that an association was observed between patients with the O blood group and their lower susceptibility to SARS-CoV-2 infection, both for those admitted to the hospitalization ward and for those who required admission to the ICU

Modelling the basin of attraction as a two-dimensional manifold from experimental data: applications to balance in humans

We present a method of modeling the basin of attraction as a three-dimensional function describing a two-dimensional manifold on which the dynamics of the system evolves from experimental time series data. Our method is based on the density of the data set and uses numerical optimization and data modeling tools. We also show how to obtain analytic curves that describe both the contours and the boundary of the basin. Our method is applied to the problem of regaining balance after perturbation from quiet vertical stance using data of an elite athlete. Our method goes beyond the statistical description of the experimental data, providing a function that describes the shape of the basin of attraction. To test its robustness, our method has also been applied to two different data sets of a second subject and no significant differences were found between the contours of the calculated basin of attraction for the different data sets. The proposed method has many uses in a wide variety of areas, not just human balance for which there are many applications in medicine, rehabilitation, and spor

Heuristics Applied to Mutation Testing in an Impure Functional Programming Language

The task of elaborating accurate test suites for program testing can be an extensive computational work. Mutation testing is not immune to the problem of being a computational and time-consuming task so that it has found relief in the use of heuristic techniques. The use of Genetic Algorithms in mutation testing has proved to be useful for probing test suites, but it has mainly been enclosed only in the field of imperative programming paradigms. Therefore, we decided to test the feasibility of using Genetic Algorithms for performing mutation testing in functional programming environments. We tested our proposal by making a graph representations of four different functional programs and applied a Genetic Algorithm to generate a population of mutant programs. We found that it is possible to obtain a set of mutants that could find flaws in test suites in functional programming languages. Additionally, we encountered that when a source code increases its number of instructions it was simpler for a genetic algorithm to find a mutant that can avoid all of the test cases

“COAGULATION”: a mnemonic device for treating coagulation disorders following traumatic brain injury—a narrative-based method in the intensive care unit

IntroductionCoagulopathy associated with isolated traumatic brain injury (C-iTBI) is a frequent complication associated with poor outcomes, primarily due to its role in the development or progression of haemorrhagic brain lesions. The independent risk factors for its onset are age, severity of traumatic brain injury (TBI), volume of fluids administered during resuscitation, and pre-injury use of antithrombotic drugs. Although the pathophysiology of C-iTBI has not been fully elucidated, two distinct stages have been identified: an initial hypocoagulable phase that begins within the first 24 h, dominated by platelet dysfunction and hyperfibrinolysis, followed by a hypercoagulable state that generally starts 72 h after the trauma. The aim of this study was to design an acronym as a mnemonic device to provide clinicians with an auxiliary tool in the treatment of this complication.MethodsA narrative analysis was performed in which intensive care physicians were asked to list the key factors related to C-iTBI. The initial sample was comprised of 33 respondents. Respondents who were not physicians, not currently working in or with experience in coagulopathy were excluded. Interviews were conducted for a month until the sample was saturated. Each participant was asked a single question: Can you identify a factor associated with coagulopathy in patients with TBI? Factors identified by respondents were then submitted to a quality check based on published studies and proven evidence. Because all the factors identified had strong support in the literature, none was eliminated. An acronym was then developed to create the mnemonic device.Results and conclusionEleven factors were identified: cerebral computed tomography, oral anticoagulant & antiplatelet use, arterial blood pressure (Hypotension), goal-directed haemostatic therapy, use fluids cautiously, low calcium levels, anaemia-transfusion, temperature, international normalised ratio (INR), oral antithrombotic reversal, normal acid–base status, forming the acronym “Coagulation.” This acronym is a simple mnemonic device, easy to apply for anyone facing the challenge of treating patients of moderate or severe TBI on a daily basis

Mycobacteriosis pulmonar. Presentación de dos casos quirúrgicos

Introducción: la Mycobacteriosis es una enfermedad producida por Mycobacterias ambientales, su diagnóstico hasta hace pocos años era un hecho ocasional, actualmente ha pasado a ser una patología relativamente frecuente, sobre todo en los pacientes SIDA y asociada a enfermedades pulmonares crónicas. Requiere tratamientos agresivos y prolongados, así como la exéresis quirúrgica en casos de afección pulmonar localizada.Objetivo: determinar la importancia de la cirugía como tratamiento alternativo en caso de fracaso del tratamiento farmacológico. Presentación de los casos: se presentan dos casos con diagnóstico de Mycobacteriosis ambiental, por Mycobacterium Avium. Pacientes con síntomas respiratorios de larga fecha de evolución, principalmente tos y expectoración, asociado a fiebre. En el segundo caso se recoge el antecedente de neumonías frecuentes durante la infancia, con diagnóstico de Bronquiectasias. En ambos se les aisló en el cultivo del esputo un Mycobacterium Avium, la prueba de Mantoux resultó negativa (0 mm) y en los estudios imagenológicos se presentan las formas típicas de esta enfermedad, dadas por lesiones fibrocavitarias en los lóbulos superiores. Conclusiones: en los casos presentados, hubo fracaso en el tratamiento farmacológico recomendados en la actualidad, manteniendo cultivos de esputo positivos a Mycobacterium Avium. Se realizó tratamiento quirúrgico, obteniendo resultados positivos, con esputos negativos y mejoría del estado clínico. Palabras clave: Mycobacteriosis, tuberculosis pulmonar, cultivo de esputo, síntomas respiratorios, tratamiento quirúrgico. </p

High-frequency stratigraphic architecture of a 3rd order depositional sequence in the coastal margin setting of Iberian Basin (Segovia Province, Spain)

En este trabajo se analiza la arquitectura estratigráfica detallada y la ciclicidad interna de la secuencia deposicional de 3er orden del Turoniense Superior – Coniaciense Basal en el margen costero de la Cuenca Ibérica (Provincia de Segovia), dentro de sucesiones predominantemente terrígenas con algunas intercalaciones carbonatadas de plataforma somera. La correlación de 16 columnas estratigráficas a lo largo de un perfil perpendicular al margen costero ha permitido identificar cuatro conjuntos de parasecuencias (4º orden) y 10 parasecuencias (5º orden), cuyo espesor y continuidad lateral varían en función de relaciones de onlap y toplap de las parasecuencias inferiores y superiores respectivamente, dentro de cada conjunto mayor (4º orden). Asimismo, dentro de las parasecuencias de 5º orden, se han identificado hasta dos parasecuencias de orden mayor (6º orden), cuyo reconocimiento está supeditado a los términos carbonatados de las sucesiones sedimentarias. En el trabajo se analiza la compleja superposición de cortejos sedimentarios que genera un patrón de apilamiento deposicional en el que coexisten tres rangos de secuencias de alta frecuencia (4º, 5º y 6º orden), aclarando las relaciones entre las facies terrígenas y carbonatadas en este margen costero, así como las diferentes tendencias sedimentarias que se reconstruyen en función de la escala de observación.The cyclicity and the stratigraphic architecture of the Upper Turonian-Lower Coniacian 3rd-order sequence have been analysed in the coastal margin of the Iberian Basin (north of the Central System, province of Segovia). This sequence is composed of coastal terrigenous sediments with some shallow shelf carbonate intercalations. The 3rd-order sequence is composed of several ranges of high-frequency superimposed parasequences. Each of the four parasequence sets (4th-order), can be divided into up to three parasequences (5th-order), which in turn are composed of two minor parasequences (6th-order), recognized only in the carbonate sediments of the sedimentary succession. Thickness and lateral extent of the parasequence sets depend on the number of their internal parasequences. Parasequences and minor parasequences thins and pinch out landwards with onlap and toplap relationships regarding the basal and top parasequence set and parasequence boundaries. The presence in the sedimentary record of 4th- 5th- and 6th-order parasequences originates a complex overlap of Systems Tracts; and thus, depending on the observation scale, different sedimentary trends can be recognized. At a detailed scale, the presence of these Systems Tracts allows to clarify the terrigenous and carbonate facies relationships. Although both facies have been formed in a single depositional episode, they were deposited in different stages of the episode. Siliciclastic facies represent the Shelf Margin Wedge/Transgressive Systems Tracts, being supplied to the Basin during a relative sea level lowstand and located at the coastal margin; later, during the subsequent transgression, they are reworked. On the other hand, carbonate sediments were deposited basinwards, during relative sea level highstands (Highstand System Tract). This depositional model explains the scarce presence of mixed facies. Two other different sedimentary trends are recognized in the entire sequence. First, the thinning upwards trend of parasequence sets, which is related with the overall regressive trend in the upper part of the sequence (due to accommodation loss). Secondly, the progressive upwards decrease of siliciclastic deposits and a correlative increase in carbonate sediments in the parasequence sets, which suggests the existence of a longer transgressive trend (2nd-order), which continues in the overlying Coniacian sequence.Depto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasTRUEMadrid (Comunidad Autónoma)Universidad de Alcalá de Henarespu

Extracorporeal Membrane Oxygenation in Patients With COVID-19:An International Multicenter Cohort Study

BACKGROUND: To report and compare the characteristics and outcomes of COVID-19 patients on extracorporeal membrane oxygenation (ECMO) to non-COVID-19 acute respiratory distress syndrome (ARDS) patients on ECMO. METHODS: We performed an international retrospective study of COVID-19 patients on ECMO from 13 intensive care units from March 1 to April 30, 2020. Demographic data, ECMO characteristics and clinical outcomes were collected. The primary outcome was to assess the complication rate and 28-day mortality; the secondary outcome was to compare patient and ECMO characteristics between COVID-19 patients on ECMO and non-COVID-19 related ARDS patients on ECMO (non-COVID-19; January 1, 2018 until July 31, 2019). RESULTS: During the study period 71 COVID-19 patients received ECMO, mostly veno-venous, for a median duration of 13 days (IQR 7-20). ECMO was initiated at 5 days (IQR 3-10) following invasive mechanical ventilation. Median PaO(2)/FiO(2) ratio prior to initiation of ECMO was similar in COVID-19 patients (58 mmHg [IQR 46-76]) and non-COVID-19 patients (53 mmHg [IQR 44-66]), the latter consisting of 48 patients. 28-day mortality was 37% in COVID-19 patients and 27% in non-COVID-19 patients. However, Kaplan-Meier curves showed that after a 100-day follow-up this non-significant difference resolves. Non-surviving COVID-19 patients were more acidotic prior to initiation ECMO, had a shorter ECMO run and fewer received muscle paralysis compared to survivors. CONCLUSIONS: No significant differences in outcomes were found between COVID-19 patients on ECMO and non-COVID-19 ARDS patients on ECMO. This suggests that ECMO could be considered as a supportive therapy in case of refractory respiratory failure in COVID-19

Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study

IntroductionMajor trauma is one of the major health care problems facing modern society, trauma systems require careful planning to achieve an ideal level of coverage for the population. The Patient Blood Management Program is an integrated and global strategy to provide patient care that aims to assess and address, when possible, the etiology of blood abnormalities rather than transfuse without treating the underlying cause. We aimed to describe the factors that are associated with the clinical decision to transfuse polytraumatized patients admitted to the Intensive Care Unit (ICU).MethodWe performed a cross sectional multicenter study of patients admitted to ICUs for trauma in 14 Spanish hospitals from September 2020 to December 2021.ResultsA total of 69 patients were treated in the emergency room due to polytrauma, 46% of them were considered serious in the initial triage. Thirty were caused by a fall from considerable height (43.47%), followed by 39 patients admitted due to trac accidents (56.52%). The location of the trauma was mainly cranioencephalic, followed by thoracic trauma. Of the 69 patients, 25 received a blood transfusion during their ICU stay (36.23%).DiscussionNo significant differences were observed between transfused and non-transfused patients, except for the severity scales, where transfused patients have a higher score on all the scales assessed in the ICU except for the Revised Trauma Score. As we can see, the incidence of kidney failure was also different between the groups analyzed, reaching 44.00% in transfused patients and 13.64% in the group of patients without blood transfusion, p = 0.005. In this sense, 92.00% of the transfusions performed were inadequate according to the criteria of Hb in blood prior to the decision to transfuse (Hb &amp;lt; 9). Our data support the need to consider clinical practice guidelines regarding blood transfusion and its practices