Prognostic significance of the PROFUND index on one year mortality in acute heart failure: results from the RICA registry

Background: Heart failure (HF) is a syndrome with high prevalence, mainly affecting elderly patients, where the presence of associated comorbidities is of great importance. Methods: An observational study from a prospective registry was conducted. Patients identified from the National Registry of Heart Failure (RICA), which belongs to theWorking Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. The latter is a prospective, multicenter registry that has been active since 2008. It includes individual consecutive patients over 50 years of age with a diagnosis of HF at hospital discharge (acute decompensated or new-onset HF). Results: In total, 5424 patients were identified from the registry. Forty-seven percent were men and mean left ventricular ejection fraction (LVEF) was 51.4%; 1132 had a score of 0 to 2 according to the PROFUND index, 3087 had a score of 3 to 6, and 952 patients had a score of 7 to 10 points. In the sample, 252 patients had a score above 11 points. At the end of the year of follow-up, 61% of the patients died. This mortality increased proportionally as the PROFUND index increased, specifically 75% for patients with PROFUND greater than 11. The Kaplan-Meier survival curve shows that survival at one year progressively decreases as the PROFUND index value increases. Thus, subjects with scores greater than seven (intermediate-high and high-risk) presented the worst survival with a log rank of 0.96 and a p < 0.05. In the regression analysis, we found a higher risk of death from any cause at one year in the group with the highest risk according to the PROFUND index (score greater than 11 points (HR 1.838 (1.410-2.396)). Conclusions: The PROFUND index is a good index for predicting mortality in patients admitted for acute HF, especially in those subjects at intermediate to high risk with scores above seven. Future studies should seek to determine whether the PROFUND index score is simply a prognostic marker or whether it can also be used to make therapeutic decisions for those subjects with very high short-term mortality

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Luz del Renacimiento y contraluz en la Posmodernidad

Creemos que cualquier acercamiento a la obra de Thomas Pynchon debe tener en cuenta sus dos grandes componentes: la cultura clásica recuperada en los albores de la modernidad y la propia de la posmodernidad con las múltiples referencias, relaciones y conexiones con todas las modalidades del conocimiento. Sin embargo, y puesto que el humor y la ironía conforman también los aspectos narrativos de Pynchon, hemos tratado de buscar, primeramente, los elementos primordiales en la construcción de la..

Autorité et pouvoir dans le théâtre du Siècle d'Or

On connaît l’interprétation défendue par José Antonio Maravall, qui voyait dans le théâtre du Siècle d’Or une machine de propagande du pouvoir. Les choses ne peuvent pas être aussi simples dans une société et une culture aussi complexes et qui ont vu naître des dramaturges tels que Lope ou Calderón et des narrateurs comme Cervantès. Que le théâtre du Siècle d’Or ait défendu le système ne peut se dire sans en nuancer divers aspects. Le présent volume du Bulletin Hispanique aborde certains de ces problèmes appliqués à une large liste d’auteurs. Au premier plan, Tirso de Molina et Calderón, mais aussi des auteurs et des pièces moins connus : le criollo Peralta Barnuevo, la Epístola de Amarilis a Belardo, Enríquez Gómez, Pérez de Montalbán ou Lope de Liaño. Les points de vue sont tout aussi vastes et variés : depuis l’annotation philologique jusqu’aux thématiques morales, mythiques et anthropologiques ; les genres et conventions ; les problèmes de traduction et de transposition à d’autres contextes culturels ; les figures incarnant différents modes de pouvoir ; la survivance ou la caducité des modèles ; la relation théorie/pratique ; sans oublier la question classique de l’inconstante fortune des favoris ou ce symbole central des emblèmes politiques : le cheval. Es conocida la interpretación que defendió José Antonio Maravall, quien veía en el teatro del Siglo de Oro una máquina de propaganda del poder. Las cosas no son tan simples. No lo pueden ser en una sociedad y una cultura tan compleja en la que florecieron dramaturgos como Lope y Calderón, o narradores como el mismo Cervantes. Que el teatro del Siglo de Oro defienda el sistema no se puede decir sin matizar múltiples aspectos. El presente volumen del Bulletin hispanique aborda algunos de estos problemas. Es de subrayar la amplitud del arco contemplado: destacan las figuras de Tirso de Molina y de Calderón pero no faltan análisis sobre autores y piezas menos estudiadas : el criollo Peralta Barnuevo, la Epístola de Amarilis a Belardo, Enríquez Gómez, Pérez de Montalbán o Lope de Liaño. Igualmente amplios y diversos son los enfoques: desde la anotación filológica a las temáticas, morales, míticas y antropológicas; cuestiones genéricas y de convenciones; problemas de traducción y trasposición a otros ambientes culturales; figuras que encarnan distintos modos de poder; pervivencia o caducidad de modelos; relación teoría/práctica; sin olvidar un asunto tan clásico como la voltaria fortuna de los privados o un símbolo nuclear de la emblemática política como el del caballo. One knows the interpretation championed by José Antonio Maravall, who saw in the theatre of the Golden Century, a propaganda machine for the power. Things cannot be that simple in such a complex society and culture, which saw the birth of playwrights like Lope or Calderón, or writers like Cervantès. That the theatre had defended the political system in the Golden Century cannot be said without nuances. The present volume of the Bulletin Hispanique tackles with some of these problems, applied to a large list of authors. Tirso de Molina and Calderón in the first place, but also authors of less known plays: the criollo Peralta Barnuevo, the “Epístola de Amarilisa Belardo”, Enríquez Gómez, Pérez de Montalbán ou Lope de Liaño. The points of view are as vast and varied: from philological annotation to moral, mythological and anthropological themes; genres and conventions; problems of translation and transposition to other cultural contexts; the figures embodying diverse modes of power; the survival or nullity of models; the relation theory/practice; without forgetting the usual question of the inconstant good fortune of favourites, or the symbol, central in political emblems: the horse

Autorité et pouvoir dans le théâtre du Siècle d'Or

On connaît l’interprétation défendue par José Antonio Maravall, qui voyait dans le théâtre du Siècle d’Or une machine de propagande du pouvoir. Les choses ne peuvent pas être aussi simples dans une société et une culture aussi complexes et qui ont vu naître des dramaturges tels que Lope ou Calderón et des narrateurs comme Cervantès. Que le théâtre du Siècle d’Or ait défendu le système ne peut se dire sans en nuancer divers aspects. Le présent volume du Bulletin Hispanique aborde certains de ces problèmes appliqués à une large liste d’auteurs. Au premier plan, Tirso de Molina et Calderón, mais aussi des auteurs et des pièces moins connus : le criollo Peralta Barnuevo, la Epístola de Amarilis a Belardo, Enríquez Gómez, Pérez de Montalbán ou Lope de Liaño. Les points de vue sont tout aussi vastes et variés : depuis l’annotation philologique jusqu’aux thématiques morales, mythiques et anthropologiques ; les genres et conventions ; les problèmes de traduction et de transposition à d’autres contextes culturels ; les figures incarnant différents modes de pouvoir ; la survivance ou la caducité des modèles ; la relation théorie/pratique ; sans oublier la question classique de l’inconstante fortune des favoris ou ce symbole central des emblèmes politiques : le cheval. Es conocida la interpretación que defendió José Antonio Maravall, quien veía en el teatro del Siglo de Oro una máquina de propaganda del poder. Las cosas no son tan simples. No lo pueden ser en una sociedad y una cultura tan compleja en la que florecieron dramaturgos como Lope y Calderón, o narradores como el mismo Cervantes. Que el teatro del Siglo de Oro defienda el sistema no se puede decir sin matizar múltiples aspectos. El presente volumen del Bulletin hispanique aborda algunos de estos problemas. Es de subrayar la amplitud del arco contemplado: destacan las figuras de Tirso de Molina y de Calderón pero no faltan análisis sobre autores y piezas menos estudiadas : el criollo Peralta Barnuevo, la Epístola de Amarilis a Belardo, Enríquez Gómez, Pérez de Montalbán o Lope de Liaño. Igualmente amplios y diversos son los enfoques: desde la anotación filológica a las temáticas, morales, míticas y antropológicas; cuestiones genéricas y de convenciones; problemas de traducción y trasposición a otros ambientes culturales; figuras que encarnan distintos modos de poder; pervivencia o caducidad de modelos; relación teoría/práctica; sin olvidar un asunto tan clásico como la voltaria fortuna de los privados o un símbolo nuclear de la emblemática política como el del caballo. One knows the interpretation championed by José Antonio Maravall, who saw in the theatre of the Golden Century, a propaganda machine for the power. Things cannot be that simple in such a complex society and culture, which saw the birth of playwrights like Lope or Calderón, or writers like Cervantès. That the theatre had defended the political system in the Golden Century cannot be said without nuances. The present volume of the Bulletin Hispanique tackles with some of these problems, applied to a large list of authors. Tirso de Molina and Calderón in the first place, but also authors of less known plays: the criollo Peralta Barnuevo, the “Epístola de Amarilisa Belardo”, Enríquez Gómez, Pérez de Montalbán ou Lope de Liaño. The points of view are as vast and varied: from philological annotation to moral, mythological and anthropological themes; genres and conventions; problems of translation and transposition to other cultural contexts; the figures embodying diverse modes of power; the survival or nullity of models; the relation theory/practice; without forgetting the usual question of the inconstant good fortune of favourites, or the symbol, central in political emblems: the horse

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization