Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort.

OBJECTIVE: Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19. METHODS: This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments. RESULTS: One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant. CONCLUSIONS: Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.

Outcomes of nonsevere relapses in antineutrophil cytoplasmic antibody-associated vasculitis treated with glucocorticoids.

OBJECTIVE: Nonsevere relapses are more common than severe relapses in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but their clinical course and treatment outcomes remain largely unexamined. We undertook this study to analyze the outcomes of patients with nonsevere relapses in the Rituximab in ANCA-Associated Vasculitis (RAVE) trial who were treated with prednisone according to a prespecified protocol. METHODS: RAVE was a randomized, double-blind, placebo-controlled trial comparing rituximab (RTX) to cyclophosphamide (CYC) followed by azathioprine (AZA) for induction of remission. Patients who experienced nonsevere relapses between months 1 and 18 were treated with a prednisone increase without a concomitant change in their nonglucocorticoid immunosuppressants, followed by a taper. RESULTS: Forty-four patients with a first nonsevere relapse were analyzed. In comparison to the 71 patients who maintained relapse-free remission over 18 months, these patients were more likely to have proteinase 3-ANCAs, diagnoses of granulomatosis with polyangiitis (Wegener's), and a history of relapsing disease at baseline. A prednisone increase led to remission in 35 patients (80%). However, only 13 patients (30%) were able to maintain second remissions through the followup period (mean 12.5 months); 31 patients (70%) had a second disease relapse, 14 of them with severe disease. The mean time to second relapse was 9.4 months (4.7 months in the group treated with RTX versus 13.7 months in the group treated with CYC/AZA; P < 0.01). Patients who experienced nonsevere relapses received more glucocorticoids than those who maintained remission (6.7 grams versus 3.8 grams; P < 0.01). CONCLUSION: Treatment of nonsevere relapses in AAV with an increase in glucocorticoids is effective in restoring temporary remission in the majority of patients, but recurrent relapses within a relatively short interval remain common. Alternative treatment approaches are needed for this important subset of patients.

Duration of day care attendance during infancy predicts asthma at the age of seven: the Cincinnati Childhood Allergy and Air Pollution Study.

BACKGROUND: Studies vary with respect to the reported effects of day care attendance on childhood asthma. OBJECTIVES: To evaluate the independent and combined effects of day care attendance and respiratory infections on the development of asthma at the age of seven in a prospective birth cohort. METHOD: At the age of seven, the study sample included 589 children with complete data of 762 enrolled at birth. Day care hours and number of respiratory infections were reported in follow-up questionnaires through age four. At 7 years of age, asthma was diagnosed in 95 children (16%), based on predefined symptoms criteria confirmed by either asthma FEV1 reversibility after bronchodilator or a positive methacholine test (PC20 ≤ 4 mg/mL). Logistic regression was used to investigate the relationships between asthma at the age of seven, cumulative hours of day care attendance and reported respiratory infections at ages 1-4. RESULTS: In the univariate analyses, day care attendance at 12 months was associated with an increased risk of asthma [odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.1-3.0]. Both upper and lower respiratory infections at 12 months also increased the likelihood of asthma [OR = 2.4 (1.4-4.1); OR = 2.3 (1.5-3.7), respectively]. In the final multivariate logistic model, cumulative hours of day care attendance and number of lower respiratory infections at 12 months were associated with asthma [OR = 1.2 (1.1-1.5); OR = 1.4 (1.2-1.7), respectively]. However, a threshold of greater than 37.5 hours per week of day care attendance was associated with a lower risk of asthma [OR = 0.6 (0.4-0.9)]. CONCLUSION: Depending on duration of attendance, day care during infancy can either increase or reduce risk of asthma at the age of seven.

Cross-cultural confirmatory factor analysis of the CES-D in Spanish and Mexican dementia caregivers.

The Center for Epidemiologic Studies-Depression Scale (CES-D) is the most frequently used scale for measuring depressive symptomatology in caregiving research. The aim of this study is to test its construct structure and measurement equivalence between caregivers from two Spanish-speaking countries. Face-to-face interviews were carried out with 595 female dementia caregivers from Madrid, Spain, and from Coahuila, Mexico. The structure of the CES-D was analyzed using exploratory and confirmatory factor analysis (EFA and CFA, respectively). Measurement invariance across samples was analyzed comparing a baseline model with a more restrictive model. Significant differences between means were found for 7 items. The results of the EFA clearly supported a four-factor solution. The CFA for the whole sample with the four factors revealed high and statistically significant loading coefficients for all items (except item number 4). When equality constraints were imposed to test for the invariance between countries, the change in chi-square was significant, indicating that complete invariance could not be assumed. Significant between-countries differences were found for three of the four latent factor mean scores. Although the results provide general support for the original four-factor structure, caution should be exercised on reporting comparisons of depression scores between Spanish-speaking countries.

Cross-cultural confirmatory factor analysis of the CES-D in Spanish and Mexican dementia caregivers

The Center for Epidemiologic Studies-Depression Scale (CES-D) is the most frequently used scale for measuring depressive symptomatology in caregiving research. The aim of this study is to test its construct structure and measurement equivalence between caregivers from two Spanish-speaking countries. Face-to-face interviews were carried out with 595 female dementia caregivers from Madrid, Spain, and from Coahuila, Mexico. The structure of the CES-D was analyzed using exploratory and confirmatory factor analysis (EFA and CFA, respectively). Measurement invariance across samples was analyzed comparing a baseline model with a more restrictive model. Significant differences between means were found for 7 items. The results of the EFA clearly supported a four-factor solution. The CFA for the whole sample with the four factors revealed high and statistically significant loading coefficients for all items (except item number 4). When equality constraints were imposed to test for the invariance between countries, the change in chi-square was significant, indicating that complete invariance could not be assumed. Significant between-countries differences were found for three of the four latent factor mean scores. Although the results provide general support for the original four-factor structure, caution should be exercised on reporting comparisons of depression scores between Spanish-speaking countries (AU)

La Escala del Centro para Estudios Epidemiológicos (CES-D) es la más utilizada para medir sintomatología depresiva en la investigación sobre cuidadores. El objetivo de este estudio es analizar su estructura dimensional y su equivalencia de medida entre cuidadores de dos países de habla hispana. Se entrevistó a 595 mujeres cuidadoras de familiares con demencia de Madrid, España, y Coahuila, México. La estructura del CES-D se analizó mediante análisis factoriales exploratorios (AFE) y confirmatorios (AFC). Se encontraron diferencias estadísticamente significativas entre las medias de 7 ítems. Los resultados del AFE con la muestra total respaldan claramente una solución de 4 factores. El AFC de la estructura de 4 factores revela cargas elevadas y significativas para todos los ítems (excepto el 4). Al imponer restricciones de igualdad para valorar la equivalencia entre países, el cambio en chi-cuadrado fue significativo, indicando que no se puede asumir una equivalencia completa. Se encontraron diferencias significativas entre países para tres de las cuatro puntuaciones medias en los factores latentes. Aunque los resultados proporcionan un apoyo general a la estructura original de cuatro factores, se debería tener una cierta cautela a la hora de informar sobre comparaciones en puntuaciones en depresión entre países de habla hispana (AU)

Effect of ruminally protected Methionine on the productive and reproductive performance of grazing Bos indicus heifers raised in the humid tropics of Costa Rica.

With the objective of evaluating the effect of methionine supplementation prior to a breeding program, thirty one heifers (Bos taurus x Bos indicus) were used averaging 386 +/- 29 days of age and a mean body weight of 402.6 +/- 28 kg. Fifteen of the animals received a supplement (SG) during 45 days with molasses-urea mixture (2 kg molasses + 407 g urea/head/day), plus 10 g of ruminally protected methionine. The other sixteen heifers did not receive supplement (CG). Fecal and pastures samples were collected to assess dry herbage intake and digestibility. Serial ultrasound measurements from the ovary were performed in both groups to evaluate follicular dynamics. The heifers were categorized according to their follicular size and presence of a CL. Forage intake and dry matter digestibility were reduced (P < 0.05) and body condition tended to improve (P = 0.07) in the supplemented heifers, however, total intake, final weight, daily gain and dorsal back fat were not affected. After the supplementation period, the percentage of females in the categories < 3 mm and 3 to < 6 mm, was greater (P < 0.05) in CG (25% and 43.7%) that in SG (0% and 26.6%) but in the follicle category of > or = 9 mm, the percentage of animals was 60% in SG and 18.8% in CG (P < 0.05). The percentage of ovulation for the SG and CG was 86.7% and 62.5%, respectively (P < 0.05). The combination of supplementation with methionine-urea and molasses at the end of the dry season and the anticipated onset of the rainy season favored the establishment of ovarian activity and follicular dynamics.

House dust (1-3)-beta-D-glucan and wheezing in infants.

BACKGROUND: (1-3)-Beta-D-glucan is a fungal cell wall component, suspected to cause respiratory symptoms in adults. However, very little is known on the possible health effects of (1-3)-beta-D-glucan during infancy. We examined the association between (1-3)-beta-D-glucan exposure and the prevalence of allergen sensitization and wheezing during the first year of life in a birth cohort of 574 infants born to atopic parents. Endotoxin exposure was included as a possible confounder. METHODS: (1-3)-Beta-D-glucan and endotoxin exposures were measured in settled dust collected from infants' primary activity rooms. The primary outcomes at approximately age one included parental reports of recurrent wheezing and allergen sensitization evaluated by skin prick testing to a panel of 15 aeroallergens as well as milk and egg white. RESULTS: Exposure to high (1-3)-beta-D-glucan concentration (within fourth quartile) was associated with reduced likelihood of both recurrent wheezing [adjusted OR (aOR) = 0.39, 95% CI = 0.16-0.93] and recurrent wheezing combined with allergen sensitization (aOR = 0.13, 95% CI = 0.03-0.61). Similar trends were found between (1-3)-beta-D-glucan concentrations and allergen sensitization (aOR = 0.57, 95% CI = 0.30-1.10). In contrast, recurrent wheezing with or without allergen sensitization was positively associated with low (1-3)-beta-D-glucan exposure within the first quartile (aOR = 3.04, 95% CI = 1.25-7.38; aOR = 4.89, 95% CI = 1.02-23.57). There were no significant associations between endotoxin exposure and the studied health outcomes. CONCLUSIONS: This is the first study to report that indoor exposure to high levels of (1-3)-beta-D-glucan (concentration >60 microg/g) is associated with decreased risk for recurrent wheezing among infants born to atopic parents. This effect was more pronounced in the subgroup of allergen-sensitized infants.

Investigación y práctica en colaboración: la red de ensayos clínicos del NIDA / Research and practice together: the NIDA clinical trials network

La Red Nacional de Ensayos Clínicos para el Tratamiento del Abuso de Drogas (CTN), fundado por el Instituto Nacional del Abuso de Drogas (NIDA) de Estados Unidos, es una colaboración de alcance nacional Tratamientos que se encontraron efectivos en investigaciones previas están siendo evaluadas en ensayos clínicos multicéntricos. Estos estudios se llevan a cabo en los propios programas de tratamiento (con su propio personal y pacientes) para el abuso de sustancias, con el fin de determinar su buen funcionamiento en el contexto de la práctica comunitaria. En cinco años de funcionamiento, el CTN ha promovido 21 estudios multicéntricos, que abarcan casi siete mil pacientes en ensayos clínicos aleatorios. Resultados preliminares están en proceso de publicación. Este artículo describe el funcionamiento del CTN y sus 21 protocolos actuales, así como, cinco protocolos más previstos para su implementación el año 2006. Es una colaboración sin precedentes de investigadores y médicos comunitarios, destinada a comprobar los tratamientos basados en evidencia empírica en los programas de la vida real. Así como también facilitar la puesta en práctica y la diseminación de éstos tratamientos

The National Drug Abuse Treatment Clinical Trials Network (CTN), funded by the U.S. National Institute on Drug Abuse, is a nationwide collaboration of 17 addiction research centers and 152 community treatment programs. Treatments found to be effective in prior research are tested in multisite clinical trials, with the regular staff and patients of ongoing addiction treatment programs, to determine how well they work when delivered in the context of community practice. In five years of operation, the CTN has launched 21 multisite studies, enrolling nearly 7,000 patients in randomized clinical trials, and the first findings are beginning to be published. This article describes the CTN and its 21 current protocols, plus five more planned for implementation in 2006. It is a unique collaboration of research scientist and community practitioners, designed to test evidence-based treatments in real-life programs, and then facilitate their broader dissemination into practice

Survey of the extent and nature of care for adults and older adults by allergy/immunology practitioners.

BACKGROUND: The proportion of older adults in the US population will increase dramatically in the near future, yet the frequency and nature of care furnished to older adults by Allergy/Immunology practitioners has not been described. OBJECTIVE: To determine the extent and nature of care being provided to adults and older adults by Allergy/Immunology practitioners. METHODS: ACAAI members and fellows were surveyed to obtain information regarding certification and training as well as their practice patterns. RESULTS: The distribution of diagnoses among patients aged 40 to 54 years were very similar to distributions found among adults age 55 to 69 years and > or = 70 years of age. Virtually all respondents indicated they provide inhalant allergen immunotherapy for patients age 40 to 54 years with asthma and/or allergic rhinitis; administration of inhalant allergen immunotherapy for asthma and allergic rhinitis was also frequently reported for adults > or = 55 years. The proportions of respondents providing venom immunotherapy for adults aged 40 to 54, 55 to 69, and > or = 70 years were 82%, 70%, and 39%, respectively. CONCLUSION: ACAAI members and fellows commonly provide care to older adults. Our survey findings highlight the need to develop strategies for successful management of Allergy/Immunology conditions specifically pertaining to older adults, including studies to determine the therapeutic utility of inhalant allergen and venom immunotherapy in this age group.

[Parotid metastasis of liposarcoma of the lower limbs]. / Metástasis a parótida de liposarcoma de miembro inferior.

Distant metastasis affecting the parotid gland are a rare entity, with origin in most cases from cutaneous tumors of the head and neck, mainly melanoma and epidermoid carcinoma. Other histological types of metastasis and tumors originated from distant organs or sites are very rare and may be a diagnostic and therapeutic challenge, for this reason, we consider it interesting for discussion. In this paper, we present the case of a patient with a metastatic tumor of the parotid gland secondary to a liposarcoma of the leg, extremely rare case, about which we have no found previous references in the literature.

Visual orienting and alerting in rhesus monkeys: comparison with humans.

The behavioral capacities of the rhesus monkey for several sensory and cognitive tasks appear quite similar to those of humans. To evaluate the monkey's attentional capacities, we have compared monkey and human performance on a visuospatial attentional task, the cued target detection (CTD) paradigm. Animals were trained to fixate a small spot of light while a cue and a subsequent target, are flashed in the visual periphery. In valid trials, the cue and target appeared in the same spatial location; in invalid trials, the cue and target appeared in the opposite location; in double trials, two cues were presented and the target appeared in one of their locations; in no-cue trials, the cue was omitted and the target appeared in one location. In addition, we varied cognitive control over the task initiation by making the trial onset either self-paced or computer-paced. Reaction times (RTs) to target presentation, response accuracy, and frequency of aborted trials were measured for all subjects. No significant species differences were found for the patterns of RTs for different trial types or for attentional dynamics, as indexed by the decreases in RT with increasing cue-target interval. However, humans and non-human primates reacted differently to changes in cognitive control. Humans shows significant increases in no-cue trial RTs in the auto-paced task compared to the self-paced, but no differences in overall RT between tasks; monkeys showed a significant faster overall RT for the self-paced than the computer-paced task, but no difference between no-cue RTs. The performance differences between species may be related to the training history of the animals or to known anatomical differences in cortical organization, especially in the parietal lobe.

Osteoporosis in steroid-dependent asthma.

BACKGROUND: Patients on prolonged corticosteroid therapy are at risk of developing osteoporosis. Some patients with severe asthma are difficult to wean off corticosteroids and are therefore at risk of developing bony complications due to steroids. OBJECTIVE: The purpose of this study was to examine the relationship of cumulative steroid dosage and duration of therapy with osteoporosis. METHODS: We obtained bone mineral density studies using dual photon absorptiometry, and radiographs of the lumbar spine of 16 steroid-dependent patients with asthma. Patients with conditions affecting bone metabolism were excluded. RESULTS: We studied 16 male steroid-dependent patients with asthma who received 4 to 41 grams equivalent dose of prednisone over a period of 1 to 15 years. The overall prevalence rate for abnormal age-matched bone mineral density was 50%. Abnormal bone mineral density was more commonly noted in the lumbar spine (38%) than in the femoral neck (19%). The lowest dose of corticosteroid associated with a decrease in bone mineral density was a cumulative steroid dose of 5.6 equivalent grams-prednisone. CONCLUSION: Prolonged corticosteroid therapy can cause significant osteoporosis among male patients with steroid-dependent asthma. Bone loss due to corticosteroid therapy occurs at different rates at different bony sites.

Isolation and characterization of cytotoxic and antibacterial tetrasaccharide glycosides from Ipomoea stans.

Three new tetrasaccharide glycosides, differing from one reported previously in the type of short-chain fatty acids ester-linked to the tetrasaccharide core, have been isolated and identified from an oligosaccharide fraction of Ipomea stans. Preliminary screening tests showed that the fraction containing these compounds had pronounced cytotoxicity towards three human tumor cell lines as well as specific antibiotic activity against two bacterial strains.

Rural campaign to diagnose and treat mucocutaneous leishmaniasis in Bolivia.

Mucocutaneous leishmaniasis (MCL) is endemic in the tropical Amazonian lowlands of Bolivia, an area that regularly receives influxes of migratory populations. In these new agricultural development areas, a campaign to diagnose and treat the disease was carried out between 1989 and 1992, in order to provide direct access to MCL treatment in the endemic areas at a standard equivalent to that offered in the urban centres in Bolivia. The campaign led to the creation of decentralized local centres for diagnosis and treatment of the disease. A campaign to inform the population about leishmaniasis was also undertaken and courses were run to educate medical and paramedical personnel. As a result of the campaign, 3285 cases of leishmaniasis were diagnosed, including 2152 cutaneous and 326 mucosal forms. Also, a total of 1888 cases were treated, 1677 of which cutaneous and 211, mucosal.