Functional, Clinical, and Sociodemographic Variables Associated with Risk of In-Hospital Mortality by COVID-19 in People over 80 Years Old.

OBJECTIVES: The objective is to assess the role of functional, clinical, and analytic parameters in predicting mortality in older patients hospitalized due to COVID-19. DESIGN: Cohort study with a mean follow-up of 12.8 days. SETTING: Public university hospital (Madrid, Spain). PARTICIPANTS: 499 patients 80 and above consecutively admitted to a Spanish public university hospital between 4 March 2020 and 16 May 2020. MEASUREMENTS: Mortality was the main outcome. Data of sociodemographic variables (age, sex, living), comorbidities, polypharmacy, functional status, date of hospital admission and length of stay was recorded. Clinical symptoms, laboratory and X-ray findings were collected at time of admission. For multivariant analysis, logistic regressions were performed to identify risk factors for death. RESULTS: Mean age was 86.7±4.4 with 37% of death. Mortality was associated with male gender [odds ratio (OR) 1.50; 95% confidence interval (CI) 1.01-2.24], with a 5-points increase on Barthel Index [OR 1.01 (95%CI 1.00-1.02)], higher Charlson Index score [OR 1.13 (95%CI 1.02-1.26)] and comorbidities [OR 1.28 (95%CI 1.06-1.53)], hyperpolipharmacy [OR 2.00 (95%CI 1.04-3.82)], unilateral pneumonia [OR 1.83 (95%CI 1.01-3.30)], higher levels of C-reactive protein [OR 1.09 (95%CI 1.06-1.12)] and creatine [OR 1.48 (95%CI 1.15-1.89)]. Higher oxygen levels were a protective factor [OR 0.92 (95%CI 0.89-0.95)]. CONCLUSIONS: Functional status, being male, a higher burden of comorbidities, hyperpolipharmacy, unilateral pneumonia and some laboratory parameters predict in-hospital mortality in this older population. The knowledge of these mortality risk factors should be used to improve the survival of older hospitalized patients.

Impact of Social Isolation Due to COVID-19 on Health in Older People: Mental and Physical Effects and Recommendations.

OBJECTIVES: To review the impact of social isolation during COVID-19 pandemic on mental and physical health of older people and the recommendations for patients, caregivers and health professionals. DESIGN: Narrative review. SETTING: Non-institutionalized community-living people. PARTICIPANTS: 20.069 individuals from ten descriptive cross-sectional papers. MEASUREMENTS: Articles since 2019 to 2020 published on Pubmed, Scielo and Google Scholar databases with the following MeSh terms ('COVID-19', 'coronavirus', 'aging', 'older people', 'elderly', 'social isolation' and 'quarantine') in English, Spanish or Portuguese were included. The studies not including people over 60 were excluded. Guidelines, recommendations, and update documents from different international organizations related to mental and physical activity were also analysed. RESULTS: 41 documents have been included in this narrative review, involving a total of 20.069 individuals (58% women), from Asia, Europe and America. 31 articles included recommendations and 10 addressed the impact of social distancing on mental or physical health. The main outcomes reported were anxiety, depression, poor sleep quality and physical inactivity during the isolation period. Cognitive strategies and increasing physical activity levels using apps, online videos, telehealth, are the main international recommendations. CONCLUSION: Mental and physical health in older people are negatively affected during the social distancing for COVID-19. Therefore, a multicomponent program with exercise and psychological strategies are highly recommended for this population during the confinement. Future investigations are necessary in this field.

Current model systems for the study of preeclampsia.

Preeclampsia (PE) is a pregnancy complex disease, distinguished by high blood pressure and proteinuria, diagnosed after the 20th gestation week. Depending on the values of blood pressure, urine protein concentrations, symptomatology, and onset of disease there is a wide range of phenotypes, from mild forms developing predominantly at the end of pregnancy to severe forms developing in the early stage of pregnancy. In the worst cases severe forms of PE could lead to systemic endothelial dysfunction, eclampsia, and maternal and/or fetal death. Worldwide the fetal morbidity and mortality related to PE is calculated to be around 8% of the total pregnancies. PE still being an enigma regarding its etiology and pathophysiology, in general a deficient trophoblast invasion during placentation at first stage of pregnancy, in combination with maternal conditions are accepted as a cause of endothelial dysfunction, inflammatory alterations and appearance of symptoms. Depending on the PE multifactorial origin, several in vitro, in vivo, and in silico models have been used to evaluate the PE pathophysiology as well as to identify or test biomarkers predicting, diagnosing or prognosing the syndrome. This review focuses on the most common models used for the study of PE, including those related to placental development, abnormal trophoblast invasion, uteroplacental ischemia, angiogenesis, oxygen deregulation, and immune response to maternal-fetal interactions. The advances in mathematical and computational modeling of metabolic network behavior, gene prioritization, the protein-protein interaction network, the genetics of PE, and the PE prediction/classification are discussed. Finally, the potential of these models to enable understanding of PE pathogenesis and to evaluate new preventative and therapeutic approaches in the management of PE are also highlighted. Impact statement This review is important to the field of preeclampsia (PE), because it provides a description of the principal in vitro, in vivo, and in silico models developed for the study of its principal aspects, and to test emerging therapies or biomarkers predicting the syndrome before their evaluation in clinical trials. Despite the current advance, the field still lacking of new methods and original modeling approaches that leads to new knowledge about pathophysiology. The part of in silico models described in this review has not been considered in the previous reports.

Hallazgos clínicos inusuales en un brote de escarlatina / Unusual clinical findings in an outbreak of scarlet fever

Introducción: la escarlatina es una enfermedad infecciosa producida por Streptococcus pyogenes que produce un cuadro característico de faringoamigdalitis y exantema. Su diagnóstico suele ser fácil, pero los casos atípicos pueden pasar desapercibidos o ser confundidos con otros cuadros. Pacientes y método: estudio descriptivo retrospectivo de los casos de escarlatina en la población pediátrica adscrita a un centro de salud en la temporada 2013/2014. Describimos la epidemiología, las características clínicas, las pruebas microbiológicas, el tratamiento y la presencia de recidivas. Resultados: se obtuvieron 91 casos, resultando una incidencia de 3,2%, de los que 76 fueron confirmados microbiológicamente con test rápido o cultivo. La edad media fue 4,15 años. Los principales motivos de consulta fueron 'fiebre y dolor de garganta' y 'fiebre y erupción cutánea'. Las alteraciones faríngeas más frecuentes fueron la hiperemia y petequias en paladar, y en pocos pacientes se encontró exudado amigdalar. Casi un 40% de pacientes tenían síntomas catarrales, 71 pacientes presentaban un exantema típico, y 20 uno atípico. La mayoría se trató con amoxicilina o penicilina durante diez días; 15 pacientes tuvieron recidivas. Conclusiones: de los datos obtenidos destacan el gran número de casos, la presencia de síntomas catarrales y la poca frecuencia de exudado amigdalar. Fue llamativa la variabilidad de los exantemas con hallazgos como eritrodermia extensa, urticaria, exantema macular, petequias en localizaciones atípicas y edema facial y de miembros. El test rápido en Atención Primaria permite, por su utilidad, el diagnóstico de casos dudosos (AU)

Introduction: scarlet fever is an infectious disease caused by Streptococcus pyogenes that manifests as a typical pharyngoamigdalitis and exanthema. Its diagnosis is usually easy, but atypical cases may go unnoticed. Patients and methodology: retrospective descriptive study of pediatric population assigned to a Primary Care center a health centre between 2013/2014. We define the epidemiology, clinical characteristics, microbiological tests, treat­ment and appearance of relapses. Results: 91 cases, resulting in an incidence of 3.2% of which 76 were confirmed microbiologically with a rapid test or culture. The average age was 4,15 years. The main reasons for consultation were 'fever and sore throat' and 'fever and rash'. The most common alterations were pharyingeal hyper­emia and petechiae on the palate and in a few patients we found tonsillar exudate. Almost 40% of patients had catarrhal symptoms. 71 patients showed a typical exanthema and 20 of them an atypical one. Most of them were treated with amoxicillin or penicillin for 10 days. 15 patients had recurrence. Conclusions: from the data obtained it is important to highlight the large amount of cases, the presence of catarrhal symptoms and the infrequency of tonsillar exudates. It was remarkable the variability of recurrences with findings such as extensive erythroderma, urticaria, macular rashes, atypically placed petechiae and facial and member edema. The rapid test on primary care units allows diagnosis on doubtful cases (AU)

Expression levels of seven candidate genes in human peripheral blood mononuclear cells and their association with preeclampsia.

OBJECTIVE: To evaluate the peripheral blood mononuclear cell (PBMC) expression levels of hemeoxygenase 1 (HMOX-1), superoxide dismutase 1 (SOD-1), vascular endothelial growth factor A (VEGF-A), transforming growth factor beta 1 (TGF-ß1), interleukin (IL)-6, IL-15 and AdipoQ genes to study their association with preeclampsia (PE). METHODS: A total of 177 pregnant women were recruited: 108 cases and 69 controls. Quantification of gene expression was measured by quantitative real-time polymerase chain reaction (PCR) using TaqMan probes. RESULTS: Underexpression of VEGF-A and TGF-ß1 was a constant in most of the cases (80.91% and 76.36%, respectively) and their expression was associated with onset and/or severity of disease (p values < 0.05). IL-6, IL-15 and AdipoQ, showed low or no expression in PBMC samples evaluated. CONCLUSION: PBMC underexpression of VEGF-A and TGF-ß1 is a hallmark of PE in the study population.

Olfactomedin-like 3 (OLFML3) gene expression in baboon and human ocular tissues: cornea, lens, uvea, and retina.

BACKGROUND: Olfactomedin-like is a family of polyfunctional polymeric glycoproteins. This family has at least four members. One member of this family is OLFML3, which is preferentially expressed in placenta but is also detected in other adult tissues including the liver and heart. However, its orthologous rat gene is expressed in the iris, sclera, trabecular meshwork, retina, and optic nerve. METHODS: OLFML3 messenger amplification was performed by RT-PCR from human and baboon ocular tissues. The products were cloned and sequenced. RESULTS: We report OLFML3 expression in human and baboon eye. The full coding DNA sequence has 1221 bp, from which an open reading frame of 406 amino acid was obtained. The baboon OLFML3 gene nucleotidic sequence has 98% and amino acidic 99% similarity with humans. CONCLUSIONS: OLFML3 gene expression in human and baboon ocular tissues and its high similarity make the baboon a powerful model to deduce the physiological and/or metabolic function of this protein in the eye.

Genetics of variation in adiponectin in pedigreed baboons: evidence for pleiotropic effects on adipocyte volume and serum adiponectin.

To detect and localize the effects of genes influencing variation in adiponectin mRNA and protein levels, we conducted statistical genetic analyses of circulating concentrations of adiponectin and adiponectin (ADIPOQ) mRNA expression in omental adipose tissue in adult, pedigreed baboons (Papio anubis). An omental adipose tissue biopsy and blood sample were collected from 427 baboons from the colony at the Southwest Foundation for Biomedical Research, San Antonio, TX. Total RNA was isolated from adipose tissue and adiponectin mRNA levels were assayed by real-time, quantitative reverse transcriptase-PCR. Adiponectin, insulin, glucose, cholesterol, high-density lipoproteins and triglycerides were measured in fasting serum. Quantitative genetic analyses were conducted for adiponectin mRNA and serum protein using a maximum likelihood-based variance decomposition approach. A genome-wide linkage analysis was conducted using adiponectin mRNA and protein levels as phenotypes. Significant heritability was estimated for ADIPOQ mRNA levels (h2=0.19+/-0.07, P=0.01) and protein levels (h2=0.28+/-0.14, P=0.003). Genetic correlations were found between adiponectin protein and body weight (rho(G)=-0.51, P=0.03), cell volume (rho(G)=-0.73, P=0.04), serum triglycerides (rho(G)=-0.67, P=0.03), and between adiponectin mRNA and glucose (rho(G)=0.93, P<0.01). A logarithm of odds score of 2.9 was found for ADIPOQ mRNA levels on baboon chromosome 4p, which is orthologous to human 6p21. There is a significant genetic component affecting variation in the analyzed traits, and common genes may be influencing adiponectin expression, adipocyte volume, body weight and circulating triglycerides. The region on 6p21 has been linked to diabetes-related phenotypes in human studies.

Biodegradation kinetics of BTE-OX and MTBE by a diesel-grown biomass.

The biodegradation kinetics of BTE-oX and MTBE, mixed all together in the presence of diesel-grown bioaugmented bacterial populations as high as 885 mg/L VSS, was evaluated. The effect of soil in aqueous samples and the effect of Tergitol NP-10 on substrate biodegradation rates were also evaluated. Biodegradation kinetics was evaluated for 54 h, every 6 h. All BTE-oX chemicals followed a first-order two-phase biodegradation kinetic model, whereas MTBE followed a zero-order removal kinetic model in all samples. BTE-oX removal rates were much higher than those of MTBE in all samples. The presence of soil in aqueous samples retarded BTE-oX and MTBE removal rates. The addition of Tergitol NP-10 to aqueous samples containing soil had a positive effect on substrate removal rate in all samples. Substrate percent removals ranged between 64.8-98.9% for benzene, toluene and ethylbenzene. O-xylene and MTBE percent removals ranged between 18.7-40.8% and 7.2-10.3%, respectively.

BTE-OX biodegradation kinetics with MTBE through bioaugmentation.

The biodegradation kinetics of BTE-oX and MTBE, mixed all together, in the presence of bioaugmented bacterial populations as high as 880 mg/L VSS was evaluated. The effect of soil in aqueous samples and the effect of Tergitol NP-10 on substrate biodegradation rates were also evaluated. Biodegradation kinetics was evaluated for 36 hours, every 6 hours. Benzene and o-xylene biodegradation followed a first-order one-phase kinetic model, whereas toluene and ethylbenzene biodegradation was well described by a first-order two-phase kinetic model in all samples. MTBE followed a zero-order removal kinetic model in all samples. The presence of soil in aqueous samples retarded BTE-oX removal rates, with the highest negative effect on o-xylene. The presence of soil enhanced MTBE removal rate. The addition of Tergitol NP-10 to aqueous samples containing soil had a positive effect on substrate removal rate in all samples. Substrate percent removals ranged from 95.4-99.7% for benzene, toluene and ethylbenzene. O-xylene and MTBE percent removals ranged from 55.9-90.1% and 15.6-30.1%, respectively.

Amyloid goiter in a child--US, CT and MR evaluation.

There are few radiological descriptions of amyloid goiter, basically in adult patients of oriental origin. We present a ten-year-old boy with Still's disease and secondary thyroid amyloidosis, describing the US, CT and MR findings.