Radial evolution of the April 2020 stealth coronal mass ejection between 0.8 and 1 AU - Comparison of Forbush decreases at Solar Orbiter and near the Earth

Aims. We present observations of the first coronal mass ejection (CME) observed at the Solar Orbiter spacecraft on April 19, 2020, and the associated Forbush decrease (FD) measured by its High Energy Telescope (HET). This CME is a multispacecraft event also seen near Earth the next day. Methods. We highlight the capabilities of HET for observing small short-term variations of the galactic cosmic ray count rate using its single detector counters. The analytical ForbMod model is applied to the FD measurements to reproduce the Forbush decrease at both locations. Input parameters for the model are derived from both in situ and remote-sensing observations of the CME. Results. The very slow (~350 km/s) stealth CME caused a FD with an amplitude of 3 % in the low-energy cosmic ray measurements at HET and 2 % in a comparable channel of the Cosmic Ray Telescope for the Effects of Radiation (CRaTER) on the Lunar Reconnaissance Orbiter, as well as a 1 % decrease in neutron monitor measurements. Significant differences are observed in the expansion behavior of the CME at different locations, which may be related to influence of the following high speed solar wind stream. Under certain assumptions, ForbMod is able to reproduce the observed FDs in low-energy cosmic ray measurements from HET as well as CRaTER, but with the same input parameters, the results do not agree with the FD amplitudes at higher energies measured by neutron monitors on Earth. We study these discrepancies and provide possible explanations. Conclusions. This study highlights that the novel measurements of the Solar Orbiter can be coordinated with other spacecraft to improve our understanding of space weather in the inner heliosphere. Multi-spacecraft observations combined with data-based modeling are also essential to understand the propagation and evolution of CMEs as well as their space weather impacts

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

Risk factors and rate of recurrence after Mohs surgery in basal cell and squamous cell carcinomas: a nationwide prospective cohort (REGESMOHS, Spanish Registry of Mohs Surgery)

Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the "real-life" results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1-1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3-6.1), being constant over time (0-5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries

Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER); Agencia Española del Medicamento; Consejería de Salud de Andalucía.Background & Aims: Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period. Methods: Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected. Results: A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974-0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994-0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy's law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%). Conclusions: AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management. Lay summary: Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes