Efficacy and safety of antiviral plus anti-spike monoclonal antibody combination therapy vs. monotherapy for high-risk immunocompromised patients with mild-to-moderate SARS-CoV2 infection during the Omicron era: A prospective cohort study.

INTRODUCTION: Antivirals and monoclonal antibodies lower the risk of progression in immunocompromised patients. However, combination therapy with both types of agents has not been studied. PATIENTS AND METHODS: This was a single-centre, prospective, cohort study. All immunocompromised patients who received treatment for mild-to-moderate COVID-19 from 1 January 2022 to 30 October 2022 were enrolled. The primary endpoint was COVID-19 progression at 90 days, defined as hospital admission or death due to COVID-19 and/or seronegative persistent COVID-19. RESULTS: A total of 304 patients were included: 43 patients (14.1%) received sotrovimab plus a direct-acting antiviral, and 261 (85.9%) received monotherapy. Primary outcome occurred more frequently after monotherapy (4.6% vs. 0%, P=0.154). Among patients with anti-spike immunoglobulin G (anti-S IgG) titre <750 BAU/mL, COVID-19 progression was more common after monotherapy (23.9% vs. 0%, P=0.001), including more frequent COVID-related admission (15.2% vs. 0%, P=0.014) and seronegative persistent COVID-19 (10.9% vs. 0%, P=0.044). Combination therapy was associated with lower risk of progression (odds ratio [OR] 0.08, 95% confidence interval [95% CI] 0.01-0.64). Anti-S IgG titre <750 BAU/mL and previous anti-CD20 were associated with higher risk of progression (OR 13.70, 95% CI 2.77-67.68; and OR 3.05, 95% CI 1.20-10.94, respectively). CONCLUSIONS: In immunocompromised patients, combination therapy with sotrovimab plus an antiviral may be more effective than monotherapy for SARS-CoV2.

Analysis of Bacterial Communities around the Adventdalen Landfill Site in Svalbard.

Ecosystems are often resilient enough to fully recover following a natural disturbance, or to transform into a new equilibrium favourable to the surrounding flora and fauna. However, at a local level, whether this transformation will be beneficial or not depends strongly on the level of disturbance and the available mechanisms for recovery. The Arctic, however, provides a potentially extreme environment for microbial growth and this is reflected in the microbial biodiversity, the in-situ growth rates, the biogeochemical cycling and its sensitivity to environmental change. In this study, we evaluated the current microbial biodiversity and environmental conditions around the landfill site in Adventdalen, Svalbard to identify differences across bacterial communities that might promote or accelerate naturally occurring environmental recovery. Landfill sites can induce changes in the local environment through the input of exogenous chemicals (both organic and inorganic) and microorganisms. Leachate can flow with run-off from the primary location of the landfill site due to rain, snow or ice melt and spread material into soils surrounding the site. In this study we found a strong effect of the landfill site on the bacterial diversity in the local landscape. Intervention is highly desirable to enhance the environment and improve the restoration by subtly altering the conditions at the site (such as the pH or drainage courses) and by encouraging specific groups of naturally occurring indigenous microorganisms to bioremediate the site.

Aerobiology over the Southern Ocean - Implications for bacterial colonization of Antarctica.

Parts of the Antarctic are experiencing dramatic ecosystem change due to rapid and record warming, which may weaken biogeographic boundaries and modify dispersal barriers, increasing the risk of biological invasions. In this study, we collected air samples from 100 locations around the Southern Ocean to analyze bacterial biodiversity in the circumpolar air around the Antarctic continent, as understanding dispersal processes is paramount to assessing the risks of microbiological invasions. We also compared the Southern Ocean air bacterial biodiversity to non-polar ecosystems to identify the potential origin of these Southern Ocean air microorganisms. The bacterial diversity in the air had both local and global origins and presented low richness overall but high heterogeneity, compatible with a scenario whereby samples are composed of a suite of different species in very low relative abundances. Only 4% of Amplicon Sequence Variants (ASVs) were identified in both polar and non-polar air masses, suggesting that the polar air mass over the Southern Ocean can act as a selective dispersal filter. Furthermore, both microbial diversity and community structure both varied significantly with meteorological data, suggesting that regional bacterial biodiversity could be sensitive to changes in weather conditions, potentially altering the existing pattern of microbial deposition in the Antarctic.

Role of Early Assesment of Diuresis and Natriuresis in Detecting In-Hospital Diuretic Resistance in Acute Heart Failure.

Background and Purpose: European Guidelines recommend early evaluation of diuresis and natriuresis after the first administration of diuretic to identify patients with insufficient diuretic response during acute heart failure. The aim of this work is to evaluate the prevalence and characteristics of patients with insufficient diuretic response according to this new algorithm. Methods: Prospective observational single centre study of consecutive patients with acute heart failure and congestive signs. Clinical evaluation, echocardiography and blood tests were performed. Diuretic naïve patients received 40 mg of intravenous furosemide. Patients on an oupatient diuretic regimen received 2 times the ambulatory dose. The diuresis volume was assessed 6 h after the first loop diuretic administration, and a spot urinary sample was taken after 2 h. Insufficient diuretic response was defined as natriuresis <70 mEq/L or diuresis volume <600 ml. Results: From January 2020 to December 2021, 73 patients were included (59% males, median age 76 years). Of these, 21 patients (28.8%, 95%CI 18.4; 39.2) had an insufficient diuretic response. Diuresis volume was <600 ml in 13 patients (18.1%), and 12 patients (16.4%) had urinary sodium <70 mEq/L. These patients had lower systolic blood pressure, worse glomerular filtration rate, and higher aldosterone levels. Ambulatory furosemide dose was also higher. These patients required more frequently thiazides and inotropes during admission. Conclusion: The diagnostic algorithm based on diuresis and natriuresis was able to detect up to 29% of patients with insufficient diuretic response, who showed some characteristics of more advanced disease.

Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study. / Factores asociados a la mortalidad intrahospitalaria y reingreso en una cohorte tratada con ventilación no invasiva en urgencias extrahospitalarias y hospitalarias: estudio VentilaMadrid.

OBJECTIVES: To describe clinical, outcome, and risk factors in a cohort of patients treated with noninvasive ventilation (NIV) in a hospital emergency department (ED) or by out-of-hospital emergency medical services (OHEMSs). MATERIAL AND METHODS: Multicenter, prospective cohort study enrolling consecutive patients with acute pulmonary edema and/or exacerbated chronic obstructive pulmonary disease who were treated with NIV between November 2018 and November 2020 in a hospital ED or OHEMS setting in Madrid. We recorded baseline data, variables related to the acute episode, and outcome variables, including in-hospital mortality and 30-day readmission. RESULTS: A total of 317 patients were included; 132 (41.6%) were treated in an OHEMS setting and 185 (58.4%) in a hospital ED. Forty-seven (16.3%) in-hospital deaths occurred, and 78 patients (28.8%) were readmitted within 30 days. Mortality in the hospital ED and OHEMS subsamples did not differ, but the patients who received NIV in an OHEMS setting had a lower 30-day readmission rate. On multivariate analysis, in-hospital mortality was associated with prior dependence in activities of daily living in the multivariate analysis (odds ratio [OR], 2.4; 95% CI, 1.11-5.27) and a low-moderate score on the Simplified Acute Physiology Score II (SAPS II) versus a high-very high one (OR, 2.69; 95% CI, 1.26-5.77). Mortality after OHEMS ventilation was associated with discontinuance of NIV during transfer (OR, 8.57; 95% CI, 2.19-33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV) (OR, 3.24; 95% CI, 2.62-6.45) and prior dependence (OR, 2.08; 95% CI, 1.02-4.22). CONCLUSION: Patients treated in the hospital ED and OHEMS setting have similar baseline characteristics, although acute episodes were more serious in the OHEMS group. No significant differences were found related to in-hospital mortality. Higher mortality was associated with dependence, a SAPS II score greater than 52, and discontinuance of NIV. Readmission was associated with dependence and NIV treatment in the hospital ED setting.

OBJETIVO: Describir las características clínicas, evolutivas y los factores pronóstico de una cohorte de pacientes tratados con ventilación no invasiva (VNI) en servicios de urgencias extrahospitalarios (SUEH) y hospitalarios (SUH). METODO: Estudio de cohortes multicéntrico, prospectivo con inclusión consecutiva de pacientes con edema agudo de pulmón o agudización de enfermedad pulmonar obstructiva crónica tratados con VNI entre noviembre 2018 y noviembre de 2020 en SUEH y SUH de la Comunidad de Madrid. Se recogieron características basales, del episodio agudo, así como variables de resultado incluyendo la mortalidad hospitalaria y el reingreso a 30 días. RESULTADOS: Se incluyeron 317 pacientes, 132 (41,6%) en SUEH y 185 (58,4%) en SUH. Hubo 47 muertes intrahospitalarias (16,3%) y 78 reingresos a los 30 días (28,8%). No hubo diferencias en la mortalidad, pero el grupo VNI-SUEH tuvo menor reingreso a 30 días. En el análisis multivariado la mortalidad intrahospitalaria se asoció con la dependencia previa (OR = 2,4; IC 95%: 1,11-5,27) y el SAPS-II bajo-moderado frente al alto-muy alto (OR = 2,69; IC 95%: 1,26-5,77). En la cohorte extrahospitalaria, la mortalidad intrahospitalaria se asoció con la retirada de la VNI en la transferencia del paciente (OR = 8,57; IC 95%: 2,19-33,60). Los reingresos a los 30 días se asociaron con inicio de VNI en el hospital (OR = 3,24; IC 95%: 2,62-6,45) y dependencia previa (OR = 2,08; IC 95%: 1,02-4,22). CONCLUSIONES: Los pacientes de ambos grupos, SUH y SUEH, tienen un perfil clínico basal similar, aunque con mayor gravedad del episodio en el grupo SUEH. No se encontraron diferencias estadísticamente significativas en la mortalidad intrahospitalaria. Se asociaron a una mayor mortalidad la dependencia, la escala SAPS-II > 52 y la retirada de la VNI. El reingreso se asoció con la dependencia y pertenecer al grupo SUH.

The spider genus Diguetia Simon, 1895 (Araneae: Diguetidae) in North America: a new species, redescriptions, and comments on the distribution of the genus.

A new species of the genus Diguetia Simon, 1895, D. balandra sp. nov. is described, the male of D. signata Gertsch, 1958 is described for the first time and D. dialectica Chamberlin, 1924 stat. reval. is raised to the species level and redescribed based on specimens from Baja California Sur, Mexico. Diguetia imperiosa Gertsch & Mulaik, 1940 is recorded from Baja California Sur. Furthermore, we emend the diagnosis of the genus, biogeographic comments for all North American species. In the United States, California (five species) and Arizona (four species) have more species of Diguetia while the Mexican states of Sonora (five species), Chihuahua, Baja California, Baja California Sur (four species each) and Coahuila (three species) harbor the highest diversity of diguetids. Diguetia canities (McCook, 1890) has the highest number of records (133) in North America. Mexico has a striking diversity of Diguetia with eight out of ten species currently known.

Review of incomplete macroscopic resections (R2) in rectal cancer: Treatment, prognosis and future perspectives.

Colorectal cancer is one of the most prevalent tumours, but with improved treatment and early detection, its prognosis has greatly improved in recent years. However, when the tumour is locally advanced at diagnosis or if there is local recurrence, it is more difficult to perform a complete tumour resection, and there may be a residual macroscopic tumour. In this paper, we review the literature on residual macroscopic tumour resections, concerning both locally advanced primary tumours and recurrences, evaluating the main problems encountered, the treatments applied, the prognosis and future perspectives in this field.

Drosophila Evolution over Space and Time (DEST): A New Population Genomics Resource.

Drosophila melanogaster is a leading model in population genetics and genomics, and a growing number of whole-genome data sets from natural populations of this species have been published over the last years. A major challenge is the integration of disparate data sets, often generated using different sequencing technologies and bioinformatic pipelines, which hampers our ability to address questions about the evolution of this species. Here we address these issues by developing a bioinformatics pipeline that maps pooled sequencing (Pool-Seq) reads from D. melanogaster to a hologenome consisting of fly and symbiont genomes and estimates allele frequencies using either a heuristic (PoolSNP) or a probabilistic variant caller (SNAPE-pooled). We use this pipeline to generate the largest data repository of genomic data available for D. melanogaster to date, encompassing 271 previously published and unpublished population samples from over 100 locations in >20 countries on four continents. Several of these locations have been sampled at different seasons across multiple years. This data set, which we call Drosophila Evolution over Space and Time (DEST), is coupled with sampling and environmental metadata. A web-based genome browser and web portal provide easy access to the SNP data set. We further provide guidelines on how to use Pool-Seq data for model-based demographic inference. Our aim is to provide this scalable platform as a community resource which can be easily extended via future efforts for an even more extensive cosmopolitan data set. Our resource will enable population geneticists to analyze spatiotemporal genetic patterns and evolutionary dynamics of D. melanogaster populations in unprecedented detail.

Functional Associations and Resilience in Microbial Communities.

Microbial communities have inherently high levels of metabolic flexibility and functional redundancy, yet the structure of microbial communities can change rapidly with environmental perturbation. To understand whether such changes observed at the taxonomic level translate into differences at the functional level, we analyzed the structure of taxonomic and functional gene distribution across Arctic and Antarctic locations. Taxonomic diversity (in terms of alpha diversity and species richness) differed significantly with location. However, we found that functional genes distributed evenly across bacterial networks and that this functional distribution was also even across different geographic locations. For example, on average 15% of the functional genes were related to carbon cycling across all bacterial networks, slightly over 21% of the genes were stress-related and only 0.5% of the genes were linked to carbon degradation functions. In such a distribution, each bacterial network includes all of the functional groups distributed following the same proportions. However, the total number of functional genes that is included in each bacterial network differs, with some clusters including many more genes than others. We found that the proportion of times a specific gene must occur to be linked to a specific cluster is 8%, meaning the relationship between the total number of genes in the cluster and the number of genes per function follows a linear pattern: smaller clusters require a gene to appear less frequently to get fixed within the cluster, while larger clusters require higher gene frequencies. We suggest that this mechanism of functional association between equally rare or equally abundant genes could have implications for ecological resilience, as non-dominant genes also associate in fully functioning ecological networks, potentially suggesting that there are always pre-existing functional networks available to exploit new ecological niches (where they can become dominant) as they emerge; for example, in the case of rapid or sudden environmental change. Furthermore, this pattern did not correlate with taxonomic distribution, suggesting that bacteria associate based on functionality and this is independent of its taxonomic position. Our analyses based on ecological networks also showed no clear evidence of recent environmental impact on polar marine microbial communities at the functional level, unless all communities analyzed have changed exactly in the same direction and intensity, which is unlikely given we are comparing areas changing at different rates.

Islands in the desert for cavity-nesting bees and wasps: Ecology, patterns of diversity, and conservation at oases of Baja California Peninsula.

AIMS: The oases of Baja California Peninsula (BCP) have been proposed as important hotspots of biodiversity that hold an exceptional richness in the middle of desert conditions. We tested the effect of habitat and anthropogenic disturbance on communities of cavity-nesting taxa, with specific emphasis on bees, wasps, and their natural enemies. METHODS: In oases of BCP and desert neighbor environments, trap-nesting taxa were evaluated in response to factors affecting the nest abundance, richness, and community structure. We used statistical models to find correlates of nest abundance and patterns of diversity, as well as ecological analyses to determine the effect of habitat and human disturbance on species diversity and community structure. RESULTS: Solar irradiation, distance to a perennial waterbody and relative humidity influenced the presence of nests, number of brood cells, and parasitism. In general, abundance, species richness, and parasitism were higher in oases, especially in those with less human disturbance. Bees did not discriminate between oases and deserts to nest, whereas mud-daubing wasps were more dependent of oases. The degree of anthropogenic disturbance did not affect the occurrence of parasitism, but it had an adverse effect on the parasitism intensity (number of attacked cells). The community structure was more complex and even in oases and low-disturbed sites. The similarity between sites did not exceed 30%, and the proportion of shared species between oases and deserts varied from 2.7% to 26.6%. MAIN CONCLUSIONS: The oases of Baja California are functioning as mesic islands in the desert, each oasis hosting a unique community of cavity-nesting taxa. About 65% of the nests and 50% of species occurred exclusively in the oasis. Thus, cavity-nesting species that depend on mesic conditions could be threatened if the oases of BCP disappear in the future. Local conditions in the oases and deserts of the BCP are shaping the community structure. However, large-scale factors such as climate can influence the seasonality and occurrence of species within the community of cavity-nesting dwellers. Since habitat loss and fragmentation can degrade the oases' functionality, strategies to maintain the ecosystem services of pollination and biological control should be included in the conservation programs of these fragile habitats.

Diversity and seasonal variation of ground and understory spiders from a tropical mountain cloud forest.

We made intensive samplings to study the seasonal response of spiders across different forest strata (ground and understory) in a tropical mountain cloud forest from Mexico. We sampled spiders from ten plots in six sampling events during the dry and rainy season, to analyze their abundance, structure (distribution of abundance among species), diversity and the response of the five dominant species at each stratum. Results demonstrated that seasonal patterns of spider communities differed among strata, revealing a complex spatiotemporal dynamic. Abundance, structure, diversity of ground spiders, as well as the responses of four dominant species at this stratum, showed low seasonal variations. In contrast, a strong seasonal variation was observed for the understory assemblage, with lowest abundance and highest diversity in the rainy season, and different assemblage structures for each season. Seasonal patterns of each assemblage seem linked to the responses of their dominant species. We found high co-occurrence among most of the ground dominant species with similar habitat use and with multivoltine patterns, contrasting with low co-occurrence among most of the understory dominant species with similar habitat use and univoltine patterns. Our results showed that the spiders' assemblages of tropical mountain cloud forest (opposed to what is found in temperate and boreal forests) increase their species richness with the height, and that their responses to seasonal change differ between strata. Management programs of these habitats should consider the spatial and temporal variations found here, as a better understanding of their ecological dynamics is required to support their sustainable management.

Disentangling the coexistence strategies of mud-daubing wasp species through trophic analysis in oases of Baja California peninsula.

Species within the same trophic level show different strategies to avoid competition. Among these mechanisms, differences in body size, spatio-temporal segregation, and diet preference often leads to a niche partitioning. Nonetheless, little attention on coexisting predatory insects and their network interactions has been paid. In this study, we analyzed the strategies to avoid competition among three sympatric mud-daubing wasps of the genus Trypoxylon (Hymenoptera: Crabronidae) in oases and their surrounding xeric area from the Baja California peninsula, Mexico. We compared the prey richness, composition and proportion of spider guilds that were captured by the wasps. We tested whether the differences in wasp body size explained the niche breadth, niche overlap and the size of spider prey. We assessed the spider-wasp interactions through a network analysis. With the use of trap-nests, we collected 52 spider species captured by the wasps. Both the guild and species composition of preyed spiders was different between the three wasp species. Differential proportions in the capture of spider guilds and a little diet overlap were found among the wasp species. We found that the wasp body size was positively correlated with prey size, but it was not a proxy of niche breadth. Moreover, the largest wasp species was able to nest in both mesic and xeric habitats, while the two smaller species were restricted to the oases. This study reveals that the diversity of spiders in oases of Baja California peninsula is crucial to maintain highly specialized oasis-dependent wasp species. The niche partitioning between mud-daubing wasps can be shaped by their inherent body size limitations and hunting strategies through foraging specialization for specific spider guilds. Food selection and slight differences in body size reduce competition and allow the coexistence of sympatric wasps. Our study is the first approach exploring the interaction networks between mud-daubing wasps and their spider preys, highlighting new insights into the morphological and ecological factors that shape antagonistic interactions, and allow the coexistence of predators in deserts.

Derrame pleural asociado a metimazol / Pleural effusion associated to metimazol

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Lesiones ampollosas en mujer de 81 años / Blistering lesions on a 81 year old woman

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Redescription of Phonotimpus separatus Gertsch Davis, 1940 (Araneae: Phrurolithidae) and description of two new species of Phonotimpus from Mexico.

The female of Phonotimpus separatus Gertsch Davis (the type species of the genus) is redescribed from a specimen collected at the type locality, and two new species of Phonotimpus from Mexico are described: P. pennimani sp. nov. and P. talquian sp. nov. A more detailed description of P. separatus is provided to better distinguish them from related taxa. The two new species are closely related; males and females of both species share several somatic and genitalic characters not found in P. separatus. The resemblance of both new species to P. separatus is discussed.

A missing piece in the puzzle: the presence of Euglossa viridissima in the Baja California Peninsula (Hymenoptera, Apidae).

Orchid bees are a conspicuous component of the neotropical bee fauna, with a few species reaching the northernmost natural distribution for the group in northwestern continental Mexico. Among them, Euglossa viridissima Friese is here reported for the first time in the Cape Region of the Baja California peninsula, Mexico, where no species of the group have been found previously. These records are presented, their biogeographical implications discussed, and some interpretations of the local factors that influence the bees is presented.

Estudio retrospectivo sobre las diferencias entre insuficiencia cardíaca sistólica y diastólica en un registro de 1.000 pacientes del hospital Puerta de Hierro-Majadahonda-Madrid. Comparación con el Registro Nacional español de Insuficiencia Cardíaca (RICA) / Retrospective study on the differences between systolic and diastolic heart failure in a registry of 1,000 patients from the Puerta de Hierro-Majadahonda Hospital, Madrid. Comparison with the Spanish National Heart Failure Registry

Resumen Objetivo: Comparar las diferencias entre insuficiencia sistólica y diastólica en pacientes ingresados en el Hospital Puerta de Hierro Majadahonda, con diagnóstico al alta de ``primer episodio de insuficiencia cardiaca''. Los resultados se cotejan con el registro nacional español de insuficiencia cardiaca (RICA). Material y método: Estudio retrospectivo que incluye a 1.000 pacientes ingresados desde octubre 2008 hasta mayo 2010. El seguimiento se realizó hasta mayo 2015. Resultados: El 70,6% procedían de Medicina Interna, con predominio del sexo femenino (62%) y una mediana de 87 años de edad. La mortalidad global fue de 69,8%, mayor en pacientes con insuficiencia cardiaca-diastólica. OR 1,03 (IC 95% 0,73-1,45). El 59% de los pacientes reingresaron al menos una vez; en su mayoría eran varones (61%) e hipertensos (89,3%). Conclusiones: Los pacientes con insuficiencia cardiaca-diastólica ingresan preferentemente en Medicina Interna (76,2%); la mayoría son mujeres hipertensas y de edad más avanzada que en el grupo de insuficiencia cardiaca-sistólica. Los resultados fueron similares a los del registro RICA, salvo mayor mortalidad y reingresos, probablemente por la edad más avanzada de los pacientes y el mayor tiempo de seguimiento.

Abstract Objective: To compare the differences between systolic and diastolic dysfunction in patients admitted to the Hospital Puerta de Hierro Majadahonda, Madrid, with a diagnosis on discharge of ``first episode of heart failure''. The results were compared with the Spanish National Heart Failure Registry (RICA). Material and method: A retrospective study that included 1,000 patients admitted from October 2008 to May 2010. The follow-up was carried out up to May 2015. Results The majority of patients were admitted to Internal Medicine, with a majority of females (62%), and with a median age of 87 years. The overall mortality was 69.8%, and was higher in patients with diastolic heart failure (OR: 1.03, 95% CI; 0.73 - 1.45). More than half of the patients (59%) were admitted at least once, with the majority being males (61%) and with hypertension (89.3%). Conclusions: Patients with diastolic heart failure were mainly admitted to Internal Medicine (76.2%). The majority were women with hypertension, and of a more advanced age than the systolic heart failure group. The results were similar to the RICA, except for the higher mortality and admissions, probably due to the more advanced age of the patients, and the longer follow-up time.