External Validation of SAFE Score to Predict Atrial Fibrillation Diagnosis after Ischemic Stroke: A Retrospective Multicenter Study.

Introduction: The screening for atrial fibrillation (AF) scale (SAFE score) was recently developed to provide a prediction of the diagnosis of AF after an ischemic stroke. It includes 7 items: age ≥ 65 years, bronchopathy, thyroid disease, cortical location of stroke, intracranial large vessel occlusion, NT-ProBNP ≥250 pg/mL, and left atrial enlargement. In the internal validation, a good performance was obtained, with an AUC = 0.88 (95% CI 0.84-0.91) and sensitivity and specificity of 83% and 80%, respectively, for scores ≥ 5. The aim of this study is the external validation of the SAFE score in a multicenter cohort. Methods: A retrospective multicenter study, including consecutive patients with ischemic stroke or transient ischemic attack between 2020 and 2022 with at least 24 hours of cardiac monitoring. Patients with previous AF or AF diagnosed on admission ECG were excluded. Results: Overall, 395 patients were recruited for analysis. The SAFE score obtained an AUC = 0.822 (95% CI 0.778-0.866) with a sensitivity of 87.2%, a specificity of 65.4%, a positive predictive value of 44.1%, and a negative predictive value of 94.3% for a SAFE score ≥ 5, with no significant gender differences. Calibration analysis in the external cohort showed an absence of significant differences between the observed values and those predicted by the model (Hosmer-Lemeshow's test 0.089). Conclusions: The SAFE score showed adequate discriminative ability and calibration, so its external validation is justified. Further validations in other external cohorts or specific subpopulations of stroke patients might be required.

[High frequency of endoluminal thrombus in patients with ischaemic stroke following COVID-19]. / Alta Frecuencia de Trombo Endoluminal en pacientes con ictus isquémico tras la infección por Coronavirus 2019.

BACKGROUND: Ischaemic stroke may be a major complication of SARS-CoV-2 infection.Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS: Data were collected retrospectively on consecutive patients with COVID-19 who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS: During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack).Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%).We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS: In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.

Validación del termómetro como factor determinante de la eficacia en la toma de temperatura por infección de COVID-19 / Validation of the thermometer as a determining factor in the effectiveness of temperature measuring in covid-19 infection

FUNDAMENTOS: La pandemia por COVID-19 ha alcanzado más de cinco millones de contagios y trescientos mil fallecidos en el mundo. Todos ellos precisan la evaluación de factores pronósticos; además de la edad avanzada, las comorbilidades o la respuesta inflamatoria, es también evidente la necesidad de evaluar la temperatura corporal para determinar el contagio, la exposición, especialmente en personas con diferentes factores de riesgo, y distintos patrones evolutivos para conocer su influencia sobre los desenlaces clínicos. MÉTODOS: Se realizó un estudio transversal de tomas de temperatura a 42 sujetos voluntarios, para valorar la fiabilidad en términos de concordancia entre dos termómetros utilizados en las tomas de temperatura corporal; se compararon las mediciones de 2 termómetros en las zonas frontal y oído en 2 salas (mayor y menor iluminación). Se compararon los intervalos de confianza y se calculó el coeficiente de Correlación Intraclase (CCI) para obtener las diferencias estadísticas, proporcionando unos límites de concordancia a partir del cálculo del intervalo de confianza para la diferencia de dos mediciones. RESULTADOS: Con un intervalo de confianza del 95 %, una p < 0,5 y en las condiciones medidas, y sobre la muestra de sujetos, observamos que la correlación de las mediciones no tiene diferencia estadística significativa, pero sí en los diferentes ambientes con mayor iluminación. CONCLUSIONES: La media de temperatura corporal (frontal) medida con el termómetro láser es mayor que la temperatura (frontal) medida con el termómetro Testo. Existe diferencia significativa en las mediciones realizadas en las 2 salas, siendo mayores en la sala con menor iluminación. Hay correlación en las mediciones de temperatura del mismo instrumento en la zona frontal y en oído. Los termómetros láser son más efectivos para detectar las variaciones en la temperatura corporal, y más asertivos para identificar uno de los síntomas más asociados a la infección por SARS-CoV-2

BACKGROUND: The COVID-19 pandemic has reached more than five million infections and three hundred thousand deaths worldwide, all of which require the assessment of prognostic factors; in addition to advanced age, comorbidities or the inflammatory response, is also evident the need to assess body temperature to determine contagion, exposure, especially in people with different risk factors, and different evolutionary patterns to know its influence on clinical outcomes. METHODS: A cross-sectional study of temperature measurements was performed on 42 volunteer subjects, to assess the reliability in terms of agreement between two thermometers used in body temperature measurements; the measurements of 2 thermometers in the frontal and ear areas were compared in 2 rooms (higher and lower lighting). Confidence intervals were compared and the Intraclass Correlation Coefficient (ICC) was calculated to obtain the statistical differences, providing limits of agreement from the calculation of the confidence interval for the difference of two measurements. RESULTS: With a 95 % confidence interval, a p <0.5 and under the measured conditions, and on our sample of subjects, we observe that the correlation of the measurements does not have significant statistical difference, but indeed in different environments with greater lighting. CONCLUSIONS: The average body temperature (front) measured with the laser thermometer is greater than the temperature (front) measured with the Testo thermometer. There is a significant difference in the measurements made in the 2 rooms, being greater in the room with less lighting. There is correlation in the temperature measurements of the same instrument in the frontal zone and in the ear. Laser thermometers are more effective in detecting variations in body temperature, and more assertive in identifying one of the symptoms most associated with SARS-CoV-2 infection

Cardiovascular-renal axis disorder and acute-phase proteins in cats with congestive heart failure caused by primary cardiomyopathy.

BACKGROUND: Currently, the pathogenesis of congestive heart failure (CHF) in cats is not fully understood. OBJECTIVE: To identify novel biomarkers for CHF in cats caused by primary cardiomyopathy, particularly related to cardiovascular-renal axis disorder and systemic inflammatory response. ANIMALS: Twenty-five cats in CHF caused by primary cardiomyopathy, 12 cats with preclinical cardiomyopathy, and 20 healthy controls. METHODS: Case control and observational case series. The following serum biomarkers were compared among the 3 cat groups: a cardiorenal profile that included N-terminal pro-brain natriuretic peptide (NT-proBNP), symmetric dimethylarginine (SDMA), and creatinine and an inflammatory profile that included 7 acute-phase proteins (APPs). Survival analyses and longitudinal studies were performed in CHF cats. RESULTS: All cardiorenal biomarkers were positively correlated and higher in CHF cats, and high NT-proBNP and SDMA were associated with poor clinical outcome. Cats with CHF had significantly higher leucine-rich alpha-2-glycoprotein 1, serum amyloid A, and ceruloplasmin, and these APPs were positively correlated with NT-proBNP and left atrial size. In a multivariable survival analysis, alpha-1-acid glycoprotein concentration (P = .01), body weight (P = .02) and left atrial-to-aortic root ratio (P = .01) were independent prognostic factors for CHF in these cats. CONCLUSIONS AND CLINICAL IMPORTANCE: In cats, CHF is an inflammatory disorder and outcome in CHF may be determined by the extent of inflammation and possibly the amount of residual renal function. These novel biomarkers have potential use for the clinical management, prognosis, and future research into CHF and cardiomyopathy in cats.

Better understanding of the activated sludge process combining fluorescence-based methods and flow cytometry: A case study.

This study aims to demonstrate the validity of fluorescence-based methods, together with flow cytometry, as a complementary tool to conventional physicochemical analyses carried out in wastewater treatment plants (WWTPs), for the control of the currently largely unknown activated sludge process. Staining with SYTO 9, propidium iodide and 5-(and 6)-carboxy-2',7'-difluorodihydrofluorescein diacetate (carboxy-H2DFFDA) was used for cell viability and oxidative stress monitoring of the bacterial population forming the activated sludge of a WWTP. Throughout the period of research, several unstable periods were detected, where the non-viable bacteria exceeded the 75% of the total bacterial population in the activated sludge, but only in one case the cells with oxidative stress grew to 9%, exceeding the typical values of 2%-5% of this plant. These periods coincided in two cases with high values of total suspended solids (SST) and chemical oxygen demand (COD) in the effluent, and with an excess of ammonia in other case. A correlation between flow cytometric and physicochemical data was found, which enabled to clarify the possible origin of each case of instability in the biological system. This experience supports the application of bacterial fluorescence staining, together with flow cytometric analysis, as a simple, rapid and reliable tool for the control and better understanding of the bacteria dynamics in a biological wastewater treatment process.

Ankle sprain as a work-related accident: status of proprioception after 2 weeks.

PURPOSE: This study aims at verifying whether proprioception is abnormal or not, two weeks after a grade 1 and 2 ankle sprain in the scope of work-related accident. METHODS: A descriptive, observation and transversal study was designed to compare speed, movement and oscilation of centre of pressure in employees of companies signed up to a mutual company. Participants' healthy feet comprised the control group, and feet that had undergone an ankle sprain due to a work-related accident comprised the cases group. The following stability tests were undertaken to both the healthy and injuried feet using a force plate: Monopodal Romberg test with eyes open, Monopodal Romberg test with eyes open on a 30 mm thick foam rubber, Monopodal Romberg test with eyes closed, and Romberg test as monopodal support with eyes closed on a 30 mm thick foam rubber. A multiple logistic regression analysis was performed. From the results of this regression model the COR curve test was performed. RESULTS: 71.7% accuracy in the predictions was attained. The equation was as follows: Condition (injured or healthy) = 0.052⋅% RGC AP Movement - 0.81⋅MREO AP Movement. The variable MREO antero-posterior movement was used in the COR curve methodology. The area under the curve was greater than 0.65 and at a 95% confidence interval the 0.75 value was included, which in our case was the injured subject condition. Values for sensitivity, specificity, positive predictive value and negative predictive value were 0.667, 0.633, 64.5%, and 65.5%, respectively. CONCLUSION: The participants in this study showed a diminished capacity for postural control in an ankle two weeks after an ankle sprain.