Should Physicians Be Aware of Rhythm Disturbances in Adults with Systemic Autoimmune Diseases and Anti-Ro52 Antibodies? A Cross-Sectional Study.

Objectives: The association between anti-Ro/SSA antibodies and the appearance of cardiac rhythm disorders in adults is discussed. We aim to study this relationship, together with active treatments and comorbidities, and its impact on daily clinical practice in adults with systemic autoimmune diseases (SADs). Methods: This cross-sectional single-center study was conducted in a tertiary hospital between January 2021 and March 2022. A sample of adult patients followed up in the SAD Unit with a diagnosis of a SAD and previously tested for anti-Ro/SSA and anti-La/SSB were recruited. All of them underwent a 12-lead electrocardiogram. Results: 167 patients were included. 90 (53.9%) were positive for anti-Ro60, 101 (60.5%) for anti-Ro52, and 45 (26.9%) for anti-La/SSB; 52 (31.3%) were triple-negative. 84% were women, and the mean age was 59 years (standard deviation 12.8). The most common SAD was primary Sjögren's syndrome (34.8%), followed by systemic lupus erythematosus (24.6%) and rheumatoid arthritis (22.8%). A statistically significant relationship was found between anti-Ro52 positivity and cardiac rhythm disorders (relative risk = 2.007 [1.197-3.366]), specifically QTc prolongation (relative risk = 4.248 [1.553-11.615]). Multivariate regressions showed a significant association, with diabetes mellitus being the most related comorbidity. The association between anti-Ro52 antibodies and atrioventricular conduction disorders was not significant. Conclusions: The presence of anti-Ro52 antibodies in adult patients with SADs is associated with an increased risk of QTc prolongation. Electrocardiographic screening of patients with SAD, anti-Ro52 antibodies, and other risk factors, like diabetes mellitus or QT-prolonging drugs, seems advisable. Those with baseline electrocardiogram abnormalities or additional risk factors should undergo electrocardiographic monitoring.

Effect of intravenous pulses of methylprednisolone 250 mg versus dexamethasone 6 mg in hospitalised adults with severe COVID-19 pneumonia: An open-label randomised trial.

BACKGROUND: The efficacy and safety of high versus medium doses of glucocorticoids for the treatment of patients with COVID-19 has shown mixed outcomes in controlled trials and observational studies. We aimed to evaluate the effectiveness of methylprednisolone 250 mg bolus versus dexamethasone 6 mg in patients with severe COVID-19. METHODS: A randomised, open-label, controlled trial was conducted between February and August 2021 at four hospitals in Spain. The trial was suspended after the first interim analysis since the investigators considered that continuing the trial would be futile. Patients were randomly assigned in a 1:1 ratio to receive dexamethasone 6 mg once daily for up to 10 days or methylprednisolone 250 mg once daily for 3 days. RESULTS: Of the 128 randomised patients, 125 were analysed (mean age 60 ± 17 years; 82 males [66%]). Mortality at 28 days was 4.8% in the 250 mg methylprednisolone group versus 4.8% in the 6 mg dexamethasone group (absolute risk difference, 0.1% [95% CI, -8.8 to 9.1%]; p = 0.98). None of the secondary outcomes (admission to the intensive care unit, non-invasive respiratory or high-flow oxygen support, additional immunosuppressive drugs, or length of stay), or prespecified sensitivity analyses were statistically significant. Hyperglycaemia was more frequent in the methylprednisolone group at 27.0 versus 8.1% (absolute risk difference, -18.9% [95% CI, -31.8 to - 5.6%]; p = 0.007). CONCLUSIONS: Among severe but not critical patients with COVID-19, 250 mg/d for 3 days of methylprednisolone compared with 6 mg/d for 10 days of dexamethasone did not result in a decrease in mortality or intubation.

Curative Pericardiectomy in Interpheron-Resistant Severe Pericardial Erdheim-Chester Disease.

Erdheim-Chester disease is a rare clonal non-Langerhans cell histiocytosis with multisystemic involvement. It affects bones, large vessels, and retroperitoneum. Cardiac involvement is one of the main mortality predictors.1 We present an unusual case that debuted with cardiac tamponade and pericardial constriction requiring pericardiectomy for definitive control. (Level of Difficulty: Intermediate.).

Novel Oxime-Derivatized Synthetic Triterpene Glycosides as Potent Saponin Vaccine Adjuvants.

Vaccine adjuvants are key for optimal vaccine efficacy, increasing the immunogenicity of the antigen and potentiating the immune response. Saponin adjuvants such as the carbohydrate-based QS-21 natural product are among the most promising candidates in vaccine formulations, but suffer from inherent drawbacks that have hampered their use and approval as stand-alone adjuvants. Despite the recent development of synthetic derivatives with improved properties, their full potential has not yet been reached, allowing the prospect of discovering further optimized saponin variants with higher potency. Herein, we have designed, chemically synthesized, and immunologically evaluated novel oxime-derivatized saponin adjuvants with targeted structural modifications at key triterpene functionalities. The resulting analogues have revealed important findings into saponin structure-activity relationships, including adjuvant mechanistic insights, and have shown superior adjuvant activity in terms of significantly increased antibody response augmentation compared to our previous saponin leads. These newly identified saponin oximes emerge as highly promising synthetic adjuvants for further preclinical development towards potential next generation immunotherapeutics for future vaccine applications.

Design, synthesis, and initial immunological evaluation of glycoconjugates based on saponin adjuvants and the Tn antigen.

We report the first synthesis and immunological evaluation of a new glycoconjugate design based on streamlined saponin adjuvants and the Tn carbohydrate antigen. While the novel synthetic constructs induced moderate antibody responses in mice, the versatile chemical platform is amenable to further structure-activity optimizations for the development of self-adjuvanting glycoconjugate cancer vaccines.

Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality.

OBJECTIVES: To assess the influence of corticosteroid pulses on 60-day mortality in hospitalized patients with severe COVID-19. METHODS: We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865,096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2/FiO2<300, excluding those exposed to immunosuppressors before or during hospitalization, patients terminally ill at admission, or those who died in the first 24 hours. We performed a propensity score matching (PSM) adjusting covariates that modify the probability of being treated. Then, we used a Cox regression model in the PSM group to consider factors affecting mortality. RESULTS: From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. 124 patients were on corticosteroid pulses (250 mg of methylprednisolone for three days), and 133 were not. 30.3% (37/122) of patients died in the corticosteroid pulse group and 42.9% (57/133) in the nonexposed cohort. These differences (12.6%, 95% CI [8·54-16.65]) were statically significant (log-rank 4.72, p = 0, 03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5.31, p = 0.021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0.561; p = 0.039). CONCLUSIONS: This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both the exposed and nonexposed groups.

Natural and synthetic carbohydrate-based vaccine adjuvants and their mechanisms of action.

Modern subunit vaccines based on homogeneous antigens offer more precise targeting and improved safety compared with traditional whole-pathogen vaccines. However, they are also less immunogenic and require an adjuvant to increase the immunogenicity of the antigen and potentiate the immune response. Unfortunately, few adjuvants have sufficient potency and low enough toxicity for clinical use, highlighting the urgent need for new, potent and safe adjuvants. Notably, a number of natural and synthetic carbohydrate structures have been used as adjuvants in clinical trials, and two have recently been approved in human vaccines. However, naturally derived carbohydrate adjuvants are heterogeneous, difficult to obtain and, in some cases, unstable. In addition, their molecular mechanisms of action are generally not fully understood, partly owing to the lack of tools to elucidate their immune-potentiating effects, thus hampering the rational development of optimized adjuvants. To address these challenges, modification of the natural product structure using synthetic chemistry emerges as an attractive approach to develop well-defined, improved carbohydrate-containing adjuvants and chemical probes for mechanistic investigation. This Review describes selected examples of natural and synthetic carbohydrate-based adjuvants and their application in synthetic self-adjuvanting vaccines, while also discussing current understanding of their molecular mechanisms of action.

Replacing the Rhamnose-Xylose Moiety of QS-21 with Simpler Terminal Disaccharide Units Attenuates Adjuvant Activity in Truncated Saponin Variants.

Adjuvants are key immunostimulatory components in vaccine formulations, which improve the immune response to the co-administered antigen. The saponin natural product QS-21 is one of the most promising immunoadjuvants in the development of vaccines against cancer and infectious diseases but suffers from limitations that have hampered its widespread human use. Previous structure-activity relationship studies have identified simplified saponin variants with truncated carbohydrate chains, but have not focused on the influence of the linear oligosaccharide domain of QS-21 in adjuvant activity. Herein, an expeditious 15-step synthesis of new linear trisaccharide variants of simplified QS-21-derived adjuvants is reported, in which the complex terminal xylose-rhamnose moiety has been replaced with commercially available, simpler lactose and cellobiose disaccharides in a ß-anomeric configuration. In vivo immunological evaluation of the synthetic saponins showed attenuated antibody responses, highlighting the negative impact of such carbohydrate modifications on adjuvant activity, which could be associated with higher saponin conformational flexibility.

Utilización de biomateriales e injertos óseos autólogos en pacientes con atrofia alveolar / Bibliographic update on the use of biomaterials and autologous bone grafts in patients with alveolar atrophy

RESUMEN El material de elección para el reemplazo del hueso perdido por traumatismos, procesos patológicos congénitos o adquiridos y atrofia, son los injertos óseos autógenos o autólogos (hueso del propio paciente). A partir de la introducción del concepto de osteointegración por Branemark, los implantes dentales son parte de la terapéutica diaria para rehabilitar áreas edéntulas. La atrofia alveolar es quizás una de las condiciones bucales más incapacitantes; la razón reside en que es crónica, progresiva, acumulativa e irreversible, altera las relaciones maxilomandibulares, reduce la cantidad de hueso del área dentosoportada y la profundidad del surco. El material de injerto óseo ideal no debería ser sólo un sustituto óseo, sino un material de regeneración que se reabsorba completamente de modo simultáneo a la formación de hueso nuevo. Evaluar el éxito y fracaso de una terapia permite tomar decisiones para un mejoramiento continuo de la práctica clínica. El objetivo de la investigación fue demostrar la importancia de la utilización de biomateriales e injertos óseos autólogos en pacientes con atrofia alveolar (AU).

SUMMARY The elective material for replacing the bone lost by trauma, congenital or acquired pathological processes and atrophy are the autogenic or autologous bone grafts (the patient´s own bones). From the introduction of the concept of osseointegration by Branemark on, dental implants are part of the daily therapeutic for rehabilitating edentulous areas. Alveolar atrophy is perhaps one of the most disabling oral conditions, because it is chronic, progressive, cumulative and irreversible. It alters maxilla-mandibular relations, reduces the bone quality of the dentosupported area and the depth of the sulcus. The ideal bone graft material should not be only a bone substitute, by a regenerative material that could be completely reabsorbed simultaneously with the new bone formation. To assess the success and failure of a therapy allows taking decisions for the continuous improvement of the clinical practice. The aim of the research was to prove the importance of using biomaterials or autologous bone grafts in patients with alveolar atrophy (AU).

Revisión Bibliográfica sobre la implantología: causas y complicaciones / Bibliographic review on implantology: causes and complications

RESUMEN La implantología es una rama en constante evolución que cada vez presenta técnicas más rápidas, predecibles y mínimamente invasivas; hoy en día es una solución bastante completa para aquellas personas que por distintos motivos han perdido una o más piezas dentales y ha traído grandes avances en el área odontológica. Los avances científicos y tecnológicos, así como la mejora de la praxis quirúrgica, han logrado que la tasa de éxito de los implantes dentales sea superior al 95% después de un año de la colocación de los implantes dentales. Se conoce que el porcentaje de fracaso de estos procedimientos es relativamente bajo. Se realizó una revisión bibliográfica con el objetivo de actualizar información sobre la importancia de la implantología, sus causas y complicaciones (AU).

SUMMARY Implantology is a branch in constant evolution, presenting every time faster, more predictable and minimally invasive techniques; nowadays it is a very complete solution for those persons that, for any reason, have lost one or more teeth, and has meant great advances in odontology. Scientific and technological advances, and also the improvement of surgical praxis, have made the success rate of dental grafts higher than 95 % after a year of being made. It is known that failure percentage is relatively low. A bibliographic review was carried out with the aim of updating the importance of implantology, its causes and complications (AU).

Utilización de injertos óseos autólogos y biomateriales en pacientes con atrofia alveolar. Matanzas / Use of autologous bone grafts and biomaterials in patients with alveolar atrophy.Matanzas

RESUMEN Introducción: los injertos óseos constituyen una de las técnicas más utilizadas en la cirugía reconstructiva implantológicas, son muy utilizadas para el reemplazo del hueso perdido por traumatismos, procesos patológicos congénitos o adquiridos y atrofia, son los injertos óseos autógenos o autólogos. Objetivo: caracterizar los pacientes con rebordes atróficos que necesitaron ser rehabilitados en implantología oral como alternativa de tratamiento en la consulta de Cirugía Máxilo Facial del Hospital Universitario "Faustino Pérez" y la Clínica "III Congreso del PCC", municipio Matanzas de septiembre del 2014 a julio de 2016. Material y Método: estudio prospectivo longitudinal. El universo fue de 20 pacientes mayores de 18 años de ambos sexos, que presentaron el diagnóstico de edentulismo parcial y atrofia alveolar. Se determinó por el interrogatorio, el examen clínico y los medios diagnósticos los síntomas y signos que caracterizaron esta entidad. Resultados: los traumatismos alveolares fue la causa que predominó en la pérdida dentaria, en el sexo masculino y en las edades de 18 a 37 años. La zona de mayor afectación fue la región anterior del maxilar superior y predominó la perdida de hueso en altura y en anchura y un gran número de injertos conservaron la cresta alveolar. Conclusiones: el uso de biomateriales en el tratamiento de pacientes con atrofia alveolar junto al injerto óseo fue satisfactorio en pacientes que necesitaron una base de sostén sobre la cual se colocaron los implantes dentales osteointegrados (AU).

SUMMARY Introduction: autogenous and autologous bone grafts are the elective material for replacing bones lost by trauma, congenital or acquired pathologic processes and atrophy. Objective: to characterize patients with atrophic rims needing rehabilitation in oral grafting as an alternative treatment in the Maxilla-Facial Surgery consultation of the University Hospital "Faustino Perez" and the Clinic "III Congreso del PCC", municipality of Matanzas, from September 2014 to July 2016. Materials and Methods: longitudinal prospective study. The universe was 20 patients aged 18 years and older, males and females, who presented the diagnosis of partial lack of teeth and alveolar atrophy. The symptoms and signs characterizing this entity were stated by questioning, physical examination and diagnostic means. Results: alveolar traumas were the predominant cause of dental lost in male patients aged 18-37 years. The most affected zone was the anterior region of the upper maxilla; bone lost in height and width predominated, and a great number of grafts conserved the alveolar crest. Conclusions: the use of biomaterials in the treatment of patients with alveolar atrophy together with bone graft was satisfactory in patients who needed a base support on which to put dental grafts (AU).

Rabdomiólisis y antipsicóticos / Rhabdomyolysis and antipsychotics

No disponible

Assembly of glycoamino acid building blocks: a new strategy for the straightforward synthesis of heparan sulfate mimics.

A new strategy that enables a modular straightforward synthesis of heparan sulfate oligosaccharide mimics by the assembly of simple glycoamino acid building blocks is described. The coupling between units is readily carried out by an amidation reaction. Several glycoamino acid oligomers were prepared and their interaction with the FGF2 protein was analyzed.

Síndrome metabólico en pacientes con hipertensión arterial / Metabolic syndrome in patients with high blood pressure

Introducción: La hipertensión arterial frecuentemente se asocia con varios factores de riesgo cardiometabólico que pueden impactar en el éxito del tratamiento. La presencia del Síndrome Metabólico (SM) en los pacientes Hipertensos No Controlados es frecuente. El SM y la diabetes están asociados a un deficiente control de la presión arterial y a un alto riesgo cardiovascular. Objetivo: determinar la prevalencia de Síndrome Metabólico en pacientes hipertensos. Materiales y Métodos: Se analizaron 238 historias clínicas de pacientes con diagnóstico de hipertensión arterial esencial mayores de 18 años que provenían de consultorios de clínica médica de la ciudad Bahía Blanca. Resultados: Edad promedio: mujeres 67±13 años; varones 66±13 años. La prevalencia de Hipertensos No Controlados fue de 61% . En el grupo de Hipertensos No Controlados se incluyeron: 70% de los diabéticos; 78% de los obesos; 80 % de las glucemias alteradas; 80% de los HDL disminuidos en varones; 88% de los síndromes metabólicos. El 60% de los casos presentaron daño de órgano blanco. Como variable predictora de No Control de la Presión Arterial se halló el Síndrome Metabólico. Conclusiones. Los Hipertensos No Controlados presentan alta prevalencia de Síndrome Metabólico en comparación con los Hipertensos Controlados. En los Hipertensos No Controlados fueron más frecuentes: trastornos del metabolismo hidrocarbonado y lipídico, síndrome metabólico, daño de órgano blanco y consecuentemente, riesgo cardiovascular elevado. Los cambios profundos del estilo de vida juegan un rol fundamental en la reversión del síndrome metabólico.

Introduction: High blood pressure is often associated to several cardiometabolic risk factors that can affect the success of treatments. The presence of the Metabolic Syndrome (MS) in uncontrolled high blood pressure patients is quite frequent. MS and diabetes are associated to deficient control of blood pressure and cardiovascular risk. Objective: to determine the prevalence of Metabolic Syndrome in patients with high blood pressure. Materials and Methods: 238 medical records from patients with essential high blood pressure -18 years of age or older- from clinical private practices in the city of Bahía Blanca were analyzed. Results: Average age: females 67±13 years old; males 66±13 years old. The prevalence of uncontrolled high blood pressure patients was 61%. In the group of uncontrolled high blood pressure patients the following groups were included: 70% of diabetic patients; 78% of obese patients; 80% of patients with altered glycemia; 80% of males with diminished HDL; 88% of patients with metabolic syndrome. 60% of patients presented target organ damage. Metabolic Syndrome was found as predictor variable for uncontrolled blood pressure. Conclusions: Uncontrolled high blood pressure patients show high prevalence of Metabolic Syndrome compared to controlled high blood pressure patients. In uncontrolled high blood pressure patients the following conditions were more frequent: hydrocarbon and lipid metabolism disorders, metabolic syndrome, target organ damage, and consequently, high cardiovascular risk. Deep changes in life style have a major role in reversing metabolic syndrome.

Técnica del Gancho de Ginestet en el tratamiento de las fracturas del componente cigomático-maxilar / Ginestet hook technique in the treatment of the component zygomatic-maxilla fracture

Las fracturas del esqueleto facial constituyen un pilar fundamental dentro del contenido de trabajo de la Cirugía Máxilo Facial, existiendo varias técnicas quirúrgicas para lograr un restablecimiento funcional y estético de los lesionados en corto período. Con el propósito de demostrar la eficacia de la técnica de Gancho de Ginestet en el tratamiento de las fracturas del componente Cigomático-Maxilar, se revisaron las historias clínicas de 380 pacientes con el diagnóstico de fractura del componente Cigomático- Maxilar ingresados en el Hospital Universitario Faustino Pérez de Matanzas, en el período comprendido entre los años 1996–2006, tratados con diferentes técnicas quirúrgicas. Se analizaron los resultados estéticos y funcionales, la estadía general y post operatoria, así como las complicaciones presentadas. Se comprobó que el Gancho de Ginestet fue la técnica quirúrgica más utilizada, con ella se obtuvieron los mejores resultados y con menor tiempo de estadía y complicaciones. Se recomienda continuar utilizando esta técnica y generalizarla a otros hospitales(AU)

The fractures of the facial skeleton constitute a fundamental column inside the work content of the Maxilla.Facial Surgery, existing different surgery techniques to obtain a functional and aesthetical re-establishment of the injuries in a short period of time. With the purpose to demonstrate the efficiency of this technique, the Clinic History of 380 patients were reviewed in the University Hospital Faustino Pérez from Matanzas in the period between the years of 1996-2006, which were treated with different surgical techniques. The aesthetical and functional results were analyzed, the general training and post surgery and the complications presented. It was proved that the most used technique was the Ginestet Hook one, the best results were obtained with it. It is recomended to keep using this technique and to take it to other hospitals

Técnica del Gancho de Ginestet en el tratamiento de las fracturas del componente cigomático-maxilar / Ginestet hook technique in the treatment of the component zygomatic-maxilla fracture

Las fracturas del esqueleto facial constituyen un pilar fundamental dentro del contenido de trabajo de la Cirugía Máxilo Facial, existiendo varias técnicas quirúrgicas para lograr un restablecimiento funcional y estético de los lesionados en corto período. Con el propósito de demostrar la eficacia de la técnica de Gancho de Ginestet en el tratamiento de las fracturas del componente Cigomático-Maxilar, se revisaron las historias clínicas de 380 pacientes con el diagnóstico de fractura del componente Cigomático- Maxilar ingresados en el Hospital Universitario Faustino Pérez de Matanzas, en el período comprendido entre los años 1996–2006, tratados con diferentes técnicas quirúrgicas. Se analizaron los resultados estéticos y funcionales, la estadía general y post operatoria, así como las complicaciones presentadas. Se comprobó que el Gancho de Ginestet fue la técnica quirúrgica más utilizada, con ella se obtuvieron los mejores resultados y con menor tiempo de estadía y complicaciones. Se recomienda continuar utilizando esta técnica y generalizarla a otros hospitales.

The fractures of the facial skeleton constitute a fundamental column inside the work content of the Maxilla.Facial Surgery, existing different surgery techniques to obtain a functional and aesthetical re-establishment of the injuries in a short period of time. With the purpose to demonstrate the efficiency of this technique, the Clinic History of 380 patients were reviewed in the University Hospital Faustino Pérez from Matanzas in the period between the years of 1996-2006, which were treated with different surgical techniques. The aesthetical and functional results were analyzed, the general training and post surgery and the complications presented. It was proved that the most used technique was the Ginestet Hook one, the best results were obtained with it. It is recomended to keep using this technique and to take it to other hospitals.

Ateneo anátomo-clínico del Servicio de Clínica Médica del Hospital Interzonal "Dr. José Penna": deterioro del sensorio y fallo hemodinámico en un paciente anciano / Anatomical-clinical case conference of the internal medicine department at hospital interzonal ¶Dr. José Penna÷: sensorium deterioration and hemodynamic failure in an aging patient

Los Servicios de Clínica Médica y de Patología del Hospital Interzonal «Dr. José Penna¼ realizan los Ateneos «Dr. Guillermo Ramón Alvarez¼, con una periodicidad quincenal desde el año 1995, con el objetivo de mejorar la calidad de la asistencia médica y de contribuir a la formación de postgrado de los residentes. En esta publicación se presenta el desarrollo de un Ateneo sobre Deterioro del Sensorio y Fallo Hemodinámico en un Paciente Anciano, paciente fallecido al que se le practicó necropsia y cuyo diagnóstico presuntivo fue complejo...(AU)

Ateneo anátomo-clínico del servicio de clínica médica del hospital interzonal "Dr. José Penna": deterioro del sensorio y fallo hemodinámico en un paciente anciano / Anatomical-clinical examination of the medical clinic service of the "Dr. José Penna" interzonal hospital: deterioration of the sensory and hemodynamic failure in an elderly patient

Los Servicios de Clínica Médica y de Patología del Hospital Interzonal «Dr. José Penna¼ realizan los Ateneos «Dr. Guillermo Ramón Alvarez¼, con una periodicidad quincenal desde el año 1995, con el objetivo de mejorar la calidad de la asistencia médica y de contribuir a la formación de postgrado de los residentes. En esta publicación se presenta el desarrollo de un Ateneo sobre Deterioro del Sensorio y Fallo Hemodinámico en un Paciente Anciano, paciente fallecido al que se le practicó necropsia y cuyo diagnóstico presuntivo fue complejo.

The Departments of Internal Medicine and Pathology at the Hospital Interzonal «Dr. José Penna ¼ have been organizing the Case Conferences «Dr. Guillermo Ramón Alvarez¼, every fifteen days since 1995 with the purpose of improving the quality of medical assistance and contributing to the post-graduate education of interns. In this paper, the development of one of these Case Conferences for a complex presumptive diagnosis on Sensorium Deterioration and Hemodynamic Failure in an Aging Patient, who died and to whom a necropsy was performed, was presented.