Major adverse cardiovascular events (MACE) in patients with severe COVID-19 registered in the ISARIC WHO clinical characterization protocol: A prospective, multinational, observational study.

PURPOSE: To determine its cumulative incidence, identify the risk factors associated with Major Adverse Cardiovascular Events (MACE) development, and its impact clinical outcomes. MATERIALS AND METHODS: This multinational, multicentre, prospective cohort study from the ISARIC database. We used bivariate and multivariate logistic regressions to explore the risk factors related to MACE development and determine its impact on 28-day and 90-day mortality. RESULTS: 49,479 patients were included. Most were male 63.5% (31,441/49,479) and from high-income countries (84.4% [42,774/49,479]); however, >6000 patients were registered in low-and-middle-income countries. MACE cumulative incidence during their hospital stay was 17.8% (8829/49,479). The main risk factors independently associated with the development of MACE were older age, chronic kidney disease or cardiovascular disease, smoking history, and requirement of vasopressors or invasive mechanical ventilation at admission. The overall 28-day and 90-day mortality were higher among patients who developed MACE than those who did not (63.1% [5573/8829] vs. 35.6% [14,487/40,650] p < 0.001; 69.9% [6169/8829] vs. 37.8% [15,372/40,650] p < 0.001, respectively). After adjusting for confounders, MACE remained independently associated with higher 28-day and 90-day mortality (Odds Ratio [95% CI], 1.36 [1.33-1.39];1.47 [1.43-1.50], respectively). CONCLUSIONS: Patients with severe COVID-19 frequently develop MACE, which is independently associated with worse clinical outcomes.

Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients.

BACKGROUND: Procalcitonin (PCT) and C-Reactive Protein (CRP) are useful biomarkers to differentiate bacterial from viral or fungal infections, although the association between them and co-infection or mortality in COVID-19 remains unclear. METHODS: The study represents a retrospective cohort study of patients admitted for COVID-19 pneumonia to 84 ICUs from ten countries between (March 2020-January 2021). Primary outcome was to determine whether PCT or CRP at admission could predict community-acquired bacterial respiratory co-infection (BC) and its added clinical value by determining the best discriminating cut-off values. Secondary outcome was to investigate its association with mortality. To evaluate the main outcome, a binary logistic regression was performed. The area under the curve evaluated diagnostic performance for BC prediction. RESULTS: 4635 patients were included, 7.6% fulfilled BC diagnosis. PCT (0.25[IQR 0.1-0.7] versus 0.20[IQR 0.1-0.5]ng/mL, p<0.001) and CRP (14.8[IQR 8.2-23.8] versus 13.3 [7-21.7]mg/dL, p=0.01) were higher in BC group. Neither PCT nor CRP were independently associated with BC and both had a poor ability to predict BC (AUC for PCT 0.56, for CRP 0.54). Baseline values of PCT<0.3ng/mL, could be helpful to rule out BC (negative predictive value 91.1%) and PCT≥0.50ng/mL was associated with ICU mortality (OR 1.5,p<0.001). CONCLUSIONS: These biomarkers at ICU admission led to a poor ability to predict BC among patients with COVID-19 pneumonia. Baseline values of PCT<0.3ng/mL may be useful to rule out BC, providing clinicians a valuable tool to guide antibiotic stewardship and allowing the unjustified overuse of antibiotics observed during the pandemic, additionally PCT≥0.50ng/mL might predict worsening outcomes.

A novel model to predict severe COVID-19 and mortality using an artificial intelligence algorithm to interpret chest radiographs and clinical variables.

Background: Patients with coronavirus disease 2019 (COVID-19) could develop severe disease requiring admission to the intensive care unit (ICU). This article presents a novel method that predicts whether a patient will need admission to the ICU and assesses the risk of in-hospital mortality by training a deep-learning model that combines a set of clinical variables and features in chest radiographs. Methods: This was a prospective diagnostic test study. Patients with confirmed severe acute respiratory syndrome coronavirus 2 infection between March 2020 and January 2021 were included. This study was designed to build predictive models obtained by training convolutional neural networks for chest radiograph images using an artificial intelligence (AI) tool and a random forest analysis to identify critical clinical variables. Then, both architectures were connected and fine-tuned to provide combined models. Results: 2552 patients were included in the clinical cohort. The variables independently associated with ICU admission were age, fraction of inspired oxygen (F iO2 ) on admission, dyspnoea on admission and obesity. Moreover, the variables associated with hospital mortality were age, F iO2 on admission and dyspnoea. When implementing the AI model to interpret the chest radiographs and the clinical variables identified by random forest, we developed a model that accurately predicts ICU admission (area under the curve (AUC) 0.92±0.04) and hospital mortality (AUC 0.81±0.06) in patients with confirmed COVID-19. Conclusions: This automated chest radiograph interpretation algorithm, along with clinical variables, is a reliable alternative to identify patients at risk of developing severe COVID-19 who might require admission to the ICU.

Application of udder surface temperature by infrared thermography for diagnosis of subclinical mastitis in Holstein cows located in tropical highlands.

Several reports have indicated that udder surface temperature (UST) can be a useful indicator of subclinical mastitis (SCM). The objective was to evaluate UST by infrared thermography (IRT) as a diagnostic tool for SCM and intramammary infection (IMI), and to assess the influence of environmental conditions in the potential diagnosis of this disease in dairy cows located at high-altitude tropical regions. A total of 105 cows (397 quarters) from 3 dairy farms with mechanical and manual milking methods were enrolled in the study. Subclinical mastitis was diagnosed when quarter samples had a somatic cell count (SCC) ≥200 × 103 cells/mL, microbial growth (MG) was defined when a major pathogen (≥1 cfu/plate) or Corynebacterium spp. (≥10 cfu/plate) was isolated, and IMI was defined as the presence of MG and SCC ≥100 × 103 cells/mL. Infrared images were taken with a thermal camera placed 1 m away from the udder, and shots of the rear and left and right lateral view were made during the morning milking, before any manipulation of the udder and employing dark cardboard on the contralateral side to avoid artifacts in the background. A multilevel mixed effects linear regression model clustered within cows and herd was performed to evaluate the associations with UST. Clinical performance was evaluated using the Youden index to establish the optimum UST thresholds, which were set at 32.6°C for any case definition when milking was by hand, at 33.7°C for MG, and at 34°C for SCM and IMI in machine-milked quarters. Sensitivity (Se), specificity (Sp), area under curve (AUC), and positive likelihood ratio (+LR) were also assessed. Test agreement was assessed by kappa coefficient (κ). The UST of healthy quarters ranged between (95% CI) 32.4 and 32.6°C, lower than SCM quarters (n = 88) at 32.9°C (95% CI: 32.7-33.1 °C), MG quarters (n = 56) at 33.5°C (95% CI: 33.3-33.7°C), and IMI quarters (n = 50) at 33.5°C (95% CI: 33.2-33.7 °C). The UST was also related to the milking method: higher temperatures were observed for hand milking (n = 90) compared with machine milking (n = 185). No relation between environmental conditions such as wind speed, atmospheric temperature, relative humidity, and temperature-humidity index and UST were observed during this study. For hand milking, the optimal UST threshold was 32.6°C; for SCM, Se = 0.53, Sp = 0.89, AUC = 0.71, κ = 0.4; for MG, Se = 0.83, Sp = 0.93, AUC = 0.88, κ = 0.77; and for IMI, Se = 0.82, Sp = 0.92, AUC = 0.87, κ = 0.74. The machine milking threshold for SCM resulted in Se = 0.42, Sp = 0.97, AUC = 0.70, κ = 0.47; for MG, Se = 0.82, Sp = 0.89, AUC = 0.85, κ = 0.60; and for IMI, Se = 0.82, Sp = 0.98, AUC = 0.90, κ = 0.79. These findings suggest that UST determined by IRT is higher in machine-milked cows and in quarters with MG and IMI than in healthy quarters; therefore, UST by IRT is a reliable, clinically useful method for MG and IMI diagnosis.

Dissipative electron transfer dynamics in mixed valence dimers: microscopic approach to the solid state problem.

We propose a microscopic analytical approach to the description of the low-temperature dissipative intracluster electron transfer dynamics in centrosymmetric one-electron mixed-valence (MV) dimers. The dissipative system (bath) is supposed to consist of the acoustic phonons of the crystal surrounding that are coupled to the delocalized electron(s) of a MV dimer. Although the concept of the bath is the spin-boson model is more generic, the present consideration is relevant, for example, to a MV bi-center impurity in an ionic crystal. The model allows us to develop an approximate microscopic approach within which the relaxation processes are explicitly taken into account without additional assumption regarding spectral function of the bath. It is assumed that initially the extra electron is localized on a certain center and then the time-dependent localization probability (averaged value of the electron dipole moment) is evaluated with the emphasis on the damping of the amplitude of the Rabi oscillations. The approach assumes the following conditions: (i) the vibrational spectrum of the crystal does not show the presence of local modes; (ii) the itinerant electron is weakly coupled to the long-waves acoustic phonons which is peculiar to fully delocalized Robin and Day class III MV systems; (iii) the Debye energy ℏωD exceeds the electronic resonance energy gap 2ß (ß is the electron transfer parameter). We have demonstrated that the dissipation in this case is super-ohmic with the low-frequency spectral function J(ω) ∝ ω(5). The time dependences of the localization probabilities show nearly picosecond damped oscillations. The longitudinal relaxation time T1 has been shown to be two times shorter than the decoherence time T2 thus giving the upper bound for T2, T2 ≤ 2T1.

Electric field control of the spin state in mixed-valence magnetic molecules.

Multiferroic molecules for spintronics: In a many-electron mixed-valence dimer with dominant double exchange, as compared with antiferromagnetic superexchange, the electric field is shown to induce a spin crossover from the ferromagnetic spin state to the antiferromagnetic one. This leads to a sharp decrease in the magnetic moment of the molecule and a simultaneous stepwise increase in the electric dipole (see figure).

Perfil epidemiológico de los tumores testiculares tratados en el Hospital Clínico de la Universidad de Chile: 1992-1999 / Epidemiological profile of testicular cancers treated in the Universidad de Chile Clinical Hospital: 1992-1999

El carcinoma testicular es la neoplasia sólida maligna más común en hombres entre 15 y 35 años. Su incidencia en Chile es desconocida. Anualmente fallecen en Chile unos 100 pacientes por esta patología, duplicándose su mortalidad en los últimos 30 años. El objetivo de este trabajo es caracterizar clínicamente a los pacientes tratados por el diagnóstico de cáncer testicular. Es un estudio descriptivo, retrospectivo, de una muestra de 244 pacientes con diagnóstico de cáncer testicular tratados en el Servicio de Urología del Hospital J.J. Aguirre, entre los años 1992 y 1999. Se analizó edad, antecedente de criptorquidia, lado afectado, presentación clínica, tiempo de latencia en consultar e histología. El promedio de edad fue de 30 años, con 84 por ciento menor de 35 años. Un 4 por ciento fue bilateral, un 50 por ciento izquierdo y 46 por ciento derecho. Un 50 por ciento se presentó con aumento de volumen indoloro, un 38 por ciento aumento de volumen doloroso, un 6 por ciento dolor sin aumento de volumen y un 6 por ciento presentó manifestaciones metastásicas. El tiempo promedio de latencia en la consulta fue de 14,5 semanas. El análisis histológico reveló 38 por ciento de seminomas, 34 por ciento de tumores no seminomas y 28 por ciento de histología mixta. Se concluye que los cánceres testiculares afectan a la población joven. Son predominantemente unilaterales. El aumento de volumen gonadal está presente en cerca de un 88 por ciento de los casos. El autoexamen podría constituir un importante método de screening. Se debe realizar una campaña de educación dirigida a promover el autoexamen y a motivar una consulta precoz, disminuyendo los tiempos de latencia y por consiguiente mejorando el pronóstico