Post-mortem findings in Spanish patients with COVID-19; a special focus on superinfections

IntroductionWhole-body autopsies may be crucial to understand coronavirus disease 2019 (COVID-19) pathophysiology. We aimed to analyze pathological findings in a large series of full-body autopsies, with a special focus on superinfections. MethodsThis was a prospective multicenter study that included 70 COVID-19 autopsies performed between April 2020 and February 2021. Epidemiological, clinical and pathological information was collected using a standardized case report form. ResultsMedian (IQR) age was 70 (range 63.75-74.25) years and 76% of cases were males. Most patients (90%,) had at least one comorbidity prior to COVID-19 diagnosis, with vascular risk factors being the most frequent. Infectious complications were developed by 65.71% of the patients during their follow-up. Mechanical ventilation was required in most patients (75.71%) and was mainly invasive. In multivariate analyses, length of hospital stay and invasive mechanical ventilation were significantly associated with infections (p = 0.036 and p = 0.013, respectively). Necropsy findings revealed diffuse alveolar damage in the lungs, left ventricular hypertrophy in the heart, liver steatosis and pre-infection arteriosclerosis in the heart and kidneys. ConclusionOur study confirms the main necropsy histopathological findings attributed to COVID-19 in a large patient series, while underlining the importance of both comorbid conditions and superinfections in the pathology

Efectos de la intervención musical como estrategia de enfermería de cirugía cardíaca

[spa] Objetivos: El presente trabajo se centra en analizar, la validez de la música como actuación terapéutica, en la reducción de los signos y síntomas, que de forma negativa afectan a pacientes sometidos a un proceso de cirugía cardíaca. De manera más general, se pretende investigar donde, cuando, de qué manera y en qué tipo de procedimientos quirúrgicos del corazón, se aplica la intervención musical. Metodología: Las bases de datos en las que se realizó la búsqueda bibliográfica, son las siguientes: Cinhal, Scopus y Pubmed. Los artículos incluidos en la revisión, han sido ensayos clínicos, que estudiaban el efecto de la música en pacientes adultos, durante el proceso quirúrgico de interés. Resultados: Del análisis de los resultados, relacionados con el objetivo principal, se ha podido concluir que la música es efectiva, para la disminución del dolor y de la ansiedad. Esta intervención, también supone una mejora de los parámetros fisiológicos. Por otro lado, tras la valoración de las técnicas o metodología de empleo de la música en cirugía cardíaca, se ha podido deducir la necesidad de unificar criterios de aplicación en forma de protocolos o guías de actuación y recomendaciones. Igualmente, de la investigación, se ha desprendido una escasez cuantitativa de evidencia científica

Endoscopic submucosal dissection (ESD) of antral subepithelial lesion suspected of malignancy

Subepithelial gastric tumours comprise a heterogeneous group of lesions. Endoscopic ultrasonography with fine-needle aspiration (EUS-FNA) is a useful approach but cannot always offer a definitive diagnosis to guide future therapeutic decisions. In the case we describe, biopsy samples of an antral subepithelial lesion and cytological analysis obtained with an EUS-FNA suggested the diagnosis of an adenocarcinoma. Endoscopic submucosal dissection (ESD) allowed en bloc resection of the tumour ensuring diagnosis and providing a definitive treatment

Clases invertidas con casos clínicos de obstetricia y ginecología presentados con el apoyo de la herramienta QUIZIZZ

Depto. de Salud Pública y Materno - InfantilFac. de MedicinaFALSEsubmitte

Estudios genéticos en pacientes y familias con sospecha de enfermedades neurovasculares hereditarias

Introducción: Las enfermedades neurovasculares minoritarias como CADASIL, cavernomatosis múltiple familiar o arteriopatía de moyamoya requieren un abordaje diagnóstico multidisciplinario que incluya un panel genético. Métodos: Se ha realizado una revisión sistemática según la metodología PRISMA. Se ha tomado como referencia el protocolo diagnóstico empleado en la unidad de referencia CERVCO de París. Resultados: Se recomienda incluir los siguientes genes dentro del panel de enfermedad de pequeño vaso cerebral: NOTCH3, COL4A1, COL4A2, GLA, HTRA1, APP, TREX1 y LAMB1. En la cavernomatosis múltiple familiar se propone estudiar los genes KRIT1, CCM2 y PDCD10. Para el abordaje de la arteriopatía de moyamoya, los genes más interesantes serían: RNF123, BRCC3, MTCP1, GUCY1A3, ACTA2, SAMHD1, NOS3, CBL, DIAPH1 y ANO1. Si existen disecciones habría que incluir las colagenopatías en el diagnóstico diferencial. Conclusiones: Los paneles de exomas clínicos constituyen una herramienta diagnóstica fundamental en las enfermedades neurovasculares genéticas

Tumor–Stromal Interactions in a Co-Culture Model of Human Pancreatic Adenocarcinoma Cells and Fibroblasts and Their Connection with Tumor Spread

One key feature of pancreatic ductal adenocarcinoma (PDAC) is a dense desmoplastic reaction that has been recognized as playing important roles in metastasis and therapeutic resistance. We aim to study tumor–stromal interactions in an in vitro coculture model between human PDAC cells (Capan-1 or PL-45) and fibroblasts (LC5). Confocal immunofluorescence, Enzyme-Linked Immunosorbent Assay (ELISA), and Western blotting were used to evaluate the expressions of activation markers; cytokines arrays were performed to identify secretome profiles associated with migratory and invasive properties of tumor cells; extracellular vesicle production was examined by ELISA and transmission electron microscopy. Coculture conditions increased FGF-7 secretion and α-SMA expression, characterized by fibroblast activation and decreased epithelial marker E-cadherin in tumor cells. Interestingly, tumor cells and fibroblasts migrate together, with tumor cells in forming a center surrounded by fibroblasts, maximizing the contact between cells. We show a different mechanism for tumor spread through a cooperative migration between tumor cells and activated fibroblasts. Furthermore, IL-6 levels change significantly in coculture conditions, and this could affect the invasive and migratory capacities of cells. Targeting the interaction between tumor cells and the tumor microenvironment might represent a novel therapeutic approach to advanced PDAC

Rationale and Protocol of the Multimodality Evaluation of Antibody-Mediated Injury in Heart Transplantation (LEONE-HT) Observational Cross-Sectional Study

Introduction: Heart transplant (HT) survival has barely improved in the last decades, which is unsatisfactory for many HT recipients. The development of anti-human leukocyte antigen (anti-HLA) antibodies in HT patients is associated with a cardiac allograft dysfunction. The mechanisms leading to this damage are unclear. The Multimodality Evaluation Of Antibody-Mediated Injury In Heart Transplantation (LEONE-HT) study aimed to thoroughly describe the damage inflicted on the myocardium by anti-HLA antibodies. Methods and analysis: The LEONE-HT study is a cohort study with a cross-sectional approach in which HT patients with positive anti-HLA antibodies are compared with coetaneous HT patients with negative anti-HLA antibodies. All patients will undergo a state-of-the-art multimodal assessment, including imaging techniques, coronary anatomy and physiology evaluations and histological and immunological analyses. The individual and combined primary outcomes of structural graft injuries and longitudinal secondary outcomes are to be compared between the exposed and non-exposed groups with univariate and multivariable descriptive analyses. Ethics and dissemination: The LEONE-HT study is carried out in accordance with the principles set out in the Declaration of Helsinki and the International Conference on Harmonization guidelines for good clinical practice and following national laws and regulations. The study design, objectives and participant centers have been communicated to clinicaltrials.gov (NCT05184426). The LEONE-HT study counts on the support of patient associations to disseminate the objectives and results of the research. This study was funded by the Spanish Ministry of Science and Innovation and the Spanish Society of Cardiology

Post-mortem findings in Spanish patients with COVID-19; a special focus on superinfections

Introduction: Whole-body autopsies may be crucial to understand coronavirus disease 2019 (COVID-19) pathophysiology. We aimed to analyze pathological findings in a large series of full-body autopsies, with a special focus on superinfections. Methods: This was a prospective multicenter study that included 70 COVID-19 autopsies performed between April 2020 and February 2021. Epidemiological, clinical and pathological information was collected using a standardized case report form. Results: Median (IQR) age was 70 (range 63.75–74.25) years and 76% of cases were males. Most patients (90%,) had at least one comorbidity prior to COVID-19 diagnosis, with vascular risk factors being the most frequent. Infectious complications were developed by 65.71% of the patients during their follow-up. Mechanical ventilation was required in most patients (75.71%) and was mainly invasive. In multivariate analyses, length of hospital stay and invasive mechanical ventilation were significantly associated with infections (p = 0.036 and p = 0.013, respectively). Necropsy findings revealed diffuse alveolar damage in the lungs, left ventricular hypertrophy in the heart, liver steatosis and pre-infection arteriosclerosis in the heart and kidneys. Conclusion: Our study confirms the main necropsy histopathological findings attributed to COVID-19 in a large patient series, while underlining the importance of both comorbid conditions and superinfections in the pathology.Funding. This work was supported by the Ministry of Health (RD12/0017/0012) integrated in the National R+D+I Plan and co-financed by the ISCIII-General Subdirectorate for Evaluation and the European Regional Development Fund (FEDER). AR is the beneficiary of Contracts for the intensification of research activity in the National Health System by the Ministry of Science, Promotion and Universities of Spain (INT20-00028). DC-M is the recipient of a Rio Hortega grant by the Carlos III Health Institute (Instituto de Salud Carlos III-ISCIII) (CM22/00176). The funders did not play any role in the design, conclusions or interpretation of the study. Acknowledgments. The authors would like to acknowledge Amanda López Picado for assisting in preparing this manuscript and Juan Antonio Marín Sanz from the IMIBIC/UCAIB (Cordoba, Spain) for kindly providing help with data análisis