Global Scientific Overview of Dermatology Related to COVID-19: A Bibliometric Analysis.

Background: Coronavirus disease 2019 (COVID-19) has had a significant impact on dermatology, but to date no bibliometric analysis of this field has been identified. Therefore, the aim of this study was to perform a bibliometric indicator analysis of the worldwide scientific production of COVID-19 in dermatology. Materials and Methods: An advanced bibliographic search was performed in the Scopus database to identify articles on COVID-19 and dermatology from 2020 to 2021. The collected information was analysed with SciVal software. Bibliometric data were described through figures and summary tables. Results: A total of 1448 documents were collected and analysed. Torello Lotti was the author with the greatest scientific production; however, Esther Freeman had the greatest impact. Harvard University was the institution with the highest number of published articles. Most papers were published in the first quartiles. The United States and Italy were the leading countries in terms of production. Articles with international collaboration had the highest impact. Conclusion: Articles related to dermatology and COVID-19 are mostly published with American and Italian affiliations. In addition, there has been an increase in the distribution of articles published in the first quartile, which would reflect a growing interest in the community. Publications with international collaboration reported the highest impact, so future authors should take this into account.

3D Bioprinting of Food Grade Hydrogel Infused with Living Pleurotus ostreatus Mycelium in Non-sterile Conditions.

Mycelium is the root-like network of fungi. Mycelium biocomposites prepared by template replication (molding) can function as environmentally friendly alternatives to conventional polystyrene foams, which are energy- and carbon-intensive to manufacture. Recently, several studies have shown that 3D bioprinting technologies can be used to produce high value functional mycelium products with intricate geometries that are otherwise difficult or impossible to achieve via template replication. A diverse range of nutrients, thickeners, and gelling agents can be combined to produce hydrogels suitable for 3D bioprinting. 3D bioprinting with hydrogel formulations infused with living fungi produces engineered living materials that continue to grow after bioprinting is complete. However, a hydrogel formulation optimized for intricate 3D bioprinting of Pleurotus ostreatus mycelium, which is among the strains most commonly used in mycelium biocomposite fabrication, has yet to be described. Here, we design and evaluate a versatile hydrogel formulation consisting of malt extract (nutrient), carboxymethylcellulose and cornstarch (thickeners), and agar (gelling agent), all of which are easily sourced food grade reagents. We also outline a reproducible workflow to infuse this hydrogel with P. ostreatus liquid culture for 3D bioprinting of intricate structures comprised of living P. ostreatus mycelium and characterize the changes in height and mass as well as hardness of the prints during mycelium growth. Finally, we demonstrate that the workflow does not require a sterile bioprinting environment to achieve successful prints and that the same mycelium-infused hydrogel can be supplemented with additives such as sawdust to produce mycelium biocomposite objects. These findings demonstrate that 3D bioprinting using mycelium-based feedstocks could be a promising biofabrication technique to produce engineered living materials for applications such as mushroom cultivation, food preparation, or construction of the built environment.

Vehicle and Driver Monitoring System Using On-Board and Remote Sensors.

This paper presents an integrated monitoring system for the driver and the vehicle in a single case of study easy to configure and replicate. On-board vehicle sensors and remote sensors are combined to model algorithms for estimating polluting emissions, fuel consumption, driving style and driver's health. The main contribution of this paper is the analysis of interactions among the above monitored features highlighting the influence of the driver in the vehicle performance and vice versa. This analysis was carried out experimentally using one vehicle with different drivers and routes and implemented on a mobile application. Compared to commercial driver and vehicle monitoring systems, this approach is not customized, uses classical sensor measurements, and is based on simple algorithms that have been already proven but not in an interactive environment with other algorithms. In the procedure design of this global vehicle and driver monitoring system, a principal component analysis was carried out to reduce the variables used in the training/testing algorithms with objective to decrease the transfer data via Bluetooth between the used devices: a biometric wristband, a smartphone and the vehicle's central computer. Experimental results show that the proposed vehicle and driver monitoring system predicts correctly the fuel consumption index in 84%, the polluting emissions 89%, and the driving style 89%. Indeed, interesting correlation results between the driver's heart condition and vehicular traffic have been found in this analysis.

Cierre percutáneo de orejuela en paciente con antecedente de cierre percutáneo de comunicación interauricular / Left atrial appendage closure in a patient with prior atrial septal defect occlusion

Resumen La fibrilación auricular es la arritmia más prevalente en la práctica clínica, y se asocia con una morbimortalidad significativa, la cual, en parte, se explica por el riesgo de fenómenos embólicos. En la actualidad, el uso de anticoagulantes es el estándar de manejo en aquellos pacientes con riesgo embólico significativo (dado por un puntaje ≥ 2 en la escala CHA2DS2Vasc). Sin embargo, algunos pacientes tienen contraindicaciones que impiden recibir este tipo de tratamiento a largo plazo, en cuyo caso se considera el cierre percutáneo de la orejuela como medida para la disminución del riesgo de embolia. Al requerir una punción transeptal, la presencia de dispositivos de cierre de defectos del septo interauricular dificulta el procedimiento de manera significativa. Se presenta el caso de una paciente con contraindicación absoluta para recibir anticoagulantes debido a sangrado gastrointestinal y antecedente de cierre percutáneo de comunicación interauricular sometida a cierre percutáneo de orejuela como alternativa terapéutica a la anticoagulación.

Abstract Atrial fibrillation is the most prevalent arrythmia in clinical practice, associated with a significant morbimortality explained, in part, by the high risk of embolic phenomena. The use of anticoagulation is the standard of care in those patients with increased embolic risk (given by a score ≥ 2 in the CHA2DS2Vasc scale). However, some patients have contraindications to receiving this treatment long-term, in which case percutaneous left atrial appendage occlusion can be considered as a means of decreasing their embolic risk. Because the procedure requires transeptal puncture, the presence of devices for atrial septal defect closure can difficult the technique. We present the case of a patient with absolute contraindication to anticoagulation therapy given gastrointestinal bleeding, with history of percutaneous closure of interauricular communication, who was treated with percutaneous left atrial appendage occlusion as an alternative to oral anticoagulants.

EEG-Based Tool for Prediction of University Students' Cognitive Performance in the Classroom.

This study presents a neuroengineering-based machine learning tool developed to predict students' performance under different learning modalities. Neuroengineering tools are used to predict the learning performance obtained through two different modalities: text and video. Electroencephalographic signals were recorded in the two groups during learning tasks, and performance was evaluated with tests. The results show the video group obtained a better performance than the text group. A correlation analysis was implemented to find the most relevant features to predict students' performance, and to design the machine learning tool. This analysis showed a negative correlation between students' performance and the (theta/alpha) ratio, and delta power, which are indicative of mental fatigue and drowsiness, respectively. These results indicate that users in a non-fatigued and well-rested state performed better during learning tasks. The designed tool obtained 85% precision at predicting learning performance, as well as correctly identifying the video group as the most efficient modality.

Clinical and Serological Findings of Madariaga and Venezuelan Equine Encephalitis Viral Infections: A Follow-up Study 5 Years After an Outbreak in Panama.

BACKGROUND: Human cases of Madariaga virus (MADV) infection were first detected during an outbreak in 2010 in eastern Panama, where Venezuelan equine encephalitis virus (VEEV) also circulates. Little is known about the long-term consequences of either alphavirus infection. METHODS: A follow-up study of the 2010 outbreak was undertaken in 2015. An additional survey was carried out 2 weeks after a separate 2017 alphavirus outbreak in a neighboring population in eastern Panama. Serological studies and statistical analyses were undertaken in both populations. RESULTS: Among the originally alphavirus-seronegative participants (n = 35 of 65), seroconversion was observed at a rate of 14.3% (95% CI, 4.8%-30.3%) for MADV and 8.6% (95% CI, 1.8%-23.1%) for VEEV over 5 years. Among the originally MADV-seropositive participants (n = 14 of 65), VEEV seroconversion occurred in 35.7% (95% CI, 12.8%-64.9%). In the VEEV-seropositive participants (n = 16 of 65), MADV seroconversion occurred in 6.3% (95% CI, 0.2%-30.2%). MADV seroreversion was observed in 14.3% (95% CI, 1.8%-42.8%) of those who were originally seropositive in 2010. VEEV seroconversion in the baseline MADV-seropositive participants was significantly higher than in alphavirus-negative participants. In the population sampled in 2017, MADV and VEEV seroprevalence was 13.2% and 16.8%, respectively. Memory loss, insomnia, irritability, and seizures were reported significantly more frequently in alphavirus-seropositive participants than in seronegative participants. CONCLUSIONS: High rates of seroconversion to MADV and VEEV over 5 years suggest frequent circulation of both viruses in Panama. Enhanced susceptibility to VEEV infection may be conferred by MADV infection. We provide evidence of persistent neurologic symptoms up to 5 years following MADV and VEEV exposure.

Microstructural Changes during Degradation of Biobased Poly(4-hydroxybutyrate) Sutures.

Fibers of poly(4-hydroxybutyrate) (P4HB) have been submitted to both hydrolytic and enzymatic degradation media in order to generate samples with different types and degrees of chain breakage. Random chain hydrolysis is clearly enhanced by varying temperatures from 37 to 55 °C and is slightly dependent on the pH of the medium. Enzymatic attack is a surface erosion process with significant solubilization as a consequence of a preferent stepwise degradation. Small angle X-ray diffraction studies revealed a peculiar supramolecular structure with two different types of lamellar stacks. These were caused by the distinct shear stresses that the core and the shell of the fiber suffered during the severe annealing process. External lamellae were characterized by surfaces tilted 45° with respect to the stretching direction and a higher thickness, while the inner lamellae were more imperfect and had their surfaces perpendicularly oriented to the fiber axis. In all cases, WAXD data indicated that the chain molecular axis was aligned with the fiber axis and molecules were arranged according to a single orthorhombic structure. A gradual change of the microstructure was observed as a function of the progress of hydrolysis while changes were not evident under an enzymatic attack. Hydrolysis mainly affected the inner lamellar stacks as revealed by the direct SAXS patterns and the analysis of correlation functions. Both lamellar crystalline and amorphous thicknesses slightly increased as well as the electronic contrast between amorphous and crystalline regions. Thermal treatments of samples exposed to the hydrolytic media revealed microstructural changes caused by degradation, with the inner lamellae being those that melted faster.

Synchrotron and Raman Study of the Rotator Phases and Polymorphism in Tricosane Paraffin.

A detailed study of the phase behavior of n-paraffin C23H48 has been performed by means of real-time variable-temperature experiments with synchrotron radiation. Two detectors were employed for simultaneous analysis of the small-angle (SAXS) and wide-angle X-ray-scattering (WAXS) regions. This paraffin presents a very interesting phase behavior, involving two crystal polymorphs, three rotator phases and the liquid state. The Ostwald rule of stages is invoked to find similarities of the rotator phases with the eventual transient mesomorphic structure in the multistage model of polymer crystallization. That study is complemented by variable-temperature Raman experiments covering frequencies down to 150 cm-1. It was found that the low-frequency region is the most informative regarding the phase transitions, and specifically the intensity of the first overtone. From these analyses, several parameters are evaluated as function of temperature.

Tetra-aqua-bis-(2,3-di-hydro-1,4-benzodioxine-2-carboxyl-ato)calcium(II).

The acid-base reaction of 1,4-benzodioxane 2-carb-oxy-lic acid with calcium carbonate furnished the centrosymmetric title compound, [Ca(C9H7O4)2(H2O)4], in which the metal ion is octa-hedrally coordinated by two monodentate 1,4-benzodioxane 2-carboxyl-ate ligands and four water mol-ecules. In the crystal, O-H⋯O and C-H⋯O hydrogen bonds link the mol-ecules into a three-dimensional network.

Lymphocyte-driven regional immunopathology in pneumonitis caused by impaired central immune tolerance.

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), a monogenic disorder caused by AIRE mutations, presents with several autoimmune diseases. Among these, endocrine organ failure is widely recognized, but the prevalence, immunopathogenesis, and treatment of non-endocrine manifestations such as pneumonitis remain poorly characterized. We enrolled 50 patients with APECED in a prospective observational study and comprehensively examined their clinical and radiographic findings, performed pulmonary function tests, and analyzed immunological characteristics in blood, bronchoalveolar lavage fluid, and endobronchial and lung biopsies. Pneumonitis was found in >40% of our patients, presented early in life, was misdiagnosed despite chronic respiratory symptoms and accompanying radiographic and pulmonary function abnormalities, and caused hypoxemic respiratory failure and death. Autoantibodies against BPIFB1 and KCNRG and the homozygous c.967_979del13 AIRE mutation are associated with pneumonitis development. APECED pneumonitis features compartmentalized immunopathology, with accumulation of activated neutrophils in the airways and lymphocytic infiltration in intraepithelial, submucosal, peribronchiolar, and interstitial areas. Beyond APECED, we extend these observations to lung disease seen in other conditions with secondary AIRE deficiency (thymoma and RAG deficiency). Aire-deficient mice had similar compartmentalized cellular immune responses in the airways and lung tissue, which was ameliorated by deficiency of T and B lymphocytes. Accordingly, T and B lymphocyte-directed immunomodulation controlled symptoms and radiographic abnormalities and improved pulmonary function in patients with APECED pneumonitis. Collectively, our findings unveil lung autoimmunity as a common, early, and unrecognized manifestation of APECED and provide insights into the immunopathogenesis and treatment of pulmonary autoimmunity associated with impaired central immune tolerance.

An endothelial growth factor receptor compound mutation of T790M substitution with exon 19 deletion in a previously untreated patient: a case report.

BACKGROUND: Endothelial growth factor receptor (EGFR) mutations are an essential driver of personalized therapy for patients with lung cancer and are detected in approximately 15% of Caucasian and 50% of Asian patients. EGFR tyrosine kinase inhibitors have been developed and used for this set of patients. T790M mutation in exon 20 is usually associated with secondary resistance to EGFR tyrosine kinase inhibitors therapy but is also present in treatment-naïve patients. The frequency for baseline T790M mutation varies from 4 to 35% according to the detection method used. Newer techniques have yielded higher rates, but concerns about false-positive results have been raised. Compound mutations account for 4-14% of all EGFR-mutated tumors, with no studies yet to provide a frequency rate for T790M + 19 deletion association due to the small number of cases. However, there are reports that pretreatment T790M + L858R association is significantly more frequent compared to T790M + exon 19 deletion mutations. Diagnostic challenges, current knowledge on the subject, and therapeutic decisions are discussed. CASE PRESENTATION: We present the case of a 43-year-old Hispanic woman, a treatment-naïve patient, with metastasized lung cancer adenocarcinoma harboring a T790M deletion along with the classic 19 mutation. The initial symptoms were monoparesis of her left leg, associated with hyperreflexia, and hypoesthesia. In the absence of third-generation tyrosine kinase inhibitors, a platinum-based therapy was initiated with no response and she died 4 months after diagnosis. CONCLUSIONS: Osimertinib seems to be a suitable therapy for treatment-naïve patients with sensitizing and resistant compound EGFR mutations. More studies regarding the clinical characteristics of these patients and the appropriate management of this condition are needed to provide the highest standard of care.

Crystalline Structures and Structural Transitions of Copolyamides Derived from 1,4-Diaminobutane and Different Ratios of Glutaric and Azelaic Acids.

Copolyamides derived from even 1,4-butanediamine and different mixtures of odd dicarboxylic acids with a great difference in the number of methylene groups (i.e., glutaric and azelaic acids with 3 and 7 groups, respectively) have been synthesized, characterized and structurally studied. Calorimetric analyses revealed a complex behavior with multiple melting peaks associated to lamellar reordering and the presence of defective crystals. Equilibrium melting temperatures were evaluated and showed a eutectic behavior with composition. Copolymers were able to crystallize even for samples with comonomer percentages close to 50%. Negative and ringed spherulites from the melt state and small lath-like lamellar crystals from dilute solution crystallizations were attained. Furthermore, calorimetric data pointed out the exclusion of the less abundant monomer from the lattice of the predominant structure. All samples at room temperature showed a similar crystalline structure (form I) defined by two predominant reflections at spacings close to 0.430 and 0.380 nm, which has been related for even-odd nylons with a two-hydrogen bonded structure. Real time synchrotron experiments showed that melt crystallized samples have two polymorphic transitions on heating, which were practically reversible and consequently were also detected during cooling from the melt state. Interestingly, a different behavior was detected among solution crystallized samples and specifically the transition to the intermediate structure (form II) was not detected during heating for samples enriched on the azelate component or more precisely when they were exclusively crystallized in the form I.

Bostezo como mecanismo protector y predictor de síncope: estudio observacional en una cohorte de pacientes / Yawning as a protective mechanism and predictor of syncope: observational study in a patient cohort

Resumen Introducción: el bostezo se presenta con frecuencia en los pacientes sometidos a prueba de mesa basculante. Estudios previos han demostrado que el bostezo estimula el sistema nervioso simpático con sus consecuentes cambios hemodinámicos, principalmente en la frecuencia cardíaca y la presión arterial. Objetivo: describir los efectos hemodinámicos y sobre el sistema nervioso autónomo del bostezo, así como establecer el bostezo como mecanismo protector de síncope o predictor de respuesta hemodinámica positiva. Métodos: estudio observacional de fuente secundaria, realizado a partir de una base de datos de pacientes que fueron sometidos a prueba de mesa basculante entre agosto de 2010 hasta diciembre de 2015 y presentaron al menos un bostezo durante la prueba. Se realizaron análisis estadísticos y pruebas pareadas para determinar correlaciones. Resultados: se incluyeron 156 pacientes, la mayoría mujeres, edad promedio 40 años. 43 pacientes presentaron síncope, 113 (72,4%) bostezo sin síncope, y de éstos, 50 (44,2%) tuvieron bostezo y prueba de mesa basculante con respuesta positiva. Se observó un aumento en la mayoría de variables hemodinámicas, sin embargo, hubo una disminución significativa de la frecuencia cardíaca. En 67 pacientes se observó bostezo como protector de síncope mientras que en 61 pacientes como predictor de respuesta hemodinámica positiva. Conclusión: el bostezo se asoció con activación del sistema nervioso simpático, con efectos hemodinámicos y sobre el sistema nervioso autónomo. Puede plantearse como un signo predictor de respuesta hemodinámica positiva de tipo mixto o vasodepresora y en otros casos como un mecanismo protector frente a la aparición de síncope.

Abstract Introduction: Yawning is often present in patients subjected to a tilt table test. Previous studies have demonstrated that yawning stimulates the sympathetic nervous system, with its subsequent haemodynamic changes, mainly heart rate and blood pressure. Objective: To describe the haemodynamic effects of yawning on the autonomic nervous system, as well as to establish yawning as a protective mechanism of syncope, or a predictor of a positive haemodynamic response. Methods: A secondary source observational study conducted using a database of patients that were subjected to the tilt table test between August 2010 and December 2015, and yawned at least once during the test. Statistical analyses and paired tests were performed to determine correlations. Results: A total of 156 patients were included, the majority women, and a mean age of 40 years. Syncope was presented in 43 patients. The remaining 113 (72.4%) yawned with no syncope, and of these, 50 (44.2%) had yawned and had a positive response to the tilt-table test. Although there was an increase in the majority of haemodynamic variables, a significant decrease was observed in the heart rate. Yawning was observed as a protector of syncope in 67 patients, whilst it was a predictor of a positive haemodynamic response in 61 patients. Conclusion: Yawning is associated with activation of the sympathetic nervous system, with haemodynamic effects and on the autonomic nervous system. It could be established as a predictive sign of a mixed type or vasodepressor positive haemodynamic response, and in other cases as a protective mechanism against the appearance of a syncope.

Computational study of the hydrogen peroxide scavenging mechanism of allyl methyl disulfide, an antioxidant compound from garlic.

Although many sulfur containing garlic compounds present antioxidant activity, little is known about molecular mechanisms through which these compounds react with reactive oxygen species. In this work, the reactivity and the hydrogen peroxide scavenger reaction mechanisms (including thermodynamics and kinetics aspects) of allyl methyl disulfide in aqueous phase are studied employing density functional theory computational methods. Three reactive sites susceptible for electrophilic attack are found over sulfur atoms and the double bond allyl moiety. For each detected site, one redox reaction is proposed and analyzed. All reactions are thermodynamically feasible, whereas attack over the methyl bound sulfur atom is kinetically favored.

About endothermic sorption of tyrosine on chitosan films.

Sorption of l- and d-Tyrosine (Tyr) from aqueous solutions on chiral membranes of chitosan (CH) was studied. A high adsorption in the membrane, with a marked enantioselectivity to l-Tyr, was found. Computational calculations carried out by docking and molecular dynamics (MD) showed a difference in the affinity of the enantiomers and two regions of adsorption in the polymer matrix. The interactions of the enantiomers with the polymer matrix were studied by using FTIR, DRx, DSC and TG measurements. These results indicate that adsorption of Tyr reduces the crystallinity of the membrane and generates a rearrangement of the chains, decreasing the intercatenary spacing. Also, it was observed that the hydrated polymorph to anhydrous polymorph ratio has changed during adsorption, that is, water bound to chitosan is also modified. The energy balance of the system hydrogen bonding, desolvation and the conformational changes resulted in a spontaneous and endothermic process.

High immunological response against a Trypanosoma equiperdum protein that exhibits homology with the regulatory subunits of mammalian cAMP-dependent protein kinases.

Previously, we have identified a protein in Trypanosoma equiperdum that possesses homology with the regulatory (R) subunits of the mammalian cAMP-dependent protein kinase (PKA). The recombinant T. equiperdum PKA R-like protein was expressed in bacteria and purified to homogeneity. Mice polyclonal antibodies were raised against the recombinant R-like protein to serologically evaluate its humoral immune response. High titers of specific sera antibodies were obtained against the parasite R-like protein by indirect enzyme-linked immunosorbent assay (ELISA), and immunoblots revealed that this protein was specifically recognized by the hyperimmune mice sera. Cellular proliferation assays using splenic B cells from the immunized mice showed higher values when the recombinant T. equiperdum R-like protein was employed than when concanavalin A was utilized as an unspecific mitogen. Two healthy horses that were experimentally infected using either T. equiperdum or Trypanosoma evansi showed a curve response characterized by the appearance of anti-T. equiperdum PKA R-like protein antibody production in sera using indirect ELISA. The recombinant parasite PKA R-like protein was also recognized by sera from naturally trypanosome-infected horses using western blotting. These findings demonstrated that the T. equiperdum PKA R-like protein is an antigen that exhibits cross-reaction with T. equiperdum and T. evansi.

Prognostic impact of defibrillator shocks in a Colombian cohort / Impacto pronóstico de las descargas del desfibrilador en una cohorte colombiana

Abstract: Introduction: The implantable cardioverter defibrillator (ICD) has become the first-line treatment option for SCD prevention. In Colombia, while ICD therapy has been available for several years, extensive registries or studies documenting the impact of ICD therapy are lacking. Objective: To evaluate the association between appropriate and inappropriate ICD therapies and mortality in Colombian patients. Methods: Prospective observational cohort study including 530 patients with cardiomyopathy of varied etiology, from eight clinics in Medellin, Colombia, from 2013 to 2016. Adjusted and survival analyses were performed. Results: Of all participating patients, 72.1% were men, and median age was 64 years. Mean follow-up time was 1.5 ± 0.92 years, with a follow-up rate of 353.3 patients/year. The most common indication for ICD implantation was ischemic heart disease (48.7%), and indication of primary prevention (63.4%). Mortality was 12.8%, and patients with ischemic etiology had 1.8-times greater risk of death compared to non-ischemic patients. 14% of the patients received appropriate therapies, while 13.6% were inappropriate. There was a 65% greater risk of appropriate therapies in patients with ischemic heart disease. High blood pressure, being over 61 years of age, and having left ventricular ejection fraction < 35%, were risk factors for death, while use of beta-blockers was associated with a reduced risk of death. Conclusions: The main indication for ICD was ischemic etiology and primary prevention. Mortality is higher in patients with ischemic etiology, who in addition have increased risk of presenting appropriate therapies. The frequency of device therapies was decreased compared to previous reports.(AU)

Resumen: Introducción: El desfibrilador cardioversor implantable (DCI) se ha convertido en la opción de primera línea de tratamiento para la prevención de la MCS. En Colombia, aunque la terapia DCI ha estado disponible durante varios años, faltan extensos registros o estudios que documenten el impacto de la terapia DCI. Objetivo: Evaluar la asociación entre las terapias apropiadas e inapropiadas de DCI y la mortalidad en pacientes colombianos. Métodos: Estudio prospectivo observacional de cohorte que incluye 530 pacientes con cardiomiopatía de etiología variada, de ocho clínicas en Medellín, Colombia, de 2013 a 2016. Se realizaron análisis ajustados y de supervivencia. Resultados: De todos los pacientes participantes, el 72.1% fueron hombres y la edad mediana fue de 64 años. El tiempo medio de seguimiento fue de 1.5 ± 0.92 años, con una tasa de seguimiento de 353.3 pacientes/año. La indicación más común para la implantación del DCI fue la cardiopatía isquémica (48.7%) y la indicación de prevención primaria (63.4%). La mortalidad fue del 12.8% y los pacientes con etiología isquémica tuvieron un riesgo de muerte 1.8 veces mayor en comparación con los pacientes no isquémicos. Catorce por ciento de los pacientes recibieron terapias apropiadas, mientras que el 13.6% fueron inapropiadas. Hubo un riesgo 65% mayor de terapias apropiadas en pacientes con cardiopatía isquémica. La hipertensión arterial, el tener más de 61 años de edad y haber dejado la fracción de eyección ventricular < 35%, fueron factores de riesgo de muerte, mientras que el uso de betabloqueantes se asoció con un menor riesgo de muerte. Conclusiones: La principal indicación para la DCI fue etiología isquémica y prevención primaria. La mortalidad es mayor en pacientes con etiología isquémica, que además tienen mayor riesgo de presentar terapias apropiadas. La frecuencia de las terapias con dispositivos se redujo en comparación con los informes anteriores.(AU)

Marcapasos con sensor de asa cerrada en disautonomía secundaria a enfermedad de Sandhoff / Closed-loop pacemakers in dysautonomia secondary to Sandhoff disease

Resumen Introducción: en la enfermedad de Sandhoff se ha descrito el compromiso del sistema nervioso autónomo en piel y tracto gastrointestinal; sin embargo, las alteraciones autonómicas del sistema cardiovascular, como la disautonomía, no se han documentado en la literatura revisada. De otro lado, el síncope neuralmente mediado de características cardioinhibitorias, refractario al manejo médico, puede ser tratado con marcapasos con sensor de asa cerrada. Materiales y métodos: se describe el caso de una paciente de 42 años en quien se realizó el diagnóstico de enfermedad de Sandhof. Asociado a esta patología, presentó disautonomía con episodios de síncope diarios sin respuesta al tratamiento médico, que ameritaron el implante de un marcapasos con sensor de asa cerrada. Posteriormente se revisa la literatura existente sobre el tema. Conclusiones: hasta la fecha no se había reportado relación entre la enfermedad de Sandhoff y la disautonomía; en el caso de esta paciente el deterioro de la calidad de vida fue significativo. El uso del algoritmo CLS en síncope neuralmente mediado con características cardioinhibitorias, ha mostrado disminuir la cantidad de síncopes en este tipo de pacientes y mejorar la calidad de vida de los mismos.

Abstract Introduction: Although involvement of the autonomic nervous system in the skin and gastrointestinal tract has been described in Sandhoff disease, no reports of autonomic changes of the cardiovascular system, such as dysautonomia, have been documented in the literature reviewed. On the other hand, the neurally mediated cardioinhibitory syncope that is refractory to medical management can be treated with pacemakers with closed loop sensors. Materials and methods: The case is described of a 42 year-old patient who was diagnosed with Sandhoff disease. Associated to this condition, he presented with dysautonomia with daily episodes of syncope, with no response to medical treatment, which warranted the implant of a pacemaker with a closed loop sensor. The existing literature on this topic was subsequently reviewed. Conclusions: Up until now, there have been no reports on the relationship between Sandhoff disease and dysautonomia. In the case of this patient, the deterioration in the quality of life was significant. The use of the closed loop stimulation (CLS) algorithm in neurally mediated cardioinhibitory syncope has been shown to reduce the number of syncopes in this type of patient and improve their quality of life.

C-reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study.

BACKGROUND: The aim of this study is to evaluate the effectiveness of an Enhanced Recovery After Surgery Protocol (ERAS) in relation to reduce the Systemic Inflammatory Response (SIR) to surgery using C-reactive protein (CRP) in the first (POD1), second (POD2) and third (POD3) postoperative day. METHODS: We enrolled 121 patients (ERAS group) that underwent elective colorectal surgery with ERAS, and compared them with 135 patients (preERAS group) that had undergone surgery prior to the implementation. We made a univariate analysis to compare the CRP values in POD1, POD2, and POD3 between preERAS/ERAS group, laparoscopic/open surgery and the presence or not of Clavien Dindo complications. Multivariable lineal regression was used to assess if the ERAS had a decreasing effect on the CRP in POD1, POD2, and POD3, and was adjusted by age, male sex, use of laparoscopy, and complications. RESULTS: The presence of complications was independently associated with an increase in CRP values ​​in POD1, POD2, and POD3. Laparoscopy in POD1 and POD2, and ERAS in POD2 was independently associated with a decrease in CRP values. CONCLUSION: The analysis shows an increase in SIR measured as a CRP value in those patients that had complications. The SIR decreased with laparoscopy in POD1 and POD2 and with ERAS in POD2.