GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study.

Background: The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0. Methods: Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc). Findings: The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration. Interpretation: GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization. Funding: Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.

Vigilancia molecular de la malaria en potenciales reservorios silvestres que viven en una región históricamente endémica de Paraguay / Molecular surveillance of malaria in potential wild reservoirs that live in a historically endemic region of Paraguay

En Paraguay, no se han registrado casos autóctonos de malaria desde el 2011. Se realizó un estudio descriptivo observacional transversal en 6 monos y 23 aves que vivían en una región históricamente endémica de Paraguay para buscar presencia de reservorios silvestres de parásitos plasmodios causantes de la malaria. El ADN se extrajo por el método de Chelex a partir de una gota de sangre en un papel de filtro, y la detección del parásito se realizó mediante la PCR múltiple semianidada. Por este método, no se detectaron parásitos en ninguna de las 29 muestras. Se evaluó el riesgo potencial de circulación selvática de los parásitos que causan la malaria. Teniendo en cuenta la presencia de mosquitos anofelinos vectores en la zona, el hecho de que no se hayan observado casos positivos es un buen indicador teniendo en cuenta que nuestro país fue declarado recientemente como país libre de malaria por la OMS(AU)

In Paraguay, autochthonous cases of malaria have not been recorded since 2011. A cross-sectional observational descriptive study was conducted in 6 monkeys and 23 birds living in a historically endemic region of Paraguay to identify wild reservoirs of plasmodium parasites that cause malaria. DNA was extracted by the Chelex method from a blood drop in a filter paper, and parasite detection was performed by the seminested multiplex PCR. By this method, parasites were not detected in any of the 29 samples. The risk of potential sylvatic circulation of the parasites causing malaria was evaluated. Considering the presence of anopheline mosquitoes in the area, the fact that we did not find any positive cases is a good indicator as our country was recently certified as a malaria-free country by the WHO(AU)

Identificación molecular del sexo en 9 especies de aves del Centro de Investigación en Animales Silvestres de la hidroeléctrica de Itaipu, lado paraguayo / Sex identification by molecular methods in 9 species of birds from the wild animal research center of Itaipu dam on the paraguayan side

La importancia de determinar el sexo en especies monomórficas que viven en cautiverio conlleva a estrategias de apareamiento a fin de poder incentivar la reproducción. Existen métodos no moleculares de reconocimiento pero son factibles en edad adulta y mucho más difícil cuando son polluelos. Mediante la técnica molecular de PCR, se amplificó el gen de la Cromo Helicasa de Unión al ADN empleando los cebadores, 2550F/2718R. Por este método molecular se consiguió determinar el sexo en 19 de 23 especies de las cuales 3 son ejemplares de: Amazona aestiva, 1 de Pipile grayi, 1 de Bubo virginianus, 4 de Ara chloropterus, 6 de Crax fasciolata, 2 de Caracara plancus, 3 de Chauna torquata, 1 de Cariama cristata y 2 de Cairina moschata del Centro de Investigación de Animales Silvestres de ITAIPU binacional, del lado paraguayo. Nuestros resultados sugieren que el par de cebadores 2550F/2718R podría ser de utilidad para determinar el sexo en las especies estudiadas en el país.

In monomorphic species living in captivity, determining the sex is important because it may allow choosing mating strategies to enhance reproduction. Sex can be determined either by non-molecular recognition methods, which are only feasible in adult birds, or by molecular techniques, which may allow sexing monomorphic species at young ages. Thus, in this study, we used molecular techniques such PCR to amplifying the CHD gene by using 2550F/2718R primers. This method allowed us to determine the sex in 19 out of 23 bird specimens from the Centro de Investigación de Animales Silvestres (CIASI) of the ITAIPÚ BINACIONAL at Paraguayan side. The specimens belonged to the following species: Amazona aestiva (3), Pipile grayi (1), Bubo virginianus (1), Ara chloropterus (4), Crax fasciolata (6), Caracara plancus (2), Chauna torquata (3), Cariama cristata (1) and Cairina moschata (2). The 2550F/2718R primers were useful for determine the sex of the studied species.

Anemia is a mortality predictor in hospitalized patients for COPD exacerbation.

BACKGROUND: Anemia is a recognized prognostic factor in many chronic illnesses, but there is limited information about its impact on outcomes in patients hospitalized for acute COPD exacerbation (AECOPD). AIM: To investigate whether anemia exerts an effect on mortality in patients admitted for AECOPD after one year of follow-up. Methods. From November 2007 to November 2009 we recruited 117 patients who required hospitalization due to an AECOPD. Clinical, functional and laboratory parameters on admission were prospectively assessed. Patients were followed up during one year. Mortality and days-to-death were collected. RESULTS: Mean age 72 (SD ± 9); FEV1 37.4 (SD ± 12); mortality after 1 year was 22.2%. Mean survival: 339 days. Comparing patients who died to those who survived we found significant differences (p < 0,000) in hemoglobin (Hb) (12.4 vs 13.8 mg/dl) and hematocrit (Ht) (38 vs 41%). Anemia (Hb < 13 g.dl⁻¹) prevalence was 33%. Those who died had experienced 3.5 exacerbations in previous year vs 1.5 exacerbations in the case of the survivors (p = 0.000). Lung function and nutritional status were similar, except for percentage of muscle mass (%) (35 vs 39%; p = 0.015) and albumin (33 vs 37 mg/dl; p = 0.039). These variables were included in a Multivariate Cox Proportional Hazards Model; anemia and previous exacerbations resulted as independent factors for mortality. Mortality risk for patients with anemia was 5.9(CI: 1.9-19); for patients with > 1 exacerbation in the previous year was 5.9(CI: 1.3-26.5). CONCLUSION: Anemia and previous exacerbations were independent predictors of mortality after one year in patients hospitalized for AECOPD.

Dental health in liver transplant patients.

Since the first liver transplantation in Spain was carried out in 1984, advances in surgical technique and immunosuppressive drugs have facilitated an increase in the number of transplants performed. The present study evaluates buccodental health in liver transplant patients. A cross-sectional descriptive study was made of a sample of patients subjected to liver transplantation in Príncipes de España Hospital (Bellvitge University Health Care Complex, L'Hospitalet de Llobregat, Barcelona--Spain). Information was collected relating to demographic characteristics, general clinical history, buccodental history and intraoral exploratory findings. A total of 53 individuals were evaluated (28 males and 25 females, with a mean age of 57.6 years). The mean time elapsed from transplantation was 3 years and 9 months. The most frequent indication for liver transplantation was liver cirrhosis due to hepatitis C virus (HCV) infection (49.1% of the global series). The most widely used immunosuppressors were cyclosporine and tacrolimus. The CAOD index of the series was 11.2. In relation to periodontal disease, 22% of the dentate patients showed gingival overgrowth, while half of those with teeth had gingival recessions, and 34% presented some type of dental mobility. The examination of the oral mucosa showed fissured tongue to be the most common disorder (39.6%), followed by saburral tongue (28.3%) and xerostomia (18.9%). Buccodental pathology in these patients is related to the use of immunosuppressor medication and other factors such as a lack of preventive measures. The findings of the present study point to the need for preventive treatments in this population group.