Spontaneous pulmonary hematoma in patients with COVID-19.

The disease caused by Sars-Cov-2 (Covid-19) has become a worldwide pandemic and consequently a public health problem. Multiple complications associated with Covid-19 have been described, including coagulation abnormalities. Although the infection is known to induce a prothrombotic state, hemorrhagic complications have also been reported in patients with Covid-19, especially in anticoagulated patients. We present two cases of spontaneous pulmonary hematoma in patients with Covid-19 undergoing anticoagulant treatment. We aim to describe this complication, which although uncommon, should be taken into account in anticoagulated patients with Covid-19.

Mechanical thrombectomy beyond 6 hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: experience at a tertiary hospital.

INTRODUCTION: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. METHODS: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

[Spontaneous pulmonary hematoma in patients with COVID-19]. / Hematoma pulmonar espontáneo en pacientes con COVID-19.

The disease caused by Sars-Cov-2 (Covid-19) has become a worldwide pandemic and consequently a public health problem. Multiple complications associated with Covid-19 have been described, including coagulation abnormalities. Although the infection is known to induce a prothrombotic state, hemorrhagic complications have also been reported in patients with Covid-19, especially in anticoagulated patients. We present two cases of spontaneous pulmonary hematoma in patients with Covid-19 undergoing anticoagulant treatment. We aim to describe this complication, which although uncommon, should be taken into account in anticoagulated patients with Covid-19.

Post-intensive care syndrome one month after discharge in surviving critically ill COVID-19 patients.

OBJECTIVES: Incidence of post-intensive care syndrome at one month after hospital discharge in surviving critically ill COVID 19 patients and to identify associated factors. DESIGN: Prospective cohort study. SETTING: Two multipurpose critical care units of the Araba University Hospital. Patients admitted to critical care units for severe acute respiratory failure secondary to COVID 19. INTERVENTION: None. VARIABLES OF INTEREST: Demographic variables, length of stay, Charlson index, APACHE II, SOFA, days of mechanical ventilation, tracheotomy, delirium, tetraparesis of the critical patient, EuroQol 5D5L, Minimental Test. RESULTS: A deterioration in the EuroQol health index (HI) from 90.9±16.9 to 70.9±24.7 (p<0.001) was observed. The impairment of the five EuroQol domains is: mobility (46.1%), usual activities (44.7%), discomfort/pain (30.7%), psychological domain (27.3%) and self-care (20.3%). The 61.5% suffer a significant decrease in their health index. Multivariate analysis by logistic regression shows us that delirium (OR=3.01; 95%CI: 1.01-8.9; p=0.047) and tracheostomy (OR=2.37; 95%CI: 1.09-5.14; p=0.029) show association with drop in EuroQoL 5D5L SI. The area under the ROC curve of the model is 67.3%, with a confidence interval between 58% and 76%. The model is calibrated using the Hosmer-Lemeshow test (χ2=0.468; p=0.792). Only 1.2% of patients showed a score ≤ 24, clearly pathological, on the Folstein's Minimental Test. CONCLUSIONS: Delirium and need for tracheostomy are associated with post-intensive care syndrome assessed by EuroQol 5D5L.

[Post-intensive care syndrome one month after hospital discharge of critical patients surviving COVID 19.] / Síndrome post-cuidados intensivos al mes del alta hospitalaria de pacientes críticos supervivientes a COVID 19.

OBJECTIVES: incidence of post-intensive care syndrome at one month after hospital discharge in surviving critically ill COVID 19 patients and to identify associated factors. DESIGN: prospective cohort study. SETTING: two multipurpose critical care units of the Araba University Hospital.Patients admitted to critical care units for severe acute respiratory failure secondary to COVID 19. INTERVENTION: none. VARIABLES OF INTEREST: demographic variables, length of stay, Charlson index, APACHE II, SOFA, days of mechanical ventilation, tracheotomy, delirium, tetraparesis of the critical patient, EuroQol 5D5L, Minimental Test. RESULTS: a deterioration in the EuroQol health index (HI) from 90.9 ± 16.9 to 70.9 ± 24.7 (p < 0.001) was observed. The impairment of the five EuroQol domains is: mobility (46.1%), usual activities (44.7%), discomfort/pain (30.7%), psychological domain (27.3%) and self-care (20.3%). The 61.5% suffer a significant decrease in their health index. Multivariate analysis by logistic regression shows us that delirium (OR= 3.01; 95%CI: 1.01-8.9; p= 0.047) and tracheostomy (OR= 2.37; 95%CI: 1.09-5.14; p= 0.029) show association with drop in EuroQoL 5D5L SI. The area under the ROC curve of the model is 67.3%, with a confidence interval between 58% and 76%. The model is calibrated using the Hosmer-Lemeshow test:(χ2=0.468; p=0.792). Only 1.2% of patients showed a score ≤ 24, clearly pathological, on the Folstein's Minimental Test. CONCLUSIONS: delirium and need for tracheostomy are associated with post-intensive care syndrome assessed by EuroQol 5D5L.

Differences in Linear Epitopes of Ara h 9 Recognition in Peanut Allergic and Tolerant, Peach Allergic Patients.

Background: Peanut-allergic patients from the Mediterranean region are predominantly sensitized to the lipid transfer protein (LTP) Ara h 9, and the peach LTP Pru p 3 seems to be the primary sensitizer. However, LTP sensitization in peanut allergy is not a predictive marker for clinically relevant symptoms. Objective: We aimed to identify sequential epitopes of IgE and IgG4 from Pru p 3 and Ara h 9 in peach-allergic patients sensitized to peanuts. We also sought to determine the differences in IgE and IgG4 binding between patients who had developed peanut allergy and those tolerating peanuts. Methods: A total of 46 peach-allergic patients sensitized to peanuts were selected. A total of 35 patients were allergic to peanuts (peanut-allergic group) and 11 were tolerant to peanuts (peanut-tolerant group). We measured sIgE and sIgG4 in peanut, peach, and their recombinant allergen (Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9) with fluorescence enzyme immunoassay. We examined the IgE and IgG4 binding to sequential epitopes using a peptide microarray corresponding to linear sequences of the LTPs Ara h 9 and Pru p 3 with a library of overlapping peptides with a length of 20 amino acids (aa) and an offset of 3 aa. Results: The frequency and the intensity of IgE recognition of Ara h 9 and Pru p 3 peptides were higher in the peanut-tolerant group than in the peanut-allergic group. We found four Ara h 9 peptides (p4, p14, p21, and p25) and four Pru p 3 peptides (p1, p3, p21, and p24) with a significantly elevated IgE recognition in peanut-tolerant patients. Only one peptide of Ara h 9 (p4) recognized by IgG4 was significantly elevated in the peanut-tolerant group. The IgG4/IgE ratio of Ara h 9 peptide 4 was significantly higher in peanut-tolerant patients than in peanut-allergic patients, while no significant differences were observed in the IgG4/IgE ratio of this peptide in Pru p 3. Conclusion: Although we found significant differences in IgE and IgG4 recognition of Ara h 9 and Pru p 3 between peanut-tolerant and peanut-allergic patients (all of whom were allergic to peach), polyclonal IgE peptide recognition of both LTPs was observed in peach-allergic patients tolerating peanuts. However, the IgG4 blocking antibodies against Ara h 9 peptide 4 could provide an explanation for the absence of clinical reactivity in peanut-tolerant peach-allergic patients. Further studies are needed to validate the usefulness of IgG4 antibodies against Ara h 9 peptide 4 for peanut allergy diagnosis.

Demonstration of multiple quantum interference and Fano resonance realization in far-field from plasmonic nanostructure in Er3+-doped tellurite glass.

It is crucial to control the tuning and improve the emission of a quantum emitter at the nanoscale. We report multiple Fano resonances in metallic nanostructures on an Er3+-doped tellurite glass. Periodic nanoslits were fabricated with a focused gallium ion beam on a gold thin film deposited on the tellurite glass. Is proposed a coupling function with Fano line-shape form, and the asymmetric parameter q for each resonance wavelength in the 515 to 535 nm region was calculated. This asymmetric resonance effect is a consequence of the quantum interaction between the continuum state, generated in the nanostructure, and the Stark splits of the [Formula: see text]H[Formula: see text] state.