Q Fever Severe Pericarditis With Cardiac Tamponade: A Case Report.

Q fever can present in acute or chronic form with a wide range of clinical symptoms and presentations. Here we report severe pericarditis with cardiac tamponade due to a chronic Coxiella burnetii (C. burnetii) infection. Our report emphasizes and justifies the importance of serological testing for chronic Q fever in patients with unexplained pericarditis, particularly in areas where C. burnetii is endemic.

Synthesis, Characterization, and X-ray Crystallography, of the First Cyclohexadienyl Trifluoromethyl Metal Complex (η5-C6H7)Fe(CO)2CF3.

Fluorochemistry is a field of tremendous developments and advances in several areas of science including materials, pharmaceuticals and agriculture. This makes the design and synthesis of fluorine-containing substances highly desirable research targets. The sub-area of synthetic perfluorinated chemistry proportionately attracts widespread interest by applying to all areas of chemistry including organic and inorganic. Particularly, the latter is much underdeveloped as metal complexes with perfluoroalkyl moieties are scarce, with the vast majority of perfluorinated analogs, of long known, halo and alkylated derivatives never having been synthesized. Focusing on the chemistry of trifluoromethyl group, which is the most important in the class of perfluoroalkyls, we set out to explore the possibility of synthesizing and completely characterizing a cyclohexadienyl metal complex. Upon utilizing a number of trifluorometylating reagents, we only arrived at an efficient preparation by the use of Morrison's trifluormethylating reagent. As a result, the new, air- and moisture-sensitive complex (η5-C6H7)Fe(CO)2CF3, was prepared in 71% yield, using a nucleophilic iodo-for-trifluoromethyl substitution, and was completely characterized including by X-ray crystallography.

Syntheses and Characterization of the First Cycloheptatrienyl Transition-Metal Complexes with a M-CF3 Bond.

The organometallic chemistry of metal complexes with organocyclic ligands of higher than five hapticity is much more lacking than the chemistry of metal complexes with η5-cyclopentadienyl ligands, which has been explored in considerable depth, resulting in novel advances. The main reason for this is stability. In particular, reports indicate that (η7-C7H7)MLn complexes are considerably less stable than analogous (η5-C5H5)MLn. In perfluoroalkyl metal chemistry, there is currently no reported (η7-C7H7)MLn derivative, whereas a number of alkylated ones are known and important conclusions have been drawn about their stability. Responding to this void, and using Morrison's trifluoromethylating reagent, the present study reports the synthesis and characterization of the first cycloheptatrienyl molybdenum complexes bearing the trifluoromethyl moiety; (η7-C7H7)Mo(CO)2CF3 (I), and (η7-C7H7)Mo(CO)(PMe3)CF3 (II) and discusses their low thermal instability.

Myocardial fibrosis after COVID-19 infection and severe sinus arrest episodes in an asymptomatic patient with mild sleep apnea syndrome: A case report and review of the literature.

COVID-19 infection is a new disease mainly affecting the respiratory system but is also accompanied by many extra-pulmonary manifestations. A case of a 47-year old male with unique myocardial fibrosis after COVID-19 infection involving the left ventricular wall, intraventricular septum and almost complete damage of interatrial septum, in combination with asymptomatic severe sinus arrest episodes related to mild obstructive sleep apnea syndrome is described here.

Significant reduction in the visits to the emergency room department during the COVID-19 pandemic in a tertiary hospital in Greece: Indirect victims of the pandemic?

ABSTRACT: COVID-19 pandemic caused a major crisis, affecting and straining health care systems, including some very advanced ones. The pandemic may have also indirectly affected access to health care for patients with other conditions, not related to COVID-19, even in countries not overwhelmed by an outbreak.We analyzed and compared visits to the emergency room (ER) department during the same calendar period of 2019 and 2020 (from March 1 to March 31 of each year) in our hospital, a medium size, tertiary center, located in the center of Athens, which is not a referral center for COVID-19.Total ER visits were reduced by 42.3% and the number of those requiring hospitalization by 34.8%. This reduction was driven by lower numbers of visits for low risk, non-specific symptoms and causes. However, there was a significant decrease in admissions for cardiovascular symptoms and complications (chest pain of cardiac origin, acute coronary syndromes, and stroke) by 39.7% and for suspected or confirmed GI hemorrhage by 54.7%. Importantly, number of ER visits for infections remained unchanged, as well as the number of patients that required hospitalization for infection management; only few patients were diagnosed with COVID-19.During the initial period of the pandemic and lock-down in Greece, there was a major decrease in the patients visiting ER department, including decrease in the numbers of admissions for cardiovascular symptoms and complications. These observations may have implications for the management of non-COVID-19 diseases during the pandemic.

Effects of Mediterranean diet on hospital length of stay, medical expenses, and mortality in elderly, hospitalized patients: A 2-year observational study.

OBJECTIVES: The Mediterranean diet (MedDiet) has been related to reduced overall mortality and improved disease outcome. The aim of this study was to estimate the effects of the MedDiet on hospital length of stay (LOS), financial cost, and mortality (from hospitalization up to 24 mo afterward) in hospitalized patients >65 y of age. METHODS: Participating in this observational study were 183 patients >65 y of age, who were urgently admitted for any cause to the Internal Medicine Department of Argolidos General Hospital. Hospital LOS and its financial cost, mortality (during hospitalization, 6 and 24 mo after discharge), physical activity, and medical and anthropometric data were recorded and correlated with the level of adherence to the MedDiet (MedDiet score). RESULTS: In multivariate analyses, hospital LOS decreased by 0.3 d for each unit increase of MedDiet score (P < 0.0001), 2.1 d for each 1 g/dL increase of albumin (P = 0.001) and increased 0.1 d for each day of previous admissions (P < 0.0001). Extended hospitalization (P < 0.0001) and its interaction with MedDiet score (P = 0.01) remained the significantly associated variables for financial cost. Mortality risk increased 3% per each year increase of age (hazard ratio [HR], 1.03; P = 0.02) and 6% for each previous admission (HR, 1.06; P = 0.04); whereas it decreased 13% per each unit increase of MedDiet score (HR, 0.87; P < 0.0001). CONCLUSION: Adoption of the MedDiet decreases duration of admission and long-term mortality in hospitalized patients >65 y of age, with parallel reduction of relevant financial costs.

4f-Metal Clusters Exhibiting Slow Relaxation of Magnetization: A {Dy7} Complex with An Hourglass-like Metal Topology.

The reaction between Dy(NO3)3∙6H2O and the bulky Schiff base ligand, N-naphthalidene-2-amino-5-chlorobenzoic acid (nacbH2), in the presence of the organic base NEt3 has led to crystallization and structural, spectroscopic and magnetic characterization of a new heptanuclear [Dy7(OH)6(OMe)2(NO3)1.5(nacb)2(nacbH)6(MeOH)(H2O)2](NO3)1.5 (1) compound in ~40% yield. Complex 1 has a unique hourglass-like metal topology, among all previously reported {Dy7} clusters, comprising two distorted {Dy4(µ3-OH)3(µ3-OMe)}8+ cubanes that share a common metal vertex (Dy2). Peripheral ligation about the metal core is provided by the carboxylate groups of four η1:η1:η1:µ single-deprotonated nacbH- and two η1:η1:η2:η1:µ3 fully-deprotonated nacb2- ligands. Complex 1 is the first structurally characterized 4f-metal complex bearing the chelating/bridging ligand nacbH2 at any protonation level. Magnetic susceptibility studies revealed that 1 exhibits slow relaxation of magnetization at a zero external dc field, albeit with a small energy barrier of ~5 K for the magnetization reversal, most likely due to the very fast quantum-tunneling process. The combined results are a promising start to further explore the reactivity of nacbH2 upon all lanthanide ions and the systematic use of this chelate ligand as a route to new 4f-metal cluster compounds with beautiful structures and interesting magnetic dynamics.

'Metal Complexes as Ligands' for the Synthesis of Coordination Polymers: A MnIII Monomer as a Building Block for the Preparation of an Unprecedented 1-D {MnIIMnIII}n Linear Chain.

A relatively unexplored synthetic route in redox-active Mn(II/III) coordination chemistry has been employed toward the preparation of a new mixed-valence MnII/III 1-D linear chain from the reaction of [MnIII(sacb)2]- precursor with a MnII source, where sacbH2 is the Schiff base ligand N-salicylidene-2-amino-5-chlorobenzoic acid. The mononuclear (Pr2NH2)[MnIII(sacb)2] (1) compound was obtained in excellent yields (>85%) from the 1:2:3 reaction of Mn(O2CMe)2∙4H2O, sacbH2 and Pr2NH, respectively. In 1, the two doubly deprotonated sacb2- ligands act as Ocarboxylate,Nimine,Ophenoxide-tridentate chelates, while the second carboxylate O atom of sacb2- is dangling and H-bonded to the Pr2NH2+ countercation. Complex 1 was subsequently used as a 'ligand' to react stoichiometrically with the 'metal' Mn(NO3)2∙4H2O, thus leading to the 1-D coordination polymer {[MnIIMnIII(sacb)2(H2O)2(MeOH)2](NO3)}n (2) in good yields (~50%). The removal of Pr2NH2+ from the vicinity of the [MnIII(sacb)2]- metalloligand has rendered possible (vide infra) the coordination of the second Ocarboxylate of sacb2- to neighboring {MnII(H2O)2(MeOH)2}2+ units, and consequently the formation of the 1-D polymer 2. Direct-current (dc) magnetic susceptibility studies revealed the presence of very weak antiferromagnetic exchange interactions between alternating MnIII and MnII atoms with a coupling constant of J = -0.08 cm-1 for g = 2.00. The combined results demonstrate the potential of the 'metal complexes as ligands' approach to yield new mixed-valence Mn(II/III) coordination polymers with interesting structural motifs and physicochemical properties.

Prognostic value of exercise tolerance test for predicting cardiovascular disease in asymptomatic individuals with heterozygous familiar hypercholesterolemia.

Heterozygous familiar hypercholesterolemia (hFH) is an autosomal dominant inherited dyslipidemia, associated with premature cardiovascular disease (CVD). Aim of the study was to define prognostic factors for cardiovascular events (CVE) in asymptomatic individuals with hFH. All participants with recent diagnosis of hFH were recruited from the outpatient lipid clinic from 1987 to 2016, without any previous clinical evidence of CVD. A detailed clinical evaluation and laboratory investigation was obtained. Exercise tolerance test (ETT) was performed until maximum exercise capacity was achieved, without evidence of ischemia. Primary endpoint of the study was the first CVE. Four hundred fifty one participants were followed up for 10 ± 8 years, with 68 recorded cases of CVD (15%). Cumulative incidence of CVD was 15%, 24% and 32% for the 3 decades, respectively. In univariate analysis, male gender (p = 0.016), progression of age (p < 0.001), menopause (p = 0.030), waist-hip ratio (p = 0.043) and increased levels of Lp(α) (p = 0.014) were significantly associated with increased CVD incidence; whereas, exercise capacity (p = 0.025), low variation of heart rate (HR) during all stages of ETT compared to resting state (p = 0.020), maximum systolic (p = 0.014) and diastolic (p < 0.001) blood pressure were inversely associated with CVD. In multi-adjusted analysis, male gender (p < 0.001), duration of ETT (p = 0.023), estimated HR (p = 0.029), variation of HR during ETT compared to resting state (p < 0.05) and maximum diastolic pressure (p = 0.044) were significantly associated with CVD. Parameters of ETT in asymptomatic individuals with hFH, without any evidence of ischemia, may predict CVD in these high-risk patients after decades of observation.

Weil's disease with haemoptysis and acute respiratory distress syndrome.

A 35-year-old male patient reached the emergency department after an episode of massive haemoptysis a few hours ago. Fever and dyspnea were mentioned to be present the last 5 days. His medical history included only malaria, successfully treated 2 years ago. Clinical examination revealed high fever, jaundice, cyanosis, tachypnea and bilateral rales on pulmonary auscultation. Laboratory investigation showed high erythrocyte sedimentation rate and C reactive protein, leucocytosis, anaemia, mild thrombocytopaenia, renal impairment, hyperbilirubinaemia and abnormal liver function tests; arterial blood gas analysis showed respiratory alkalosis with severe hypoxia. Thoracic X-ray revealed bilateral pulmonary infiltrates, whereas abdominal and heart ultrasound detected hepatomegaly and small pericardial infusion, respectively. The diagnosis of leptospirosis along with acute respiratory distress syndrome was confirmed by positive IgM Leptospira antibodies. Empirical treatment with triple antibiotic therapy and corticosteroids was applied. The patient was discharged after 1 week, without any symptoms and with almost normal laboratory tests.

The surprising pairing of 2-aminoimidazo[1,2-a][1,3,5]triazin-4-one, a component of an expanded DNA alphabet.

Synthetic biologists demonstrate their command over natural biology by reproducing the behaviors of natural living systems on synthetic biomolecular platforms. For nucleic acids, this is being done stepwise, first by adding replicable nucleotides to DNA, and then removing its standard nucleotides. This challenge has been met in vitro with `six-letter' DNA and RNA, where the Watson-Crick pairing `concept' is recruited to increase the number of independently replicable nucleotides from four to six. The two nucleobases most successfully added so far are Z and P, which present a donor-donor-acceptor and an acceptor-acceptor-donor pattern, respectively. This pair of nucleobases are part of an `artificially expanded genetic information system' (AEGIS). The Z nucleobase has been already crystallized, characterized, and published in this journal [Matsuura et al. (2016). Acta Cryst. C72, 952-959]. More recently, variants of Taq polymerase have been crystallized with the pair P:Z trapped in the active site. Here we report the crystal structure of the nucleobase 2-aminoimidazo[1,2-a][1,3,5]triazin-4-one (trivially named P) as the monohydrate, C5H5N5O·H2O. The nucleobase P was crystallized from water and characterized by X-ray diffraction. Interestingly, the crystal structure shows two tautomers of P packed in a Watson-Crick fashion that cocrystallized in a 1:1 ratio.

Acute Heart Failure in a Healthy Young Patient after Severe Carbon Monoxide Poisoning.

INTRODUCTION: Carbon monoxide (CO) poisoning may cause severe cellular hypoxia. MATERIALS AND METHODS: A 28-year-old male presented reduced levels of consciousness and dyspnoea after CO exposure. Clinical examination revealed tachypnoea, bilateral rales, dilated jugular veins and confusion. Troponin I, lactate and carboxyhaemoglobin levels were increased. Thoracic X-ray depicted pulmonary oedema and an echocardiogram, severe heart failure (HF; EF<25%). He was intubated due to clinical deterioration. RESULTS: He remained intubated for 5 days with excellent improvement of left ventricular function (EF>55%). He was discharged 1 week later with full recovery. DISCUSSION: Acute HF is a rare serious complication of CO poisoning, even in healthy young individuals. LEARNING POINTS: Acute CO poisoning is an emergent condition necessitating prompt diagnosis and treatment.Neurologic and cardiovascular manifestations are the most worrying complications, which may leave permanent sequelae.Acute heart failure is a rare complication of CO poisoning, characterized by regional or global left ventricular wall hypokinesia.

Oximato-Based Ligands in 3 d/4 f-Metal Cluster Chemistry: A Family of {Cu3Ln} Complexes with a "Propeller"-like Topology and Single-Molecule Magnetic Behavior.

The organic chelating and bridging ligands 9,10-phenanthrenedione-9-oxime (phenoxH) and 9,10-phenanthrenedione-9,10-dioxime (phendoxH2) were synthesized and subsequently employed for the first time in heterometallic 3 d/4 f-metal cluster chemistry. The general reaction between CuCl2·2H2O, LnCl3·6H2O, phenoxH, and NEt3 in a 1:2:2:4 molar ratio, in a solvent mixture comprising MeCN and MeOH, afforded brown crystals of a new family of [Cu3LnCl3(phenox)6(MeOH)3] clusters (Ln = Gd (1), Tb (2), Dy (3)) that possess an unprecedented [Cu3Ln(µ-NO)6]3+ "propeller"-like core. Complexes 1-3 are the first {Cu3Ln} clusters in which the outer CuII and the central LnIII atoms are solely bridged by diatomic oximato bridges. The {Cu-N-O-Ln} bridging units are very distorted with torsion angles spanning the range 35.5-48.9° and 25.2-55.6° in 1 and 2, respectively. As a result, complexes 1-3 are antiferromagnetically coupled, in agreement with previously reported magnetostructural criteria for oximato-bridged Cu/Ln complexes. The magnetic susceptibility data for all complexes were nicely fit to an isotropic spin Hamiltonian (for 1) or a Hamiltonian that accounts for the spin of the CuII atoms, the spin component of the LnIII, the spin-orbit coupling (λ), an axial ligand-field component around the LnIII atoms (Δ), and the Zeeman effect (for the anisotropic 2 and 3). The resulting fit parameters were J = -1.34 cm-1 and g = 2.10 (1), J = -1.42 cm-1, gCu = 2.10, and Δ = -26.3 cm-1 (2), and J = -1.70 cm-1, gCu = 2.05, and Δ = -38.1 cm-1 (3). The reported fitting procedure, implemented in the PHI program, is here used for the first time. Even if this method is only valid in high-symmetry Ln environments, when it is properly used allows a very simple and efficient method to obtain the exchange parameters. In light of the negative anisotropy, compounds 2 and 3 were found to exhibit frequency-dependent tails of out-of-phase signals in the presence of a small external dc field, characteristic of the slow magnetization relaxation of a single-molecule magnet. By using the Kramers-Kronig equations, the effective energy barriers ( Ueff) were derived and reported as Ueff = 10.1 and 5.4 cm-1 for 2 and 3, respectively.

Structural and Magnetic Variations in a Family of Isoskeletal, Oximate-Bridged {MnIV2 MIII } Complexes (MIII =Mn, Gd, Dy).

The self-assembly reaction of MnCl2 ⋅4H2 O, acenaphthenequinone dioxime (acndH2 ) and NEt3 has yielded an unprecedented, linear {MnIV2 MnIII } complex with an S=5 spin ground state and non-SMM behavior. The targeted replacement of the central MnIII ion with GdIII and DyIII ions has successfully increased the S and turned on the SMM dynamics without affecting the core structure and the nature of the magnetic exchange interactions.

Controlled Dimerization of Mn12 Single-Molecule Magnets.

Controlled dimerization of Mn12 single-molecule magnets (SMMs) was achieved via a synthetic route involving a competition between bridging and terminal ligands, namely, diols and alcohols. The reaction using a 1:1 ratio of the competing ligands resulted in the isolation of a new family of covalently linked dimers of Mn12 SMMs. This is the first step toward the controlled growth of SMM oligomeric arrays.

Treat-to-target biologic therapy in patients with rheumatoid arthritis is more efficacious and safe compared to delayed initiation of biologics: a real-world study.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic, devastating disease. Treat-to-target strategy (T2T) more than the usual care, reduces disease activity by using aggressively all therapeutic options. The aim of the study was to evaluate our hypothesis that T2T strategy using biologic disease-modifying anti-rheumatic drugs (bDMARDs), when needed, is also safer than the usual care characterised by delayed initiation of bDMARDs. METHODS: Disease activity was regularly measured by DAS-28 until the end of treatment with the first bDMARD. All adverse events (AEs) and their severity were recorded. Cox proportional-hazards models were performed examining the association of treatment groups, with the risk of first AE. RESULTS: There were 113 patients in T2T and 250 patients in usual care group. The likelihood (adjusted hazard ratio, HR) of achieving remission or LDA was 71% higher in the T2T group than in the usual care group, as it has been already shown by others. The novel finding of our work was that AEs, including cancers, were less frequent in the T2T group with the corresponding HRs being less than 0.50 for serious AEs, infections and serious infections (significant or marginally non-significant results). There were 15 new cancer cases in usual care and 1 in T2T group (IR 1.99 vs. 0.4, p=0.027). CONCLUSIONS: Treat-to-target treatment with bDMARDs offers a safer, rapid and better long-term outcome to patients with RA.

Introducing Dimensionality to the Archetypical Mn12 Single-Molecule Magnet: a Family of [Mn12]n Chains.

The [Mn12O12(O2CR)16(L4)] family (R = various; L = terminal ligand) of clusters holds a special place in molecular magnetism; they are the most well-studied single-molecule magnets (SMMs). Targeted linkage of these SMMs has now been achieved for the first time. The resulting chain structures have been confirmed crystallographically, and the magnetic properties, up to 1.14 GPa, and high-field electron paramagnetic resonance spectra have been collected and analyzed.

"Ligands-with-Benefits": Naphthalene-Substituted Schiff Bases Yielding New Ni(II) Metal Clusters with Ferromagnetic and Emissive Properties and Undergoing Exciting Transformations.

The initial employment of the fluorescent bridging ligand N-naphthalidene-2-amino-5-chlorobenzoic acid (nacbH2) in metal cluster chemistry has led to new Ni12 (1) and Ni5 (2) clusters with wheel-like and molecular-chain topologies, respectively. The doubly-deprotonated nacb(2-) ligands were found to adopt four different coordination modes within 1 and 2. The nature of the ligand has also allowed unexpected organic transformations to occur and ferromagnetic and emission behaviors to emerge. The combined work demonstrates the ability of some "ligands-with-benefits" to yield beautiful structures with exciting topologies and interesting physicochemical properties.

Adverse events and infections in patients with rheumatoid arthritis treated with conventional drugs or biologic agents: a real world study.

OBJECTIVES: Treatment of rheumatoid arthritis (RA) with disease-modifying anti-rheumatic drugs (DMARDs), either synthetic (sDMARDs) or biologic agents (bDMARDs) has significantly improved disease outcome. However, the impact of therapy-related adverse events (AEs), mild, moderate or serious, on disease outcome is under debate. The purpose of the study was to test the hypothesis that AEs, including infections, are rather common in patients receiving bDMARDs than in those receiving sDMARDs. METHODS: Analysis of the medical records of patients followed in a single outpatient clinic was performed. In total, 1403 adults (295 men, 1108 women) were included in the analysis (969 treated with sDMARDs only, 434 with bDMARDs). All AEs and infections were recorded and their severity was graded according to international criteria. Incident rates were calculated and Kaplan-Meier plots as well as Cox proportional-hazards models were performed to examine the association of treatment groups with the risk of any AE. RESULTS: The risk of any AE, irrespective of severity, was significantly higher in patients with bDMARDs with the adjusted hazard ratio being 1.98 (95% CI: 1.64 to 2.39). Patients in the biologic group treated initially with infliximab or adalimumab had a higher risk of AE compared to patients receiving etanercept or other biologic agents. Among patients treated with methotrexate, those receiving a dose below 10 mg had a higher risk of any AE when compared to those receiving higher doses. CONCLUSIONS: The risk of any AE among RA patients treated with bDMARDs was significantly higher compared to those treated with sDMARDs.