Encoding of Predictive Associations in Human Prefrontal and Medial Temporal Neurons During Pavlovian Appetitive Conditioning.

Pavlovian conditioning is thought to involve the formation of learned associations between stimuli and values, and between stimuli and specific features of outcomes. Here, we leveraged human single neuron recordings in ventromedial prefrontal, dorsomedial frontal, hippocampus, and amygdala while patients of both sexes performed an appetitive Pavlovian conditioning task probing both stimulus-value and stimulus-stimulus associations. Ventromedial prefrontal cortex encoded predictive value along with the amygdala, and also encoded predictions about the identity of stimuli that would subsequently be presented, suggesting a role for neurons in this region in encoding predictive information beyond value. Unsigned error signals were found in dorsomedial frontal areas and hippocampus, potentially supporting learning of non-value related outcome features. Our findings implicate distinct human prefrontal and medial temporal neuronal populations in mediating predictive associations which could partially support model-based mechanisms during Pavlovian conditioning.

Effect on Kidney Function Recovery Guiding Decongestion with VExUS in Patients with Cardiorenal Syndrome 1: A Randomized Control Trial.

INTRODUCTION: In cardiorenal syndrome type 1 (CRS1), vascular congestion is central to the pathophysiology of heart failure and thus a key target for management. The venous evaluation by ultrasound (VExUS) system could guide decongestion effectively and thereby improve outcomes. METHODS: In this randomized clinical trial, patients with CRS1 (i.e., increase in creatinine ≥0.3 mg/dL) were randomized to guide decongestion with VExUS compared to usual clinical evaluation. The primary endpoint was to assess kidney function recovery (KFR), and the key secondary endpoint was decongestion evaluated by physical examination and changes in brain natriuretic peptide (BNP) and CA-125. Exploratory endpoints included days of hospitalization and mortality. RESULTS: From March 2022 to February 2023, a total of 140 patients were randomized 1:1 (70 in the VExUS and 70 in the control group). KFR was not statistically different between groups. However, VExUS improved more than twice the odds to achieve decongestion (odds ratio [OR]: 2.6, 95% CI: 1.9-3.0, p = 0.01) and the odds to reach a decrease of BNP >30% (OR: 2.4, 95% CI: 1.3-4.1, p = 0.01). The survival at 90 days, recongestion, and CA-125 were similar between groups. CONCLUSION: In patients with CRS1, we observed that VExUS-guided decongestion did not improve the probability of KFR but improved the odds to achieve decongestion.

Benthic sediment as stores and sources of bacteria and viruses in streams: A comparison of baseflow vs. stormflow longitudinal transport and residence times.

The presence of bacteria and viruses in freshwater represents a global health risk. The substantial spatial and temporal variability of microbes leads to difficulties in quantifying the risks associated with their presence in freshwater. Fine particles, including bacteria and viruses are transported and accumulated into shallow streambed (i.e., benthic) sediment, delaying the downstream transmission during baseflow conditions but contributing to their resuspension and transport downstream during stormflow events. Direct measurements of pathogen accumulation in benthic sediments are rare. Until now, the dynamic role of benthic sediment as both a store and source of microbes, has not been quantified. In this study, we analyze microbial abundance in benthic sediment along a 1 km reach of an intermittent Mediterranean stream receiving inputs from the effluent of a wastewater treatment plant, a known point source of microbes in streams. We sampled benthic sediment during a summer drought when the wastewater effluent constituted 100 % of the stream flow, and thus, large accumulation and persistence of pathogens along the streambed was expected. We measured the abundance of total bacteria, Escherichia coli (as a fecal indicator), and presence of enteric rotavirus (RoV) and norovirus (NoV). The abundance of E. coli, based on qPCR detection, was high (4.99∙102 gc /cm2) along the first 100 m downstream of the wastewater effluent input and in general decreased with distance from the source, with presence of RoV and NoV along the study reach. A particle tracking model was applied, that uses stream water velocity as an input, and accounts for microbial exchange into, immobilization, degradation, and resuspension out of benthic sediment during baseflow and stormflow. Rates of exchange into benthic sediment were 3 orders of magnitude higher during stormflow, but residence times were proportionately lower, resulting in increased longitudinal connectivity from up to downstream during stormflow. Model simulations demonstrated mechanistically how the rates of exchange into and out of the benthic sediment resulted in benthic sediment to act as a store during baseflow and a source during stormflow.

Fluid-Solid Reaction in Porous Media as a Chaotic Restart Process.

Chemical and biological reactions at fluid-solid interfaces are central to a broad range of porous material applications and research. Pore-scale solute transport limitations can reduce reaction rates, with marked consequences for a wide spectrum of natural and engineered processes. Recent advances show that chaotic mixing occurs spontaneously in porous media, but its impact on surface reactions is unknown. We show that pore-scale chaotic mixing significantly increases reaction efficiency compared to nonchaotic flows. We find that reaction rates are well described in terms of diffusive first-passage times of reactants to the solid interface subjected to a stochastic restart process resulting from Lagrangian chaos. Under chaotic mixing, the shear layer at no-slip interfaces sets the restart rate and leads to a characteristic scaling of reaction efficiency with Péclet number, in excellent agreement with numerical simulations. Reaction rates are insensitive to the flow topology as long as flow is chaotic, suggesting the relevance of this process to a broad range of porous materials.

Neurons in human pre-supplementary motor area encode key computations for value-based choice.

Adaptive behaviour in real-world environments requires that choices integrate several variables, including the novelty of the options under consideration, their expected value and uncertainty in value estimation. Here, to probe how integration over decision variables occurs during decision-making, we recorded neurons from the human pre-supplementary motor area (preSMA), ventromedial prefrontal cortex and dorsal anterior cingulate. Unlike the other areas, preSMA neurons not only represented separate pre-decision variables for each choice option but also encoded an integrated utility signal for each choice option and, subsequently, the decision itself. Post-decision encoding of variables for the chosen option was more widely distributed and especially prominent in the ventromedial prefrontal cortex. Our findings position the human preSMA as central to the implementation of value-based decisions.

Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

Asymptomatic hyperuricaemia and coronary artery disease. / Hiperuricemia asintomática y enfermedad arterial coronaria.

BACKGROUND: Uric acid has been related to a tendency to precipitate to form crystals, presenting asymptomatically, until the formation of arthritis, tophi or renal lithiasis. Previously, the presence of asymptomatic hyperuricaemia has been associated with the presence of cardiovascular disease. OBJECTIVES: To determine the association of complex coronary artery disease in patients with asymptomatic hyperuricaemia. MATERIAL AND METHODS: An observational retrospective, transversal, unicentric study was conducted in a tertiary hospital in Mexico, in the period from June 2017 to March 2019. All patients admitted for coronary angiography were included; patients with gout, use of diuretics and chronic kidney disease were excluded. RESULTS: During the study period, a total of 300 patients were collected, of which 40% presented hyperuricaemia. The patients with hyperuricaemia were older (59 vs. 63, P = .002). The group of patients with asymptomatic hyperuricaemia had a higher proportion of complex coronary lesions (64 vs. 35%, P ≤ .0001) as well as a higher SYNTAX I score (27 vs. 17, P ≤ .001). There was a higher probability of presenting complex coronary lesions in this group of patients (OR 3.4, P ≤ .0001). In addition, in the group division of uric acid levels, it was related to the presence of complex coronary lesions (Q1 = .5, P = .06), (Q2 = 2, P = .01) and (Q3 = 3, P ≤ .0001). CONCLUSION: Asymptomatic hyperuricaemia has a higher prevalence and association of presenting complex coronary lesions.

Left Atrial Strain in Patients With Systemic Lupus Erythematosus. / Deformación miocárdica de la aurícula izquierda en pacientes con lupus eritematoso sistémico.

BACKGROUND: In patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. OBJECTIVE: To evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. METHODS: Fifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. RESULTS: LAGLS in SLE patients was less than in the controls (41.6% vs. 50.5%; p=.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5s-1 vs. controls 2.75s-1; p=.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. CONCLUSIONS: SLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.

Value-Related Neuronal Responses in the Human Amygdala during Observational Learning.

The amygdala plays an important role in many aspects of social cognition and reward learning. Here, we aimed to determine whether human amygdala neurons are involved in the computations necessary to implement learning through observation. We performed single-neuron recordings from the amygdalae of human neurosurgical patients (male and female) while they learned about the value of stimuli through observing the outcomes experienced by another agent interacting with those stimuli. We used a detailed computational modeling approach to describe patients' behavior in the task. We found a significant proportion of amygdala neurons whose activity correlated with both expected rewards for oneself and others, and in tracking outcome values received by oneself or other agents. Additionally, a population decoding analysis suggests the presence of information for both observed and experiential outcomes in the amygdala. Encoding and decoding analyses suggested observational value coding in amygdala neurons occurred in a different subset of neurons than experiential value coding. Collectively, these findings support a key role for the human amygdala in the computations underlying the capacity for learning through observation.SIGNIFICANCE STATEMENT Single-neuron studies of the human brain provide a unique window into the computational mechanisms of cognition. In this study, epilepsy patients implanted intracranially with hybrid depth electrodes performed an observational learning (OL) task. We measured single-neuron activity in the amygdala and found a representation for observational rewards as well as observational expected reward values. Additionally, distinct subsets of amygdala neurons represented self-experienced and observational values. This study provides a rare glimpse into the role of human amygdala neurons in social cognition.

Kinetics of contact processes under segregation.

The kinetics of contact processes are determined by the interplay among local mass transfer mechanisms, spatial heterogeneity, and segregation. Determining the macroscopic behavior of a wide variety of phenomena across the disciplines requires linking reaction times to the statistical properties of spatially fluctuating quantities. We formulate the dynamics of advected agents interacting with segregated immobile components in terms of a chemical continuous-time random walk. The inter-reaction times result from the first-passage times of mobile species to and across reactive regions, and available immobile reactants undergo a restart procedure. Segregation leads to memory effects and enhances the role of concentration fluctuations in the large-scale dynamics.

Survival and confinement under quenched disorder.

We study the survival and confinement of random walkers under quenched disorder characterized by spatially-varying waiting times and decay rates. Spatial heterogeneity and segregation lead to a dynamic coupling between transport and reaction, resulting in history-dependent dynamics exhibiting long survivals and confinement. The survival probability decays as a power law, in contrast to the classical exponential law for decay at a homogeneous rate. The mean squared displacement shows dimension-dependent subdiffusive growth followed by localization, with stronger confinement in higher dimensions.

Long QT syndrome secondary to drug interaction between hydroxychloroquine and amiodarone / Síndrome de QT largo secundario a la interacción entre hidroxicloroquina y amiodarona

Abstract: A 67-year-old female patient with a diagnosis of heart failure with preserved ejection fraction secondary to severe mitral regurgitation in treatment with metoprolol, spironolactone, and digoxin. She was diagnosed systemic lupus erythematosus (SLE) because of the presence of arthritis, alopecia, thrombocytopenia, direct positive Coombs +++, positive ANAs 1:1,280 and positive lupus anticoagulant. The rheumatology service indicated hydroxychloroquine 200 mg every 24 hours. She presented atrial fibrillation, and amiodarone was initiated. Two weeks later the patient was admitted because of presyncope, electrocardiogram showed sinus bradycardia with long QT interval. A temporary pacemaker was placed, and hydroxychloroquine and amiodarone suspended. Twenty-four hours later, a new electrocardiogram was taken showing pacemaker rhythm with reduction of the QT interval. After 72 hours the temporary pacemaker was removed and on the fifth day the patient was discharged with an electrocardiogram in sinus rhythm with a corrected QT (Bazett) of 456 miliseconds. The hydroxychloroquine was reinitiated following discharge. She presented another episode of atrial fibrillation, and was treated with amiodarone, hydroxychloroquine was suspended previously, and she did not present prolongation of QT interval. The long QT syndrome was present when amiodarone and hydroxychloroquine interacted.(AU)

Resumen: Paciente femenina de 67 años, con diagnóstico de insuficiencia cardiaca con fracción de expulsión preservada, secundaria a insuficiencia mitral severa, en tratamiento con metoprolol, espironolactona y digoxina. Le fue diagnosticado lupus eritematoso sistémico, debido a la presencia de artritis, alopecia, trombocitopenia, Coombs directo positivo +++, anticuerpos antinucleares positivos 1:1,280 y anticoagulante lúpico positivo. El Servicio de Reumatología indicó hidroxicloroquina 200 mg cada 24 horas. Presentó fibrilación auricular, por lo que se le inició amiodarona. Dos semanas posteriores la paciente es ingresada debido a un episodio de presíncope, se le realizó electrocardiograma que demostró bradicardia sinusal con un intervalo QT prolongado. Se le colocó un marcapasos temporal, además de que se suspendió hidroxicloroquina y amiodarona. Después de 72 horas se retiró el marcapasos, y al quinto día se egresó con un electrocardiograma en ritmo sinusal con el intervalo QT corregido por Bazett de 456 milisegundos. La hidroxicloroquina fue reiniciada al egreso. La paciente presentó otro episodio de fibrilación auricular y fue tratada con amiodarona, previa suspensión de hidroxicloroquina, sin presentar prolongación del intervalo QT. El síndrome de QT largo sólo se presentó con la interacción de amiodarona con hidroxicloroquina.(AU)

[Case series of Clostridium difficile NAP1/027/BI with novels treatments]. / Serie de casos de Clostridium difficile cepa NAP1/027/BI con novedosos tratamientos.

BACKGROUND: Clostridium difficile is a spore-forming bacterium, producing exotoxins, causing potentially fatal nosocomial diarrhea. They have recently reported outbreaks of C. difficile ribotype 027, which is characterized by a hypervirulent strain and high resistance to standard therapy. CLINICAL CASE: We present three cases of Clostridium difficile NAP1/027/BI associated infection, they were presented with different clinical manifestations. Two of the patients were successfully treated with the combination of vancomycin plus tigecycline. The other case was treated with fecal microbiota transplant, with resolution of the disease. CONCLUSION: in patients with Clostridium difficile NAP1/027/BI associated infection is a good therapeutic option to consider the use of tigecycline in conjunction with vancomycin, as well as fecal microbiota transplantation.

INTRODUCCIÓN: Clostridium difficile es una bacteria formadora de esporas, productoras de exotoxinas, causante de diarrea nosocomial potencialmente mortal. En fechas recientes se han reportado brotes de C. difficile ribotipo 027, la cual se caracteriza por ser una cepa hipervirulenta y de gran resistencia al tratamiento habitual. CASO CLÍNICO: presentamos tres casos que fueron diagnosticados con Clostridium difficile cepa NAP1/027/BI, los cuales cursaron con diferentes cuadros clínicos. Dos de los pacientes fueron tratados exitosamente con la combinación de vancomicina más tigeciclina. El otro caso fue tratado con trasplante de microbiota fecal, con resolución de la enfermedad. CONCLUSIONES: en pacientes con infección asociada a Clostridium difficile cepa NAP1/027/BI, es una buena opción terapéutica el considerar el uso de tigeciclina en conjunto con vancomicina, así como el trasplante de microbiota fecal.

Chemical Continuous Time Random Walks.

Kinetic Monte Carlo methods such as the Gillespie algorithm model chemical reactions as random walks in particle number space. The interreaction times are exponentially distributed under the assumption that the system is well mixed. We introduce an arbitrary interreaction time distribution, which may account for the impact of incomplete mixing on chemical reactions, and in general stochastic reaction delay, which may represent the impact of extrinsic noise. This process defines an inhomogeneous continuous time random walk in particle number space, from which we derive a generalized chemical master equation. This leads naturally to a generalization of the Gillespie algorithm. Based on this formalism, we determine the modified chemical rate laws for different interreaction time distributions. This framework traces Michaelis-Menten-type kinetics back to finite-mean delay times, and predicts time-nonlocal macroscopic reaction kinetics as a consequence of broadly distributed delays. Non-Markovian kinetics exhibit weak ergodicity breaking and show key features of reactions under local nonequilibrium.

A Process-Based Model for Bioturbation-Induced Mixing.

Bioturbation refers to the transport processes carried out by living organisms and their physical effects on soils and sediments. It is widely recognized as an important mixing mechanism, particularly at the sediment-water interface in many natural systems. In order to quantify its impact on mixing, we propose a process-based model based on simple assumptions about organism burrowing behavior. Specifically, we consider burrowing events to be stochastic but memoryless, leading to exponential inter-burrow waiting times and depths. We then explore the impact of two different transport mechanisms on the vertical concentration distributions predicted by the model for a conservative (inert) tracer. We compare the results of our model to experimental data from a recent laboratory study of bioturbation by the freshwater oligochaete worm Lumbriculus variegatus, and find good quantitative agreement.

Percutaneous coronary intervention in octogenarian patients / Intervención coronaria percutánea en pacientes octogenarios

Abstract: Introduction: Octogenarian patients are usually excluded from studies in which the effectiveness of percutaneous coronary intervention (PCI) is compared. Objective: Our aim is to compare this procedure among octogenarians and those younger; in addition to comparing the radial access (RA) and femoral access (FA) in patients older than 80 years. Material and methods: This is a retrospective, observational, comparative, longitudinal, single-center study. Patients who have been referred for PCI, from 2010 to 2016 in Monterrey, Nuevo Leon, Mexico were included. The groups were divided into the octogenarians group (OG) and a group of younger than 80 years (YG). Results: A total of 1,282 patients were collected, of whom 92 were of the OG and 1,190 were of the YG. The FA was the most used. Similar levels of radiation time (RT), radiation dose (DR), and amount of administered contrast medium (CM), vascular complications (VC) and mortality between the two groups were found. However, the OG had more length of hospital stay (LHS). Comparing the FA against RA in the OG there were no differences in RT, RD, amount of CM, VC, death and LHS. Conclusion: The results are similar between the two groups, with a greater tendency to more LHS in the OG. There were not significant differences between the RA and FA in the OG, except that LHS in the FA.

Resumen: Introducción: Los pacientes octogenarios son usualmente excluidos de los estudios en los cuales se compara la efectividad de las intervenciones coronarias percutáneas. Objetivo: Nuestro objetivo es comparar este procedimiento entre los pacientes octogenarios y aquéllos más jóvenes; además se compara el abordaje radial y el abordaje femoral en los pacientes octogenarios. Material y métodos: Éste es un estudio retrospectivo, observacional, comparativo, longitudinal, unicéntrico. Se realizó con aquellos pacientes que se refirieron para realización de un intervencionismo coronario percutáneo, en Monterrey, Nuevo León, México del 2010 al 2016. Los grupos se dividieron en el grupo de pacientes octogenarios y el grupo de pacientes menores de 80 años. Resultados: Se recabó un total de 1,282 pacientes, de los cuales 92 eran pacientes octogenarios, mientras que 1,190 fueron más jóvenes. En ambos el abordaje femoral fue el más utilizado. Se encontraron valores similares de dosis de radiación, tiempo de radiación, cantidad de contraste administrado, complicaciones vasculares y mortalidad entre los dos grupos. Sin embargo, los pacientes octogenarios tuvieron más días de estancia hospitalaria. Al comparar el abordaje femoral y el radial en octogenarios no se encontraron diferencias en dosis de radiación, tiempo de radiación, cantidad de medio de contraste, complicaciones vasculares, muerte y días de estancia hospitalaria. Conclusiones: Los resultados fueron similares entre ambos grupos de edad, con una mayor tendencia de estancia hospitalaria en octogenarios. No se encontraron diferencias significativas entre ambos abordajes en pacientes octogenarios, a excepción de mayores días de estancia hospitalaria en el abordaje femoral.

Noise-Driven Return Statistics: Scaling and Truncation in Stochastic Storage Processes.

In countless systems, subjected to variable forcing, a key question arises: how much time will a state variable spend away from a given threshold? When forcing is treated as a stochastic process, this can be addressed with first return time distributions. While many studies suggest exponential, double exponential or power laws as empirical forms, we contend that truncated power laws are natural candidates. To this end, we consider a minimal stochastic mass balance model and identify a parsimonious mechanism for the emergence of truncated power law return times. We derive boundary-independent scaling and truncation properties, which are consistent with numerical simulations, and discuss the implications and applicability of our findings.

An Integrated Experimental and Modeling Approach to Predict Sediment Mixing from Benthic Burrowing Behavior.

Bioturbation is the dominant mode of sediment transport in many aquatic environments and strongly influences both sediment biogeochemistry and contaminant fate. Available bioturbation models rely on highly simplified biodiffusion formulations that inadequately capture the behavior of many benthic organisms. We present a novel experimental and modeling approach that uses time-lapse imagery to directly relate burrow formation to resulting sediment mixing. We paired white-light imaging of burrow formation with fluorescence imaging of tracer particle redistribution by the oligochaete Lumbriculus variegatus. We used the observed burrow formation statistics and organism density to parametrize a parsimonious model for sediment mixing based on fundamental random walk theory. Worms burrowed over a range of times and depths, resulting in homogenization of sediments near the sediment-water interface, rapid nonlocal transport of tracer particles to deep sediments, and large areas of unperturbed sediments. Our fundamental, parsimonious random walk model captures the central features of this highly heterogeneous sediment bioturbation, including evolution of the sediment-water interface coupled with rapid near-surface mixing and anomalous late-time mixing resulting from infrequent, deep burrowing events. This approach provides a general, transferable framework for explicitly linking sediment transport to governing biophysical processes.

Caso de EVC isquémico y tromboembolia pulmonar asociado a foramen ovale permeable

Resumen Introducción: Caso clínico: Se presenta el caso de una paciente femenina de 53 años, con antecedente de una safenectomía 2 días previos a su ingreso. Ingresa a urgencias por cuadro de pérdida del estado de alerta súbito, Glasgow 3, por lo que se realiza intubación orotraqueal, presenta hipotensión persistente que se maneja con vasopresores. Se le realiza AngioTAC cerebral y se diagnostica EVC isquémico, es ingresado a terapia endovascular, durante el procedimiento presenta desaturación persistente, a pesar de aporte de O2 al 100, motivo por el cual se realiza Angio TAC pulmonar y se le diagnostica tromboembolia pulmonar, se realiza EcoCardiograma transtorácico el cual reporta foramen ovale permeable. Paciente posterior presenta pérdida de reflejos de tallo, se realiza TAC de cráneo que reporta conversión hemorrágica. Se diagnostica muerte cerebral un día después y se ingresa a protocolo de trasplante. Entra a cirugía de donación de órganos donde se procuran riñones, hígado, hueso y córneas.

Abstract Female patient 53 years old, presented with a history of saphenectomy two days before admission. Upon arrival to the emergency room because sudden loss of status alert, Glasgow 3, endotracheal intubation is done, she had persistent hypotension with vasopressors handled. She is performed CT angiography and cerebral ischemic stroke is diagnosed, she is entered endovascular therapy, during the procedure have persistent desaturation, despite O2 supply 100%, pulmonary CT angiography was performed and was diagnosed with pulmonary embolism, transesophageal echocardiogram is made which reports patent foramen ovale. 6 hours later patient has lost stem reflexes, cranial CT is performed reporting hemorrhagic brain conversion. It is diagnosed brain dead a day later and is entered transplant protocol. Enter organ donation surgery where kidneys, liver, bone and corneas were procurement.

Contrast-induced nephropathy in patients undergoing percutaneous coronary intervention / Nefropatía inducida por medio de contraste en angiografías coronarias

Abstract: Introduction: Contrast-induced nephropathy (CIN) is defined as the impairment of renal function and is measured as either a 25% increase in serum creatinine (SCr) from baseline or 0.5 mg/dL increase in absolute value, within 48-72 hours of intravenous contrast administration. Objectives: Objectives were to calculate incidence of CIN and to describe the clinical and periprocedural risk factors for patients receiving contrast media. Secondary objective was to compare mortality between group 1 and group 2. Material and methods: In a retrospective, observational, descriptive cohort study, patients who were admitted to the hospital for diagnostic and/or therapeutic coronary angiography between January 2014 to September 2015, the serum creatinine and glomerular filtration rate (GFR) prior to angiography and 72 hours later was measured. Results: 70 patients were included, of which 14.2% developed CIN. The leading risk factors for developing AKI were: age > 65 years (OR 12.6, CI95 1.6-105.9, p = 0.03); the presence of anemia (OR 7.5, CI95 1.8-31.2, p = 0.006); and procedural time more than 90 minutes (OR 16, CI95 3.1-85.3, p = 0.001). Higher mortality was observed in the NIC group (30% vs. 1.6%, p = 0.004). Conclusions: The incidence is higher than in the literature review. The leading associated risk factors were age > 65, anemia and procedural time > 90 minutes. The development of CIN carries a higher mortality.

Resumen: Introducción: Se define como nefropatía inducida por medio de contraste (NIC) a un aumento absoluto de la creatinina sérica mayor a 0.5 mg/dL o un aumento relativo de la creatinina sérica mayor al 25%, 48-72 horas posteriores a la exposición al medio de contraste en comparación con los niveles previos después de haber excluido otras causas de lesión renal aguda (LRA). Objetivo: Determinar la incidencia de NIC y analizar los factores de riesgo asociados en los pacientes que desarrollaron LRA posterior a un procedimiento de angiografía coronaria. Se determinó mortalidad entre ambos grupos como objetivo secundario. Material y métodos: Se realizó un estudio de cohortes, observacional, descriptivo y retroelectivo. Se analizaron los pacientes que ingresaron en enero de 2014 a septiembre de 2015, para angiografía coronaria diagnostica y/o terapéutica. Se determinó la creatinina sérica y tasa de filtración glomerular (TFG) previa a la angiografía y 72 horas; además se identificaron los factores de riesgo asociados al desarrollo de NIC. Resultados: Se incluyeron 70 pacientes, de los cuales 14.2% desarrollaron NIC. Los factores de riesgo predictores más importantes para desarrollar FRA fueron la edad > 65 años (OR 12.6; IC95 1.6-105.9, p = 0.03); la presencia de anemia (OR 7.5; IC95 1.8-31.2, p = 0.006); y una duración de procedimiento mayor a 90 minutos (OR 16; IC95 3.1-85.3, p = 0.001). Se observó mayor mortalidad en el grupo NIC (30 versus 1.6%, p = 0.004). Conclusiones: La incidencia reportada es mayor que la literatura. Los factores de riesgo asociados más importantes fueron la edad > 65, anemia y procedimiento > 90 minutos. El desarrollo de NIC conlleva una mayor mortalidad.