Systematic screening for a proximal DVT in COVID-19 hospitalized patients: Results of a comparative study.

INTRODUCTION: The COVID-19 pandemic is associated with a high incidence of venous thromboembolism questioning the utility of a systematic screening for deep venous thrombosis (DVT) in hospitalised patients. METHODS: In this prospective bicentric controlled study, 4-point ultrasound using a pocket device was used to screen for DVT, in patients with SARS-CoV-2 infection and controls admitted for acute medical illness not related to COVID-19 hospitalised in general ward, in order to assess the utility of a routine screening and to estimate the prevalence of VTE among those patients. RESULTS: Between April and May 2020, 135 patients were screened, 69 in the COVID+ group and 66 in the control one. There was no significant difference in the rate of proximal DVT between the two groups (2.2% vs. 1.5%; P=0.52), despite the high rate of PE diagnosed among COVID-19 infected patients (10.1% vs. 1.5%, P=0.063). No isolated DVT was detected, 37.5% of PE was associated with DVT. Mortality (7.2% vs. 1.5%) was not different (P=0.21) between COVID-19 patients and controls. CONCLUSION: The systematic screening for proximal DVT was not found to be relevant among COVID-19 patients hospitalized in general ward despite the increase of VTE among this population. Further studies are needed to confirm the hypothesis of a local pulmonary thrombosis which may lead to new therapeutic targets.

Coccidioidomycosis in patients with HIV-1 infection in the era of potent antiretroviral therapy.

BACKGROUND: Coccidioidomycosis is a common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected individuals living in regions where coccidioidomycosis is endemic. However, there have been no studies on its incidence or clinical expression during the era of potent antiretroviral therapy. METHODS: Clinical data were abstracted from the records of all HIV-1-infected patients attending a single clinic in a region where coccidioidomycosis is endemic from January 2003 through May 2008. Additional follow-up was performed through May 2009 for individuals with active coccidioidomycosis. A case-control study was performed that compared all individuals who attended the clinic with individuals who received a diagnosis of coccidioidomycosis. RESULTS: Among 257 HIV-1-infected patients seen over a 64-month period, 29 cases (11.3%) of coccidioidomycosis were identified. Twelve patients (4.7%) received a diagnosis of coccidioidomycosis during the study period (annual incidence, 0.9%). Patients with less severe coccidioidomycosis were significantly more likely to have an undetectable HIV RNA level and to be receiving potent antiretroviral therapy than were those with more severe disease (for both, P< .01). Five patients with coccidioidomycosis received no antifungal therapy, and 11 others had antifungal therapy discontinued. All were healthy during follow-up. Patients with coccidioidomycosis had significantly lower CD4 T lymphocyte counts than did control subjects (mean +/- standard deviation, 285 +/- 42 cells/microL vs 477 +/- 21 cells/microL; P= .003). CONCLUSIONS: The incidence of symptomatic coccidioidomycosis in the era of potent antiretroviral therapy has decreased, and its clinical expression is less severe than it was before the potent antiretroviral therapy era. Severity of coccidioidomycosis was inversely associated with control of HIV-1 infection.

La quimionucleolisis en el tratamiento de la hernia discal lumbar resultados clínicos y radiológicos / The chymonucleolysis in the treatment for discal hernia. Clinics and radiolgical results

En este trabajo se intenta demostrar la eficacia o inocuidad de la quimionucleolisis en el tratamiento de la hernia discal como alternativa a la cirugía convencional. Para ello se seleccionó un grupo de 91 pacientes a los cuales se aplica dicha técnica, consistente en la inyección bajo control radiológico y mediante punción intradiscal, del enzima quiomiopapaína en el núcleo pulposo, con el fin de conseguir la disolución química del mismo. Se valora la respuesta clínica al tratamiento, así como radiológica, al mes a los 6 meses del mismo, practicándose radiografía de columna vertebral para valorar las curvas de presión intradiscales. De los 91 pacientes seleccionados, se obtuvieron resultados excelentes en 25 casos (29.41 por ciento), Buenos en 37 casos (43.52 por ciento), aceptables en 11 casos (12.94 por ciento), malos en 5 casos (5.88 por ciento), apreciándose correlación entre la disminución del volumen intradiscal y los resultados clínicos obtenidos.

Successful treatment of Candida albicans osteomyelitis of the spine with fluconazole and surgical debridement: case report.

A 65-year old diabetic male presented with progressive bone destruction of thoracic spine (T-11&12) with cord compression. Candida albicans was isolated from aspirated materials pre-and intra-operative. Two weeks of fluconazole was given prior to surgical debridement, and fixation of the lesion. C. albicans isolated pre-and 2-weeks after fluconazole treatment were DNA-typed using AP-PCR. MIC was 2-4 mg/l in all isolates tested. The pre-and post treatment isolates had two DNA patterns, indicating the existence of two different strains. Surgical treatment was necessary for patient recovery.

[Fine needle myelography. Current status]. / Mielografía con aguja fina. Estado actual.

One hundred three patients with different diseases of the vertebral or spinal column were studied with hydrosoluble myelography. In fifty-three patients spinal puncture was carried out with a 25 G needle (fine) and in the remaining 50 patients a 22 G needle (thick) was used. Post myelographic control by means of a scale which we designed permitted the clear establishment of the responsibility of needle diameter in the incidence of complications, fundamentally cephaleas with 11.3% with the 25 G needle vs 66% with the 22 G needle. Following the therapies herein suggested, only rarely was there a complication of little significance thereby encouraging the use of this method when non invasive procedures are insufficient for clarifying diagnostic doubts.

Induction of nitrate transport in maize roots, and kinetics of influx, measured with nitrogen-13.

Unlike phosphate or potassium transport, uptake of nitrate by roots is induced, in part, by contact with the substrate ion. Plasmalemma influx of (13)N-labeled nitrate in maize roots was studied in relation to induction of the uptake system, and the influence of short-term N starvation. Maize (Zea mays) roots not previously exposed to nitrate had a constitutive transport system (state 1), but influx increased 250% during six hours of contact with 100 micromolar nitrate, by which time the transport mechanism appeared to be fully synthesized (state 2). A three-day period of N starvation prior to induction and measurement of nitrate influx resulted in a greater capacity to transport nitrate than in unstarved controls, but this was fully expressed only if roots were kept in contact with nitrate for the six hours needed for full induction (state 2E). A kinetic analysis indicated a 160% increase in maximum influx in N-starved, induced roots with a small decrease in K(m). The inducible component to nitrate influx was induced only by contact with nitrate. Full expression of the nitrate inducible transport system was dependent upon mRNA synthesis. An inhibitor of cytoplasmic protein synthesis (cycloheximide) eliminated the formation of the transport system while inhibition by chloramphenicol of mitochondrial- or plastid-coded protein synthesis had no effect. Poisoning of membrane-bound proteins effectively disabled both the constitutive and induced transport systems.