Incidence of pulmonary embolism in non-critically ill COVID-19 patients. Predicting factors for a challenging diagnosis.

Recent studies suggest that thrombotic complications are a common phenomenon in the novel SARS-CoV-2 infection. The main objective of our study is to assess cumulative incidence of pulmonary embolism (PE) in non critically ill COVID-19 patients and to identify its predicting factors associated to the diagnosis of pulmonary embolism. We retrospectevely reviewed 452 electronic medical records of patients admitted to Internal Medicine Department of a secondary hospital in Madrid during Covid 19 pandemic outbreak. We included 91 patients who underwent a multidetector Computed Tomography pulmonary angiography(CTPA) during conventional hospitalization. The cumulative incidence of PE was assessed ant the clinical, analytical and radiological characteristics were compared between patients with and without PE. PE incidence was 6.4% (29/452 patients). Most patients with a confirmed diagnosed with PE recieved low molecular weight heparin (LMWH): 79.3% (23/29). D-dimer peak was significatly elevated in PE vs non PE patients (14,480 vs 7230 mcg/dL, p = 0.03). In multivariate analysis of patients who underwent a CTPA we found that plasma D-dimer peak was an independen predictor of PE with a best cut off point of > 5000 µg/dl (OR 3.77; IC95% (1.18-12.16), p = 0.03). We found ninefold increased risk of PE patients not suffering from dyslipidemia (OR 9.06; IC95% (1.88-43.60). Predictive value of AUC for ROC is 75.5%. We found a high incidence of PE in non critically ill hospitalized COVID 19 patients despite standard thromboprophylaxis. An increase in D-dimer levels is an independent predictor for PE, with a best cut-off point of > 5000 µg/ dl.

Radiological assessment of placement of the hysteroscopically inserted Essure permanent birth control device.

Essure is a permanent birth control device that is inserted through the cervix by hysteroscopy. The device is placed in the fallopian tubes, where it causes occlusion by stimulating fibrosis. Patients can be followed up with plain-film X-rays, hysterosalpingography, and ultrasonography, although the devices can also be identified incidentally on CT and MRI. The follow-up of Essure is based on checking the criteria for appropriate positioning and correct functioning (tubal occlusion) and on diagnosing complications. The most common complications are perforation, migration (toward the uterine or peritoneal cavity), and occlusion failure. In hysterosalpingography, vascular intravasation is the most common cause of diagnostic error. Radiologists need to know how to recognize the device on different imaging techniques, how to check that it is correctly placed and functioning, and how to diagnose complications.

Understanding the importance of the aromatic amino-acid residues as hot-spots.

Protein-protein interactions (PPI) are crucial for the establishment of life. However, its basic principles are still elusive and the recognition process is yet to be understood. It is important to look at the biomolecular structural space as a whole, in order to understand the principles behind conformation-function relationships. Since the application of an alanine scanning mutagenesis (ASM) study to the growth hormone it was demonstrated that only a small subset of residues at a protein-protein interface is essential for binding - the hot-spots (HS). Aromatic residues are some of the most typical HS at a protein-protein interface. To investigate the structural role of the interfacial aromatic residues in protein-protein interactions, we performed Molecular Dynamic (MD) simulations of protein-protein complexes in a water environment and calculated a variety of physical-chemical characteristics. ASM studies of single residues and of dimers or high-order clusters were performed to check for cooperativity within aromatic residues. Major differences were found between the behavior of non-HS aromatic residues and HS aromatic residues that can be used to design drugs to block the critical interactions or to predict major interactions at protein-protein complexes.

Tobacco use among medical students in Europe: results of a multicentre study using the Global Health Professions Student Survey.

OBJECTIVE: To examine smoking prevalence, knowledge and attitudes, and tobacco cessation training among university students attending European medical schools using the Global Health Professional Students Survey approach. METHODS: A cross-country, cross-sectional study was performed among 12 medical schools in four countries in Europe (Germany, Italy, Poland and Spain). The survey was performed during the second semester of the third year of study from March to May 2009. RESULTS: In total, 2249 subjects entered the study (overall response rate 92%). The overall prevalence of smoking among medical students was 29.3% (95% confidence interval 28.1-34.7), with percentages ranging from 28% in Germany to 31.3% in Italy. This study found that more than two-thirds of medical students believe that health professionals are role models for patients, with different beliefs in Poland (89.6%) and Germany (77.7%) vs Italy and Spain (57.2% and 54.4%, respectively) (P < 0.001). Smoking cessation training at medical school was only reported by 16.5% of students (lowest proportion in Italy, 3.5%) (P < 0.001). In terms of smoking cessation methods, the vast majority (89.8%) of medical students were aware of nicotine patches and gum (highest prevalence in Spain, 96.3%), and 24.4% were aware of the use of antidepressants (highest prevalence in Germany, 33.6%). CONCLUSION: This European survey found that the prevalence of smoking was higher among medical students than the general population. There is a strong need to provide medical students with training in smoking cessation techniques.

Dual energy X-ray absorptimetry: fundamentals, methodology, and clinical applications.

Dual-energy X-ray absorptiometry (DXA; DEXA) is the technique of choice to diagnose osteoporosis and to monitor the response to treatment. It is also useful for measuring body composition. In recent years, new applications have been developed, including vertebral morphometry through the study of the lateral spine, prosthesis integration in orthopedics, and lipodystrophy in HIV+ patients, although its use in these cases is not well established. DXA densitometry is accurate and precise. It is essential to optimize each step of the diagnostic process, taking care to ensure the best acquisition, image analysis, and interpretation of the results. Thus, to obtain the greatest utility from DXA, radiologists need to know the technique, its indications, and its pitfalls. This article reviews the fundamentals, modalities, methods, and clinical applications of DXA.

Bleeding patterns and acceptability among Norplant users in two Asian countries.

Changes in menstrual bleeding patterns are the most frequent reason for discontinuing NORPLANT during the first year of use. Although NORPLANT is used by more women in Asia than in any other region, the changes that occur among these women are not well documented. In pre-introductory clinical trials of NORPLANT in the Philippines and Sri Lanka, 175 women were enrolled with greater than 95% continuing the method after one year. Daily menstrual bleeding calendars were kept by 94% of subjects for nine months and by 66% for one year. In contrast to findings in previous studies which showed that approximately 60% of NORPLANT users had bleeding disruptions in the first year of use, almost all of these women experienced bleeding disruptions. In a one-year study of menstrual pattern changes, increased bleeding was found to occur with the same frequency as reduced bleeding. However, the changes experienced by the Asian women tended to be decreases, rather than increases, in menstrual bleeding.

A 3-year evaluation of the TCu380Ag and the Cu-7.

The TCu380Ag and the Cu-7 intrauterine devices (IUDs) were evaluated in a randomized comparative clinical trial. A total of 198 women who had not recently been pregnant entered the trial in Manila, Philippines and were followed-up through 3 years postinsertion. The 36-month follow-up rates were impressively high at 80.3 for TCu 380A users and 76.7 for users of the Cu-7. Although the two IUDs demonstrated statistically similar termination rates, the findings suggest a higher efficacy for the TCu380Ag. Gross cumulative life-table pregnancy rates were 0.0 and 4.5 for the TCu380Ag and Cu-7, respectively, at 3 years. Overall 3-year continuation rates were 74.3 and 64.9 for users of the respective devices.

Downstream processing for xylitol recovery from fermented sugar cane bagasse hydrolysate using aluminium polychloride.

Xylitol, a sweetener comparable to sucrose, is anticariogenic and can be consumed by diabetics. This sugar has been employed successfully in many foods and pharmaceutical products. The discovery of microorganisms capable of converting xylose present in lignocellulosic biomass into xylitol offers the opportunity of producing this poliol in a simple way. Xylitol production by biotechnological means using sugar cane bagasse is under study in our laboratories, and fermentation parameters have already been established. However, the downstream processing for xylitol recovery is still a bottleneck on which there is only a few data available in the literature. The present study deals with xylitol recovery from fermented sugar cane bagasse hydrolysate using 5.2 g/l of aluminium polychloride associated with activated charcoal. The experiments were performed at pH 9, 50 degrees C for 50 min. The results showed that aluminium polychloride and activated charcoal promoted a 93.5% reduction in phenolic compounds and a 9.7% loss of xylitol from the fermented medium, which became more discoloured, facilitating the xylitol separation.

A non-invasive assessment of hepatitis B virus carrier status using saliva samples.

A non-invasive testing method to determine hepatitis B virus (HBV) carrier status in pregnant women was evaluated. Paired serum and saliva samples were collected and assessment of hepatitis B markers were performed. Of the 502 women enrolled, 5.6% (28/502) of their sera were found to be positive for HBV surface antigen (HBsAg). Assessment of 28 HBsAg seroreactive and 200 HBsAg sero-non-reactive paired saliva samples showed that 17 saliva contained HBsAg. Fourteen of the saliva reactive samples were matched to the serum reactive samples (50% sensitivity); and 3 saliva samples were positive for HBsAg among 200 subjects seronegative for HBsAg (98.5% specificity). Seven of the 28 HBsAg positive sera were found to be reactive for HBV envelope antigen (HBeAg) (25%). One of seven HBeAg seroreactive and 16 HBeAg seronegative paired saliva samples tested were non-reactive for HBeAg. This report found a non-invasive saliva testing method to be a possible alternative approach for determining chronic HBV carrier status if the sensitivity of the test can be improved.

[Gallbladder torsion: report of a case]. / Torsión de la vesícula biliar: a propósito de un caso.

A case of an 81 year old woman who had fever, abdominal pain and a palpable mass in epigastrium and right hypochondriac region is presented. She was diagnosed as having acute cholecystitis and hydrops of the gallbladder. The surgical operation was performed and the findings were: dilated gallbladder with necrotic aspect, free floating with torsion of the cystic duct (greater than 180 degrees) wrapped in the mentum. There was no hepatic bed of the gallbladder. After correcting the torsion, the gallbladder was extirpated, with good clinical evolution. The etiopathogenia is discussed and the literature is reviewed. Despite the rareness of the gallbladder's torsion and the disease being relatively unknown, it has to be considered in the differential diagnosis of acute abdomen in the elderly.

Extending the applicability of the O-ring theory to protein-DNA complexes.

Many biological processes depend on protein-based interactions, which are governed by central regions with higher binding affinities, the hot-spots. The O-ring theory or the "Water Exclusion" hypothesis states that the more deeply buried central regions are surrounded by areas, the null-spots, whose role would be to shelter the hot-spots from the bulk solvent. Although this theory is well-established for protein-protein interfaces, its applicability to other protein interfaces remains unclear. Our goal was to verify its applicability to protein-DNA interfaces. We performed Molecular Dynamics simulations in explicit solvent of several protein-DNA complexes and measured a variety of solvent accessible surface area (SASA) features, as well as, radial distribution functions of hot-spots and null-spots. Our aim was to test the influence of water in their coordination sphere. Our results show that hot-spots tend to have fewer water molecules in their neighborhood when compared to null-spots, and higher values of ΔSASA, which confirms their occlusion from solvent. This study provides evidence in support of the O-ring theory with its applicability to a new type of protein-based interface: protein-DNA.

[Medullary carcinoma of the breast: a malignant lesion mimicking a benign one]. / Carcinoma medular de mama: una lesión maligna que simula benignidad.

Medullary carcinoma of the breast is an unfrequent type of tumor. We present a case of medullary carcinoma of the breast. The patient presented with a palpable breast mass, corresponding on mammography to an obscured mass, which showed a cystic appearance with thick wall on sonography. We review the radiological findings of this type of tumor which should be considered in the differential diagnosis of lesions with well-circumscribed margins.

Risk of ovulation during lactation.

60 breastfeeding mothers in Baltimore and 41 in Manila recorded their infant feeding patterns daily, and gave additional information at weekly interviews. Ovarian activity was monitored by assays for hormone metabolites in daily urine samples. On average, women in Baltimore breastfed less often but for longer at each feed than women in Manila, and the mean times until ovulation were 27 and 38 weeks post partum. 41% of first ovulations had luteal phase defects. Anovular first menses were common (45.1%) during the first 6 months post partum but the rate fell greatly thereafter. The risk of ovulation was reduced by a higher frequency of breastfeeds, longer duration of each feed, and less supplementary feeding. During the first 6 months post partum, amenorrhoeic women had low risks of ovulation (below 10%) with partial breastfeeding, and exclusive breastfeeding reduced the risk to 1-5% with either frequent short feeds or infrequent longer feeds. However, if the woman started menstruating before 6 months post partum, or if she continued breastfeeding beyond 6 months, the risk of ovulation rose, and contraception would be needed.

PIP: The factors predicting the return of ovulation during lactation were investigated in 60 breast feeding mothers from Baltimore, Maryland, and 41 mothers from Manila, the Philippines. The women in Manila breast fed more frequently (11.0 mean daily feeds) than those in Baltimore (5.8 feeds) throughout the first postpartum year. However, during the first 6 months, the average length of an individual breast feed was longer among US women. Although both groups gave few supplementary feeds during the first 20 weeks after delivery, more non-bottle feeds were given thereafter in Manila. Use of bottle feeds was similar in both groups. Women who first ovulated before 6 months gave significantly fewer mean daily breast feeds during this period (8.5) than those who first ovulated after this point (10.7). Women who first ovulated before 6 months also had a lower percentage breast feeds of total feeds (84.2%) than women who first ovulated later (88.2%). The mean duration of amenorrhea was 25.3 weeks in Baltimore and 31.7 weeks in Manila; the average times before first ovulation were 27.0 weeks and 38.0 weeks, respectively. Multivariate analyses showed that the length of suckling per feed, the daily number of breast feeds, and the proportion of breast feeds were all significantly and independently associated with a low risk of ovulation. Up to 6 months postpartum, exclusive breast feeding reduced the risk of ovulation by 98-99% during amenorrhea and by 94-97% after anovular menstruation. Only amenorrheic women practicing exclusive breast feeding during the first 6 postpartum months can achieve a pregnancy rate below 2%. These findings suggest that contraceptive use is indicated among women who resume menstruating before 6 postpartum months or continue breast feeding beyond 6 months.

[Vascular complications in pediatric renal transplant: echographic diagnosis]. / Complicaciones vasculares en el trasplante renal pediátrico: diagnóstico ecográfico.

OBJECTIVE: The purpose of this study was to assess the incidence of vascular complications in pediatric renal transplant patients and to evaluate the accuracy and limitations of duplex-Doppler color ultrasound (US) in their diagnosis. PATIENTS AND METHODS: The US studies of 89 transplants performed in 76 patients were reviewed. Ages of the patients ranged from 11 months to 23 years (mean 13 years). The US exams were performed every 24 hours during the first week post-transplantation, once a week during the hospital stay and whenever graft dysfunction occurred. A vascular map of the graft was performed with color Doppler and maximum systolic velocity, systolic acceleration time, resistive index and flow velocity in the renal vein were determined with pulsed Doppler. An angiography was performed in all patients with US diagnosis of vascular thrombosis, stenosis or arteriovenous fistula. RESULTS: Seventeen grafts (15%) showed vascular complications including renal artery stenosis (8 cases), renal artery thrombosis (4 cases), arteriovenous fistula (4 cases) and one renal vein thrombosis. US studies were able to detect six renal artery stenosis (false negative results in two cases), seven renal artery thrombosis (false positive results in three grafts), all of the arteriovenous fistulas and one renal vein thrombosis. CONCLUSIONS: Doppler-duplex color US has a high sensitivity and specificity in diagnosis of vascular complications and should be the first approach for their diagnosis. The presence of false positive and false negative results makes it necessary to perform angiography when symptomatic thrombosis, arteriovenous fistula or stenosis is suspected.

Sonographic diagnosis of intramural duodenal hematomas.

We present 2 cases of duodenal hematoma. Sonography demonstrated a heterogeneous mass within the duodenal wall in both patients, and neither patient had signs of bowel perforation. CT confirmed the sonographic findings. Sonography and computed tomography are useful in diagnosing duodenal hematoma, in excluding accompanying lesions, and in monitoring resolution with conservative treatment.

Clinical evaluation of the therapeutic effectiveness of ethinyl oestradiol and oestrone sulphate on prolonged bleeding in women using depot medroxyprogesterone acetate for contraception. World Health Organization, Special Programme of Research, Development and Research Training in Human Reproduction, Task Force on Long-acting Systemic Agents for Fertility Regulation.

A placebo-controlled randomized clinical trial was conducted in six centres to compare the effects of a 14 day treatment with either 50 micrograms ethinyl oestradiol daily or 2.5 mg oestrone sulphate daily, on depot medroxyprogesterone acetate (DMPA)-induced prolonged bleeding. Out of 1035 women admitted to the study, 278 requested treatment and were given ethinyl oestradiol (n = 90), oestrone sulphate (n = 91) or placebo (n = 97). Ethinyl oestradiol was successful in stopping the bleeding episode in 93% of cases, compared with oestrone sulphate and placebo which had success rates of 76 and 74% respectively. However, the relative advantage of ethinyl oestradiol was marginal, with an average reduction of 1 bleeding day and 3 spotting days compared with the other two groups. Immediately after treatment, women given ethinyl oestradiol had less bleeding but a more unpredictable pattern than the other two groups. In the long term, there were no differences between the bleeding patterns or the discontinuation rates for any reason in the three groups, and the most important single reason for discontinuation in those groups remained 'menstrual problems'. In summary, the study showed that treatment of DMPA-induced prolonged bleeding with ethinyl oestradiol had a limited short-term effect but no beneficial effect on the acceptability of DMPA as a contraceptive method. Treatment with oestrone sulphate was no different from placebo.

PIP: The findings of a multicenter clinical trial challenge the practice of estrogen treatment of the prolonged or irregular vaginal bleeding associated with depot medroxyprogesterone acetate (DMPA) contraceptive use. Included in the study were 1035 DMPA users (mean age, 27 years) from Alexandria, Egypt; Bangkok, Thailand; Chiang Mai, Thailand; Jakarta, Indonesia; Karachi, Pakistan; and Manila, Philippines. 456 (44%) of these women experienced a bleeding episode lasting more than 7 days during their first 6 months of DMPA use. Of these, only 278 (61%) requested treatment. These 278 women were randomly allocated to receive 50 mcg of ethinyl estradiol (n = 90), 2.5 mg of estrone sulfate (n = 91), or placebo (n = 97) daily for 14 days. The treatment stopped the bleeding episode for 93% of women in the ethinyl estradiol group, 76% of those in the estrone sulfate group, and 74% of women receiving a placebo. The ethinyl estradiol advantage was marginal, however. On average, women treated with ethinyl estradiol had their bleeding episode shortened by 1 bleeding day and 3 spotting days. Immediately after treatment, women given ethinyl estradiol had less bleeding and spotting days than their counterparts in the 2 other groups, but demonstrated a more unpredictable pattern, including a greater range of lengths of bleeding/spotting-free intervals. Three months after treatment, there were no differences between the 3 groups in vaginal bleeding patterns.

Absorciometría con rayos X de doble energía. Fundamentos, metodología y aplicaciones clínicas / Dual energy X-ray absorptimetry: fundamentals, methodology, and clinical applications

La absorciometría con rayos X de doble energía (DXA o DEXA) es la técnica de elección para diagnosticar la osteoporosis y monitorizar la respuesta al tratamiento. Además, es útil para estudiar la composición corporal. En los últimos años han surgido nuevas aplicaciones como la morfometría vertebral, estudiando la columna en visión lateral, la integración de prótesis en ortopedia, o la lipodistrofia en los pacientes con infección por VIH, aunque su utilización en estos casos no está bien consolidada. En el estudio de la osteoporosis, densitometría es precisa y exacta. Para ello, es imprescindible optimizar cada etapa del proceso diagnóstico, cuidando la adquisición, el análisis de imágenes y la interpretación de los resultados. Por ello, para obtener la máxima utilidad para el clínico y el paciente, el radiólogo debe conocer la técnica, sus indicaciones y las dificultades. El objetivo de este artículo es revisar la DXA, haciendo hincapié en sus fundamentos, modalidades, metodología y aplicaciones clínicas (AU)

Dual-energy X-ray absorptiometry (DXA; DEXA) is the technique of choice to diagnose osteoporosis and to monitor the response to treatment. It is also useful for measuring body composition. In recent years, new applications have been developed, including vertebral morphometry through the study of the lateral spine, prosthesis integration in orthopedics, and lipodystrophy in HIV+ patients, although its use in these cases is not well established. DXA densitometry is accurate and precise. It is essential to optimize each step of the diagnostic process, taking care to ensure the best acquisition, image analysis, and interpretation of the results. Thus, to obtain the greatest utility from DXA, radiologists need to know the technique, its indications, and its pitfalls. This article reviews the fundamentals, modalities, methods, and clinical applications of DXA (AU)