Las afecciones del pericardio en el Kitab al-Taysir de Avenzoar (c. 1095-1162)

Avenzoar aparece como el primer descriptor de las inflamaciones del pericardio en la literatura historico-médica. De nuestro trabajo se desprende que, si bien Avenzoar elaboró un estudio propio de las enfermedades del pericardio, con una marcada orientación patológica, su marco epistemológico fue semejante al utilizado por autores que constituyeron la fuente de conocimiento para la medicina islámica, Galeno y Avicena. Hemos constatado que la consideración dada a Avenzoar parece haberse derivado de la carencia de datos anatomofisiológicos y de la pormenorizada descripción de las indicaciones y de los recursos terapéuticos que distinguen su estudio de los anteriores

Cystic fibrosis with liver involvement in adults has a benign course. Results from a tertiary referral center cohort

Cystic fibrosis liver disease is a poorly understood entity, especially in adults, in terms of its real prevalence, natural history and diagnostic criteria, despite being the most important extrapulmonary cause of mortality. The aim was to evaluate the prevalence, characteristics and potential risk factors of liver disease in adults with cystic fibrosis, according to two diagnostic criteria accepted in the scientific literature. Patients were recruited in a tertiary referral hospital, and laboratory, ultrasound, non-invasive liver fibrosis tests (AST to Platelet Ratio Index [APRI]; Fibrosis-4 Index [FIB4]) and transient elastography (Fibroscan®) were performed. The proportion of patients with liver disease according to the Debray and Koh criteria were evaluated. ninety-five patients were included, 48 (50.5 %) females, with a mean age of 30.4 (28.6-32.2) years. According to the Debray criteria, six (6.3 %) patients presented liver disease. According to the Koh criteria, prevalence increased up to 8.4 %, being statistically different from the 25 % value described in other published series (p = 0.005). Seven (7.5 %) presented ultrasonographic chronic liver disease. Eleven (13 %) presented liver fibrosis according to the APRI score; 95 (100 %) had a normal FIB-4 value. Mean liver stiffness value was 4.4 (4.1-4.7) kPa. FEV1 (OR = 0.16, p 0.05), meconium ileus (OR = 14.16, p 0.002), platelets (Pearson coefficient -0.25, p 0.05) and younger age (Pearson coefficient -0.19, p 0.05) were risk factors. prevalence and severity of liver disease in adult cystic fibrosis patients were lower than expected. Meconium ileus, platelets, age and respiratory function were confirmed as risk factors associated to cystic fibrosis liver diseas

Continuous glucose monitoring as an additional tool in early cystic fibrosis-related diabetes monitoring and in evaluation of short-term sitagliptin response

Cystic fibrosis-related diabetes (CFRD) is a complication associated with a negative prognosis in patients with cystic fibrosis (CF). Although the oral glucose tolerance test (OGTT) is the widely recommended screening test for CFRD diagnosis, continuous glucose monitoring (CGM) is increasingly considered a useful and easy-to-perform test for diagnosis and follow-up in clinical practice. Regarding CFRD treatment, although insulin is the classic approved pharmacological option, incretins could also be a helpful alternative in early stages. CGM could be also a useful tool to measure the early response to this therapy. METHODS: We studied 25 CF patients with abnormal OGTT results and compared glucose and insulin levels during the OGTTs with CGM results as a tool for early CFRD diagnosis. In addition, we evaluated glycaemic control with CGM before and after treatment with sitagliptin. RESULTS: A correlation was found between lower plasma insulin levels during the OGTTs and higher average sensor glucose (p = 0.009) and hyperglycaemic excursions (p = 0.017). The CGM data on sitagliptin treatment (n = 25) showed an average glycaemic improvement from 124.2 to 117.2 mg/dL (p = 0.002) with a 5.6-point standard deviation of glucose decrease (p < 0.001). Hyperglycaemic excursions ≥200 mg/dL diminished 57.1% (p = 0.021). Both time in range and time above 180 mg/dL improved during treatment (p = 0.036 and p = 0.006, respectively). CONCLUSION: CGM is a useful tool that offers valuable information for both the diagnosis and the management of CFRD. Lower plasma insulin levels during OGTTs are associated with a poor ambulatory glucose profile in CGM. Sitagliptin could play an important role in the treatment of the early stages of CFRDThis work was funded by Proyectos de Investigacion en Salud (FIS) PI19-00584 and PI22/01404 (funded by Instituto de Salud Carlos III), TIRONET2-CM, B2017/BMD-3724, iTIRONET. P2022/BMD7379 (funded by Comunidad de Madrid), and co-financed by FEDER funds to Mónica Marazuela Azpiro

Usefulness of the CONUT index upon hospital admission as a potential prognostic indicator of COVID-19 health outcomes

Background: In-hospital mortality in patients with coronavirus disease 2019 (COVID-19) is high. Simple prognostic indices are needed to identify patients at high-risk of COVID-19 health outcomes. We aimed to determine the usefulness of the CONtrolling NUTritional status (CONUT) index as a potential prognostic indicator of mortality in COVID-19 patients upon hospital admission. Methods: Our study design is of a retrospective observational study in a large cohort of COVID-19 patients. In addition to descriptive statistics, a Kaplan-Meier mortality analysis and a Cox regression were performed, as well as receiver operating curve (ROC). Results: From February 5, 2020 to January 21, 2021, there was a total of 2969 admissions for COVID-19 at our hospital, corresponding to 2844 patients. Overall, baseline (within 4 days of admission) CONUT index could be scored for 1627 (57.2%) patients. Patients' age was 67.3 ± 16.5 years and 44.9% were women. The CONUT severity distribution was: 194 (11.9%) normal (0-1); 769 (47.2%) light (2-4); 585 (35.9%) moderate (5-8); and 79 (4.9%) severe (9-12). Mortality of 30 days after admission was 3.1% in patients with normal risk CONUT, 9.0% light, 22.7% moderate, and 40.5% in those with severe CONUT (P < 0.05). An increased risk of death associated with a greater baseline CONUT stage was sustained in a multivariable Cox regression model (P < 0.05). An increasing baseline CONUT stage was associated with a longer duration of admission, a greater requirement for the use of non-invasive and invasive mechanical ventilation, and other clinical outcomes (all P < 0.05). The ROC of CONUT for mortality had an area under the curve (AUC) and 95% confidence interval of 0.711 (0.676-0746). Conclusion: The CONUT index upon admission is potentially a reliable and independent prognostic indicator of mortality and length of hospitalization in COVID-19 patientsThe work is supported by a grant from the European Union’s Horizon 2020 Research and Innovation Programme under Grant Agreement (No 101016216

Fungal microbiota dynamics and its geographic, age and gender variability in patients with cystic fibrosis

[Objectives] In cystic fibrosis (CF), there is a predisposition to bronchial colonization by potentially pathogenic microorganisms, such as fungi. Our aims were to describe the dynamics of respiratory mycobiota in patients with CF and to evaluate the geographic, age and gender variability in its distribution.[Methods] Cohort study in which 45 patients with CF from four hospitals in three Spanish cities were followed up during a 1-year period, obtaining spontaneous sputum samples every 3 to 6 months. Fungal microbiota were characterized by Internal Transcribed Spacer sequencing and Pneumocystis jirovecii was identified by nested PCR in a total of 180 samples.[Results] The presence of fungi were detected in 119 (66.11%) of the 180 samples and in 44 (97.8%) of the 45 patients: 19 were positive and 1 negative throughout all follow-ups and the remaining 25 presented alternation between positive and negative results. A total of 16 different genera were identified, with Candida spp. (50/180, 27.78%) and Pneumocystis spp. (44/180, 24.44%) being the most prevalent ones. The distribution of fungal genera was different among the evaluated centres (p < 0.05), by age (non-adults aged 6–17 years vs. adults aged ≥18 years) (p < 0.05) and by gender (p < 0.05).[Discussion] A high prevalence of fungal respiratory microbiota in patients with CF was observed, whose dynamics are characterized by the existence of multiple cycles of clearance and colonization, reporting the existence of geographic, age and gender variability in the distribution of fungal genera in this disease.The study was supported by the Spanish Ministry of Science and Innovation (grant number FIS-PS09/00957), by Plan Andaluz de Investigación, Desarrollo e Innovación, Consejería de Economía Conocimiento, Empresas y Universidad de la Junta de Andalucía (grant number PS20_00894), and by Consejería de Salud y Familia, Junta de Andalucía (grant number CSyF Exp. RH-0061/2021).Peer reviewe

Las afecciones del pericardio en el "..." de Avenzoar (c. 1095-1162)

Avenzoar aparece como el primer descriptor de las inflamaciones del pericardio en la literatura historico-médica. De nuestro trabajo se desprende que, si bien Avenzoar elaboró un estudio propio de las enfermedades del pericardio, con una marcada orientación patológica, su marco epistemológico fue semejante al utilizado por autores que constituyeron la fuente de conocimiento para la medicina islámica, Galeno y Avicena. Hemos constatado que la consideración dada a Avenzoar parece haberse derivado de la carencia de datos anatomofisiológicos y de la pormenorizada descripción de las indicaciones y de los recursos terapéuticos que distinguen su estudio de los anteriores

Las afecciones del pericardio en el "..." de Avenzoar (c. 1095-1162)

Avenzoar aparece como el primer descriptor de las inflamaciones del pericardio en la literatura historico-médica. De nuestro trabajo se desprende que, si bien Avenzoar elaboró un estudio propio de las enfermedades del pericardio, con una marcada orientación patológica, su marco epistemológico fue semejante al utilizado por autores que constituyeron la fuente de conocimiento para la medicina islámica, Galeno y Avicena. Hemos constatado que la consideración dada a Avenzoar parece haberse derivado de la carencia de datos anatomofisiológicos y de la pormenorizada descripción de las indicaciones y de los recursos terapéuticos que distinguen su estudio de los anteriores

Effect of tillage systems on soil aggregation and hydraulic properties in SW Spain

4 Pag., 3 Fig.Conservation tillage is particularly important in arid and semi-arid zones, where water is the limiting factor for crop development under rainfed conditions. Conservation tillage improves physical properties and increases organic matter of soils under Mediterranean conditions. This work studies the influence of two tillage systems (traditional tillage, TT, and conservation (reduced) tillage, RT) on soil hydraulic properties and on soil aggregation after 15 years of experimentation. The effect of no-tillage (NT) in a short-term experimentation (4 years) was also considered. In the long-term experiment, the aggregate size distribution (ASD), mean weight diameter (MWD) and aggregation index (AI) values were greater in RT than in TT, although differences were not significant. Water stability (WAS) values for 1-2 mm size aggregates were greater in TT, despite the organic carbon (OC) and CaCO3 contents in these aggregates were greater in RT. However, under our conditions NT seems to have a greater effect on WAS. The increase of this variable in NT respect to TT, was observed after only three years of experimentation. In the long-term experiment, the hydraulic conductivity was higher in TT than in RT for h > -20 mm in agreement with a greater characteristic mean pore radius for h > -20 mm. In the short-term experiment, the lower hydraulic conductivity in NT than in TT suggests a lack of interconnected pores in NT treatment.Peer reviewe