Usefulness of severity scales for cardiogenic shock in-hospital mortality. Proposal for a new prognostic model.

Cardiogenic shock (CS) is a condition comprising multiple etiologies, which associates high mortality rates. Some scoring systems have been shown to be good predictors of hospital mortality in patients admitted to Critical Care Units (CCU). The main objective of this study is to analyze their usefulness and validity in a cohort of CS patients. METHODS: Observational unicentric study of a cohort of CS patients. SOFA, SAPS II and APACHE II scores were calculated in the first 24 h of CCU admission. RESULTS: 130 patients with CS were included. SOFA, SAPS II and APACHE II scores revealed good discrimination for hospital mortality: (AUC) ROC values (AUC: 0.711, 0.752 and 0.742 respectively; P = .6). Calibration, estimated by the Hosmer-Lemeshow test, was adequate in all cases. Acute coronary syndrome, lactate serum values, SAPS II score and vasoactive inotropic score (VIS) were found to be independent predictors for mortality, upon ICU admission. With these variables, a specific prognostic indicator was developed (SAPS-2-LIVE), which improved predictive capability for mortality in our series (AUC) ROC, 0.825 (95% CI 0.752-0.89). CONCLUSION: In this contemporary CS cohort, the aforementioned scores have been shown to have good predictive ability for hospital mortality. These findings could contribute to a more accurate risk stratification in CS.

Current Situation and Prognostic Evolution of Combined Heart-lung Transplantation in a European Union Country.

Background: This study aims to evaluate the entire experience in heart-lung transplantation (HLTx) in a country of the European Union with 47 million inhabitants according to the etiologies that motivated the procedure. Methods: A retrospective study on 1,751 consecutive transplants (HLTx: 78) was performed from 1990 to 2020 in two centers. Overall survival, adjusted for clinical profile and etiological subgroups, was compared. 7 subgroups were considered: 1) Cardiomyopathy with pulmonary hypertension (CM + PH). 2) Eisenmenger syndrome. 3) Congenital heart disease (CHD). 4) Idiopathic pulmonary arterial hypertension (IPAH). 5) Cystic fibrosis. 6) Chronic obstructive pulmonary disease (COPD)/Emphysema. 7) Diffuse interstitial lung disease (ILD). Results: Early mortality was 44% and that of the rest of the follow-up was 31%. There were differences between HTLx and HTx in survival, also comparing groups with a similar clinical profile with propensity score (p= 0.04). Median survival was low in CM + PH (18 days), ILD (29 days) and CHD (114 days), intermediate in Eisenmenger syndrome (600 days), and longer in IPAH, COPD/Emphysema and cystic fibrosis. Conclusion: HLTx has a high mortality. The etiological analysis is of the utmost interest to make the most of the organs and improve survival.

High Frequency of Smell and Taste Dysfunction in Health Care Professionals With COVID-19 Working in Allergy Departments.

INTRODUCTION AND OBJECTIVE: Since the early stages of the novel coronavirus 2019 (SARS-CoV-2) outbreak, smell and/or taste dysfunction (STD) has been reported in 5% to 88% of COVID-19 patients. Objective: We aimed to assess STD in health care professionals (HCPs), mainly allergists, affected by COVID-19. We carried out a survey to evaluate the association between STD and its severity and demographic characteristics, symptoms, comorbidities, and hospital admission. METHODS: We designed a 15-item questionnaire comprising various sections, as follows: demographics, diagnostic characteristics, STD patterns, medication use, and comorbidities. The questionnaire was developed using Google forms. It was distributed to members of the Spanish Society of Allergology and Clinical Immunology (SEAIC) and sent via social media to be completed by HCPs with COVID-19. RESULTS: The survey was completed by HCPs (n=234), of whom 76.5% were aged ≤55 years and 73.5% were female. STD was detected in 74.4% of respondents, of whom 95.6% reported moderate-severe impairment. Mean time until recovery of taste dysfunction was 21.6 (24.0) days in HCPs aged ≤55 years and 33.61±26.2 days in those aged >55 years (P=.019). Analysis stratified by severity of STD showed that more than a half of COVID-19 patients presented severe loss of smell. Older age (>55 years) was associated with fever, anorexia, lower frequency of headache, and longer persistence of taste dysfunction. CONCLUSION: STD is a common symptom in COVID-19, even as a unique or preceding symptom. HCPs who reported smell dysfunction were younger than those not affected with STD. Taste dysfunction may imply more systemic involvement in COVID-19-positive HCPs.

"Influence of diet on mood and social cognition: a pilot study".

Recently, a relationship has been observed between nutrition and social cognition. In this aspect, several dietary patterns, or even some probiotics, have been reported as social cognition modulators. However, to date, no studies have reported the effects of specific nutrients. Our aim was to evaluate the relationship between dietary macronutrients and the processing of social and affective information. Participants were undergraduates from the University of Extremadura (Badajoz, Spain) aged 21.3 ± 2.9 years., with a BMI of 22.8 ± 3.9 (kg m-2). The students' social cognition and diet were analysed through questionnaires and a dietary record. The diets were analysed with DIAL v.1.18® software (Alce Ingeniería®). The participants filled out the WHO-5 well-being index, Beck's anxiety inventory, Beck's depression inventory, ruminative response scale (RSS), Leiden index of depression sensitivity (LEIDS-r), empathy quotient (EQ), and interpersonal reactivity index (IRI). To analyse the data, nutrients were grouped through principal component analysis (PCA) into lipids, carbohydrates and proteins. Additionally, we assayed if these principal components were associated with psychological questionnaire scores using multiple linear regression analyses. The dietary pattern differed from the traditional Mediterranean diet due to high intake of proteins and saturated fatty acids. Regarding social cognition and macronutrients, we found a positive association between lipids, specifically cholesterol, and the Perspective-Taking Scale (an IRI component). Carbohydrates influenced the RSS, indicating that complex carbohydrates may be a risk factor for depression. Moreover, the brooding factor, a component of the RRS, was negatively affected by dietary carbohydrates and proteins, specifically by fiber and aspartate. Diet may influence several variables related to social cognition and mood. Particularly, a low-cholesterol diet rich in fiber, complex carbohydrates, and aspartate apparently provides benefits, improving the processing of social and affective information and psychic well-being.

Clinical and anatomopathological features of eosinophilic oesophagitis in children and adults.

INTRODUCTION: Eosinophilic oesophagitis (EoE) is a chronic clinical-pathological disorder with an immunological basis characterised by symptoms of oesophageal dysfunction and, histologically, eosinophilic inflammation. OBJECTIVE: To evaluate the clinical characteristics and differences in children and adults diagnosed with EoE in a tertiary level hospital. METHOD: Descriptive, retrospective and cross-sectional study. We randomly selected 40 children and 40 adults diagnosed with EoE between 2009 and 2016. The patient characteristics were analysed by means of epidemiological, clinical, diagnostic and therapeutic variables. RESULTS: The average age at diagnosis was 10 years (children) and 34 years (adults), with a higher frequency in males. The majority were sensitised to aeroallergens (77.5% children vs. 82.5% adults) and foods (75% children vs. 82.5% adults). Statistically significant differences were detected in sensitisation to fruits (p=0.007) and grains (p<0.001). Differences were observed in impaction (22.5% children vs. 82.5% adults), dysphagia (42.5% children vs. 77.5% adults) and abdominal pain (25% children vs. 7.5% adults). Endoscopy showed that children had a higher frequency of exudates (92.5%) and adults, trachealisation (50% vs. 5%) and stenosis (17.5% vs. 2.5%). Statistically significant differences were found in treatment with topical corticosteroids (30% children vs. 77.5% adults), with a variable positive response. 77.5% of the patients received elimination diets. CONCLUSIONS: Statistically significant differences were observed between the paediatric and adult populations in the food sensitisation profiles, clinical manifestations, endoscopic findings and treatments received. This is a complex pathology that calls for a multidisciplinary team and would require new non-invasive techniques to facilitate its management.

Experience in anaesthetic management of non-cardiac surgery in patients with ventricular assist devices. / Experiencia en manejo anestésico para cirugía no cardiaca en pacientes con asistencias ventriculares.

Heart failure (HF) is a syndromic condition with a high incidence in current medicine. When the symptoms of HF progress, and become refractory, cardiac transplant is the best therapeutic option. However, due to the shortage of donors and the long waiting lists, many of those patients are candidates for implantation of ventricular assist devices as a bridge to the cardiac transplant, or when this is not an option, as a definitive therapy. A series of four clinical cases of patients with ventricular assist devices that required surgical intervention, is presented. Three of them were assisted with long-term care: two EXCOR (pulsatile and para-corporeal) and one HEARTWARE (non-pulsatile and intra-corporeal), and the last one with short-term assistance; CentriMag biventricular Levitronix. There is no significant literature on the peri-operative implications of these patients when they undergo urgent or scheduled surgery. The experience in our centre leads us to raise the need to determine a series of aspects: operation of each device, emphasising the correct placement of the cannulas during the surgery; the proper management of any medication, emphasising the importance of anticoagulant and anti-platelet therapies; the Pathophysiological changes at cardiopulmonary level due to the implantation of these devices; and the importance of the administration of a correct antibiotic therapy. Given the complexity of these cases, the limited experience in this field, and the few cases that exist in these situations, it is recommended to create protocols to ensure their proper management.

Mould and grass pollen allergy as risk factors for childhood asthma in Zaragoza, Spain.

OBJECTIVE: Examine the prevalence of asthma and associated predictive factors in a group of 468 students. PATIENTS AND METHODS: A descriptive, cross-sectional observational study in a randomly selected population of 468 children aged 10-12, in the city of Zaragoza. We used the ISAAC questionnaire on asthma completed by children under supervision of the investigators. We assessed the genetic risk (family history of asthma) and environmental risks. The risk for atopy was assessed by the presence of positive skin prick tests. RESULTS: 25.3% of the children had symptoms consistent with asthma in the city of Zaragoza. Among them 33.1% reported a history of asthma in close relatives (OR=1.78, p<0.001). The history of hospitalisations for lower respiratory tract illness was strongly associated with the presence of asthma (OR=6.72, p<0.0001). Positive skin tests to Alternaria (OR=2.00, p<0.0001) and grass pollen (OR=1.76, p<0.001) were predictors of asthma. 63.6% of asthmatic children had presented clinical rhinitis in the previous 12 months, compared with 32% of non-asthmatics, and this difference was statistically significant (OR=3.89, p<0.0001). 47% of asthmatics presented with or previously had eczema, whereas only 26.9% of non-asthmatics presented with or previously had these types of lesions (p<0.0001). CONCLUSION: The following are predictors of asthma: History of hospital admissions for lower respiratory tract illness, presence of rhinitis and/or eczema, positive prick test for certain aeroallergens, especially Alternaria and grass pollen, and family history of asthma.

Activity/inactivity circadian rhythm shows high similarities between young obesity-induced rats and old rats.

The objective of the present study was to compare differences between elderly rats and young obesity-induced rats in their activity/inactivity circadian rhythm. The investigation was motivated by the differences reported previously for the circadian rhythms of both obese and elderly humans (and other animals), and those of healthy, young or mature individuals. Three groups of rats were formed: a young control group which was fed a standard chow for rodents; a young obesity-induced group which was fed a high-fat diet for four months; and an elderly control group with rats aged 2.5 years that was fed a standard chow for rodents. Activity/inactivity data were registered through actimetry using infrared actimeter systems in each cage to detect activity. Data were logged on a computer and chronobiological analysis were performed. The results showed diurnal activity (sleep time), nocturnal activity (awake time), amplitude, acrophase, and interdaily stability to be similar between the young obesity-induced group and the elderly control group, but different in the young control group. We have concluded that obesity leads to a chronodisruption status in the body similar to the circadian rhythm degradation observed in the elderly.

Draft Genome Sequence of Xanthomonas arboricola pv. pruni Strain Xap33, Causal Agent of Bacterial Spot Disease on Almond.

We report the annotated genome sequence of Xanthomonas arboricola pv. pruni strain Xap33, isolated from almond leaves showing bacterial spot disease symptoms in Spain. The availability of this genome sequence will aid our understanding of the infection mechanism of this bacterium as well as its relationship to other species of the same genus.

Multiresolution analysis over simple graphs for brain computer interfaces.

OBJECTIVE: Multiresolution analysis (MRA) offers a useful framework for signal analysis in the temporal and spectral domains, although commonly employed MRA methods may not be the best approach for brain computer interface (BCI) applications. This study aims to develop a new MRA system for extracting tempo-spatial-spectral features for BCI applications based on wavelet lifting over graphs. APPROACH: This paper proposes a new graph-based transform for wavelet lifting and a tailored simple graph representation for electroencephalography (EEG) data, which results in an MRA system where temporal, spectral and spatial characteristics are used to extract motor imagery features from EEG data. The transformed data is processed within a simple experimental framework to test the classification performance of the new method. MAIN RESULTS: The proposed method can significantly improve the classification results obtained by various wavelet families using the same methodology. Preliminary results using common spatial patterns as feature extraction method show that we can achieve comparable classification accuracy to more sophisticated methodologies. From the analysis of the results we can obtain insights into the pattern development in the EEG data, which provide useful information for feature basis selection and thus for improving classification performance. SIGNIFICANCE: Applying wavelet lifting over graphs is a new approach for handling BCI data. The inherent flexibility of the lifting scheme could lead to new approaches based on the hereby proposed method for further classification performance improvement.

Tryptophan-enriched cereal intake improves nocturnal sleep, melatonin, serotonin, and total antioxidant capacity levels and mood in elderly humans.

Melatonin and serotonin rhythms, which exhibit a close association with the endogenous circadian component of sleep, are attenuated with increasing age. This decrease seems to be linked to sleep alterations in the elderly. Chrononutrition is a field of chronobiology that establishes the principle of consuming foodstuffs at times of the day when they are more useful for health, improving, therefore, biorhythms and physical performance. Our aim was to analyze whether the consumption of cereals enriched with tryptophan, the precursor of both serotonin and melatonin, may help in the reconsolidation of the sleep/wake cycle and counteract depression and anxiety in 35 middle-aged/elderly (aged 55-75 year) volunteers in a simple blind assay. Data were collected for 3 weeks according to the following schedule: The control week participants consumed standard cereals (22.5 mg tryptophan in 30 g cereals per dose) at breakfast and dinner; for the treatment week, cereals enriched with a higher dose of tryptophan (60 mg tryptophan in 30 g cereals per dose) were eaten at both breakfast and dinner; the posttreatment week volunteers consumed their usual diet. Each participant wore a wrist actimeter that logged activity during the whole experiment. Urine was collected to analyze melatonin and serotonin urinary metabolites and to measure total antioxidant capacity. The consumption of cereals containing the higher dose in tryptophan increased sleep efficiency, actual sleep time, immobile time, and decreased total nocturnal activity, sleep fragmentation index, and sleep latency. Urinary 6-sulfatoxymelatonin, 5-hydroxyindoleacetic acid levels, and urinary total antioxidant capacity also increased respectively after tryptophan-enriched cereal ingestion as well as improving anxiety and depression symptoms. Cereals enriched with tryptophan may be useful as a chrononutrition tool for alterations in the sleep/wake cycle due to age.

Comparative genomics to bridge Vicia faba with model and closely-related legume species: stability of QTLs for flowering and yield-related traits.

This study presents the development of an enhanced map in faba bean. The map contains 258 loci, mostly gene-based markers, organized in 16 linkage groups that expand 1,875 cM, with an average inter-marker distance of 7.26 cM. The combination of EST-derived markers with a number of markers physically located or previously ascribed to chromosomes by trisomic segregation, allowed the allocation of eight linkage groups (229 markers), to specific chromosomes. Moreover, this approach provided anchor points to establish a global homology among the faba bean chromosomes and those of closely-related legumes species. The map was used to identify and validate, for the first time, QTLs controlling five flowering and reproductive traits: days to flowering, flowering length, pod length, number of seeds per pod and number of ovules per pod. Twelve QTLs stable in the 2 years of evaluation were identified in chromosomes II, V and VI. Comparative mapping suggested the conservation of one of the faba bean genomic regions controlling the character days to flowering in other five legume species (Medicago, Lotus, pea, lupine, chickpea). Additional syntenic co-localizations of QTLs controlling pod length and number of seeds per pod between faba bean and Lotus japonicus are likely. The new genetic map opens the way for further translational studies between faba bean and related legume species, and provides an efficient tool for breeding applications such as QTL analysis and marker-assisted selection.

Immunossupressant and organ transplantation: immunophilins targeting agent and alternative therapies.

Since the first attempt to replace a dysfunctional organ, clinics and scientific had to overcome many setbacks in order to warrant the success and viability of both the organ and the receptor. Despite the improvement of surgical procedures, some grafts fail within the following days or week due to immunologic rejection. Many ongoing researches are still seeking the perfect immunossupresors. Calcineurin targeting agents have been consolidated as a worldwide immnunossupressant therapy, but due to its widely functional role in many cell types, this strategy often represents a highly risk therapy due to side effects observed with these agents. Here we summarized the latest and past knowledge regarding immunossupression therapies, including the promising and widely used Immunophilin-targeting antagonist therapies.

[Nitrogen and protein content analysis of human milk, diurnality vs nocturnality]. / Análisis del contenido en nitrógeno y proteínas de leche materna, día vs noche.

Breast milk is changing with the progression of lactation and during a 24-h period. To determine the effect of diurnality or nocturnality on total nitrogen and protein content of the breast milk. We collected human milk samples from health mothers living throughout Community of Extremadura (Spain) from January 2008 to December 2008 with less than two months of lactation. We divided the samples in three groups: calostral group (1-5 days postpartum), transitional group (6-15 days postpartum) and mature group (> 15 days postpartum). All samples were stored in a freezer at -80 ºC. We considered as day period between 08:00-20:00 h and night period 20:00-08:00 h. Analysis of the human milk samples was based on the Kjeldahl method. Protein contents were calculated from total nitrogen x 6,25. The statistical analysis of the data was descriptive (mean ± standard deviation) and inferential (T-Student test). No differences (P > 0,05) were found to exist among the contents of individual human milk samples. The mean contents of each component were as follows: Total nitrogen of calostral, transitional and mature group was 0,30 ± 0,06 g/dL (night period), 0,29 ± 0,05 g/dL (day period); 0,26 ± 0,04 g/dL (night period), 0,25 ± 0,04 g/dL (day period); 0,22 ± 0,05 g/dL (night period), 0,20 ± 0,04 g/dL (day period) respectively, in this mature group with a statistical variation (P < 0,05). Protein content of calostral, transitional and mature group was 1,88 ± 0,4 g/dL (night period), 1,81 ± 0,3 g/dL (day period); 1,62 ± 0,3 g/dL (night period), 1,59 ± 0,3 g/dL (day period); 1,35 ± 0,3 g/dL (night period), 1,26 ± 0,3 g/dL (day period) respectively, in this mature group with a statistical variation (P < 0,05). Although we observed differences in the nitrogen and protein content during the individual stages of lactation, it is just in the population of mature lactating women, where the components analyzed varied significantly between day and night.

Evolution of glomerular filtration rate, renal injury markers, anemia, and angiotensin blockers use after change from calcineurin inhibitors to sirolimus in transplant patients with neoplasia versus chronic allograft nephropathy.

BACKGROUND: The change from calcineurin inhibitors (CNI) to sirolimus (SRL) is a safe alternative in transplant patients with neoplasia (NEO) whereas the results of conversion for chronic allograft nephropathy (CAN) are controversial, depending on the histologic score, degree of proteinuria, and glomerular filtration rate (GFR). Our aim in this study was to compare GFR, proteinuria, albuminuria, blood pressure (BP) effects, and anemia after switching to sirolimus (SRL) among renal transplant recipients with CAN versus NEO. METHODS: Fifty-five kidney transplant recipients with conversion from CNI to SRL owing to CAN or NEO were analyzed for the variables at 6 months before, at the time of, and at 6 months and 1, 2, and 3 years after the switch to SRL. RESULTS: There were no differences between CAN and NEO in the slope of estimated GFR (mL/min/1.73 m(2) by Cockcroft-Gault formula) at 1 year (-5.5 vs 3.7; P = .007) and at 2 years (-3.86 vs -10.3; P = .01). The values of proteinuria (mg/24 h/1.73 m(2)) before (665 ± 136 vs 329 ± 69; P = .036) as well as at 1 (1,122 ± 306 vs 863 ± 190; P = .478) and at 2 years after conversion (1,360 ± 430 vs 457 ± 154; P = .045) showed some significant differences, as did the use of both antiangiotensin agents, angiotensin-converting enzyme inhibitor and angiotensin receptor blocker at the moment of switch (35% vs 0%; P = .005) at 1 year (69% vs. 6% P = .02) and at 2 years (67% vs 28%; P = .047). There were no differences in graft survival (log rank: P = .515). By logistic regression analysis, the best covariate associated with GFR >45 mL/min at 2 years was GFR >60 mL/min at the moment of switch to SRL (odds ratio, 1.33; 95% confidence interval, 1.002-1.74). CONCLUSIONS: The evolution of renal damage was more important in the CAN group requiring greater use of 2 angiotensin antagonists for control of proteinuria. We probably need histologic and serologic biomarkers to show which patients with CAN will show a bad evolution after the change to SRL.

Prevalence of metabolic syndrome among human immunodeficiency virus-infected subjects is widely influenced by the diagnostic criteria.

BACKGROUND: The aim of this study was to compare the prevalence of metabolic syndrome in human immunodeficiency virus (HIV)-infected patients treated with highly active antiretroviral therapy (HAART), using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), European Group for the Study of Insulin Resistance (EGIR), and International Diabetes Federation (IDF) definitions. METHODS: A cross-sectional study was carried out with 159 consecutive adult HIV-infected subjects (120 males and 39 females) under HAART. Anthropometric and laboratory parameters were measured by standard methods. Hyperinsulinemia was defined by a fasting concentration >75th percentile of values obtained in healthy individuals (107.5 pmol/L). RESULTS: The prevalence of ATP III-defined metabolic syndrome was 10.1%; it was 28.3% according to EGIR criteria and 15.1% using the IDF definition. The concordance between the definitions was low (kappa coefficient ranging between 0.134 and 0.296). All subjects with EGIR-defined metabolic syndrome had hyperinsulinemia, but only 50% of those with ATP III-defined metabolic syndrome and 62.5% in the IDF metabolic syndrome population had hyperinsulinemia. CONCLUSIONS: The inclusion of hyperinsulinemia as a criterion in the EGIR metabolic syndrome definition made it more discriminative than the ATP III definition, both in men and women, and than the IDF definition in men to identify metabolic syndrome in HIV-infected subjects under HAART.

Efficacy of low doses of pamidronate in osteopenic patients administered in the early post-renal transplant.

UNLABELLED: This study evaluates the efficacy of low doses of pamidronate after renal transplantation to prevent bone loss in osteopenic patients. Results show that pamidronate is safe and significantly reduced spinal bone loss when administered immediately after renal transplantation. INTRODUCTION: The purpose of this work is to evaluate the efficacy of two intravenous infusions of pamidronate in the immediate post-transplant period in a renal transplant (RT) population. METHODS: In this 12-month, randomized, double-blind, multicenter trial, 39 kidney recipients with diagnosed osteopenia received two doses of 30 mg of disodium pamidronate (n = 24) or placebo (n = 15), at surgery and 3 months post-RT. All patients received calcium and vitamin D. Bone density of the lumbar spine and total femur was measured by dual-energy X-ray absorptiometry (DXA) and X-rays were performed at RT, 6 and 12 months post-RT. Biochemical and hormonal determinations were performed before and after treatment. RESULTS: Pamidronate significantly reduced spinal bone loss, but no significant benefit was found for the incidence of fractures. Elevated baseline intact parathyroid hormone (iPTH) and bone remodeling markers returned to normal levels 3 months post-RT. However, normal procollagen type I N propeptide (PINP) concentrations were only maintained in the pamidronate group. After RT, a comparable graft function was observed in both groups according to creatinine values, 25-hydroxyvitamin-D (25-OH-D) levels were improved, and serum calcium levels normalized after a transient fall during the first 3 months. CONCLUSION: A low dose of pamidronate prevents bone loss in osteopenic patients when administered immediately after RT.