Chagas heart disease is associated with decreased physical activity levels: A cross-sectional analysis.

Background: Studies evaluating physical activity (PA) levels in individuals with Chagas disease (CD) are still scarce. The present study aimed to evaluate PA levels in CD individuals and examine their association with Chagas heart disease (ChHD). Methods: We included patients with CD regularly followed in a reference center for treatment of infectious diseases. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). ChHD was determined following the Brazilian Consensus on Chagas Disease. The association between ChHD and levels of PA (total, walking, moderate, and vigorous) as a continuous variable was fitted using generalized linear models. Logistic regression models were fitted to evaluate the association between ChHD and meeting WHO's PA recommendations. Results: Among the 361 participants included in the analysis (60.7 ± 10.7 years; 56.2 % women), 58.1 % (n = 210) complied with the WHO's PA recommendations. After adjustments for potential confounders, regression analyses revealed that ChHD without heart failure was significantly associated with reduced vigorous PA (Exp ß 0.32 95 % CI 0.10 to 0.98). ChHD with heart failure had significantly lower levels of total (Exp ß 0.61 95 % CI 0.44 to 0.84) and moderate (Exp ß 0.59 95 % CI 0.39 to 0.89) PA. ChHD with heart failure had a lower odd of meeting the PA recommendation in comparison to those with no cardiac involvement (OR 0.48 95 % CI 0.24 to 0.97). Conclusions: We found low levels of PA among individuals with CD. Presence of ChHD (mainly with HF) was associated with decreased levels of PA.

Sleep duration and quality during the COVID-19 pandemic and the association with physical activity and screen time among Brazilian college students.

BACKGROUND: As a result of social isolation during the COVID-19 pandemic, changes in sleep patterns have been observed in many countries, as well as changes in physical activity and screen time. The objective was to investigate sleep duration and quality during the COVID-19 pandemic and its association with physical activity and screen time. METHODS: Cross-sectional study with students from a University in Rio de Janeiro who answered an online questionnaire between August 2020 and March 2021. Physical activity was assessed using IPAQ-SF. Sleep was investigated based on questions about duration and sleep quality change, and screen time through self-reported questions. Multinomial logistic regression was performed to assess the association between physical activity and screen time with sleep duration and quality. Secondary analyses investigated the influence of the isolation time on this association. The confounding factors used were diagnosis of COVID-19, time of isolation, anxiety, depression, skin color, and gender. RESULTS: A total of 771 college students with a mean age of 24.5 years (±8.6) answered the questionnaire. About 75% reported more than 8 h of screen time per day and 49.8% were physically inactive. Regarding sleep, 54.9% had worsening sleep, while 40.6% had inadequate sleep duration during the pandemic. Physical activity was associated with improved sleep quality (Odds ratio (OR) 1.72; confidence interval (95% CI) 1.05-2.97). Also, physically active students who spent more than 14 weeks in social isolation demonstrated improved sleep quality (OR 1.99; 95% CI 1.02-3.78) compared to physically inactive individuals. No association was observed for sleep duration. No association was observed between screen time and sleep quality, or sleep duration. CONCLUSION: During the COVID-19 pandemic, there was considerable worsening of sleep quality, and physical activity was positively associated with improved sleep quality.

Corrigendum: Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): a study protocol for a randomized clinical trial.

[This corrects the article DOI: 10.3389/fmed.2022.1087188.].

Rosacea Topical Treatment and Care: From Traditional to New Drug Delivery Systems.

Rosacea is a multifactorial chronic inflammatory dermatosis characterized by flushing, nontransient erythema, papules and pustules, telangiectasia, and phymatous alterations accompanied by itching, burning, or stinging, the pathophysiology of which is not yet fully understood. Conventional topical treatments usually show limited efficacy due to the physical barrier property of the skin that hinders skin penetration of the active ingredients, thereby hampering proper drug skin delivery and the respective therapeutic or cosmetic effects. New advances regarding the physiopathological understanding of the disease and the underlying mechanisms suggest the potential of new active ingredients as promising therapeutic and cosmetic approaches to this dermatosis. Additionally, the development of new drug delivery systems for skin delivery, particularly the potential of nanoparticles for the topical treatment and care of rosacea, has been described. Emphasis has been placed on their reduced nanometric size, which contributes to a significant improvement in the attainment of targeted skin drug delivery. In addition to the exposition of the known pathophysiology, epidemiology, diagnosis, and preventive measures, this Review covers the topical approaches used in the control of rosacea, including skin care, cosmetics, and topical therapies, as well as the future perspectives on these strategies.

The effects of laser procedure in symptomatic patients with haemorrhoids: A systematic review.

Purpose: Haemorrhoids are normal structures in the human body, only seen as pathological when symptomatic. Nowadays, new techniques have surfaced using a diode laser which, after locating the target arteries, blocks the blood flow while hitting and shrinking the local mucosa/submucosa at a depth of 4 mm. Our work aimed to give a broad view over this new technique and its consequences in the post-operative follow-up with a systematic review. Methods: EMBASE and MEDLINE databases were consulted, retrieving clinical trials, which mentioned the use of 980 nm diode laser on the treatment of haemorrhoids. Results: Ten clinical trials analyzing the post-operative effects of laser haemorrhoidectomy were selected, including 2 randomized controlled clinical trials and 1 controlled clinical trial. The overall quality of the trials was low, indicating a high risk of bias. Conclusion: The laser haemorrhoidectomy procedure revealed a high therapeutic potential, considering the reduced number of postoperative complaints (bleeding/pain), the high symptom resolution and the reduced recurrence, albeit the high heterogeneity between the studies in terms of reported results. Future investigations with higher quality and controlled double-blinded studies obtaining better-categorized results should be conducted in order to better evaluate this procedure and compare it to the current paradigm.

Association of non-chronic low back pain with physical function, endurance, fatigability, and quality of life in middle- and older-aged adults: Findings from Baltimore Longitudinal Study of Aging.

Low back pain (LBP) is an important condition associated with high healthcare burden. However, the relationship of this condition with physical function (PF) and health-related quality of life (HRQoL) remains unclear. This is a cross-sectional study that aims to investigate the association between presence and intensity of non-chronic LBP with PF and HRQoL in middle-and older-aged adults. Participants answered questions about presence and intensity of LBP in the previous year, self-reported their PF and HRQoL (SF-12), and underwent objective measures of PF ([ExSPPB] including usual gait speed, narrow walk, chair stands, and standing balance), endurance performance ([EP] long-distance corridor walk) and fatigability. Generalized linear models and logistic regression models were performed. A total of 1500 participants (52.5% women, 70.3% white) aged 69.0 (SD 13.1) years were included. Of those, 642 (42.8%) reported LBP and the mean pain intensity was 4.1 (SD 2.2). After adjustments for potential confounders, presence of LBP was associated with lower self-reported PF (OR 1.73, 95% CI 1.27 to 2.37), lower physical component of HRQoL (ß -0.03, 95% CI -0.04 to -0.02) and poorer chair stand performance (ß -0.05, 95% CI -0.09 to -0.008). Higher intensity of LBP was associated with lower physical component of HRQoL (ß -0.01, 95% CI -0.02 to -0.007), poorer ExSPPB performance (ß -0.01, 95% CI -0.02 to -0.004), slower usual gait speed (ß -0.01, 95% CI -0.02 to -0.004), lower total standing balance time (ß -0.01, 95% CI -0.02 to -0.001) and higher fatigability (OR 1.13, 95% CI 1.01 to 1.25). The presence of non-chronic LBP was more consistently associated with lower self-reported PF, while higher intensity non-chronic LBP was associated with poorer objectively measured PF and fatigability. Collectively, this evidence suggests that although presence of pain may affect perception of function, greater pain intensity appears more strongly associated with unfavorable functional performance in mid-to-late life.

Ion release and surface roughness of silver soldered bands with two different polishing methods: An in-vitro study.

OBJECTIVE: To evaluate the surface roughness and ion release of silver-soldered joints by using two polishing methods. METHODS: 174 orthodontic bands with and without silver-soldered joints were evaluated and divided into three groups: two experimental, with different polishing methods (SP1 and SP2), and one control (SS) composed of bands without silver solder. For ionic release, 50 bands of each group were immersed in saline solution and submitted to atomic absorption spectrophotometry to quantify the amount of Fe, Ni, Cr (in all the three groups), Ag, Cu, Cd, and Zn (in the two experimental groups). A rugosimeter was employed to verify the surface roughness. RESULTS: Ni and Cr were released in higher amounts after soldering. Cd, Ag, Zn, and Cu may be released from silver-soldered bands independently of the polishing method employed. Ag was released in higher amounts from the soldered bands that presented higher surface roughness. CONCLUSIONS: Differences exist in relation to the surface roughness of silver-soldered bands when distinct polishing methods are used. Toxic ions may be released from silver soldered joints and higher surface roughness may cause higher ionic release.

Association of Physical Activity With Maximal and Submaximal Tests of Exercise Capacity in Middle- and Older-Aged Adults.

Although physical activity (PA) is an important determinant of exercise capacity, the association between these constructs is modest. The authors investigated the associations of self-reported and objectively measured PA with maximal and submaximal tests of exercise capacity. Participants aged ≥40 years (N = 413; 49.6% female) completed a PA questionnaire, wore a uniaxial accelerometer (5.2 ± 1.1 days), and performed maximal (cardiopulmonary exercise test [CPET]) and submaximal (long-distance corridor walk) tests with indirect calorimetry (oxygen consumption, V˙O2). Linear regression models were fitted to assess the variation in exercise capacity explained (partial eta squared, η2) by PA variables. Accelerometer-measured vigorous (η2 = 22% female; η2 = 16% male) and total PA (η2 = 17% female; η2 = 13% male) explained the most variance in CPET V˙O2 (p < .001). All η2 values were lower for long-distance corridor walk V˙O2 (η2 ≤ 11%). Age contributed more to CPET V˙O2 than any PA variable in males (η2 = 32%), but not in females (η2 = 19%). Vigorous and total PA play important roles in CPET V˙O2 in mid to late life.

Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): A study protocol for a randomized clinical trial.

Background: Chagas disease (CD) is a neglected endemic disease with worldwide impact due to migration. Approximately 50-70% of individuals in the chronic phase of CD present the indeterminate form, characterized by parasitological and/or serological evidence of Trypanosoma cruzi infection, but without clinical signs and symptoms. Subclinical abnormalities have been reported in indeterminate form of CD, including pro-inflammatory states and alterations in cardiac function, biomarkers and autonomic modulation. Moreover, individuals with CD are usually impacted on their personal and professional life, making social insertion difficult and impacting their mental health and quality of life (QoL). Physical exercise has been acknowledged as an important strategy to prevent and control numerous chronic-degenerative diseases, but unexplored in individuals with the indeterminate form of CD. The PEDI-CHAGAS study (which stands for "Home-Based Exercise Program in the Indeterminate Form of Chagas Disease" in Portuguese) aims to evaluate the effects of a home-based exercise program on physical and mental health outcomes in individuals with indeterminate form of CD. Methods and design: The PEDI-CHAGAS is a two-arm (exercise and control) phase 3 superiority randomized clinical trial including patients with indeterminate form of CD. The exclusion criteria are <18 years old, evidence of non-Chagasic cardiomyopathy, musculoskeletal or cognitive limitations that preclude the realization of exercise protocol, clinical contraindication for regular exercise, and regular physical exercise (≥1 × per week). Participants will be assessed at baseline, and after three and 6 months of follow-up. The primary outcome will be QoL. Secondary outcomes will include blood pressure, physical fitness components, nutritional status, fatigability, autonomic modulation, cardiac morphology and function, low back pain, depression and anxiety, stress, sleep quality, medication use and adherence, and biochemical, inflammatory and cardiac biomarkers. Participants in the intervention group will undergo a home-based exercise program whilst those in the control group will receive only general information regarding the benefits of physical activity. Both groups will receive the same general nutritional counseling consisting of general orientations about healthy diets. Conclusion: The findings from the present study may support public health intervention strategies to improve physical and mental health parameters to be implemented more effectively in this population. Clinical trial registration: [https://ensaiosclinicos.gov.br/rg/RBR-10yxgcr9/], identifier [U1111-1263-0153].

Trends in the interest in COVID-19 news of the local media and their readers: The case of Spain.

The COVID-19 has caused not just an unprecedented sanitary crisis but a social crisis, which has affected, among many other fields, the local journalism, which had to adapt to meet the public's information needs about coronavirus. In this study we analyzed the evolution of local news about COVID-19 in Spain throughout the pandemic by examining local news articles in social media. Using a unique dataset of over 230k Facebook posts published by Spanish local media organizations during 2020 and 2021, we found evidence that the interest of local media in COVID-19, measured as the proportion of the news related to COVID-19, changed as the pandemic evolved. Our results also show that the interest that local media readers had in COVID-19, measured as the proportion Facebook interactions related to COVID-19, was even higher, and also evolved during the pandemic. Although the interest in COVID-19 of local media and their readers essentially progressed in parallel, we also identified some periods in which they behaved differently. While a fatigue with COVID-19 related news would be expected after 2 years of pandemic, a clear decrease of interest was not observed neither in journalists nor in readers.

Encephalitis: A rare complication of mediterranean spotted fever.

Mediterranean spotted fever (MSF) is an emerging zoonosis caused by Rickettsia conorii. The MSF typically presents with a triad of fever, generalized cutaneous rash and inoculation eschar, but its clinical spectrum may range from a mild febrile illness to a potentially life-threatening condition, being central nervous system involvement highly rare. We report the clinical case of a 63-year-old male patient with MSF complicated by acute encephalitis and multi-organic failure.

Effectiveness of a school-based randomized controlled trial aimed at increasing physical activity time in adolescents.

BACKGROUND: This study aimed to evaluate the effectiveness of obesity prevention educational activities, isolated or combined with the modification of the school environment on total physical activity time. METHODS: This is a school-based randomized controlled trial, conducted with 2511 students from fifth and sixth-grade in Brazil, that employed a parallel, three-group experimental arms: control group (CG), PAAPPAS group (PG) and PAAPPAS-environment group (PEG). During the 2016 school year, the PG received educational activities in the classroom, providing a general basis for a healthy lifestyle. The PEG received the same educational activities and also modifications in the school environment to stimulate physical activity practice during one month. Physical activity was evaluated through a validated physical activity questionnaire. Intention-to-treat analysis was performed to evaluate the rate of change of physical activity time between groups using PROC GENMOD procedure. All analyses were performed using SAS. RESULTS: Total physical activity time increased by 22% in PEG compared with CG (P = 0.003). No difference was observed between PEG and PG (Δ = 60.20 vs. 36.37, respectively; P = 0.27) and between PG and CG (Δ = 36.37 vs. 9.70, respectively; P = 0.23). The proportion of individuals who attended at least 150 min week-1 of physical activity increased in PEG compared with PG (P = 0.04); however, no difference was observed between PEG and CG (P = 0.19) and between PG and CG (P = 0.26). For 300 min week-1, no difference was observed between groups. CONCLUSION: A school-based multi-component intervention including modification of the school environment was effective for increasing physical activity time among adolescents.

Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges.

Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

Impactos da dor lombar em adultos de meia idade e idosos - Resultados do Baltimore Longitudinal Study of Aging / Impacts of low back pain in middle and older-aged adults - findings from Baltimore Longitudinal Study of Aging

A dor lombar (DL) é uma preocupação global e urgente de saúde pública pela alta prevalência, repercussões econômicas e sobre outros aspectos da saúde. O objetivo desta tese é produzir dois manuscritos: (1) associação entre presença e intensidade de DL com função física (FF) e qualidade de vida relacionada à saúde (QVRS); (2) associação entre presença e intensidade da DL prévia e no momento com atividade física diária (AF), comportamento sedentário, fragmentação da atividade e alcance das recomendações AF em adultos de meia-idade e idosos. Esta é uma análise transversal com voluntários do Baltimore Longitudinal Study of Aging acima de 40 anos que responderam sobre presença e intensidade da DL no ano anterior Participantes do primeiro manuscrito autorrelataram FF e QVRS (SF-12) e realizaram testes objetivos de FF ([Short Physical Performance Battery Expanded - ExSPPB] incluindo velocidade usual da marcha, Narrow walk, levantar da cadeira, equilíbrio de pé), de endurance (long distance corridor walk) e fatigabilidade. Voluntários do segundo manuscrito usaram acelerômetro Actiheart na semana seguinte à entrevista. Modelos lineares generalizados e de regressão logística foram gerados brutos e ajustados. No manuscrito 1, participaram 1.500 voluntários (52,5% mulheres, 70,3% brancos) com idade média de 69,0 (+13,1). A frequência de DL foi de 42,8%, com intensidade média de 4,1 (+2,2). Após ajustes, presença de DL foi associada à FF autorrelatada (OR 1,73, IC 95% 1,27 a 2,37), domínio físico da QVRS (ß -0,03, IC 95% -0,04 a -0,02) e pior desempenho do levantar da cadeira (ß -0,05, IC 95% -0,09 a -0,008). Maior intensidade de DL foi associada com menor QVRS ­ domínio físico (ß -0,01, IC 95% -0,02 a -0,007), pior desempenho no ExSPPB (ß -0,01, IC 95% -0,02 a -0,004), menor velocidade usual da marcha (ß -0,01, IC 95% -0,02 a -0,004), menor tempo de equilíbrio em pé (ß -0,01, IC 95% -0,02 a -0,001) e alta fatigabilidade (OR 1,13, IC 95% 1,01 a 1,25). No manuscrito 2, participaram 662 voluntários (50,8% mulheres, 68,1% brancos) com idade média de 68,0 (+11,4) anos. A frequência de DL prévia foi de 36,3%, com intensidade média de 3,5 (+2,0), e DL no momento foi de 5,7%, com intensidade média de 4,1 (+2,3). Indivíduos com DL no momento apresentaram menores níveis de AF total (ß -0,18, IC 95% -0,34 a -0,02), vigorosa (ß -0,29, IC 95% -0,56 a -0,007) e menor chance de alcançar as recomendações de AF (OR 0,20, 95% CI 0,05 a 0,92) independente da intensidade da dor. DL prévia não foi associada com os desfechos de AF. Concluímos que a presença de DL foi mais consistentemente associada com FF autorrelatada, enquanto maiores intensidades de DL foram associadas a FF medida objetivamente e alta fatigabilidade. Independentemente da intensidade, a presença de DL no momento parece interferir negativamente nos níveis de AF, dificultando o alcance das recomendações do guia de AF. A diminuição da AF total parece ser impulsionada pela diminuição da vigorosa, sem impacto sobre leve e moderada, comportamento sedentário e fracionamento das atividades.

Low back pain (LBP) is a global and urgent public health concern due to its high prevalence, economic repercussions and other health aspects. The aim of this thesis is to produce two manuscripts: (1) association of presence and intensity of LBP in the previous year and physical function (PF) and health-related quality of life (HRQoL); (2) association between the presence and intensity of previous and current LBP and daily physical activity (PA), sedentary behavior, activity fragmentation and meeting PA guidelines in middle- and older- aged adults. This is a cross-sectional analysis with volunteers from the Baltimore Longitudinal Study of Aging, over 40 years old, who answered questions about presence and intensity of LBP in the previous year. For the first manuscript, participants self-reported PF and HRQoL (SF-12) and performed objective PF tests ([Short Physical Performance Battery Expanded - ExSPPB] including usual gait speed, Narrow walk, chair stands, standing balance), endurance performance (long distance corridor walk) and fatigability. For the second manuscript, volunteers wore Actiheart accelerometers for thr subsequent week. Generalized linear models and logistic regression models were generated crude and adjusted. In manuscript 1, 1,500 volunteers participated (52.5% women, 70.3% white) aged 69.0 (+13.1). 642 (42.8%) reported LBP with mean intensity of 4.1 (+2.2). After adjustments, presence of LBP was associated with self-reported PF (OR 1.73, 95% CI 1.27 to 2.37), physical domain of HRQOL (ß -0.03, 95% CI -0.04 to -0 .02) and poorer chair stand performance (ß -0.05, 95% CI -0.09 to -0.008). Higher LBP intensity was associated with lower HRQoL ­ physical domain (ß -0.01, 95% CI -0.02 to -0.007), poorer ExSPPB performance (ß -0.01, 95% CI -0.02 to -0.004), slower usual gait speed (ß -0.01, 95% CI -0.02 to -0.004), lower total standing balance time (ß -0.01, 95% CI -0.02 to - 0.001) and higher fatigability (OR 1.13, 95% CI 1.01 to 1.25). In manuscript 2, 662 volunteers (50.8% women, 68.1% white) aged 68.0 (+11.4) Years were included. 240 (36.3%) reported previous LBP (<12 weeks) with mean pain intensity of 3.5(+2.0), and 38 (5.7%) current LBP with mean pain intensity of 4.1 (+2 .3). Participants reporting current LBP had lower levels of objectively measured total (ß -0.18, 95% CI -0.34 to -0.02) and vigorous PA (ß -0.29, 95% CI -0.56 to -0.007) and lower odds to meet PA guidelines (OR 0.20, 95% CI 0.05 to 0.92) regardless of pain intensity. Previous LBP was not associated with PA outcomes. We conclude that presence of LBP was more consistently associated with self-reported PF, whereas higher LBP intensity were associated with objectively measured PF and high fatigability. Regardless of intensity, presence of current LBP seems to negatively interfere in PA levels, making difficult to meet PA guidelines recommendation. The decrease in total PA levels seem to be driven by a decrease in vigorous PA, with no impact on light and moderate PA, sedentary behavior and activity fragmentation.

Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges

Abstract Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

Real-world analysis of acute decompensated heart failure outcomes in Portugal.

AIMS: In Portugal, in the last 5 years, no study has published recent data regarding outcomes of patients with acute decompensated heart failure (ADHF). We aimed to determine the characteristics and outcomes of a large contemporaneous Portuguese cohort of ADHF patients admitted to our emergency department (ED). METHODS AND RESULTS: We conducted a retrospective, study of all 1024 patients admitted to our ED with a discharge diagnosis of ADHF from November 2016 to December 2017. Baseline clinical data and outcomes {in-hospital, 30 day, and follow-up all-cause mortality, and readmissions; median follow-up, 5 months; interquartile range [(IQR), 3-11 months]} were determined. Mean age was 78 ± 10 years, and 53% were male; of the 1024 patients, 554 (54%) were hospitalized. The median hospitalization length was 9 (IQR, 5-15) days, and in-hospital mortality was 12.7%. Hospitalized patients were predominantly men (56% vs. 47%; P < 0.001), younger (77 ± 9 vs. 79 ± 11 years; P = 0.002) and had higher creatinine values and B-type natriuretic peptide values (P < 0.001) than discharged patients. Patients with prior hospitalization had lower 30 day readmission rate (8% vs. 14%; P = 0.01), same overall readmission rate (30% vs. 32%), and higher 30 day (13% vs. 5%; P < 0.001) and overall mortality rates (28% vs. 15%; P < 0.001). CONCLUSIONS: Approximately half of the patients admitted to the ED were hospitalized. Of these, only 8% were readmitted in the ED within 30 days. The clinical and analytical status in the ED are important predictors of hospitalization.

Macitentan in the treatment of severe digital ulcers.

Digital ulcers are one of the earliest and most disabling manifestations of systemic sclerosis (SSc). We report the clinical case of a female patient with SSc and severe digital ulcers, recurrent and refractory to the classic treatments to whom it was prescribed off-label macitentan with complete resolution of the condition.