Clinical characteristicas of patients suffering atrial fibrillation and diabetes mellitus. The attitude of the clinical cardiologist

[ES] [Resumen] Introducción y objetivos: La coexistencia de la fibrilación auricular y la diabetes mellitus es frecuente. Nuestro objetivo es analizar la manera como los cardiólogos tratamos a los pacientes que padecen ambas enfermedades en 2019. Métodos: Diseñamos un registro multicéntrico y prospectivo en el que incluimos todos los pacientes atendidos en consultas externas en los que coexistían ambas entidades. Se recogen parámetros clínicos, electrocardiográficos, ecocardiográficos y analíticos, el tratamiento que venían tomando los pacientes y la actitud terapéutica de los cardiólogos. Resultados: Durante 11 meses incluimos 658 pacientes, 55% mujeres, de 73,8 ± 8,5 años de edad. Encontramos una elevadísima prevalencia de otros factores de riesgo con diferencias significativas entre géneros. No se utiliza el ácido acetilsalicílico y se anticoagula al 96% de aquellos que lo precisan según las guías. Aquellos que siguen tratados con antivitamina K tienen un tiempo en rango terapéutico de Rosendaal de 59,8 ± 31, pero solo se optimiza el tratamiento en el 57,4% (rango de variabilidad entre cardiólogos 10-93%, p = 0,001) de los que tenían un tiempo en rango terapéutico < 65%. La hemoglobina glucosilada era de 7 ± 1,2, y el 37,5% presentaban cifras de hemoglobina glucosilada ≥ 7. Los cardiólogos optimizaron el tratamiento en el 35,2% de ellos (rango de variabilidad entre cardiólogos 6,3-93%, p = 0,0001). Si esta era ≥ 7,5, se optimizaba en el 46,3% y si era ≥ 9 en el 63,2%. Conclusiones: La coexistencia de fibrilación auricular y diabetes mellitus define una población de elevadísimo riesgo cardiovascular. La intervención del cardiólogo en el tratamiento anticoagulante y antidiabético es buena, pero mejorable, y hay gran variabilidad entre profesionales.[EN] Introduction and objectives: The coexistence of atrial fibrillation and diabetes mellitus is frequent. Our goal was to analyse how cardiologists treated patients with both pathologies in 2019. Methods: We designed a prospective, multicentre registry in which we included all the patients in whom both pathologies coexisted. Clinical, analytical, electrocardiographic, and echocardiographic parameters were collected. In addition, we collected the treatment that patients had been taking and the attitude of cardiologists. Results: Over 11 months we included 658 patients, 55% women, 73.8 ± 8.5 years. We found an extremely high prevalence of other risk factors with significant differences between genders. Acetylsalicylic acid was not used and 96% of those who required it were anticoagulated according to the guidelines. Those who were treated with aVK had a Rosendaal's time in therapeutic range of 59.8 ± 31, but treatment was only optimized in 57.4% (range of variability between cardiologists 10%-93%, P = .001) of which < 65% had time in therapeutic range. Glycated haemoglobin was 7.0 ± 1.2, and 37.5% had glycated hemoglobin levels ≥ 7.0. Cardiologists optimized treatment in 35.2% of them (range of variability between cardiologists 6.3%-93%, P = .0001). If it was ≥ 7.5, it was optimized in 46.3% and if it was ≥ 9 in 63.2%. Conclusions: The coexistence of atrial fibrillation and diabetes mellitus defines a population with a very high cardiovascular risk. The intervention of the cardiologist in anticoagulant and antidiabetic treatment is good, but it can be improved, and there is great variability among professionals.Estudio financiado por la Agencia de Investigación de la Sociedad Española de Cardiología, que recibió una beca no condicionada de Boehringer-Ingelheim-España

Izaña Atmospheric Research Center. Activity Report 2021-2022

Editors: Emilio Cuevas, Celia Milford and Oksana Tarasova.[EN]The Izaña Atmospheric Research Center (IARC), which is part of the State Meteorological Agency of Spain (AEMET), is a site of excellence in atmospheric science. It manages four observatories in Tenerife including the high altitude Izaña Atmospheric Observatory. The Izaña Atmospheric Observatory was inaugurated in 1916 and since that date has carried out uninterrupted meteorological and climatological observations, contributing towards a unique 100-year record in 2016. This reports are a summary of the many activities at the Izaña Atmospheric Research Center to the broader community. The combination of operational activities, research and development in state-of-the-art measurement techniques, calibration and validation and international cooperation encompass the vision of WMO to provide world leadership in expertise and international cooperation in weather, climate, hydrology and related environmental issues.[ES]El Centro de Investigación Atmosférica de Izaña (CIAI), que forma parte de la Agencia Estatal de Meteorología de España (AEMET), representa un centro de excelencia en ciencias atmosféricas. Gestiona cuatro observatorios en Tenerife, incluido el Observatorio de Izaña de gran altitud, inaugurado en 1916 y que desde entonces ha realizado observaciones meteorológicas y climatológicas ininterrumpidas y se ha convertido en una estación centenaria de la OMM. Estos informes resumen las múltiples actividades llevadas a cabo por el Centro de Investigación Atmosférica de Izaña. El liderazgo del Centro en materia de investigación y desarrollo con respecto a las técnicas de medición, calibración y validación de última generación, así como la cooperación internacional, le han otorgado una reputación sobresaliente en lo que se refiere al tiempo, el clima, la hidrología y otros temas ambientales afines

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Tandem Radical Fragmentation/Cyclization of Guanidinylated Monosaccharides Grants Access to Medium-Sized Polyhydroxylated Heterocycles

The fragmentation of anomeric alkoxyl radicals (ARF) and the subsequent cyclization promoted by hypervalent iodine provide an excellent method for the synthesis of guanidino-sugars. The methodology described herein is one of the few existing general methodologies for the formation of medium-sized exo- and endoguanidine-containing heterocycles presenting a high degree of oxygenation in their structure.This research study was supported by Mineco/Feder (SAF2013-48399-R). A.G.S. thanks the I3P-CSIC Program for a fellowship and MINECO for a JdC-incorporacion contract.Peer reviewe

Intramolecular Metal-free C(sp3)-H Activation Enables a Selective Mono O-Debenzylation of Fully Protected Aminosugars

Carbamate-bearing benzylated aminosugars undergo an I2/I(III)-promoted intramolecular hydrogen atom transfer (IHAT) followed by a nucleophilic attack to provide polycyclic structures. Thus, suitably positioned benzyl ethers are surgically oxidized into the corresponding mixed N/O-benzylidene acetals, which can be conveniently deprotected under mild acidic conditions to grant access to selectively O-deprotected aminosugars amenable for further derivatization. The scope of this strategy has been proven with a battery of furanosic and pyranosic scaffolds. Preliminary mechanistic studies, including Hammett LFER and KIE analyses, support a reaction pathway with the nucleophilic cyclization as the rate-determining step.This research study was supported by Mineco/Feder (SAF2013-48399-R). A.G.S. thanks the I3P-CSIC Program for a fellowship and MINECO for a JdC-incorporación contract.Peer reviewe

Synthesis of Chiral Polyhydroxylated Benzimidazoles by a Tandem Radical Fragmentation/Cyclization Reaction: A Straight Avenue to Fused Aromatic-Carbohydrate Hybrids

The synthesis of benzimidazole-fused iminosugars through a tandem β-fragmentation-intramolecular cyclization reaction is described. The use of the benzimidazole ring as the internal nucleophile and the use of phenyliodosophthalate (PhI(Phth)), a new metal-free and low toxic hypervalent iodine reagent, are the most remarkable novelties of this synthetic strategy. With this approach, we have demonstrated the usefulness of the fragmentation of anomeric alkoxyl radicals promoted by the PhI(Phth)/I system for the preparation of new compounds with potential interest for both medicinal and synthetic chemists.Financial support from Gobierno de Canarias (Research Program ProID20100088) and the MINECO/FEDER (SAF-2013-48399-R) is gratefully acknowledged. E.A.-J. thanks theUniversity of Nantes for a fellowship. A.G.S. thanks the I3P-CSIC Program for a fellowship and MINECO for a JdC-incorporación contract.Peer Reviewe

Synthesis of guanidines from azides: A general and straightforward methodology in carbohydrate chemistry

The ability of the guanidinylating reagent N′,N′′-diBoc-N-triflyl-guanidine (GN-Tf) to react with in situ formed free amines from azides in carbohydrate scaffolds was explored. This reaction proved to be an efficient method to prepare guanidine derivatives in a one-pot manner with good to excellent yields, either with primary or secondary azides with different substitution patterns. Labile protecting groups such as benzyl ethers are not removed under these hydrogenolytic conditions

Synthesis of tetrazole-fused glycosides by a tandem fragmentation- cyclization reaction

The fragmentation of anomeric alkoxyl radicals (ARF) and the subsequent intramolecular cyclization promoted by hypervalent iodine reagents provide an excellent method for the synthesis of tetrazolo-sugars. This new reaction offers additional advantages for the synthesis of these compounds, including the ready availability of the starting materials, experimental simplicity, mild conditions, and good yields.This work was supported by the Gobierno de Canarias (Research Program ProID20100088) and the investigation program no. CTQ2007-67492/BQU of the Ministerio de Educación y Ciencia (Spain) cofinanced with the Fondo Europeo de Desarrollo Regional (FEDER). A.G.S. thanks the I3P-CSIC Program for a fellowship

Synthesis of branched iminosugars through a hypervalent iodine(III)-mediated radical-polar crossover reaction

The synthesis of a novel type of branched iminosugars is described. This synthetic strategy is based on two key reactions: first, an aldol reaction with formaldehyde in order to introduce selectively the hydroxymethyl branch, and second, a tandem β-fragmentation-intramolecular cyclization reaction. The combination of both reactions afforded a battery of compounds exhibiting a great structural complexity, with the concomitant formation of a quaternary center, starting from readily available aldoses. With this approach we have demonstrated the usefulness of the fragmentation of anomeric alkoxyl radicals (ARF) promoted by the PhIO/I2 system for the preparation of new compounds with potential interest for both medicinal and synthetic chemists.This work was supported by the Gobierno de Canarias (Research Program ProID20100088) and the investigation program no. CTQ2007-67492/BQU of the Ministerio de Educación y Ciencia (Spain) cofinanced with the Fondo Europeo de Desarrollo Regional (FEDER). A.G.S. thanks the I3P-CSIC Program for a fellowshipPeer Reviewe