HIV infection is associated with a less aggressive phenotype of inflammatory bowel disease. A multicenter study of the ENEIDA registry.

BACKGROUND: The coexistence of human immunodeficiency virus (HIV) infection and inflammatory bowel disease (IBD) is uncommon. Data on the impact of HIV on IBD course and its management is scarce. AIM: To describe the IBD phenotype, therapeutic requirements and prevalence of opportunistic infections (OI) in IBD patients with a coexistent HIV infection. METHODS: Case-control, retrospective study including all HIV positive patients diagnosed with IBD in the ENEIDA registry. Patients with positive HIV serology (HIV-IBD) were compared to controls (HIV seronegative), matched 1:3 by year of IBD diagnosis, age, gender and type of IBD. RESULTS: A total of 364 patients (91 HIV-IBD and 273 IBD controls) were included. In the whole cohort, 58% had ulcerative colitis (UC), 35% had Crohn's disease (CD) and 7% were IBD unclassified. The HIV-IBD group presented a significantly higher proportion of proctitis in UC and colonic location in CD but fewer extraintestinal manifestations than controls. Regarding treatments, non-biological therapies (37.4% vs. 57.9%; P=0.001) and biologicals (26.4% vs. 42.1%; P=0.007), were used less frequently among patients in the HIV-IBD group. Conversely, HIV-IBD patients developed more OI than controls regardless of non-biological therapies use. In the multivariate analysis, HIV infection (OR 4.765, 95%CI 2.48-9.14; P<0.001) and having ≥1 comorbidity (OR 2.445, 95%CI 1.23-4.85; P=0.010) were risk factors for developing OI, while CD was protective (OR 0.372, 95%CI 0.18-0.78;P=0.009). CONCLUSIONS: HIV infection appears to be associated with a less aggressive phenotype of IBD and a lesser use of non-biological therapies and biologicals but entails a greater risk of developing OI.

Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care.

OBJECTIVE: To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services. DESIGN: Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021). METHODS: The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health. RESULTS: The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care. CONCLUSIONS: Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality. IMPLICATIONS: The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. REPORTING METHOD: We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.

Pesticide bioremediation in liquid media using a microbial consortium and bacteria-pure strains isolated from a biomixture used in agricultural areas.

Microorganisms' role in pesticide degradation has been studied widely. Insitu treatments of effluents containing pesticides such as biological beds (biobeds) are efficient biological systems where biomixture (mixture of substrates) and microorganisms are the keys in pesticide treatment; however, microbial activity has been studied poorly, and its potential beyond biobeds has not been widely explored. In this study, the capacity of microbial consortium and bacteria-pure strains isolated from a biomixture (soil-straw; 1:1, v/v) used to treat agricultural effluents under real conditions were evaluated during a bioremediation process of five pesticides commonly used Yucatan Mexico. Atrazine, carbofuran, and glyphosate had the highest degradations (>90%) using the microbial consortium; 2,4-D and diazinon were the most persistent (DT50 = 8.64 and 6.63 days). From the 21 identified bacteria species in the microbial consortium, Pseudomonas nitroreducens was the most abundant (52%) according to identified sequences. For the pure strains evaluation 2,4-D (DT50 = 9.87 days), carbofuran (DT50 = 8.27 days), diazinon (DT50 = 8.80 days) and glyphosate (DT50 = 8.59 days) were less persistent in the presence of the mixed consortium (Ochrobactrum sp. DGG-1-3, Ochrobactrum sp. Ge-14, Ochrobactrum sp. B18 and Pseudomonas citronellolis strain ADA-23B). Time, pesticide, and strain type were significant (P < 0.05) in pesticide degradation, so this process is multifactorial. Microbial consortium and pure strains can be used to increase the biobed efficiency by inoculation, even in the remediation of soil contaminated by pesticides in agricultural areas.

Synthesis and Surface Modification of Small Pore Size Zeolite W for Improving Removal Efficiency of Anionic Contaminants from Water.

The presence of regulated inorganic contaminants in water such as AsO43- and PO43- anions, is becoming a relevant environmental research topic. The harm that these anions cause to human health and the ecosystem have been reported in several works. The adsorption processes using low-cost materials, such as zeolites, have proven to be an option to removal hazardous contaminants from water. The coal fly ash, a waste from thermoelectrical plants, offers a raw pollutant material to synthesis an effective adsorbent (Zeolite W). In this research was studied the removal of arsenic and phosphates anions from water, applying a functionalized by iron and zirconium Zeolite W, which was modified using a fast and efficient process through microwave-assisted method (1 min at 150°C). The obtained Zeolite W did not show significant changes in its structure and morphology. The maximum adsorption capacity (Qm expressed in mg g-1) was found to be 42.31 (Iron-zirconium-zeolite) and 27.82 (Iron-zeolite) for AsO43-, while it reached 50.89 for PO43- using Zirconium-zeolite. Results showed that functionalized zeolites are efficient adsorbents for hazardous anionic species; therefore, it could be useful for aqueous effluents remediation.

Epidemiology of Cardiac Events During Prehospital Care in Mountain Rescues Conducted in Aragón.

INTRODUCTION: Cardiac events are one of the leading causes of death in the Spanish population. Given the increase in the nontraumatic medical conditions found in mountain rescues, the objective of this study was to report on the heart conditions of patients rescued in the mountains of Aragón in the Spanish Pyrenees. METHODS: We conducted a retrospective observational study based on data collected from patients' medical histories for rescues undertaken in from 2010 to 2016 (at altitudes between 500 m [1640 ft] and 3404 m [11,168 ft]). RESULTS: Of the 2079 individuals rescued from 2010 to 2016, 34 (2%) were diagnosed with heart conditions, accounting for 21% of all nontraumatic medical conditions. The data showed a statistically significant increase in the age of the rescued patients with heart conditions (55±15 y) and those with acute coronary syndrome/sudden death (60±8 y). Eighty-five percent of the rescued patients with heart conditions were men, 62% were rescued above 2000 m (6500 ft), 42% had acute coronary syndrome (of whom 56% had inferior infarction), and 35% died suddenly. CONCLUSIONS: Aragón mountain rescues show an increase in patient age in recent years. The most common medical case among rescued individuals with heart conditions was a hiker over the age of 50 y with cardiovascular risk factors, inferior infarction, and occurrence at an altitude above 2000 m. Based on our observations, appropriate training should be undertaken, especially by older hikers, who may also benefit from cardiac screening, and rescue vehicles/personnel and mountain huts should be equipped with semiautomatic external defibrillators.

A Rapid and Green Method for the Determination of Veterinary Pharmaceuticals in Swine Wastewater by Fluorescence Spectrophotometry.

A growing concern exists over water contamination by veterinary pharmaceuticals from small pig farms in Yucatan, Mexico, where the anaerobic digesters installed as the wastewater treatment system are not operated properly. Therefore, considerable interest exists to develop analytical methods to detect these compounds and characterize their fate in the environment. In this study, the detection of three antibiotics (enrofloxacin, oxytetracycline and sulfamethoxazole) and a ß-agonist (ractopamine) was carried out using fluorescence spectrophotometry, with a semi-quantitative approach and a low environmental impact. Wastewater samples from 10 pig farms were analyzed, detecting concentrations of approximately 0.043 µg mL-1 for enrofloxacin, 1.427 µg mL-1 for oxytetracycline, and 9.748 µg mL-1 for sulfamethoxazole. The detection of these pharmaceuticals in the effluents of treated wastewater from the biodigesters of the pig farms suggests the need to optimize the system and prevent the entry of these compounds into the environment.

Bone fractures and lumbar mineral density after renal transplantation. A long-term cross-sectional study.

BACKGROUND: The purpose of this work was to investigate the association of vertebral and peripheral fractures 10 yr after grafting with bone metabolic markers and body mass density (BMD). PATIENTS AND METHODS: One hundred thirty-eight recipients with stable graft function were included in a cross-sectional study. Graft function, biochemical mineral metabolism markers and body mass density (DEXA) were measured. Vertebral fractures were assessed by a semiquantitative analysis of lateral spine X-ray exam. RESULTS: At the time of the study, intact parathyroid hormone levels were 127.5 ± 78.4 pg/mL and serum calcidiol 20.4 ± 9.3 ng/mL. DEXA showed osteopenia in 47% and osteoporosis in 23% at lumbar spine, 51% and 14% at femoral neck, and 53% and 8% at trochanter. Eighty-five recipients presented vertebral fractures, 69 mild and 16 moderate/severe fractures. In the multivariate analysis, vertebral fractures were associated with older age (p = 0.010), length of follow-up (p = 0.022) and trochanter T-score (p = 0.038). Twenty-three patients presented peripheral fractures and 19 of them also had vertebral fractures. Patients with peripheral fractures were younger, mostly women and had lower BMD. CONCLUSIONS: Vertebral fractures were associated with lower BMD at trochanter. Most fractures were mild and were several times more frequent than in general population. Their clinical significance needs to be determined.

Lipid Profile and Cardiovascular Risk Modification after Hepatitis C Virus Eradication.

The eradication of the hepatitis C virus (HCV) has revolutionized the hepatology paradigm, halting the progression of advanced liver disease in patients with chronic infection and reducing the risk of hepatocarcinoma. In addition, treatment with direct-acting antivirals can reverse the lipid and carbohydrate abnormalities described in HCV patients. Although HCV eradication may reduce the overall risk of vascular events, it is uncertain whether altered lipid profiles increase the risk of cerebrovascular disease in certain patients. We have conducted a review on HCV and lipid and carbohydrate metabolism, as well as new scientific advances, following the advent of direct-acting antivirals.

Space-temporal analysis of groundwater quality in three areas of the state of Yucatán, México, and its relationship with existing anthropogenic activity.

Groundwater in the Yucatan State is the only source of water. The karst aquifer in Yucatan is vulnerable to pollution. Anthropic activities in Yucatan, such as pig farming, are usually related to high wastewater discharges and water pollution. Administrative and logistical issues in developing on-site sampling to evaluate water quality are common in Mexico. The RENAMECA database provides official data related to groundwater quality. However, no analysis based on this database has been reported. A groundwater quality evaluation based on five reference pig farms and the effect of spatial and temporal anthropic activities in the study area was developed. Eighteen wells based on their location concerning the selected pig farms were studied. On-site sampling and laboratory analysis of the supply water and wastewater in the study case farm were done. Fecal coliforms (FC) values (maximum 2850 MPN [100 mL] -1) in most cases for supply water wells exceeded the allowed limit by NOM-127-SAA1-2021. The year of monitoring was significant (P < 0.05) on FC concentrations. Population density and the proximity of wells to population centers affect negatively the presence of total dissolved solids (TDS) and total nitrogen (TN). TDS (maximum value 2620 mg L -1) and phosphorus presence could be related to agricultural activities, human settlements, and local aquifer conditions. A local wastewater treatment issue is evident. Groundwater is not quality for consumption without treatment. Regarding the issues in on-site water monitoring, database analysis provides an approximation of the real situation of groundwater quality.

MASLD-Related Hepatocarcinoma: Special Features and Challenges.

Metabolic-associated steatohepatitis liver disease (MASLD) currently impacts a quarter of the global population, and its incidence is expected to increase in the future. As a result, hepatocellular carcinoma associated with MASLD is also on the rise. Notably, this carcinoma does not always develop alongside liver cirrhosis, often leading to a more advanced stage at diagnosis. The challenge lies in accurately identifying patients who are at a higher risk to tailor screening processes effectively. Additionally, several therapeutic approaches are being explored to prevent hepatocellular carcinoma, although there are no universally accepted guidelines yet.

[Complications of the PICC in neurologic patients of the Hospital Ramon y Cajal]. / Catéter central de inserción periférica: complicaciones en pacientes neurológicos.

Descriptive study focused on the complications arising from the use of the PICC (peripherally inserted central catheter) in a sample of patients admitted to the neurology unit of the "Hospital Ramón y Cajal". After collecting and analyzing the information about the sex and age of the patients, indication of implantation of the PICC, thickness of the same, days of permanence, complications found, cause of withdrawal of the catheter, and date of introduction and removal of the same, we not found significant complications arising from the use of the same. PICC is a safe and viable system for the administration of intravenous treatment of long duration and nursing personnel is more qualified for which. This allows the administration of intravenous treatment while preserving the vascular anatomy of the patient, that is the purpose of all long-term catheters.

Liver Disease Undernutrition Screening Tool Questionnaire Predicts Decompensation and Mortality in Cirrhotic Outpatients with Portal Hypertension.

BACKGROUND: Numerous scores are designed to predict outcomes of patients with liver cirrhosis. Our study aimed to evaluate the ability of the Liver Disease Undernutrition Screening Tool (LDUST) in predicting mortality and decompensation in outpatients with clinically significant portal hypertension (CSPH). We hypothesized that LDUST could help identify patients in need of nutritional supplementation and intervention. METHODS: A prospective study of 57 CSPH patients (36.8% female, mean age: 63.5 ± 9.9 years) with a median follow-up of 41 months was conducted. Baseline liver function, nutrition, and sarcopenia were assessed, alongside LDUST. During follow-up, the occurrence of liver decompensation, hospital admission, need for emergency care, and mortality were evaluated. RESULTS: A total of 56.1% of patients were Child A, and the most frequent etiology was alcohol (50.9%). Malnutrition risk according to LDUST raised mortality (HR: 25.96 (1.47-456.78)), decompensation (HR 9.78 (2.08-45.89)), and admission (HR 4.86 (1.09-21.61)) risks in multivariate Cox analysis. Combining LDUST with Child and MELD scores improved their decompensation prediction (0.936 vs. 0.811 and 0.866 vs. 0.700). CONCLUSIONS: The LDUST has a solid ability to predict complications in cirrhosis outpatients with CSPH, and its integration with Child and MELD models enhances their predictive power. LDUST implementation could identify individuals necessitating early nutritional support.

Exploring Disparities in Self-Reported Mental Health Symptoms Across Professional Categories in Spain's Emergency Medical Services: A Nationwide Cross-Sectional Study.

OBJECTIVE: This study aimed to analyze stress, anxiety, depression, and self-efficacy levels among Spanish out-of-hospital emergency medical professionals from February 1, 2021, to April 30, 2021. METHODS: A nationwide survey was completed by 1666 Emergency Medical Services (EMS) workers. The Depression, Anxiety, and Stress Scale (DASS-21) and the General Self-Efficacy Scale (GSE) were used. Data analysis used chi-squared, análisis of variance (ANOVA), and logistic regressions. RESULTS: The sample comprised 833 (50%) men, with an average age of 44.3 ± 9.9 y (range: 19-67 y). Occupational distribution included 453 (27.2%) physicians, 474 (28.4%) nurses, and 739 (44.4%) emergency medical technicians (EMTs). EMTs exhibited higher odds of severe or extremely severe depression compared with physicians (odds ratio [OR]: 1.569; 95% confidenceinterval [95% CI]: 1.213-2.030) and nurses (OR: 1.561; 95% CI: 1.211-2.012). EMTs also displayed higher probabilities of severe or extremely severe anxiety compared with nurses (OR: 1.944; 95% CI: 1.529-2.701). Furthermore, EMTs demonstrated elevated probabilities of severe or extremely severe stress compared with physicians (OR: 1.387; 95% CI: 1.088-1.770). However, no significant differences were found in self-efficacy, with a median value of 73 [20]. CONCLUSIONS: Out-of-hospital EMS workers experienced mental health challenges, showing varying levels of depression, stress, and anxiety across different occupational groups. EMTs were particularly affected.

Perceptions of the Educational Community on the Inclusion and Presence of Students with SEN in Mainstream Schools: A Mixed Study.

Achieving inclusive education is a primary challenge for the educational community. Inclusion refers to equal access to education-to the presence, participation and learning of all students. Offering an inclusive education requires all students to share time and space together in the mainstream classroom, that the educational community manifests a positive attitude towards diversity, and that educational centers plan to welcome diversity in their classrooms. The general objective of this study was to evaluate the inclusion of students with SEN enrolled in SOCs in mainstream schools based on their presence, the attitudes of the educational community and the planning processes developed. This was a descriptive study with a dominant status mixed design (QUAN-Qual). The population investigated in this research included the total number of SOCs of the Autonomous Community of the Region of Murcia (Spain) (n = 108). The sample obtained comprised 3.891 people belonging to 88 SOCs from 68 educational centers, which implies a confidence interval of 99% (Z = 2.576) and a margin of error of less than 5%. The data collection instruments used included seven questionnaires, adapted for the purposes of the study, for the quantitative phase, and semi-structured interviews, focus groups and discussion groups for the qualitative phase. The study results indicated that the attitudes of the educational community were the main determinant of inclusion. There is a need to reflect on and undertake actions to eliminate existing barriers to the operation of SOCs, since the involvement of students with SEN in the academic and social life of educational centers, and in mainstream classrooms, is not guaranteed.

[Observational study of the adherence to the correct use of face masks by the general population in open public places during two periods of the COVID-19 pandemic in four Spanish cities.] / Estudio observacional de la adherencia al correcto uso de mascarillas por la población general en lugares públicos abiertos durante dos periodos de la pandemia por COVID-19 en 4 ciudades españolas.

OBJECTIVE: One of the steps adopted to mitigate the pandemic due to SARS-CoV-2 is the use of face masks by the general population. For a face mask to be effective it should cover the nose and the mouth. We wanted to measure the correct use of the face mask by the general population in open public spaces through direct observation. METHODS: We conducted an observational study of the proper use of face masks among the general population in open public places in Bilbao, Santander, Oviedo and Zaragoza from 16th to 26th July, 2020 and from 23rd January to 2nd March, 2021. Sampling for convenience; compliance of the proper use of a mask was evaluated when adults completely covered their mouth and nose. The type of mask and its improper use was registered using a standardized form. The results were obtained using frequency distribution, Pearson's chi-squared test and multivariate logistic regression analysis. RESULTS: A total of 5,464 observations were documented. The overall compliance was 89.5%. We observed that the compliance in 2021 (94.7%) was 10.9 percentage points higher than in 2020 (83.8%) (p<0.001). The main cause of non-compliance was the incorrect placement of face masks (64%); 36% were without masks. The non-reusable face masks were most commonly worn (54.1%). We observed a significant increase in use of high-efficiency face masks in 2021 (27.1%) versus 2020 (13.7%). CONCLUSIONS: In all the cities where the study was conducted we observed an increase in compliance of the proper use of face masks as well as an increased usage of high-efficiency masks. The main cause of non-compliance was incorrect placement.

OBJETIVO: Dentro de las medidas adoptadas para mitigar la pandemia por SARS-CoV-2 se encuentra el uso de mascarillas en la población general. Para que esta medida sea efectiva las mascarillas deben cubrir la nariz y la boca. Nos propusimos conocer su uso correcto por la población general en espacios públicos abiertos mediante observación directa. METODOS: Estudio prospectivo observacional del correcto uso de mascarillas en la población general en espacios abiertos en Bilbao, Santander, Oviedo y Zaragoza, del 16 al 26/07/2020 y del 23/01 al 02/03/2021. Se realizó un muestreo por conveniencia evaluando el cumplimiento del uso de mascarilla cuando los adultos la llevaban cubriendo completamente nariz y boca. Se registró el tipo e inadecuación de su uso mediante formulario estandarizado. Se realizó distribución de frecuencias, comparaciones con χ2 de Pearson y regresión logística multivariable. RESULTADOS: Se realizaron 5.464 observaciones. El cumplimiento global fue del 89,5%; 10,9 puntos mayor en 2021 (94,7%) que en 2020 (83,8%) (p<0,001). La principal causa de incumplimiento fue la colocación incorrecta (64%) frente no llevar nada (36%). Respecto al tipo de mascarillas, las más utilizadas fueron las no reutilizables (54,1%), aumentando en 2021 el uso de las de alta eficacia (13,7% versus 27,6%) de forma significativa. CONCLUSIONES: En todas las ciudades estudiadas se observa un aumento del uso correcto de la mascarilla desde que se hizo obligatorio en espacios públicos, así como aumento de las mascarillas de alta eficacia. La principal causa de incumplimiento es llevar la mascarilla mal colocada.

Pesticide treatment in biobed systems at microcosms level under critical moisture and temperature range using an Orthic Solonchaks soil from southeastern Mexico amended with corn husk as support.

Agriculture effluents from cleaning and handling equipment used in pesticide applications can contaminate superficial and groundwater sources when not correctly disposed of. Biobeds using soil enriched with amendments represent a viable technology to control and minimize pesticide pollution of soil and water in farmlands. They are usually installed outdoors without protection, making them vulnerable to rain flooding, lack of moisture, drought, and intense heat or cold. Temperature (T) and moisture (M) of the biomixture are considered two of the most important physical factor affecting pesticide dissipation. This study aimed to evaluate the effect of T and M on the dissipation of five of the most used pesticides (carbofuran, atrazine, 2,4-D, diazinon, and glyphosate) in Yucatan State, Mexico. Three experiments using miniaturized biobeds considering optimal temperature and moisture (T of 30 ± 2 °C and 90% water holding capacity [WHC]) were performed. The optimal dissipation time and the effect of T, M variations, and volatilization was determined. The optimal dissipation time was over 14 days. Carbofuran was the least dissipated pesticide and glyphosate the most. The primary factor affecting pesticide dissipation was T (P < 0.05), reaching rates of dissipation of 99% at 45 °C. Variations of M in the biomixture were not significant on pesticide dissipation (P > 0.05). The white-rot fungi were observed; its presence was related to increments of T. Head Space analysis (at 45 °C) showed low pesticide volatilization (≤0.03%) for all pesticide used were quantified; water vapor condensation could reduce the pesticide volatilization for experimental conditions.

Analyzing the Impact of COVID-19 Trauma on Developing Post-Traumatic Stress Disorder among Emergency Medical Workers in Spain.

The early stages of the COVID-19 pandemic presented the characteristics of a traumatic event that could trigger post-traumatic stress disorder. Emergency Medical Services workers are already a high-risk group due to their professional development. The research project aimed to analyse the impact of the COVID-19 pandemic on EMS professionals in terms of their mental health. For this purpose, we present a descriptive crosssectional study with survey methodology. A total of 317 EMS workers (doctors, nurses, and emergency medical technicians) were recruited voluntarily. Psychological distress, post-traumatic stress disorder, and insomnia were assessed. The instruments were the General Health Questionnaire-12 (GHQ-12), the Davidson Trauma Scale (DTS-8), and the Athens Insomnia Scale (AIS-8). We found that 36% of respondents had psychological distress, 30.9% potentially had PTSD, and 60.9% experienced insomnia. Years of work experience were found to be positively correlated, albeit with low effect, with the PTSD score (r = 0.133). Finally, it can be stated that the COVID-19 pandemic has been a traumatic event for EMS workers. The number of professionals presenting psychological distress, possible PTSD, or insomnia increased dramatically during the early phases of the pandemic. This study highlights the need for mental health disorder prevention programmes for EMS workers in the face of a pandemic.

The Prognostic Value of Prehospital Blood Lactate Levels to Predict Early Mortality in Acute Cardiovascular Disease.

INTRODUCTION: The knowledge of the prognostic value of prehospital lactate (PLA) is limited. Our objective was to evaluate the predictive capacity of PLA to predict early mortality (within 48 h) from the index event in acute cardiovascular disease (ACVD). METHODS: Prospective, longitudinal, multicenter, observational study in patients, attended by advanced life support units, transferred to the emergency department of their reference hospital and diagnosed with ACVD. We collected demographic, physiological, clinical, analytical variables, main cardiological diagnosis, and data on hospital admission and early mortality. The main outcome variable was mortality from any cause within 2 days. RESULTS: Between March 1, 2018 and January 31, 2019, a total of 492 patients were included in our study. Early mortality after the index event within the first 48 h affected 27 patients (5.5%). The most frequent cause of care demand was chest pain with 223 cases (45.3%). The predictive power of PLA to discriminate mortality at 2 days obtained an area under the curve of 0.911 (95% confidence interval [CI]: 0.83-0.98, P < 0.001). A value equal or superior to 4.3 mmol/L globally attained a sensitivity of 92.6% (95% CI, 76.6-97.9) with a specificity of 82.8% (95% CI, 79.1-86.0), with a positive predictive value of 23.8 (16.7-32.8) and a negative predictive value of 99.5 (98.1-99.9). CONCLUSION: PLA represents a prognostic biomarker with excellent predictive capacity for ACVD. Prehospital Emergency Services (PhEMS) should incorporate this test routinely in their usual procedures.

How Does Pyridoxamine Inhibit the Formation of Advanced Glycation End Products? The Role of Its Primary Antioxidant Activity.

Pyridoxamine, one of the natural forms of vitamin B6, is known to be an effective inhibitor of the formation of advanced glycation end products (AGEs), which are closely related to various human diseases. Pyridoxamine forms stable complexes with metal ions that catalyze the oxidative reactions taking place in the advanced stages of the protein glycation cascade. It also reacts with reactive carbonyl compounds generated as byproducts of protein glycation, thereby preventing further protein damage. We applied Density Functional Theory to study the primary antioxidant activity of pyridoxamine towards three oxygen-centered radicals (•OOH, •OOCH3 and •OCH3) to find out whether this activity may also play a crucial role in the context of protein glycation inhibition. Our results show that, at physiological pH, pyridoxamine can trap the •OCH3 radical, in both aqueous and lipidic media, with rate constants in the diffusion limit (>1.0 × 108 M - 1 s - 1 ). The quickest pathways involve the transfer of the hydrogen atoms from the protonated pyridine nitrogen, the protonated amino group or the phenolic group. Its reactivity towards •OOH and •OOCH3 is smaller, but pyridoxamine can still scavenge them with moderate rate constants in aqueous media. Since reactive oxygen species are also involved in the formation of AGEs, these results highlight that the antioxidant capacity of pyridoxamine is also relevant to explain its inhibitory role on the glycation process.