The aggregate index of systemic inflammation may predict mortality in COVID-19 patients with chronic renal failure.

OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first detected in December 2019 and then spread globally, resulting in a pandemic. Initially, it was unknown if chronic kidney disease (CKD) contributed to the mortality caused by COVID-19. The immunosuppression associated with this disease may minimize the COVID-19-described hyper-inflammatory state or immunological dysfunction, and a high prevalence of comorbidities may lead to a poorer clinical prognosis. Patients with COVID-19 have abnormal circulating blood cells associated with inflammation. Risk stratification, diagnosis, and prognosis primarily rely on hematological features, such as white blood cells and their subpopulations, red cell distribution width, mean platelet volume, and platelet count, in addition to their combined ratios. In non-small-cell lung cancer, the aggregate index of systemic inflammation (AISI), (neutrophils x monocytes x platelets/lymphocytes) is evaluated. In light of the relevance of inflammation in mortality, the objective of this study is to determine the impact of AISI on the hospital mortality of CKD patients. PATIENTS AND METHODS: This study is an observational retrospective study. Data and test outcomes of all CKD patients, stages 3-5, hospitalized for COVID-19 and followed between April and October 2021 were analyzed. RESULTS: Patients were divided into two groups according to death (Group 1-Alive, Group 2-Died). Neutrophil count, AISI and C-reactive protein (CRP) levels were increased in Group-2 [10.3±4.6 vs. 7.65±4.22; p=0.001, 2,084.1 (364.8-2,577.5) vs. 628.9 (53.1-2,275); p=0.00 and 141.9 (20.5-318) vs. 84.75 (0.92-195); p=0.00; respectively]. Receiver operating characteristic (ROC) analysis demonstrated 621.1 as a cut-off value for AISI to predict hospital mortality with 81% sensitivity and 69.1% specificity [area under ROC curve 0.820 (95% CI: 0.733-0.907), p<.005]. Cox regression analysis was used to analyze the effect of risk variables on survival. In survival analysis, AISI and CRP were identified as important survival predictors [hazard ratio (HR): 1.001, 95% CI: 1-1.001; p=0.00 and HR: 1.009, 95% CI: 1.004-1.013; p=0.00]. CONCLUSIONS: This study demonstrated the discriminative effectiveness of AISI in predicting disease mortality in COVID-19 patients with CKD. Quantification of AISI upon admission might assist in the early detection and treatment of individuals with a bad prognosis.

Effect of Situational Factors on the Rate of Perceived Exertion of Liga Femenina 2 Players / Efecto de factores situacionales en la tasa de esfuerzo percibido de jugadoras de Liga Femenina 2

The aim of the study is to understand the impact of certain situational variables (game location, season phase, game outcome, score-line and quality of opposition) on the rate of perceived exertion (RPE) of women players of Liga Femenina 2 in competition. 24 matches played by 12 players of a team from group B of Liga Femenina 2 of the Spanish Basketball Federation during the 2019/2020 season were analysed. The RPE of the players was collected between 20 and 30 minutes after the end of the game. A multiple regression analysis was performed, considering the five situational variables as predictors of RPE. The results show that 44.61% of the RPE values are explained by these situational variables in a statistically significant way. Of the 5 situational variables analysed, the game location and the quality of opposition are dependent on the RPE. Playing away and against a weaker opponent is directly related to a higher RPE of the players in competition.(AU)

Prophylaxis in nonorthopaedic surgery. / Profilaxis en cirugía no ortopédica.

Surgery increases the risk (by 20-fold) of venous thromboembolism (VTE), but there are prophylaxis methods (mechanical, pharmaceutical or combined) that safely reduce the incidence rate of VTE. The administration of prophylaxis requires a prior assessment of the risks associated with the patient and with the type of surgery. The Caprini and Rogers scales classify patients into four VTE risk categories (very low, low, moderate and high). In pharmacological prophylaxis, the risk of bleeding should also be assessed. At this time, the recommendation is to administer prophylaxis to all patients: mechanical prophylaxis for low, moderate or high risk with contraindications for the administration of heparin; combined with heparin for very high risk; and with drugs such as low-molecular-weight heparin, unfractionated heparin and fondaparinux for moderate to high risk. These measurements should be kept until full ambulation, discharge, or at least seven days (for major oncologic and bariatric surgery, maintain for four weeks).

Single-mode Bragg gratings in tapered few-mode and multimode fibers.

We propose the implementation of fiber Bragg gratings in tapered few-mode and multimode fibers to accomplish single-mode operation by reducing the core diameter, while preserving the core-cladding structure. The gratings present a single reflection band, and the device shows low insertion losses after the taper fabrication and the fiber Bragg gratings inscription. The excitation of high-order odd modes in the core of the fiber has been identified as the main loss mechanism; it can be prevented by means of symmetric illumination of the fibers. We also demonstrate the excitation of high-order cladding modes (cladding-air modes) along the taper transitions; these modes can be removed without a significant increment of the insertion loss.

Measurement of UV-induced absorption and scattering losses in photosensitive fibers.

UV-assisted fabrication of gratings using photosensitive fibers is a well-established technique, based on the UV-induced permanent modification of the refractive index of the fiber material. As a result, the absorption coefficient is also changed. Here, we exploit the thermal sensitivity of whispering gallery mode resonances of the fiber itself to measure the profile of the heating along an irradiated fiber versus the input power and for different UV radiation intensities. Our technique allows discriminating between the absorption and scattering contributions to the overall losses, by comparing the results obtained with our technique with direct transmission measurements. Different photosensitive fibers are characterized by means of this technique. Nonuniform UV irradiation of photosensitive fibers can be characterized with this technique.

Early Pregnancy Losses: Review of Nomenclature, Histopathology, and Possible Etiologies.

Miscarriage is a frequent complication of human pregnancy: ∼50% to 70% of spontaneous conceptions are lost prior to the second trimester. Etiology of miscarriage includes genetic abnormalities, infections, immunological and implantation disorders, uterine and endocrine abnormalities, and lifestyle factors. Given such variability, knowledge regarding causes, pathophysiological mechanisms, and morphologies of primary early pregnancy loss has significant gaps; often, pregnancy losses remain unexplained. Pathologic evaluation of miscarriage tissue is an untapped source of knowledge. Although miscarriage specimens comprise a significant part of pathologists' workload, information reported from these specimens is typically of minimal clinical utility for delineating etiology or predicting recurrence risk. Standardized terminology is available, though not universally used. We reintroduce the terminology and review new information about early pregnancy losses and their morphologies. Current clinical terminology is inconsistent, hampering research progress. This review is a resource for diagnostic pathologists studying this complex problem.

Stillbirth, Inflammatory Markers, and Obesity: Results from the Stillbirth Collaborative Research Network.

BACKGROUND: Obesity is associated with increased risk of stillbirth, although the mechanisms are unknown. Obesity is also associated with inflammation. Serum ferritin, C-reactive protein, white blood cell count, and histologic chorioamnionitis are all markers of inflammation. OBJECTIVE: This article determines if inflammatory markers are associated with stillbirth and body mass index (BMI). Additionally, we determined whether inflammatory markers help to explain the known relationship between obesity and stillbirth. STUDY DESIGN: White blood cell count was assessed at admission to labor and delivery, maternal serum for assessment of various biomarkers was collected after study enrollment, and histologic chorioamnionitis was based on placental histology. These markers were compared for stillbirths and live births overall and within categories of BMI using analysis of variance on logarithmic-transformed markers and logistic regression for dichotomous variables. The impact of inflammatory markers on the association of BMI categories with stillbirth status was assessed using crude and adjusted odds ratios (COR and AOR, respectively) from logistic regression models. The interaction of inflammatory markers and BMI categories on stillbirth status was also assessed through logistic regression. Additional logistic regression models were used to determine if the association of maternal serum ferritin with stillbirth is different for preterm versus term births. Analyses were weighted for the overall population from which this sample was derived. RESULTS: A total of 497 women with singleton stillbirths and 1,414 women with live births were studied with prepregnancy BMI (kg/m2) categorized as normal (18.5-24.9), overweight (25.0-29.9), or obese (30.0 + ). Overweight (COR, 1.48; 95% confidence interval [CI]: 1.14-1.94) and obese women (COR, 1.60; 95% CI: 1.23-2.08) were more likely than normal weight women to experience stillbirth. Serum ferritin levels were higher (geometric mean: 37.4 ng/mL vs. 23.3, p < 0.0001) and C-reactive protein levels lower (geometric mean: 2.9 mg/dL vs. 3.3, p = 0.0279), among women with stillbirth compared with live birth. Elevated white blood cell count (15.0 uL × 103 or greater) was associated with stillbirth (21.2% SB vs. 10.0% live birth, p < 0.0001). Histologic chorioamnionitis was more common (33.2% vs. 15.7%, p < 0.0001) among women with stillbirth compared with those with live birth. Serum ferritin, C-reactive protein, and chorioamnionitis had little impact on the ORs associating stillbirth with overweight or obesity. Adjustment for elevated white blood cell count did not meaningfully change the OR for stillbirth in overweight versus normal weight women. However, the stillbirth OR for obese versus normal BMI changed by more than 10% when adjusting for histologic chorioamnionitis (AOR, 1.38; 95% CI: 1.02-1.88), indicating confounding. BMI by inflammatory marker interaction terms were not significant. The association of serum ferritin levels with stillbirth was stronger among preterm births (p = 0.0066). CONCLUSION: Maternal serum ferritin levels, elevated white blood cell count, and histologic chorioamnionitis were positively and C-reactive protein levels negatively associated with stillbirth. Elevated BMIs, both overweight and obese, were associated with stillbirth when compared with women with normal BMI. None of the inflammatory markers fully accounted for the relationship between obesity and stillbirth. The association of maternal serum ferritin with stillbirth was stronger in preterm than term stillbirths.

Aprender medicina de la literatura / Learning medicine from the literature

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Fabrication of long period fiber gratings of subnanometric bandwidth.

This Letter reports on the fabrication of long period fiber gratings having subnanometric bandwidths in the 1500 nm spectral region. Large gratings have been photo inscribed in a high NA fiber; the grating pitch and the order of the HE cladding mode are optimized to produce gratings with a large number of periods and prevent the coupling to TE, TM, or EH modes. Resonances with a FWHM of 0.83 and 0.68 nm have been achieved for gratings 15 and 20 cm long, respectively; the free spectral range between the transmission notches is 125 nm. The polarization effects and the sensitivity of the gratings to temperature and to strain variations are presented as well.

¿Tesis doctoral tradicional o por compendio de publicaciones? / Traditional doctorate thesis or by a compendium of publications?

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Anxiety disorders and risk of stroke: A systematic review and meta-analysis.

BACKGROUND: Anxiety disorders are the most common mental health problem worldwide. However, the evidence on the association between anxiety disorders and risk of stroke is limited. This systematic review and meta-analysis presents a critical appraisal and summary of the available evidence on the association between anxiety disorders and risk of stroke. METHODS: Cohort studies reporting risk of stroke among patients with anxiety disorders were searched in PubMed, Embase, PsycINFO, Scopus, and the Web of Science, from database inception to June 2016. The quality of the studies was assessed using standard criteria. A meta-analysis was undertaken to obtain pooled estimates of the risk of stroke among patients with anxiety disorders. RESULTS: Eight studies, including 950,759 patients, from the 11,764 references initially identified, were included in this review. A significantly increased risk of stroke for patients with anxiety disorders was observed, with an overall hazard ratio: 1.24 (1.09-1.41), P=0.001. No significant heterogeneity between studies was detected and the funnel plot suggested that publication bias was unlikely. Limited evidence suggests that the risk of stroke is increased shortly after the diagnosis of anxiety and that risk of stroke may be higher for patients with severe anxiety. CONCLUSIONS: Anxiety disorders are a very prevalent modifiable condition associated with risk of stroke increased by 24%. This evidence could inform the development of interventions for the management of anxiety and the prevention of stroke. Further studies on the risk of stroke in patients with anxiety, and the explanatory factors for this association, are required.

Measurement of Pockels' coefficients and demonstration of the anisotropy of the elasto-optic effect in optical fibers under axial strain.

The elasto-optic effect in optical fibers under axial strain can be characterized by means of the whispering gallery mode (WGM) resonances of the fiber itself. This technique enables a direct measurement of the anisotropy, the determination of the individual Pockels' coefficients, and the study of the wavelength dependence. The method is based on a rigorous theoretical study of WGM resonances in cylindrical microresonators. The shift of the WGM resonances as a function of strain was measured for the TE and TM modes, showing a strong modal anisotropy. In particular, the shift rate for TE modes was 1.84 times the one for TM modes. From these measurements, experimental values for the Pockels' coefficients were obtained: p11=0.116 and p12=0.255 at 1531 nm, and p11=0.131 and p12=0.267 at 1064 nm. The dispersion of p44 with wavelength was shown to be 5% µm-1.

Risk of incident cardiovascular events amongst individuals with anxiety and depression: A prospective cohort study in the east London primary care database.

BACKGROUND: It is unknown how risk of myocardial infarction and stroke differ for patients with and without anxiety or depression, and whether this risk can be explained by demographics, medication use, cardiovascular risk factors. The aim of this study is to quantify differences in risk of non-fatal MI or stroke among patients with anxiety or depression. METHODS: Prospective cohort study examining risk of incident MI and stroke between March 2005 and March 2015 for 524,952 patients aged 30 and over from the east London primary care database for patients with anxiety or depression. RESULTS: Amongst 21,811 individuals with depression at baseline, 1.2% had MI and 0.4% had stroke. Of 22,128 individuals with anxiety at baseline, 1.1% had MI and 0.3% had stroke. Depression was independently associated with both MI and stroke, whereas anxiety was associated with MI only before adjustment for cardiovascular risk factors. Antidepressant use increased risk for MI but not stroke. Mean age at first MI was lower in those with anxiety, while mean age at first stroke was lower in those with depression. LIMITATIONS: The study was limited to patients currently registered in the database and thus we did not have any patients that died during the course of follow-up. CONCLUSIONS: Patients with depression have increased risk of cardiovascular events. The finding of no increased cardiovascular risk in those with anxiety after adjusting for cardiovascular risk factors is of clinical importance and highlights that the adequate control of traditional risk factors is the cornerstone of cardiovascular disease prevention. Targeting management of classical cardiovascular risk factors and evaluating the risks of antidepressant prescribing should be prioritized.

Cardiovascular risk factors among patients with schizophrenia, bipolar, depressive, anxiety, and personality disorders.

BACKGROUND: The evidence informing the management of cardiovascular risk in patients with psychiatric disorders is weak. METHODS: This cohort study used data from all patients, aged≥30, registered in 140 primary care practices (n=524,952) in London to estimate the risk of developing diabetes, hypertension, hyperlipidemia, tobacco consumption, obesity, and physical inactivity, between 2005 and 2015, for patients with a previous diagnosis of schizophrenia, depression, anxiety, bipolar or personality disorder. The role of antidepressants, antipsychotics and social deprivation in these associations was also investigated. The age at detection of cardiovascular risk factor was compared between patients with and without psychiatric disorders. Variables, for exposures and outcomes, defined from general practitioners records, were analysed using multivariate regression. RESULTS: Patients with psychiatric disorders had an increased risk for cardiovascular risk factors, especially diabetes, with hazard ratios: 2.42 (2.20-2.67) to 1.31 (1.25-1.37), hyperlipidemia, with hazard ratios: 1.78 (1.60-1.97) to 1.25 (1.23-1.28), and obesity. Antidepressants, antipsychotics and social deprivation did not change these associations, except for smoking and physical inactivity. Antidepressants were associated with higher risk of diabetes, hypertension and hyperlipidemia. Antipsychotics were associated with a higher risk of diabetes. Antidepressants and antipsychotics were associated with lower risk of other risk factors. Patients with psychiatric conditions have later detection of cardiovascular risk factors. The interpretation of these results should acknowledge the lower rates of detection of risk factors in mentally ill patients. CONCLUSIONS: Cardiovascular risk factors require special clinical attention among patients with psychiatric disorders. Further research could study the effect of antidepressants and antipsychotics on cardiovascular risk factors.

Measurement of temperature profile induced by the optical signal in fiber Bragg gratings using whispering-gallery modes.

The temperature sensitivity of whispering-gallery mode resonances of an optical fiber is exploited to measure thermal effects induced by an optical signal of moderate power along a fiber Bragg gating (FBG). The UV inscription technique used for the fabrication of FBG introduces a permanent change in the absorption coefficient of the fiber; thus, thermal effects are expected. The resonance wavelength shift of whispering-gallery modes provides information about the temperature change in the fiber, point to point. We present the experimental characterization of the thermal effects in FBG as a function of the wavelength and the power of the launched optical signal through the grating.

Características de la personalidad de jóvenes jugadores de baloncesto (15-under) / Characteristics in the Personality of Young Basketball Players (15 and under)

El objetivo de este trabajo fue estudiar los rasgos de personalidad de los jóvenes jugadores de baloncesto de 13-15 años (n=54) a través de la evaluación de las dimensiones del cuestionario de personalidad BFQ-NA, para niños y adolescentes. Se trata de un estudio no experimental en el que se emplea un diseño transeccional o transversal descriptivo. Los resultados obtenidos permiten afirmar que los jugadores seleccionados para la muestra se caracterizan por ser personas: a) perseverantes, tenaces y exigentes, b)abiertas a la novedad, creativas, espontáneas y cultas, c) con valores normales de sociabilidad, seguridad y entusiasmo, d) amables, honestas, educadas y e) tranquilas, serenas y poco irritables (AU)

The aim of the present work was to assess the personality traits of young basketball players aged 13-15 years (n=54) through the evaluation of the dimensions of personality questionnaire BFQ-NA, for children and adolescents. We used a descriptive transversal design in this study which was non-experimental. The results that were obtained confirm that the players selected for the sample are characterized by being: a) persistent, tenacious and demanding, b) open to novelty, creative, spontaneous and educate, c)with normal values of sociability, confidence and enthusiasm, d)friendly, honest and polite, e) calm, serene and slightly irritable (AU)

Relación entre la ansiedad y la eficacia de un equipo de baloncesto durante la competición / No disponible

El baloncesto, como cualquier deporte, es una actividad multidimensional donde se relacionan las emociones, cogniciones y conductas del deportista. Conocer los motivos de su excelencia ha llevado a los investigadores a analizar el efecto de emociones sobre el rendimiento deportivo (Arent y Landers, 2003). Según Spielberger (1966) los deportistas con un alto grado de ansiedad rasgo tendrán, a su vez, un mayor nivel de ansiedad estado y en consecuencia, mayor riesgo de rendir por debajo de su potencial en la competición.El objetivo de este estudio fue analizar si existía alguna relación entre la ansiedad un grupo de jugadores y su rendimiento durante la competición, además de evaluar si los valores de ansiedad de los jugadores variaban según el nivel del equipo rival (AU)

¿Antibióticos en la infección respiratoria baja? Consideraciones desde su etiología,incertidumbre diagnóstica, efectos terapéuticosy adversos del antibiótico y expectativas del paciente / No disponible

En Atención Primaria vemos muchos pacientes con infección respiratoria baja (IRB), la mayoría víricas, aunque un porcentaje incierto de ellas son bacterianas. El diagnóstico diferencial IRB/neumonía es difícil. La medida de la proteína C reactiva (PCR) y pro calcitonina pueden servir para este diagnóstico diferencial, pero estas técnicas requieren más estudios. La placa de tórax es lo más útil, pero la enorme prevalencia de la IRB limita su uso. El diagnóstico y tratamiento de la IRB se hace en base a hallazgos clínicos. Los antibióticos no son eficaces en la IRB, además de tener su tasa de efectos secundarios. Además el uso de antibióticos se asocia al riesgo de padecer infecciones por bacterias resistentes. La prescripción racional de antibióticos disminuye la prevalencia de dichas infecciones. Una explicación apropiada, la prescripción retardada, y la educación para la salud, son clave cuando no se pautan antibióticos a un paciente con IRB que esperaba recibirlos (AU)

Attention is given in Primary Care to many patients with Lower Respiratory Tract Infection (LRTI), most of these infections being viral, although some unknown percentage is bacterial. It is difficult to make a differential LRTI/pneumonia diagnosis. Measuring the C-reactive protein and pro calcitonin may aid in this differential diagnosis, but these techniques require further study. The chest X-ray is the most useful tool in this situation; however, the high prevalence of LRTI limits its use. The diagnosis and treatment of LRTI is based on clinical findings. Antibiotics are not effective in LRTI and also have a rate of side effects. In addition, the use of antibiotics is associated to the risk of suffering resistant bacterial infections. A rational use of antibiotics can decrease the prevalence of resistant bacterial infections. Giving a proper explanation to the patient and delaying the antibiotic prescription and providing health education are key aspects when not prescribing antibiotics to a patient who is expecting them (AU)