Prognostic performance of an index based on lactic dehydrogenase and transaminases for patients with liver steatosis and COVID-19.

BACKGROUND: Metabolic associated fatty liver disease (MAFLD) is associated with complications and mortality in patients with coronavirus disease 2019 (COVID-19). However, there are no prognostic scores aimed to evaluate the risk of severe disease specifically in patients with MAFLD, despite its high prevalence. Lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase have been used as markers of liver damage. Therefore, we propose an index based on lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase for the prediction of complications and mortality in patients with MAFLD and COVID-19. AIM: To evaluate the prognostic performance of an index based on lactate dehydrogenase and transaminases (aspartate aminotransferase/alanine aminotransferase) in patients with COVID-19 and MAFLD [liver fibrosis and nutrition (LNF)-COVID-19 index]. METHODS: In this retrospective cohort study, two cohorts from two different tertiary centers were included. The first was the derivation cohort to obtain the score cutoffs, and the second was the validation cohort. We included hospitalized patients with severe COVID-19 and MAFLD. Liver steatosis was evaluated by computed tomography scan. Area under the receiver operating characteristic (ROC) curve analysis and survival analysis were used. RESULTS: In the derivation cohort, 44.6% had MAFLD; ROC curve analysis yielded a LFN-COVID-19 index > 1.67 as the best cutoff, with a sensitivity of 78%, specificity of 63%, negative predictive value of 91% and an area under the ROC curve of 0.77. In the multivariate analysis, the LFN-COVID-19 index > 1.67 was independently associated with the development of acute kidney injury (odds ratio: 1.8, 95% confidence interval: 1.3-2.5, P < 0.001), orotracheal intubation (odds ratio: 1.9, 95% confidence interval: 1.4-2.4, P < 0.001), and death (odds ratio: 2.86, 95% confidence interval: 1.6-4.5, P < 0.001) in both cohorts. CONCLUSION: LFN-COVID-19 index has a good performance to predict prognosis in patients with MAFLD and COVID-19, which could be useful for the MAFLD population.

Secondary sclerosing cholangitis after critical COVID-19: Three case reports.

BACKGROUND: The global coronavirus disease 2019 (COVID-19) pandemic has caused more than 5 million deaths. Multiorganic involvement is well described, including liver disease. In patients with critical COVID-19, a new entity called "post-COVID-19 cholangiopathy" has been described. CASE SUMMARY: Here, we present three patients with severe COVID-19 that subsequently developed persistent cholestasis and chronic liver disease. All three patients required intensive care unit admission, mechanical ventilation, vasopressor support, and broad spectrum antibiotics due to secondary infections. Liver transplant protocol was started for two of the three patients. CONCLUSION: Severe COVID-19 infection should be considered a potential risk factor for chronic liver disease and liver transplantation.

Geographic distribution analysis of the genusXenodacnis (Birds: Thraupidae) using ecologicalniche modeling

Xenodacnis is a monotypic thraupid genus restricted to the tropical high Andes of Peru and Ecuador. Its only species, X. parina has a large discontinuous distribution from central Ecuador to southern Peru. To date, three subspecies are recognized, all separated by geographical barriers that clouded promote allopatric events. The taxonomic affinities of the Ecuadorian population have not been assessed since its discovery in the 1970s at the Cajas National Park in Azuay province. I studied the environmental affinities between the distribution of the described subspecies and the Ecuadorian population bias ecological niche modeling. I found a distinctive ecological niche in the distribution of each of the analyzed populations and also for the southern Arequipa population. These different environmental niche conditions come apart by deep Andean valleys playing a role as geographical barriers for the isolation of these populations that need further taxonomic analysis.

Xenodacnis es un género de traupido mono típico restringido a los altos Andes tropicales de Perú y Ecuador. Su única especie, X. parina tiene una distribución extensa pero discontinua desde el centro Ecuador hasta el sur de Perú. A la fecha se reconocen tres subespecies, todas separadas por barreras geográficas que pudieron promover eventos alopátricos. Las afinidades taxonómicas de la población de ecuador no se han analizado desde su descubrimiento en los años 70 dentro del Parque Nacional Cajas en la provincia del Azuay. Yo estudié las afinidades ambientales entre las distribuciones de las subespecies descritas y la población en Ecuador mediante modelos de nicho ambiental. Encontré diferentes condiciones ambientales en los nichos de cada una de las poblaciones analizadas y también para la población sureña de Arequipa. Estas diferencias ambientales están separadas por profundos valles Andinos que cumplen el roll de barreras geográficas para el aislamiento de estas poblaciones que necesitan un próximo análisis taxonómico.

Left superior vena cava draining into the left atrium: Clinical entities, diagnosis and surgical treatment.

Left superior vena cava draining into the left atrium in the absence of coronary sinus is an anomaly that can appear in heterotaxy syndrome and unroofed coronary sinus syndrome. Regardless of the origin of these syndromes, biventricular repair can be done through rerouting by intracardiac procedures or through disconnection-reconnection of the left superior vena cava to the right atrium or right superior vena cava by extracardiac procedures. Different techniques can be used for this purpose, each of which has its own advantages and limitations. Therefore, appropriate selection is necessary to obtain the best results for each patient, and many factors, such as patient anatomy, age, associated cardiomyopathies, etc., have to be considered. In this review, we focus on heterotaxy and unroofed coronary sinus syndromes, associated cardiomyopathies, the state-of-the-art in their surgical treatment and our results in a sample of 10 patients. Our experience highlights the importance of accurate diagnosis and specific selection of surgical technique for the management of biventricular repair in patients with left superior vena cava draining into the left atrium in the absence of coronary sinus.

Aortic coarctation, aneurysm, and ventricular dysfunction in an asymptomatic infant.

Aortic arch coarctation with post-coarctation aneurysm is rare in infants. We present the case of an asymptomatic 3-month-old infant with severe left ventricular dysfunction in this setting. The patient underwent surgical repair, and the left ventricular ejection fraction improved to recovery the 4th post-operative month.

Pulmonary vasodilator therapy and early postoperative outcome after modified Fontan operation.

Although mortality is low after the modified Fontan procedure, there is a significant percentage of patients with prolonged postoperative recovery. The objective of this study is to evaluate the usefulness of postoperative administration of oral sildenafil and inhaled nitric oxide on early postoperative outcome. A prospective interventional and comparison study with a historical cohort was conducted. Between January, 2010 and March, 2013, 16 patients received oral sildenafil during immediate modified Fontan postoperative period. Inhaled nitric oxide was also administered if the patient was kept intubated 12 hours after surgery. Early postoperative outcome was compared with a historical cohort of 32 patients on whom the modified Fontan procedure was performed between March, 2000 and December, 2009. Postoperative administration of sildenafil and nitric oxide had no influence on early postoperative outcome after the modified Fontan procedure in terms of duration of pleural effusions, mechanical ventilation time, length of stay in the ICU, and length of hospital stay.

Evolution and structure of Tomato spotted wilt virus populations: evidence of extensive reassortment and insights into emergence processes.

Tomato spotted wilt virus (TSWV; genus Tospovirus, family Bunyaviridae) genetic diversity was evaluated by sequencing parts of the three RNA genome segments of 224 isolates, mostly from pepper and tomato crops in southern Europe. Eighty-three per cent of the isolates showed consistent clustering into three clades, corresponding to their geographical origin, Spain, France or the USA, for the three RNA segments. In contrast, the remaining 17% of isolates did not belong to the same clade for the three RNA segments and were shown to be reassortants. Among them, eight different reassortment patterns were observed. Further phylogenetic analyses provided insights into the dynamic processes of the worldwide resurgence of TSWV that, since the 1980s, has followed the worldwide dispersal of the western flower thrips (Frankliniella occidentalis) tospovirus vector. For two clades composed essentially of Old World (OW) isolates, tree topology suggested a local re-emergence of indigenous TSWV populations following F. occidentalis introductions, while it could not be excluded that the ancestors of two other OW clades were introduced from North America contemporarily with F. occidentalis. Finally, estimation of the selection intensity that has affected the evolution of the NSs and nucleocapsid proteins encoded by RNA S of TSWV suggests that the former could be involved in the breakdown of resistance conferred by the Tsw gene in pepper.

Resistance to Cucurbit yellow stunting disorder virus in Cucumber.

Three hundred accessions of Cucumis sativus, including wild cucumbers, land races, traditional cultivars, and breeding lines, were evaluated under natural-infection conditions in order to identify potential sources of resistance to Cucurbit yellow stunting disorder virus (CYSDV). Although 100% of the susceptible control plants showed typical yellowing symptoms induced by CYSDV, another 24 C. sativus accessions showed partial or total absence of yellowing symptoms. In contrast, when CYSDV inoculation was carried out under controlled conditions, only two (A1 and A2) of these 24 accessions showed resistance to the virus. The nature of the resistance found in A1 and A2 plants was characterized by studying the pattern of virus accumulation and symptom development under controlled infection conditions, and by analyzing the possible nonpreference of Bemisia tabaci for these accessions under free-choice conditions. There was a delay in the establishment of the CYSDV infection in A1 and A2 plants which was evident shortly after inoculation and in apical leaves of the plants at long times after inoculation. Symptom severity was also less for A1 and A2 than for a susceptible control at 8 and 12 weeks postinoculation. Thus, delayed viral infection appeared to be associated with decreased symptom severity in A1 and A2 plants. Our results also showed nonpreference for plants of the A2 accession by B. tabaci, the CYSDV vector.

Further variability within the genus Crinivirus, as revealed by determination of the complete RNA genome sequence of Cucurbit yellow stunting disorder virus.

The complete nucleotide (nt) sequences of genomic RNAs 1 and 2 of Cucurbit yellow stunting disorder virus (CYSDV) were determined for the Spanish isolate CYSDV-AlLM. RNA1 is 9123 nt long and contains at least five open reading frames (ORFs). Computer-assisted analyses identified papain-like protease, methyltransferase, RNA helicase and RNA-dependent RNA polymerase domains in the first two ORFs of RNA1. This is the first study on the sequences of RNA1 from CYSDV. RNA2 is 7976 nt long and contains the hallmark gene array of the family Closteroviridae, characterized by ORFs encoding a heat shock protein 70 homologue, a 59 kDa protein, the major coat protein and a divergent copy of the coat protein. This genome organization resembles that of Sweet potato chlorotic stunt virus (SPCSV), Cucumber yellows virus (CuYV) and Lettuce infectious yellows virus (LIYV), the other three criniviruses sequenced completely to date. However, several differences were observed. The most striking novel features of CYSDV compared to SPCSV, CuYV and LIYV are a unique gene arrangement in the 3'-terminal region of RNA1, the identification in this region of an ORF potentially encoding a protein which has no homologues in any databases, and the prediction of an unusually long 5' non-coding region in RNA2. Additionally, the CYSDV genome resembles that of SPCSV in having very similar 3' regions in RNAs 1 and 2, although for CYSDV similarity in primary structures did not result in predictions of equivalent secondary structures. Overall, these data reinforce the view that the genus Crinivirus contains considerable genetic variation. Additionally, several subgenomic RNAs (sgRNAs) were detected in CYSDV-infected plants, suggesting that generation of sgRNAs is a strategy used by CYSDV for the expression of internal ORFs.

Melon Resistance to Cucurbit yellow stunting disorder virus Is Characterized by Reduced Virus Accumulation.

ABSTRACT The pattern of accumulation of Cucurbit yellow stunting disorder virus (CYSDV; genus Crinivirus, family Closteroviridae) RNA has been analyzed in several cucurbit accessions. In susceptible accessions of melon (Cucumis melo), cucumber (Cucumis sativus), marrow (Cucurbita maxima), and squash (Cucurbita pepo), CYSDV RNA accumulation peaked during the first to second week postinoculation in the first to third leaf above the inoculated one; younger leaves showed very low or undetectable levels of CYSDV. Three melon accessions previously shown to remain asymptomatic after CYSDV inoculation under natural conditions were also assayed for their susceptibility to CYSDV. Hybridization and reverse transcription-polymerase chain reaction (RT-PCR) analysis of noninoculated leaves showed that only one of these, C-105, remained virus-free for up to 6 weeks after whitefly inoculation. In this accession, very low CYSDV levels were detected by RT-PCR in whitefly-inoculated leaves, and therefore, multiplication or spread of CYSDV in C-105 plants appeared to remain restricted to the inoculated leaves. When C-105 plants were graft inoculated, CYSDV RNA could be detected in phloem tissues, but the systemic colonization of C-105 by CYSDV upon graft inoculation seemed to be seriously impeded. Additionally, in situ hybridization experiments showed that, after C-105 graft inoculation, only a portion of the vascular bundles in petioles and stems were colonized by CYSDV and virus could not be found in leaf veins. RT-PCR experiments using primers to specifically detect negative-sense CYSDV RNA were carried out and showed that CYSDV replication took place in graft-inoculated C-105 scions. Therefore, the resistance mechanism may involve a restriction of the virus movement in the vascular system of the plants and/or prevention of high levels of virus accumulation.

Dolor precordial en pacientes hospitalizados en el servicio de medicina interna del Hospital General de Medellin, septiembre de 1986 a septiembre de 1987 / Chest pain in patients hospitalized in the internal medicine service of Hospital General de Medellin, september 1986 to september 1987

Se realizo este estudio retrospectivo en el servicio de medicina interna del hospital general de Medellin, con el fin de conocer las causas de dolor precordial y su relacion con ciertas variables clinicas, tomando una muestra de 48 pacientes, entre septiembre 1986 a septiembre de 1987 que consultaron por esta causa