Efecto atrayente del ácido láctico sobre poblaciones naturales de Anopheles albimanus de Laredo (Trujillo, Perú)

La presente investigación tuvo como objetivo determinar cuál de las concentraciones de ácido láctico: de 0.1 ó 1%, produce mayor atracción sobre una población de Anopheles albimanus hembra, obtenidos a partir de larvas colectadas en criaderos naturales, del sector Conache-Laredo (Trujillo, Perú). Para determinar la concentración atrayente, se escogieron 60 hembras que fueron sometidas al ácido láctico a 0.1% y 1% en un olfatómetro de acrílico en forma de “Y”.   El análisis estadístico de los datos se realizó mediante la prueba T de student. Se demostró que  el  ácido láctico al  1%  tuvo  el  mayor efecto atrayente sobre la  población utilizada de  An. albimanus. Palabras clave: Anopheles, ácido láctico, concentración, olfatómetro

Predicting Adverse Events beyond Stroke and Bleeding with the ABC-Stroke and ABC-Bleeding Scores in Patients with Atrial Fibrillation: The Murcia AF Project

Background The ABC (age, biomarkers, and clinical history)-stroke and ABC-bleeding are biomarker-based scores proposed to predict stroke and bleeding, but non-specificity of biomarkers is common, predicting different clinical events at the same time. We assessed the predictive performance of the ABC-stroke and ABC-bleeding scores, for outcomes beyond ischemic stroke and major bleeding, in a cohort of atrial fibrillation (AF) patients. Methods We included AF patients stable on vitamin K antagonists for 6 months. The ABC-stroke and ABC-bleeding were calculated and the predictive values for myocardial infarction (MI), acute heart failure (HF), a composite of cardiovascular events, and all-cause deaths were compared. Results We included 1,044 patients (49.2% male; median age 76 [71–81] years). During 6.5 (4.3–7.9) years, there were 58 (5.6%) MIs, 98 (9.4%) acute HFs, 167 (16%) cardiovascular events, and 418 (40%) all-cause deaths. There were no differences in mean ABC-stroke and ABC-bleeding scores in patients with/without MI (p = 0.367 and p = 0.286, respectively); both scores were higher in patients with acute HF, cardiovascular events, or death (all p  0.70). Clinical usefulness whether assessed by ABC-stroke or ABC-bleeding was similar for various primary endpoints. Conclusion In AF patients, the ABC-stroke and ABC-bleeding scores demonstrated similar predictive ability for outcomes beyond stroke and bleeding, including MI, acute HF, a composite of cardiovascular events, and all-cause deaths. This is consistent with nonspecificity of biomarkers that predict “sick” patients or poor prognosis overall

Prediction of Residual Stroke Risk in Anticoagulated Patients with Atrial Fibrillation: mCARS

Our ability to evaluate residual stroke risk despite anticoagulation in atrial fibrillation (AF) is currently lacking. The Calculator of Absolute Stroke Risk (CARS) has been proposed to predict 1-year absolute stroke risk in non-anticoagulated patients. We aimed to determine whether a modified CARS (mCARS) may be used to assess the residual stroke risk in anticoagulated AF patients from ‘real-world’ and ‘clinical trial’ cohorts. We studied patient-level data of anticoagulated AF patients from the real-world Murcia AF Project and AMADEUS clinical trial. Individual mCARS were estimated for each patient. None of the patients were treated with non-vitamin K antagonist oral anticoagulants. The predicted residual stroke risk was compared to actual stroke risk. 3503 patients were included (2205 [62.9%] clinical trial and 1298 [37.1%] real-world). There was wide variation of CARS for each category of CHA(2)DS(2)-VASc score in both cohorts. Average predicted residual stroke risk by mCARS (1.8 ± 1.8%) was identical to actual stroke risk (1.8% [95% CI, 1.3–2.4]) in the clinical trial, and broadly similar in the real-world (2.1 ± 1.9% vs. 2.4% [95% CI, 1.6–3.4]). AUCs of mCARS for prediction of stroke events in the clinical trial and real-world were 0.678 (95% CI, 0.598–0.758) and 0.712 [95% CI, 0.618–0.805], respectively. mCARS was able to refine stroke risk estimation for each point of the CHA(2)DS(2)-VASc score in both cohorts. Personalised residual 1-year absolute stroke risk in anticoagulated AF patients may be estimated using mCARS, thereby allowing an assessment of the absolute risk reduction of treatment and facilitating a patient-centred approach in the management of AF. Such identification of patients with high residual stroke risk could help target more aggressive interventions and follow-up

Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary

In 2013, the European Heart Rhythm Association (EHRA) published a Practical Guide on the use of non-VKA oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) (Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P, European Heart Rhythm A. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013;34:2094-2106). The document received widespread interest, not only from cardiologists but also from neurologists, geriatricians, and general practitioners, as became evident from the distribution of > 350 000 copies of its pocket version (the EHRA Key Message Booklet) world-wide. Since 2013, numerous new studies have appeared on different aspects of NOAC therapy in AF patients. Therefore, EHRA updated the Practical Guide, including new information but also providing balanced guiding in the many areas where prospective data are still lacking. The outline of the original guide that addressed 15 clinical scenarios has been preserved, but all chapters have been rewritten. Main changes in the Update comprise a discussion on the definition of 'non-valvular AF' and eligibility for NOAC therapy, inclusion of finalized information on the recently approved edoxaban, tailored dosing information dependent on concomitant drugs, and/or clinical characteristics, an expanded chapter on neurologic scenarios (ischaemic stroke or intracranial haemorrhage under NOAC), an updated anticoagulation card and more specifics on start-up and follow-up issues. There are also many new flow charts, like on appropriate switching between anticoagulants (VKA to NOAC or vice versa), default scenarios for acute management of coronary interventions, step-down schemes for longterm combined antiplatelet-anticoagulant management in coronary heart disease, management of bleeding, and cardioversion under NOAC therapy. The Updated Guide is available in full in EP Europace (Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, HackeW, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P, Advisors. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507), while additional resources can be found at the related ESC/EHRA website (www.NOACforAF.eu)

Higher-dose sitagliptin and the risk of congestive heart failure in older adults with CKD

Background and objectives Sitagliptin, a dipeptidylpeptidase-4 inhibitor, is commonlyprescribed to patientswith type 2 diabetes. As this drug is primarily eliminated by the kidney, a reduced dose is recommended for patients with CKD. Some evidence suggests that sitagliptin is associated with a higher risk of congestive heart failure, particularly at higher doses.Wecompare the 1-year risk of death or hospitalizationwith congestive heart failure in patients with CKD newly prescribed sitagliptin at \u3c50 versus ≤50 mg/d. Design, setting, participants, & measurements This population-based cohort study included older adults (\u3e66 years) with type 2 diabetes and an eGFR\u3c45 ml/min per 1.73 m2 (but not receiving dialysis) who were newly prescribed sitagliptin between 2010 and 2017 in Ontario, Canada. We used inverse probability of treatment weighting on the basis of propensity scores to balance baseline characteristics. The primary composite outcome was death or hospitalization with congestive heart failure. Secondary outcomes included hospitalization with pancreatitis or hypoglycemia, all-cause hospitalization, and glycemic control. Weighted hazard ratios were obtained using Cox proportional hazards regression, and 95%confidence intervalswere obtained using bootstrap variance estimators. Results Of 9215 patients, 6518 started sitagliptin at \u3e50 mg/d, and 2697 started sitagliptin at ≤50 mg/d. The 1-year risk of death or hospitalization with congestive heart failure did not differ significantly between groups (79 versus 126 events per 1000 person-years; weighted hazard ratio, 0.88; 95% confidence interval, 0.67 to 1.14); hospitalization with pancreatitis (weighted hazard ratio, 0.98; 95% confidence interval, 0.32 to 3.03) and hypoglycemia (weighted hazard ratio, 1.10; 95% confidence interval, 0.64 to 1.90) also did not differ significantly between groups. Patients starting sitagliptin at \u3e50 mg/d had lower mean glycated hemoglobin concentrations (weighted between-group difference, 20.12%; 95% confidence interval, 20.19 to 20.06) and a lower risk of allcause hospitalization (weighted hazard ratio, 0.81; 95% confidence interval, 0.66 to 0.98). Conclusions The risk of death or congestive heart failure was not higher in older adults with CKD starting sitagliptin at \u3e50 versus ≤50 mg/d

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Environmental Correlates of Sensory Sampling Rate in the Electrosensory System of Neotropical Electric Fishes

The nocturnally-active freshwater Neotropical gymnotiform electric fish generate weak electric organ discharges (EODs) that are detected by electroreceptors to facilitate active electroreception (object detection and communication - including species recognition). The EOD rate of \u27pulse-type\u27 species varies among individuals as a function of activity rate and during sexual or agonistic interactions. The extent to which EOD rate varies between and within species in natural conditions, and the ecological and evolutionary factors that influence such variation are poorly known. EOD rate is presumed to represent a measure of sensory sampling rate, and therefore we hypothesized that water flow velocity may correlate positively to EOD rate variation (both between and within species). To test this hypothesis, we made nocturnal EOD-rate recordings of 862 non-breeding individuals of nine common species in rainforest streams of the upper Amazon. These recordings were accompanied by measurements of additional parameters hypothesized to influence intraspecific (but not interspecific) variation in pulse rate by influencing activity rate. These parameters included conductivity and turbidity (proxies for recent rainfall), temperature and dissolved oxygen (a possible metabolic constraint on signaling), body size (representing ontogeny), and moonlight intensity (a metric of predation risk). Using multiple regression in the form of linear mixed effect models, and model selection, we determined that none of these variables explain interspecific variation in EOD rate – suggesting that other factors such as species recognition or non-adaptive drift represent more important ultimate drivers of interspecific variation in pulse rate. However, at the intraspecific level, we reported a substantial reduction in mean pulse rate on nights with strong moonlight in two species, Brachyhypopomus sullivani and Gymnorhamphichthys rondoni. In two other species, Brachyhypopomus beebei and Brachyhypopomus verdii, we reported elevated pulse rate during periods of increased conductivity and/or turbidity that followed rainfall and consequent flooding of ephemeral swamps adjacent to terra-firme streams

Urinary iodine concentration and iodine intake in pregnant Norwegian women. Results from the “Little in Norway” Study (LiN)

Background Iodine is an essential nutrient for the synthesis of thyroid hormones. Inadequate iodine intake is especially critical during pregnancy, lactation and early childhood. Iodine deficiency early in life impairs the developing brain. Iodine deficiency is defined as a median urine concentration less than 150 µg/ L in pregnant women. Seafood, milk-and dairy products, eggs and iodine-containing supplements are dietary iodine sources in Norway. Recently studies indicate that iodine status in pregnant women could be suboptimal. Aims The aims of the study were: [1] to determinate the iodine status of the pregnant women based on urinary iodine concentration from a spot urine sample using the World Health Organization (WHO). [2] to estimate the iodine intake from selected food groups and iodine- containing supplements using a food frequency questionnaire (FFQ) to evaluate whether or not it is in accordance with the Norwegian recommendation. [3] to assess influence of some factors (e.g. weeks of gestation, timing and season of spot urine collection) on the urinary iodine concentration (UIC) during pregnancy. Methods A total of 1036 pregnant women included in the study were recruited within the period 2011 - 2012 from nine well-baby clinics across the Norwegian Health Regions. A spot urine sample (to measure UIC) was collected from 1008 participants at the first meeting in the clinic. UIC were determined using inductively couple plasma spectrometry (ICP-MS). A self- administrative, semi quantitative FFQ (to estimate iodine intake) were filled in at home from 833 participants. Results Median UIC was 82 µg/ L and 80% of the urine samples were below 150 µg/ L. Data from the FFQ revealed that 30% ate seafood 2 - 3 times per week at dinner, 68% ate milk-and dairy products 2 - 3 times per day and 39% ate egg 2 - 3 times per week. Iodine-containing supplements were reported by 14% of the women. The total median iodine intake from foods and supplements was 153 µg/ day. Intake of milk-and dairy products and gestational age correlated significantly with median UIC. Conclusions Findings in the present study from median UIC classify the pregnant women as iodine deficient. Estimated dietary iodine intake also shows inadequate iodine intake among the women. In conclusion, this study shows that the diet of the pregnant women does not secure a sufficient iodine intake and one strategy to increase the iodine intake could be to increase the seafood intake