Incidence, Clinical Characteristics, Risk Factors and Outcomes of Acute Coronary Syndrome in Patients With COVID-19: Results of the UMC-19-S1010.

BACKGROUND: There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses. OBJECTIVE: We investigated the incidence, clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department. METHODS: We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non-COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes. RESULTS: We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% [95% confidence interval {CI} 1.21-1.78%]). This incidence was lower than that observed in non-COVID-19 patients (3.64% [95% CI 3.54-3.74%]; odds ratio [OR] 0.40 [95% CI 0.33-0.49]). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR [aOR] 6.36 [95% CI 1.84-22.1], aOR 4.63 [95% CI 1.88-11.4], and aOR 2.46 [95% CI 1.15-5.25]). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21-0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84-12.4). CONCLUSIONS: The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.

Sociodemographic characteristics, functional status, and health resource use of older patients treated in Spanish emergency departments: a description of the EDEN cohort. / Características sociodemográficas, funcionales y consumo de recursos de la población mayor atendida en los servicios de urgencias españoles: una aproximación desde la cohorte EDEN.

OBJECTIVES: To describe the sociodemographic characteristics of and the health care resources used to treat patients aged 65 years or older who come to hospital emergency departments (EDs) in Spain, according to age groups. MATERIAL AND METHODS: We studied the phase-1 data for the EDEN cohort (Emergency Department and Elder Needs). Forty Spanish EDs collected data on all patients aged 65 years or older who were treated on the first 7 days in April 2019. We registered information on 6 sociodemographic and 5 function variables for all patients. For health resource use we used 6 diagnostic, 13 therapeutic, and 5 physical structural variables, for a total of 24 variables. Differences were analyzed according to age in blocks of 5 years. RESULTS: A total of 18 374 patients with a median age of 78 years were included; 55% were women. Twenty-seven percent arrived by ambulance, 71% had not previously been seen by a physician, and 13% lived alone without assistance. Ten percent had a high level of functional dependence, and 14% had serious comorbidity. Resources used most often were blood analysis (in 60%) and radiology (59%), analgesics (25%), intravenous fluids (21%), antibiotics (14%), oxygen (13%), and bronchodilators (11%). Twenty-six percent were kept under observation in the ED, 26% were admitted to wards, and 2% were admitted to intensive care units (ICUs). The median stay in the ED was 3.5 hours, and the median hospital stay was 7 days. Sociodemographic characteristics changed according to age. Functional dependence worsened with age, and resource requirements increased in general. However, benzodiazepine use was unaffected, while the use of nonsteroidal anti-inflammatory drugs and ICU admission decreased. CONCLUSION: The functional dependence of older patients coming to EDs increases with age and is associated with a high level of health care resource use, which also increases with age. Planners should take into consideration the characteristics of the older patients and the proportion of the caseload they represent when arranging physical spaces and designing processes for a specific ED.

OBJETIVO: Investigar las características sociodemográficas y consumo de recursos de los pacientes de 65 o más años que consultan en servicios de urgencias hospitalarios (SUH) en España, y su modificación por grupos etarios. METODO: Se utilizaron datos de la cohorte EDEN obtenidos en fase 1 (Emergency Department and Elder Needs). Cuarenta SUH españoles incluyeron todos los pacientes de $ 65 años atendidos del 1-4-2019 al 7-4-2019 (7 días). Se analizaron 6 características sociodemográficas, 5 funcionales y 24 referidas a consumo de recursos (6 diagnósticos, 13 terapéuticos, 5 estructurales) y sus cambios a medida que avanza la edad (agrupada en bloques de 5 años). RESULTADOS: Se analizaron 18.374 pacientes (mediana edad: 78 años; 55% mujeres). El 27% acude a urgencias en ambulancia, el 71% sin consulta médica previa y el 13% vive solo sin cuidadores. Funcionalmente, el 10% tiene dependencia grave y el 14% comorbilidad grave. La solicitud de analítica sanguínea (60% de casos) y radiología (59%) destaca entre el consumo de recursos diagnósticos, y el uso de analgésicos (25%), sueroterapia (21%), antibioticoterapia (14%), oxigenoterapia (13%) y broncodilatadores (11%), entre los terapéuticos. El 26% requiere observación en urgencias, el 26% hospitalización y el 2% cuidados intensivos. La mediana de estancia en urgencias es de 3:30 horas y la de hospitalización es de 7 días. Las características sociodemográficas se modifican con la edad, las funcionales empeoran y el consumo de recursos aumenta (excepto benzodiacepinas, que no se modifica, y antinflamatorios no esteroideos y cuidados intensivos, que disminuye). CONCLUSIONES: Las características funcionales de la población mayor que consulta en los SUH empeora a medida que su edad avanza, y se asocia a un consumo de recursos alto que también se incrementa con la edad. Las características de esta población y su proporción en un determinado SUH deben tenerse en cuenta en su planificación estructural y funcional.

Both pineal and lateral eyes are needed to sustain daily circulating melatonin rhythms in sea bass.

This study investigates the role of the pineal organ and lateral eyes (the two most important sources of melatonin in vertebrate species) on daily melatonin rhythms of sea bass, a fish exhibiting reversed melatonin profiles, as well as their contribution to circulating melatonin levels. To this aim, the pineal and/or the eyes were surgically removed (Exp. 1), the optic nerve sectioned and retinal dopaminergic neurons damaged with injections of 6-hydroxydopamine (Exp. 2), and the pineal or the eyes covered with aluminium foil (Exp. 3). The results show that plasma and ocular melatonin display opposing profiles. In Experiment 1, pinealectomized fish displayed lower nightly plasma melatonin levels (66+/-22 pg/ml) than intact or sham-operated groups (131+/-14 pg/ml), as it occurred in ophthalmectomized fish (64+/-12 pg/ml). Fish that were both pinealectomized and ophthalmectomized showed a further decrease in plasma melatonin levels (1.4+/-0.4 pg/ml), which approached daytime levels. In Experiment 2, plasma melatonin levels in both optic nerve-sectioned and ophthalmectomized fish were lower than control levels, while injection of 6-hydroxydopamine did not modify plasma melatonin concentrations. In Experiment 3, covering only the pineal made melatonin drop after a light pulse at MD, and covering only the eyes had a similar effect. In conclusion, these findings suggest that even though sea bass eyes do not directly contribute to plasma melatonin, the pineal organ, which unlike that of mammals is a direct photoreceptor in fish, requires light information from the lateral eyes to normally secrete melatonin into the bloodstream.

Melatonin binding sites in the brain of European sea bass (Dicentrarchus labrax).

Characteristics, day-night changes, guanosine 5'-O-(3-thiotriphosphate) (GTPgammaS) modulation, and localization of melatonin binding sites in the brain of a marine teleost, European sea bass Dicentrarchus labrax, were studied by radioreceptor assay using 2-[(125)I]iodomelatonin as a radioligand. The specific binding to the sea bass brain membranes was rapid, stable, saturable and reversible. The radioligand binds to a single class of receptor site with the affinity (Kd) of 9.3 +/-0.6 pM and total binding capacity (Bmax) of 39.08 +/-0.86 fmol/mg protein (mean+/-SEM, n=4) at mid-light under light-dark (LD) cycles of 12:12. Day-night changes were observed neither in the Kd nor in the Bmax under LD 12:12. Treatment with GTPgammaS significantly increased the Kd and decreased the Bmax both at mid-light and mid-dark. The binding sites were highly specific for 2-phenylmelatonin, 2-iodomelatonin, melatonin, and 6-chloromelatonin. Distribution of melatonin binding sites in the sea bass brain was uneven: The Bmax was determined to be highest in mesencephalic optic tectum-tegmentum and hypothalamus, intermediate in telencephalon, cerebellum-vestibulolateral lobe and medulla oblongata-spinal cord, and lowest in olfactory bulbs with the Kd in the low picomolar range. These results indicate that melatonin released from the pineal organ and/or retina plays neuromodulatory roles in the sea bass brain via G protein-coupled melatonin receptors.

Exposure of larvae to daily thermocycles affects gonad development, sex ratio, and sexual steroids in Solea senegalensis, kaup.

The effect of water temperature during the development of fish larvae on sex differentiation is well known, but not so well known is the impact of the daily thermocycles. Our aim was to investigate the effect of early exposure of Senegal sole larvae to different temperature cycles on gonad development, sex ratio, and sex steroid (11-ketotestosterone (11-KT); estradiol (E(2) ); and testosterone, (T)) content in muscle extracts of juveniles. From 1 to 97 days posthatching (DPH) fish larvae and post-larvae were subjected to three temperature regimes: Thermophase-Cryophase (TC), Cryophase-Thermophase (CT), and constant temperature. In fish exposed to TC, sex determination occurred earlier, because 90% of soles were males/females at 110 DPH, whereas 45% of fish under CT were undifferentiated at that time. Fish under TC showed the highest growth rates, followed by fish under constant temperature and by fish under CT, the differences being statistically significant between the TC and CT groups. Regarding sex ratio, juveniles exposed to TC showed a higher proportion of females than fish under CT or constant temperature. Under TC, fish showed the highest concentration of E(2) , whereas 11-KT concentration was highest in fish under CT and constant temperature. Fish under constant temperature and CT showed higher T levels than those under TC. These results provide the first insights into the effect of daily thermocycles on sex differentiation in fish, and underline the key role of natural environmental cycles on the control of sex ratios during larval development, which may be applied to the manipulation of sex ratio in aquaculture.

Effects of continuous light on the reproductive system of European sea bass gauged by alterations of circadian variations during their first reproductive cycle.

The European sea bass is a short-day breeder, a characteristic that is highly valued in aquaculture. A high percentage of males of this species mature precociously before reaching commercial size, resulting in economic losses for fish farmers. We investigated the effects of continuous light (LL) on the circadian variations of several reproductive hormones in males of this species in order to understand how the presumed absence of the melatonin rhythm caused by LL affects their daily profile. The study was conducted during four critical stages of the sea bass reproductive cycle: pre-spermatogenesis (PSpg), spermatogenesis (Spg), spermiation (Spm), and post-spermiation (PSpm). Every 3 h during a complete 24 h cycle, six fish kept under a natural photoperiod (NP), and another six fish kept under LL were anaesthetized, measured, weighed, and bled. The pituitary was removed and frozen at -80 degrees C. The pituitary content of sea bream gonadotrophin-releasing (sbGnRH) and luteinizing hormone (LH), as well as plasma content of LH, testosterone, and 11-ketotestosterone (11-KT) were analyzed by ELISA. The percentage of spermiating males (precocity) per group was determined by periodic abdominal massages of the animals. Our results confirm that LL treatment, maintained from the early stages of development onward, effectively reduces the percentage of precocious male sea bass. As has already been described for caged sea bass, plasma LH showed a clearly marked nocturnal rise near midnight during Spg and Spm during NP, but which was absent under LL. Pituitary sbGnRH and LH content and plasma LH concentration, under both NP and LL, increased during the second half of the reproductive cycle, while sexual steroids were higher at the beginning of the cycle. LL inhibited steroid secretion, especially testosterone secretion, during Spg. In summary, without photoperiod cue, as accomplished by continuous exposure to LL, circadian variations of reproductive hormones appeared altered, causing irregularities in the reproductive process of male sea bass. These findings may have a practical application in aquaculture, namely by applying LL treatment in an effort to reduce the presence of precocious males in a stock.

Light synchronization of the daily spawning rhythms of gilthead sea bream (Sparus aurata L) kept under different photoperiod and after shifting the LD cycle.

Reproduction in most fish is typically a seasonal process, as spawning takes place usually at a given time of the year, depending on the reproduction strategy of the species, to ensure maximal survival of offspring. Nevertheless, fish reproduction cannot be considered an exclusively annual phenomenon, because spawning may also show daily rhythmicity. In this study, we investigated the existence of a daily spawning rhythm in gilthead seabream (Sparus aurata L) exposed to different light-dark (LD) cycles and at different times of the year using an automatic and programmable egg collector. Floatability and fertilization rates were analyzed at different times throughout the 24 h. The results showed a daily spawning rhythm with spanning occurring from 14:30 to 21:30 h, with the acrophase (peak time) being 18:29 and 18:08 h in fish exposed to an artificial photoperiod of 9L:15D in winter and in spring, respectively. Nevertheless, in fish exposed to a natural photoperiod of 12L:12D in spring, the acrophase of the rhythm was recorded later, at 21:28 h. The average fertilization rate was 87%, and no significant differences were found between the different hours of spawning. Moreover, when the LD cycle (9L:15D) was shifted by 12 h, the daily spawning rhythm gradually re-synchronized, resuming a stable phase-relationship after 4-5 transient days, which is characteristic of a endogenous circadian rhythm. Our results clearly demonstrated the existence of a 24 h period of spawning in gilthead sea bream, with a peak anticipating the forthcoming night, and its capacity to gradually re-synchronize after a 12 h shift in the LD cycle, pointing to the endogenous nature of this rhythm. These findings will be valuable for better understanding the reproductive physiology of this species and for optimizing the protocols of egg collection and larvae production in aquaculture.