Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study.

BACKGROUND: To compare the severity of pulmonary embolism (PE) and the long-term complications between patients with and without COVID-19, and to investigate whether the tools for risk stratification of death are valid in this population. METHODS: We retrospectively included hospitalized patients with PE from 1 January 2016 to 31 December 2022. Comparisons for acute episode characteristics, risk stratification of the PE, outcomes, and long-term complications were made between COVID and non-COVID patients. RESULTS: We analyzed 116 (27.5%) COVID patients and 305 (72.4%) non-COVID patients. In patients with COVID-19, the traditional risk factors for PE were absent, and the incidence of deep vein thrombosis was lower. COVID patients showed significantly higher lymphocyte count, lactate dehydrogenase, lactic acid, and D-dimer levels. COVID patients had PE of smaller size (12.3% vs. 25.5% main pulmonary artery, 29.8% vs. 37.1% lobar, 44.7% vs. 29.5% segmental and 13.2% vs. 7.9% subsegmental, respectively; p < 0.001), less right ventricular dysfunction (7.7% vs. 17.7%; p = 0.007) and higher sPESI score (1.66 vs. 1.11; p < 0.001). The need for mechanical ventilation was significantly higher in COVID patients (8.6% vs. 1.3%; p < 0.001); However, the in-hospital death was less (5.2% vs. 10.8%; p = 0.074). The incidence of long-term complications was lower in COVID cohort (p < 0.001). PE severity assessed by high sPESI and intermediate and high-risk categories were independently associated with in-hospital mortality in COVID patients. CONCLUSION: The risk of in-hospital mortality and the incidence of long-term complications were lower in COVID-19. The usual tools for risk stratification of PE are valid in COVID patients.

Rendimiento y validación del puntaje NoSAS en la evaluación inicial del síndrome de apnea/hipopnea del sueño / Performance and validation of NoSAS score in sleep apnea-hypopnea syndrome initial assessment

Introducción: El método de referencia para diagnosticar el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es la polisomnografía, esta no es diagnóstica en otros trastornos respiratorios del sueño, por lo que es necesario la implementación de puntajes predictivos para diferenciar aquellos pacientes que tienen más riesgos de padecer SAHOS y necesiten de una polisomnografía. El objetivo de este estudio fue validar el puntaje NoSAS y la escala de Berlín frente a la polisomnografía tipo 1 en pacientes con sospecha de SAHOS. Materiales y métodos: Estudio de pruebas diagnósticas. A 264 pacientes se les realizó una polisomnografía basal, la aplicación del puntaje NoSAS y la escala de Berlín; luego, se hizo el análisis de las pruebas diagnósticas y se calculó el rendimiento de cada una en relación con el índice de apnea hipopnea (IAH). Resultados: La sensibilidad del puntaje NoSAS para un IAH ≥ 20 fue 88,57% con intervalo de confianza (IC) 95% 80,4-96,74; especificidad 56,70 %; IC 95% 49,47-63,93 y valor predictivo negativo (VPN) de 93,22, IC 95% 91,70- 99,82. Para la escala de Berlín, la sensibilidad fue de 81,43%, IC 95% 71,60-91,25; especificidad de 58,76%, IC 95% 51,58-65,95 y VPN 89,76%, IC 95% 89,08-98,32. Conclusión: Se demostró que el puntaje NoSAS y la escala de Berlín tienen una buena sensibilidad para descartar a las personas con un menor riesgo de SAHOS. Un paciente clasificado de bajo riesgo probablemente está sano o tiene bajo riesgo para SAHOS moderado a severo y no requeriría de una polisomnografía inicial.

Introduction: The gold standard for diagnosing obstructive sleep apnea-hypopnea syndrome (OSAHS) is the polysomnography, and it is not a diagnostic tool for another sleep breathing disorders, so that it is necessary to implement predictive scores to differentiate those patients who have more risk of suffering OSAHS, therefore they need a polysomnography. The aim to this study was to validate the NoSAS score and Berlin scale in relation to the polysomnography type 1, in patients who have the clinical suspicion of OSAHS. Material and methods: Diagnostic tests study. 264 patients underwent polysomnography, and the NoSAS score and Berlin scale were applied to them. After that, the diagnostic tests analysis was done and the performance of each one of them was calculated in relation to the apnea- hypopnea index (AHI). Results: The sensitivity of the NoSAS score for an AHI ≥ 20 was 88.57%, confidence interval (CI) 95% (80.4-96.74), specificity 56.70 %, CI 95% (49.47-63.93), and the negative predictive value (NPV) was 93.22, CI 95% (91.70-99.82). For Berlin scale the sensitivity was 81.43%, CI 95% (71.60-91.25), specificity 58.76%, CI 95% (51.58-65.95) and NPV 89.76%, CI 95% (89.08-98.32). Conclusions: It was shown that NoSAS score and Berlin scale have a good sensitivity to rule out people who have less OSAHS risk. A patient classified as low risk, probably is healthy or at low risk for moderate to severe OSAHS and would not require an initial polysomnography.

Enhancing the activity and stability of carbon-supported platinum-gadolinium nanoalloys towards the oxygen reduction reaction.

The activity/stability towards the ORR of Pt x Gd/C nanoalloys has been enhanced by controlling the atmosphere during the dealloying process. By minimising the formation of porous nanoarchitectures, the ORR activity is increased, and is accompanied by higher activity retention and attenuation of metal dissolution on cycling to high voltage.

Neurocisticercosis / Neurocysticercosis

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Climate change effects on biodiversity, ecosystems, ecosystem services, and natural resource management in the United States.

Climate change is a pervasive and growing global threat to biodiversity and ecosystems. Here, we present the most up-to-date assessment of climate change impacts on biodiversity, ecosystems, and ecosystem services in the U.S. and implications for natural resource management. We draw from the 4th National Climate Assessment to summarize observed and projected changes to ecosystems and biodiversity, explore linkages to important ecosystem services, and discuss associated challenges and opportunities for natural resource management. We find that species are responding to climate change through changes in morphology and behavior, phenology, and geographic range shifts, and these changes are mediated by plastic and evolutionary responses. Responses by species and populations, combined with direct effects of climate change on ecosystems (including more extreme events), are resulting in widespread changes in productivity, species interactions, vulnerability to biological invasions, and other emergent properties. Collectively, these impacts alter the benefits and services that natural ecosystems can provide to society. Although not all impacts are negative, even positive changes can require costly societal adjustments. Natural resource managers need proactive, flexible adaptation strategies that consider historical and future outlooks to minimize costs over the long term. Many organizations are beginning to explore these approaches, but implementation is not yet prevalent or systematic across the nation.

Analysis of Kidney Donation and Its Relationship With Graft Failure of the Recipient at 1 Year.

INTRODUCTION: Currently, the shortage of organs available for kidney transplantation and a change in donors' and recipients' profiles (elderly, with cardiovascular risk, donors after cardiac death), it is becoming necessary to assess grafts from expanded-criteria donors (ECD) in order to have methods that allow us to predict viability and graft survival. OBJECTIVE: The aim of this study was to analyze the different methods of renal donor assessment (estimated glomerular filtration rate [eGFR], preimplantation biopsy, and Kidney Donor Profile Index [KDPI] score) as predictors of graft survival and renal function of our recipient at 1 year. METHODS: We performed a descriptive and retrospective study of 183 deceased donor kidney transplantations performed at our center between 2011 and 2015. We calculated the KDPI scores, donor eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration Formula equation, and biopsies were evaluated using Banff classification. RESULTS: ECDs comprised 59.60%, 93% of donors had an eGFR ≥ 60 mL/min/1.73 m2, and 41% presented with a KDPI score ≥ 90%. The most frequent range in the biopsy score was 0-3. The 1-year graft survival rate was 86.90%. Factors that negatively influenced graft survival were donor/recipient age, ECD, KDPI, and cold ischemia time (CIT). CONCLUSION: Prolonged CIT and KDPI ≥ 90% were donor variables that were related to graft failure at 1 year in our center.

Dynamics of predator-prey habitat use and behavioral interactions over diel periods at sub-tropical reefs.

The dynamics of fish communities at tropical and sub-tropical rocky reefs are influenced in many cases by predation activity and predator-prey interactions. These processes usually follow specific diel patterns in reef areas with higher rates of these interactions occurring during the crepuscular periods. However, other factors such as habitat complexity and species-specific behavior may alter these patterns, increasing variability in species interactions. A better understanding of the dynamics of these patterns and processes would allow us to manage and monitor fish communities in these productive and vulnerable areas more efficiently. We investigated behavioral changes of predators and prey fish in sub-tropical "live-bottom" (sandstone) reefs at Gray's Reef National Marine Sanctuary (GRNMS), located 20 nautical miles off the coast of Georgia, USA, using fisheries acoustic methods in association with visual census and direct observation using SCUBA. Changes in co-location and habitat preferences of predators and prey over time throughout the diel cycle were investigated using species distribution models (MAXENT) based on habitat predictors and by means of spatial statistics. The results indicate that predator and prey distribution patterns changed considerably throughout the day. Prey and predator species exhibited complex spatial dynamics and behavior over diel periods, with prey modifying patterns of habitat use and spatial distribution, likely as a response of their interactions with predators. Crepuscular periods were confirmed to be the most active phases in terms of predator-prey interactions and consequently the most variable. The combination of tools and approaches used in this study provided valuable sources of information that support the inferences of predation risk-driven habitat selection of prey in this sub-tropical reef system.

Hallazgos de neuroimagen en una serie de 14 pacientes con cefalea tratados con parche hemático epidural / Neuroimaging findings in a series of 14 patients witch headache for spontaneous intracranial hypotension treated with epidural blood patch

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Anti-HLA Antibodies After Precocious Transplantectomy by Vascular Thrombosis.

BACKGROUND: Our objective in this study was to determine the effects of early renal transplantectomy on patients and the production of anti-human leukocyte antigen (anti-HLA) antibodies. METHODS: Between January 2003 and May 2017, we analyzed a group of patients for the presence of specific HLA class I and/or II donor-specific antibodies (DSA), their panel-reactive antibodies (PRA), and the time period in which the antibodies were still detectable after transplantectomy. RESULTS: Anti-HLA antibodies were detected in 60.8% of patients, 60.8% and 52.2% of those patients had anti-class I and anti-class II antibodies, respectively. DSA were detected in 91.7% of the anti-HLA class I patients. Class II DSA were detected all of the patients with anti-HLA class II antibodies. The average (mean ± SD) PRA levels in our patients after transplantectomy was 60 ± 34% in class I and 63 ± 36% in class II. CONCLUSION: Anti-HLA antibodies can be detected well after transplantectomy. Even if the kidney allograft had been transplanted for only a short time, when the intensity of immunosuppression was the highest, many patients developed anti-HLA antibodies. The patients who continued with immunosuppression after transplantectomy did not develop anti-HLA antibodies.

Conventional and technical diving surveys reveal elevated biomass and differing fish community composition from shallow and upper mesophotic zones of a remote United States coral reef.

The world's coral reefs appear to be in a global decline, yet most previous research on coral reefs has taken place at depths shallower than 30 m. Mesophotic coral ecosystem (depths deeper than ~30 m) studies have revealed extensive, productive habitats and rich communities. Despite recent advances, mesophotic coral ecosystems remain understudied due to challenges with sampling at deeper depths. The few previous studies of mesophotic coral ecosystems have shown variation across locations in depth-specific species composition and assemblage shifts, potentially a response to differences in habitat or light availability/water clarity. This study utilized scuba to examine fish and benthic communities from shallow and upper mesophotic (to 45 m) zones of Flower Garden Banks National Marine Sanctuary (FGBNMS, 28°0'N; 93°50'W) from 2010-2012. Dominant planktivores were ubiquitous in shallow and upper mesophotic habitats, and comparisons with previous shallow research suggest this community distribution has persisted for over 30 years. Planktivores were abundant in shallow low-relief habitats on the periphery of the coral reef, and some of these sites that contained habitat transitioning from high to low relief supported high biomass of benthic predators. These peripheral sites at FGBNMS may be important for the trophic transfer of oceanic energy to the benthic coral reef. Distinct differences between upper mesophotic and shallow communities were also observed. These included greater overall fish (as well as apex predator) biomass in the upper mesophotic, differences in apex predator community composition between depth zones, and greater percent cover of algae, rubble, sand, and sponges in the upper mesophotic. Greater fish biomass in the upper mesophotic and similar fish community composition between depth zones provide preliminary support that upper mesophotic habitats at FGBNMS have the capacity to serve as refugia for the shallow-water reefs. Diving surveys of the upper mesophotic and shallow-water coral reef have revealed valuable information concerning the reef fish community in the northern Gulf of Mexico, with implications for the conservation of apex predators, oceanic coral reefs, and the future management of FGBNMS.

[Performance of the KAtex test in screening and diagnosis for visceral leishmaniasis in a reference hospital]. / Comportamiento de la prueba KAtex en el cribado y diagnóstico de la leishmaniasis visceral en un hospital de referencia.

OBJECTIVE: Performing of diagnostic test simple using samples not invasive in the diagnosis of visceral leishmaniasis (VL) may be very beneficial, being necessary comparing to traditional methods. The objective of this study was to know the reliability of test KAtex in the urine of patients with suspicion of VL. METHODS: Retrospectively were reviewed the medical histories of patients with suspected of VL to which are performed the test between 2009 and 2015. For its analysis were selected the patients to which is them had made study of the parasite in bone marrow. RESULTS: A total of 110 patients were studied, and bone marrow biopsy for research of Leishmania was performed in 44 (40%). In these patients the sensitivity of the test was 50%, the specificity of 96.7%, positive predictive value of 87.5% and negative predictive value of 80.5%. CONCLUSIONS: KAtex antigenuria sensitivity is too low recommending it as a unique method in the detection of VL in our medium.

[Effects on the elbow of radial head resection following isolated radial head fracture in young patients]. / Efectos sobre el codo de la resección de la cabeza radial por fractura aislada de la cabeza del radio en pacientes jóvenes.

BACKGROUND: Radial head resection has been a widely used procedure in cases of non-reconstructable radial head fracture. Some authors propose the use of radial head arthroplasty. The purpose of this study was to evaluate the long-term outcome of radial head resection for isolated fracture, without instability at the time of the fracture, and its radiological and functional repercussions at the elbow level. METHODS: We reviewed 44 clinical records with acute resection of the radial head following isolated radial head fracture, with absence of associated injuries, younger than forty, with a minimum follow-up of 15 years. Information was collected on elbow pain, biomechanical function, flexion and extension elbow strength and elbow instability compared with the non-affected side. A radiological study was conducted on all patients to determine the presence of degenerative changes, calcifications and measurement of the carrying angle. Outcomes were evaluated with Disabilities of the Arm, Shoulder and Hand score as an instrument to measure the patient's perceived disability. RESULTS: The group under study is made up of ten women and thirty-four men, with an average age at the time of fracture of 28.6 years (ranging from 15-40) and an average time since the fracture or follow-up time of 28.5 years (ranging from 16-38). The affectation was on the dominant side in thirty cases (23 right-handed and 7 left-handed). Thirty-nine patients (88.6%) had no elbow pain, and in all other cases was mild or moderate. Loss of mobility and strength was 1.5% for flexo-extension, 3.5% for prono-supination, 7.9% for flexion strength and 3.5% for extension strength. We appreciated four cases of valgus instability and two of postero-lateral instability. The average DASH score was 6.9 points. Radiographic changes of arthritis were present in 93.3% and 54.4% of calcifications. The mean increase of carrying angle was 7.7º compared with non-affected gide (ranking from 0.9-15.8º). CONCLUSION: Radial head resection for isolated fracture in young patients presents satisfactory results, with very low losses of elbow mobility and strength. Despite the high presence of osteoarthritic changes or lower clinical signs of instability, elbow pain and disability are very low. Our conclusion, based in these results, is that radial head resection is still a useful surgical procedure for isolated fractures even in young patients.

Vacuolar control of subcellular cation distribution is a key parameter in the adaptation of Debaryomyces hansenii to high salt concentrations.

Debaryomyces hansenii is a halotolerant and Na+-includer yeast that can be isolated from different food and low-water activity products. It has also been defined as a marine-occurring yeast but key aspects for this salt tolerant behavior are far from being understood. Here, we searched for clues helping to elucidate the basis of this ability. Our results on growth, Rb+ transport, total K+ and Na+ content and vacuolar fragmentation are compatible with a yeast species adapted to cope with salt stress. On the other hand, we confirmed the existence of D. hansenii strategies that are generally observed in sensitive organisms, such as the production of glycerol as a compatible solute and the efficient vacuolar sequestration of Na+. We propose a striking role of D. hansenii vacuoles in the maintenance of constant cytosolic K+ values, even in the presence of extracellular Na+ concentration values more than two orders of magnitude higher than extracellular K+. Finally, the ability to deal with cytosolic Na+ levels significantly higher than those found in S. cerevisiae, shows the existence of important and specific salt tolerance mechanisms and determinants in D. hansenii.

Conjunctival lymphoma in right eye: Case report. / Linfoma conjuntival de ojo derecho: a propósito de un caso.

CASE REPORT: A 43-year-old woman presented with a salmon-coloured patch of 0.7mm diameter in the right eye that extended into the lower fornix in the bulbar and tarsal conjunctiva, with irregular edges, and highly vascularised. Incisional biopsy was performed, showing it to be a low-grade conjunctival non-Hodgkin B cell lymphoma (or a mucosa associated lymphoid tissue [MALT] lymphoma). DISCUSSION: The lesion remained stable for 24 months of follow-up, when a relapse of the condition occurred, producing an enlargement of the initial lesion. The definitive diagnosis is made by biopsy of the affected tissue and histopathologic study.

Progression in children with intestinal failure at a referral hospital in Medellín, Colombia.

BACKGROUND: Patients with intestinal failure are unable to maintain adequate nutrition and hydration due to a reduction in the functional area of the intestine. Different strategies have the potential to benefit these patients by promoting intestinal autonomy, enhancing quality of life, and increasing survival. AIMS: To describe the clinical characteristics of children with intestinal failure and disease progression in terms of intestinal autonomy and survival. MATERIALS AND METHODS: A retrospective study was conducted, evaluating 33 pediatric patients with intestinal failure that were hospitalized within the time frame of December 2005 and December 2013 at a tertiary care referral center. Patient characteristics were described upon hospital admission, estimating the probability of achieving intestinal autonomy and calculating the survival rate. RESULTS: Patient median age upon hospital admission was 2 months (interquartile range [IQR]: 1-4 months) and 54.5% of the patients were boys. Intestinal autonomy was achieved in 69.7% of the cases with a median time of 148 days (IQR: 63 - 431 days), which decreased to 63 days in patients with a spared ileocecal valve. Survival was 91% during a median follow-up of 281 days (IQR: 161 - 772 days). CONCLUSIONS: Medical management of patients with intestinal failure is complex. Nutritional support and continuous monitoring are of the utmost importance and long-term morbidity and mortality depends on the early recognition and management of the associated complications.

Nanoscale imaging of buried topological defects with quantitative X-ray magnetic microscopy.

Advances in nanoscale magnetism increasingly require characterization tools providing detailed descriptions of magnetic configurations. Magnetic transmission X-ray microscopy produces element specific magnetic domain images with nanometric lateral resolution in films up to ∼100 nm thick. Here we present an imaging method using the angular dependence of magnetic contrast in a series of high resolution transmission X-ray microscopy images to obtain quantitative descriptions of the magnetization (canting angles relative to surface normal and sense). This method is applied to 55-120 nm thick ferromagnetic NdCo5 layers (canting angles between 65° and 22°), and to a NdCo5 film covered with permalloy. Interestingly, permalloy induces a 43° rotation of Co magnetization towards surface normal. Our method allows identifying complex topological defects (merons or ½ skyrmions) in a NdCo5 film that are only partially replicated by the permalloy overlayer. These results open possibilities for the characterization of deeply buried magnetic topological defects, nanostructures and devices.