Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome.

AIMS: We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization. METHODS AND RESULTS: We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92‰). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51-9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65-1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97-2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66-4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations. CONCLUSIONS: PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE.

A Brain Ischemia-Reperfusion Model for the Study of Tau Phosphorylation and O-GlcNAcylation.

Cerebral ischemia produces a decrease, loss, or instability of the assembly processes in the neuronal cytoskeleton, related to the alteration in the normal processes of phosphorylation of the Tau protein, triggering its hyperphosphorylation and altering the normal processes of formation of neuronal microtubules. Here we describe the methods used to study the impact of middle cerebral artery occlusion (MCAo) on neurological functions and Tau phosphorylation in Wistar rat brain.

Prediction of potential cysteine synthase inhibitors of Leishmania braziliensis and Leishmania major parasites by computational screening.

Leishmaniasis is a neglected tropical disease considered a public health problem that requires innovative strategies for its chemotherapeutic control. In the present investigation, a molecular docking approach was carried out using the protein cysteine synthase (CS) of Leishmania braziliensis (CSLb) and Leishmania major (CSLm) parasites to identify new compounds as potential candidates for the development of selective leishmaniasis therapy. CS protein sequence similarity, active site, structural modeling, molecular docking, and ADMET properties of compounds were analyzed using bioinformatics tools. Molecular docking analyses identified 1000 ligands with highly promising binding affinity scores for both CS proteins. A total of 182 compounds for CSLb and 173 for CSLm were selected for more detailed characterization based on the binding energy and frequency values and ADMET properties. Based on Principal Component Analysis (PCA) and K-means clusterization for both CS proteins, we classified compounds into 5 clusters for CSLb and 7 for CSLm, thus providing an excellent starting point for verification of enzyme inhibition in in vitro studies. We found the ZINC16524774 compound predicted to have a high affinity and stability for both CSLb and CSLm proteins, which was also evaluated through molecular dynamics simulations. Compounds within each of the five clusters also displayed pharmacological and structural properties that make them attractive drug candidates for the development of selective cutaneous leishmaniasis chemotherapy.

Impact of hospital and emergency department structural and organizational characteristics on outcomes of acute heart failure.

INTRODUCTION AND OBJECTIVES: To determine whether structural/organizational characteristics of hospitals and emergency departments (EDs) affect acute heart failure (AHF) outcomes. METHODS: We performed a secondary analysis of the EAHFE Registry. Six hospital/ED characteristics were collected and were related to 7 postindex events and postdischarge outcomes, adjusted by the period of patient inclusion, baseline patient characteristics, AHF episode features, and hospital and ED characteristics. The relationship between discharge directly from the ED (DDED) and outcomes was assessed, and interaction was analyzed according to the hospital/ED characteristics. RESULTS: We analyzed 17 974 AHF episodes included by 40 Spanish EDs. Prolonged stays were less frequent in high-technology hospitals and those with hospitalization at home and with high-inflow EDs, and were more frequent in hospitals with a heart failure unit (HFU) and an ED observation unit. In-hospital mortality was lower in high-technology hospitals (OR, 0.78; 95%CI, 0.65-0.94). Analysis of 30-day postdischarge outcomes showed that hospitals with a short-stay unit (SSU) had higher hospitalization rates (OR, 1.19; 95%CI, 1.02-1.38), high-inflow EDs had lower mortality (OR, 0.73; 95%CI, 0.56-0.96) and fewer combined events (OR, 0.87; 95%CI, 0.76-0.99), while hospitals with HFU had fewer ED reconsultations (OR, 0.83; 95%CI, 0.76-0.91), hospitalizations (OR, 0.85; 95%CI, 0.75-0.97), and combined events (OR, 0.84; 95%CI, 0.77-0.92). The higher the percentage of DDED, the fewer the prolonged stays. Among other interactions, we found that more frequent DDED was associated with more 30-day postdischarge reconsultations, hospitalizations and combined events in hospitals without SSUs, but not in hospitals with an SSU. CONCLUSIONS: AHF outcomes were significantly affected by the structural/organizational characteristics of hospitals and EDs and their aggressiveness in ED management.

Factors associated with late presentation to the emergency department in patients complaining of chest pain.

OBJECTIVE: We investigated which factors predict late presentation (LP) to the emergency department (ED) in patients with non-traumatic chest pain (CP). METHODS: All CP cases attended at a single ED (2008-2017) were included. LP was considered if time from CP onset to ED arrival was>6 h. We analyzed associations between 42 patient/CP-related characteristics and LP in the whole cohort and in patients with CP due to acute coronary syndrome (ACS). RESULTS: The cohort included 25,693 cases (LP=50.6%; ACS=19.0%). Twenty factors were associated with LP, and 8 were also found in patients with ACS: CP of short-duration, aggravated by exertion or breathing/movement, undulating or recurrent CP increased the risk of LP, whereas CP accompanied by diaphoresis, irradiated to the throat, and chronic treatment with nitrates decreased the risk of LP. Exertional and recurrent CP were associated with both, LP and ACS. CONCLUSION: Some characteristics, mainly CP-related, may lead to LP to the ED. CP aggravated by exercise and recurrent CP were associated with both LP and a final diagnosis of ACS. PRACTICE IMPLICATIONS: Patient educational initiatives should consider these two features as potential warnings for ACS and thereby encourage patients to seek early medical consultation.

Effect of pretreatment and temperature on the drying kinetics and physicochemical and techno-functional characteristics of pumpkin (Cucurbita maxima).

The study was carried out to assess fresh slices and thermally pretreated pumpkin (Cucurbita maxima) dried at temperatures of 55 °C, 60 °C, 65 °C, and 70 °C. The drying kinetics and quality attributes of the dried product were determined, and results indicated that the modified Page model was the best fit, with activation energies of 29.47 kJ mol-1 and 16.06 kJ mol-1 for drying fresh and thermally pretreated slices, respectively. A significant effect (p < 0.05) related to thermal pretreatment and temperature was evidenced on the physicochemical properties. The fresh pulp powders presented the following ranges of moisture and color (ΔE), 7.10%-8.31% w.b.; 21.23-25.23, respectively, and for the pretreated pulp powders, they were 8.94%-11.54% w.b., and from 19.00- 28.30, respectively. There were no significant effects on the techno-functional properties in the powders; cold water solubility was 5.36%-6.46%, water absorption capacity was 3.42-6.52 g/g, and oil absorption capacity was 1.00-1.30 g/g. The carbohydrate and fiber contents significantly decreased in the pretreated powder. An increase in antioxidant activity was found in fresh and thermally pretreated pulp powder at a temperature of 70 °C, presenting values between 2.23-2.98 µmol Trolox equivalent g-1d.b. evaluated by the DPPH method and between 40.48-45.92 µmol Trolox equivalent g-1d.b. by ABTS, and no significant differences (p > 0.05) were determined after pulp pretreatment. The total content of carotenoids presented retention percentages for fresh pulp powders of 52.09%, 41.92%, 30.55%, and 22.79%, while for pretreated pulp powders, they were 30.67%, 32.86%, 24.84%, and 14.71% when dried at temperatures of 55 °C, 60 °C, 65 °C, and 70 °C, respectively. The powders obtained from heat-pretreated pumpkin pulp showed significant differences (p < 0.05) in physicochemical characteristics and total carotenoids, but they were not found (p > 0.05) in the techno-functional properties and antioxidant activity evaluated by the DPPH and ABTS methods.

Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study.

BACKGROUND: Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined. RESEARCH QUESTION: Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP? STUDY DESIGN AND METHODS: This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes. RESULTS: We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups. INTERPRETATION: SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.

Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S8.

BACKGROUND AND IMPORTANCE: A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19. OBJECTIVE: We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization. METHODS: We retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls. RESULTS: We identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50‰; 95% confidence interval (CI), 1.23-1.80‰]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52‰; 95% CI, 1.45-1.69‰; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45). CONCLUSIONS: DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.

Clinical findings, risk factors, and final outcome in patients diagnosed with pulmonary thromboembolism and COVID-19 in hospital emergency departments. / Características clínicas, factores de riesgo y resultados finales de pacientes con COVID-19 diagnosticados de tromboembolia de pulmón en urgencias.

OBJECTIVES: To analyze clinical, laboratory, and radiologic findings and final health outcomes in patients with pulmonary embolism and coronavirus disease 2019 (COVID-19). To compare them to findings and outcomes in patients with pulmonary embolism without COVID-19. MATERIAL AND METHODS: Multicenter, observational, retrospective study in 4 Spanish hospital emergency departments (EDs) from January 15 to April 15, 2020. Cases were located by reviewing all ED requests for pulmonary computed tomography angiography (CTA) procedures. Clinical, laboratory, and radiologic findings; medical histories and comorbidity; risk factors; and outcomes were compared between the 2 groups of patients (with or without COVID-19). RESULTS: A total of 399 CTAs were ordered; 88 pulmonary embolisms were diagnosed, 28 of them (32%) in patients with COVID-19. This group had more men, and a history of thromboembolic disease was more common. We found no between-group differences in clinical presentation, laboratory, or radiologic findings; nor were there differences in final outcomes. In-hospital mortality was 7% (2 cases) in patients with COVID-19 and 17% (10 cases) in patients without the virus (odds ratio for death in patients with pulmonary embolism and COVID-19, 0.38; 95% CI, 0.08-1.89). CONCLUSION: We found no clinically important differences in the clinical, laboratory, or radiologic findings between patients with or without COVID-19 who were treated for pulmonary embolism in our hospital EDs. Final outcomes also did not differ.

OBJETIVO: Analizar las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con embolia pulmonar (EP) y COVID-19, y compararlas con un grupo de pacientes con EP sin COVID-19. METODO: Estudio multicéntrico, observacional y retrospectivo realizado en cuatro servicios de urgencias hospitalarios (SUH) españoles del 15 de enero al 15 de abril de 2020. La detección de EP se hizo mediante la revisión de todas las angiografías por tomografía computarizada (angioTC) pulmonares solicitadas desde los SUH. Se han analizado dos grupos de pacientes con EP, con o sin enfermedad por COVID-19, y se comparan las características clínicas, analíticas, radiológicas, antecedentes y comorbilidad, factores de riesgo y resultados finales. RESULTADOS: Se realizaron 399 angioTC y se diagnosticaron 88 EP, 28 (32%) en pacientes con COVID-19. Estos pacientes fueron con más frecuencia hombres y tenían más antecedentes de enfermedad tromboembólica previa. No hubo diferencias en la presentación clínica, características analíticas o radiológicas ni en los resultados finales entre ambos grupos. La mortalidad intrahospitalaria fue del 7% (2 casos) en pacientes COVID y del 17% (10 casos) en pacientes sin COVID (OR de muerte en pacientes COVID con EP: 0,38, IC 95%: 0,08-1,89). CONCLUSIONES: No se han observado diferencias clínicamente relevantes en las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con EP y COVID-19 respecto a los pacientes con EP sin esta enfermedad atendidos en los SUH.

Genetic diversity of the rain tree (Albizia saman) in Colombian seasonally dry tropical forest for informing conservation and restoration interventions.

Albizia saman is a multipurpose tree species of seasonally dry tropical forests (SDTFs) of Mesoamerica and northern South America typically cultivated in silvopastoral and other agroforestry systems around the world, a trend that is bound to increase in light of multimillion hectare commitments for forest and landscape restoration. The effective conservation and sustainable use of A. saman requires detailed knowledge of its genetic diversity across its native distribution range of which surprisingly little is known to date. We assessed the genetic diversity and structure of A.saman across twelve representative locations of SDTF in Colombia, and how they may have been shaped by past climatic changes and human influence. We found four different genetic groups which may be the result of differentiation due to isolation of populations in preglacial times. The current distribution and mixture of genetic groups across STDF fragments we observed might be the result of range expansion of SDTFs during the last glacial period followed by range contraction during the Holocene and human-influenced movement of germplasm associated with cattle ranching. Despite the fragmented state of the presumed natural A. saman stands we sampled, we did not find any signs of inbreeding, suggesting that gene flow is not jeopardized in humanized landscapes. However, further research is needed to assess potential deleterious effects of fragmentation on progeny. Climate change is not expected to seriously threaten the in situ persistence of A. saman populations and might present opportunities for future range expansion. However, the sourcing of germplasm for tree planting activities needs to be aligned with the genetic affinity of reference populations across the distribution of Colombian SDTFs. We identify priority source populations for in situ conservation based on their high genetic diversity, lack or limited signs of admixture, and/or genetic uniqueness.

Worsening renal function during an episode of acute heart failure and its relation to short- and long-term mortality: associated factors in the Epidemiology of Acute Heart Failure in Emergency Departments- Worsening Renal Function study. / Factores asociados con el empeoramiento de la función renal durante un episodio de insuficiencia cardiaca aguda y su relación con la mortalidad a corto y largo plazo: estudio EAHFE - EFRICA.

OBJECTIVES: To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF). MATERIAL AND METHODS: Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group. RESULTS: A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences. CONCLUSION: AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency.

OBJETIVO: Identificar los factores asociados con el empeoramiento de la función renal (EFR) y si este se asocia a mayor mortalidad en pacientes que presentan un episodio de insuficiencia cardiaca aguda (ICA). METODO: Participaron 7 servicios de urgencias (SU) que incluyeron consecutivamente pacientes con ICA con determinación de creatinina en urgencias y a las 24-48 horas, y se identificaron aquellos con EFR (incremento de creatinina $ 0,3 mg/dL). Entre 47 características clínicas, se identificó las asociadas a EFR. Se investigó la mortalidad por cualquier causa a 30 días (OR) y al final del seguimiento (HR), esta última global y por periodos trimestrales, que se ajustó por las diferencias entre grupos. Se analizaron subgrupos según edad, sexo, creatinina basal, tipo de ICA y grupo de riesgo. RESULTADOS: Se incluyeron 1.627 pacientes, 220 (13,5%) con EFR, los cuales presentaban mayor edad, presión arterial sistólica, crisis hipertensiva como precipitante, tratamiento con morfina e insuficiencia renal crónica, aunque solo esta última se asoció independientemente a EFR (ORajustada = 1,695, IC 95% = 1,264-2,273). La mortalidad a 30 días fue de 13,1% (mayor en pacientes con EFR: 20,9% vs 11,8%, ORajustada = 1,793, IC 95% = 1,207-2,664) y la mortalidad acumulada a 18 meses (tiempo medio de seguimiento 14 meses/paciente) fue del 40,0% (mayor en pacientes con EFR: HRajustada = 1,275, IC 95% = 1,018-1,598). Este incremento de riesgo fue durante el primer trimestre. El análisis de subgrupos no mostró diferencias. CONCLUSIONES: La ICA con EFR en las primeras 48 horas posteriores a la atención en el SU se asocia a mayor mortalidad, que se concentra durante el primer trimestre.

Covid-19: algunos efectos delictuales con impacto en la convivencia y seguridad en Colombia / Covid-19: some criminal effects with an impact on coexistence and securityin Colombia / Covid-19: alguns efeitos do crime com impacto na coexistência e na segurança na Colômbia

El presente texto tiene como objetivo analizar los impactos tempranos en la seguridad de Colombia, en contextos de la pandemia de covid-19, a partir del registro del primer caso de contagio en el país. En el marco de una investigación empírico-analítica y de revisión cualitativa y cuantitativa de fuentes primarias y secundarias en torno a la pregunta ¿cómo se comportaron los delitos (homicidio, hurtos), saqueos a establecimientos comerciales, emergencia carcelaria, delitos informáticos, acciones de los grupos armados ilegales y violencia intrafamiliar, en el contexto temprano de la pandemia de covid-19 en Colombia? Para aproximarnos a una respuesta, trabajamos un método inductivo con base en cifras oficiales, lo cual arrojó como resultado la manifestación de un cambio significativo con relación al periodo prepandémico y las primeras fases de manifestación de las restricciones sociales por causa de la covid-19; lo que permitió concluir que, en contextos de excepcionalidad, los indicadores de seguridad experimentan variaciones significativas, en particular de forma temprana, lo cual es funcional para la corrección de protocolos y manuales para el proceso de toma de decisiones desde un enfoque prospectivo.

The aim of this text is to analyse the early impacts on security in Colombia, in the context of the covid-19 pandemic, based on the registration of the first case of contagion in the country. Within the framework of an empirical-analytical research and a qualitative and quantitative review of primary and secondary sources, the question is: how did crime (homicide, theft), looting of commercial establishments, prison emergencies, computer crimes, actions of illegal armed groups and domestic violence function in the early context of the covid-19 pandemic in Colombia? To approach an answer, we used an inductive method based on official figures, which resulted in the manifestation of a significant change in relation to the pre-pandemic period and the first phases of manifestation of social restrictions due to covid-19; which allowed us to conclude that, in contexts of exceptionality, security indicators experienced significant variations, particularly early on, which is functional for the correction of protocols and manuals for the decision-making process based on a prospective approach.

O objetivo deste texto é analisar os primeiros impactos sobre a segurança na Colômbia, no contexto da pandemia da covid-19, com base no registro do primeiro caso de contágio no país. No âmbito de uma pesquisa empírico-analítica e de uma revisão qualitativa e quantitativa de fontes primárias e secundárias, a pergunta é: como se comportaram a criminalidade (homicídios, roubos), os saques a estabelecimentos comerciais, as emergências carcerárias, os crimes informáticos, as ações de grupos armados ilegais e a violência doméstica no contexto inicial da pandemia da covid-19 na Colômbia? Para chegar a uma resposta, utilizamos um método indutivo baseado em números oficiais, o que resultou na manifestação de uma mudança significativa com relação ao período pré-pandêmico e às primeiras fases de manifestação de restrições sociais devido à covid-19; o que nos permitiu concluir que, em contextos de excepcionalidade, os indicadores de segurança experimentam variações significativas, particularmente no início, o que é funcional para a correção de protocolos e manuais para o processo de tomada de decisão a partir de uma abordagem prospectiva.

Características clínicas, factores de riesgo y resultados finales de pacientes con COVID-19 diagnosticados de tromboembolia de pulmón en urgencias / Clinical findings, risk factors, and final outcome in patients diagnosed with pulmonary thromboembolism and COVID-19 in hospital emergency departments

OBJETIVO: Analizar las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con embolia pulmonar (EP) y COVID-19, y compararlas con un grupo de pacientes con EP sin COVID-19. MÉTODO: Estudio multicéntrico, observacional y retrospectivo realizado en cuatro servicios de urgencias hospitalarios (SUH) españoles del 15 de enero al 15 de abril de 2020. La detección de EP se hizo mediante la revisión de todas las angiografías por tomografía computarizada (angioTC) pulmonares solicitadas desde los SUH. Se han analizado dos grupos de pacientes con EP, con o sin enfermedad por COVID-19, y se comparan las características clínicas, analíticas, radiológicas, antecedentes y comorbilidad, factores de riesgo y resultados finales. RESULTADOS: Se realizaron 399 angioTC y se diagnosticaron 88 EP, 28 (32%) en pacientes con COVID-19. Estos pacientes fueron con más frecuencia hombres y tenían más antecedentes de enfermedad tromboembólica previa. No hubo diferencias en la presentación clínica, características analíticas o radiológicas ni en los resultados finales entre ambos grupos. La mortalidad intrahospitalaria fue del 7% (2 casos) en pacientes COVID y del 17% (10 casos) en pacientes sin COVID (OR de muerte en pacientes COVID con EP: 0,38, IC 95%: 0,08-1,89). CONCLUSIONES: No se han observado diferencias clínicamente relevantes en las características clínicas, analíticas, radiológicas y los resultados finales de salud en una cohorte de pacientes con EP y COVID-19 respecto a los pacientes con EP sin esta enfermedad atendidos en los SUH

OBJECTIVE: To analyze clinical, laboratory, and radiologic findings and final health outcomes in patients with pulmonary embolism and coronavirus disease 2019 (COVID-19). To compare them to findings and outcomes in patients with pulmonary embolism without COVID-19. METHODS: Multicenter, observational, retrospective study in 4 Spanish hospital emergency departments (EDs) from January 15 to April 15, 2020. Cases were located by reviewing all ED requests for pulmonary computed tomography angiography (CTA) procedures. Clinical, laboratory, and radiologic findings; medical histories and comorbidity; risk factors; and outcomes were compared between the 2 groups of patients (with or without COVID-19). RESULTS: A total of 399 CTAs were ordered; 88 pulmonary embolisms were diagnosed, 28 of them (32%) in patients with COVID-19. This group had more men, and a history of thromboembolic disease was more common. We found no between-group differences in clinical presentation, laboratory, or radiologic findings; nor were there differences in final outcomes. In-hospital mortality was 7% (2 cases) in patients with COVID-19 and 17% (10 cases) in patients without the virus (odds ratio for death in patients with pulmonary embolism and COVID-19, 0.38; 95% CI, 0.08-1.89). CONCLUSIONS: We found no clinically important differences in the clinical, laboratory, or radiologic findings between patients with or without COVID-19 who were treated for pulmonary embolism in our hospital EDs. Final outcomes also did not differ

Factores asociados con el empeoramiento de la función renal durante un episodio de insuficiencia cardiaca aguda y su relación con la mortalidad a corto y largo plazo: estudio EAHFE - EFRICA / Worsening renal function during an episode of acute heart failure and its relation to short- and long-term mortality: associated factors in the Epidemiology of Acute Heart Failure in Emergency Departments- Worsening Renal Function study

OBJETIVO: Identificar los factores asociados con el empeoramiento de la función renal (EFR) y si este se asocia a mayor mortalidad en pacientes que presentan un episodio de insuficiencia cardiaca aguda (ICA). MÉTODO: Participaron 7 servicios de urgencias (SU) que incluyeron consecutivamente pacientes con ICA con determinación de creatinina en urgencias y a las 24-48 horas, y se identificaron aquellos con EFR (incremento de creatinina $ 0,3 mg/dL). Entre 47 características clínicas, se identificó las asociadas a EFR. Se investigó la mortalidad por cualquier causa a 30 días (OR) y al final del seguimiento (HR), esta última global y por periodos trimestrales, que se ajustó por las diferencias entre grupos. Se analizaron subgrupos según edad, sexo, creatinina basal, tipo de ICA y grupo de riesgo. RESULTADOS: Se incluyeron 1.627 pacientes, 220 (13,5%) con EFR, los cuales presentaban mayor edad, presión arterial sistólica, crisis hipertensiva como precipitante, tratamiento con morfina e insuficiencia renal crónica, aunque solo esta última se asoció independientemente a EFR (ORajustada = 1,695, IC 95% = 1,264-2,273). La mortalidad a 30 días fue de 13,1% (mayor en pacientes con EFR: 20,9% vs 11,8%, ORajustada = 1,793, IC 95% = 1,207-2,664) y la mortalidad acumulada a 18 meses (tiempo medio de seguimiento 14 meses/paciente) fue del 40,0% (mayor en pacientes con EFR: HRajustada = 1,275, IC 95% = 1,018-1,598). Este incremento de riesgo fue durante el primer trimestre. El análisis de subgrupos no mostró diferencias. CONCLUSIÓN: La ICA con EFR en las primeras 48 horas posteriores a la atención en el SU se asocia a mayor mortalidad, que se concentra durante el primer trimestre

OBJECTIVE: To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF). METHODS: Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group. RESULTS: A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences. CONCLUSION: AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency

Acute myocardial infarction due to left main compression aortic dissection treated by direct stenting.

We describe a case of acute myocardial infarction (AMI) due to compression of the left main coronary artery (LMCA) by a false channel created by an acute aortic dissection (AAD). The dynamic pattern of artery obstruction is detailed as a key element to the diagnosis of extrinsic coronary compression throughout the angiography. Treatment by direct stenting restored complete anterograde coronary flow and improved myocardial perfusion.

EFECTO DE LA LIOFILIZACIÓN SOBRE LAS PROPIEDADES FUNCIONALES DEL AJÍ ROCOTO (Capsicum pubescens)

El ají rocoto (Capsicum pubescens) es un fruto perecedero, por lo cual, se hace necesario explorar alternativas agroindustriales, que permitan conservar sus propiedades funcionales. Entre los desarrollos tecnológicos estudiados en la transformación y la conservación de alimentos, se encuentra la liofilización. En esta investigación, se liofilizó ají rocoto, colectado en San Cristóbal-Medellín, Antioquia (Colombia) y se evaluó su efecto sobre las propiedades funcionales, como la capacidad antioxidante, por el método Ferric Reducing Antioxidant Power (FRAP), fenoles totales, carotenoides, contenido de ácido ascórbico y capsaicina, tanto en el producto fresco como en los tratamientos liofilizados. Se realizó un arreglo de parcelas dividas, con el factor de la programación de la velocidad de calentamiento, entre 0,02 y 0,05°C/ min, durante la sublimación, asignado a la parcela principal y al factor categórico de semilla en la subparcela, con una aleatorización completamente al azar (DCA), con tres repeticiones. Se registró, que el ají rocoto fresco con semilla incluida, la placenta valores de 1,18mg, equivalentes de ácido ascórbico/g base seca (b.s.), como capacidad antioxidante, por FRAP; 5,37mg, equivalentes de ácido gálico/g b.s., para el contenido de fenoles totales; 4,74mg/g, b.s. de carotenoides; 1,88mg/g b.s., de ácido ascórbico y 1,57mg/g b.s., de capsaicina. Se concluyó que para los tratamientos liofilizados con y sin semillas, se incrementó la capacidad antioxidante y fenoles totales con respecto al producto en fresco. Se evidenció diferencia estadística en las programaciones de calentamiento durante la sublimación, afectando el contenido de capsaicina, en los tratamientos con y sin semillas.

The chili pepper (Capsicum pubescens) is a perishable fruit whereby it is necessary to explore agroindustrial alternatives, that preserves its functional properties; within the technological developments studied in food processing and preservation is freeze-drying. In this research, the rocoto chili pepper harvested in rural area of San Cristobal-Medellin, Antioquia (Colombia), was freeze-drying and it was evaluated the effect on the functional properties such as antioxidant capacity by the Ferric Reducing Antioxidant Power method (FRAP), total phenols, carotenoids, ascorbic acid and capsaicin, both in the fresh product and in freeze- drying treatments. Was realized a fix split plots, with the factor of programming the heating rate, between 0.02 and 0.05°C/min during sublimation assigned to the principal plot and the categorical factor seeds in the subplot, was performed with a Randomized Block Design (RBD) with three replications. It was obtained in fresh chilli with seed including placenta values of 1.18mg of eq. ascorbic acid/g dried basis (d.b.) as antioxidant capacity by FRAP; 5.37mg of eq. gallic acid/g d.b. for total phenols content; 4.74mg/g d.b. of carotenoids; 1.88mg/g d.b. of ascorbic acid and 1.57mg/g d.b. of capsaicin. It was concluded that for the freeze-drying treatments, the antioxidant capacity and total phenols were increased, with respect to the fresh product. It evidenced a statistical difference in the heating schedules during sublimation affecting the capsaicin content in seed and seedless treatments.

Análisis del grado de Conocimiento y actitudes hacia el aborto en estudiantes del Programa de Salud en la Universidad de Santander Bucaramangac / Analysis of the degree of knowledge and attitudes towards abortion in students of the Health Program at the University of Santander Bucaramanga

Cada año 16 millones de mujeres de 15 a 19 años quedan embarazadas, la mayoría, de países de ingresos bajos y medios, lo que genera embarazos no deseados y en algunos casos interrupción voluntaria del embarazo (IVE). El proyecto que se presenta a continuación, tiene como propósito medir el grado de conocimientos y actitudes hacia el aborto en estudiantes de programas de la salud en la universidad de Santander. Esta investigación se aplicó a estudiantes de la facultad de ciencias de la salud en la Universidad de Santander sede Bucaramanga, mayores de 18 años que cursen entre 4° y 10° semestre. Para el desarrollo de este estudio se hizo uso de un cuestionario desarrollado por Marván & Lagunes y en su investigación "Diseño de un cuestionario de actitudes hacia el aborto inducido", y parte de un cuestionario desarrollado por León & Gómez en su investigación "Diseño y Validación de un cuestionario sobre conocimientos de sexualidad responsable en jóvenes". En relación a los resultados, se indica que la población se caracteriza por ser mujeres y hombres heterosexuales, ubicados entre los 18 y 35 años de edad. Según sus respuestas en materia de salud sexual y reproductiva, el 87,2% de las personas contestaron favorablemente esta encuesta, demostrando que cuentan con los conocimientos básicos en cuanto a la temática. Se puede concluir que no se presenta ninguna tendencia sobre permitir a las mujeres decidir lo que deben hacer con su propio cuerpo, y eso incluye la decisión de abortar o no. Sin embargo, de la proporción de personas a favor, se puede inferir que consideran que el aborto debería ser contemplada como una opción para las mujeres que propicie la libertad de la misma y el respeto por su propio cuerpo, siendo una decisión 100% autónoma. (AU)

Every year 16 million women between the ages of 15 and 19 become pregnant, the majority from low- and middle-income countries, leading to unwanted pregnancies and in some cases voluntary termination of pregnancy (IVE). The purpose of the project presented below is to measure the degree of knowledge and attitudes towards abortion in students of health programs at the University of Santander. This research was applied to students from the Faculty of Health Sciences at the University of Santander, Bucaramanga, over 18 years of age who are in the 4th to 10th semester. For the development of this study, a questionnaire developed by Marván & Lagunes and in their research "Design of a questionnaire on attitudes towards induced abortion" was used, and part of a questionnaire developed by León & Gómez in their research "Design and Validation of a questionnaire on knowledge of responsible sexuality in young people". In relation to the results, it is indicated that the population is characterized by being heterosexual women and men, located between 18 and 35 years of age. According to their responses on sexual and reproductive health, 87.2% of people answered this survey favorably, showing that they have basic knowledge on the subject. It can be concluded that there is no tendency to allow women to decide what to do with their own body, and that includes the decision to abort or not. However, from the proportion of people in favor, it can be inferred that considering that abortion should be considered as an option for women that encourages freedom of the same and respect for their own body, being a 100% autonomous decision.

[Secondary hyperparathyroidism and anemia. Effects of a calcimimetic on the control of anemia in chronic hemodialysed patients. Pilot Study]. / Hyperparathyroïdie secondaire et anémie. Effets d'un calcimimétique sur le contrôle de l'anémie des hémodialysés chroniques. Étude pilote.

UNLABELLED: The main cause of resistance to erythropoiesis-stimulating agents (ESA) used for treatment of anemia in chronic hemodialysed patients (CHP) is the iron deficiency, absolute or functional. Secondary hyperparathyroidism (SHPT) is a secondary factor of resistance. Indeed, it has been reported in the literature an improvement of anemia parameters after surgical parathyroidectomy (PTX). The objective of this study is to assess in CHP, the impact of the correction of SHPT by a calcimimetic, cinacalcet (CI), (which is considered as a pharmacological PTX) on the response to ESA, measured by the erythropoietin resistance index (ERI). Twenty-two CHP with severe SHPT documented by an intact parathyroid hormone (iPTH) above 800pg/mL were included in this prospective pilot study. Mineral bone metabolism, anemia and nutritional parameters were measured baseline and after 6 months of treatment by CI. The effect on anemia was assessed at the end of study by the ERI, the change in Hb concentration, and the proportion of patients with Hb levels above 11g/dL. RESULTS: At the end of study there was a significant decrease (M6 vs M0) in iPTH (1302 vs 674pg/mL or -48%, p=0.006), serum calcium (2.39 vs 2.15mmol/L or -10%), serum phosphate (2 vs 1.7mmol/L or -15%), serum calcium-phosphorus product (CaxP) (4.8 vs 3.8mmol(2)/L(2) or - 20% (p<0.05), and the number of patients with CaxP>4.4mmol(2)/L(2) (64 vs 32%, p<0.05). The level of bone alkaline phosphatase remained stable during the study (28 vs 27 IU/L). The Hb levels increased from 11 to 11.4g/dL, as did the proportion of patients whose Hb concentration reached 11g/dL or higher (50 vs 70%, p<0.05) without important change of the median weekly ESA dosis in the majority of patients, 18 cases (81%) vs four (19%). Two subgroups were identified from the median decreases in iPTH (delta iPTH) between M0 and M6, Group 1 (delta iPTH≥400pg/mL, n=10) and group 2 (delta iPTH<400pg/mL, n=12): in group 1, we found a correlation between the decrease in iPTH by CI and the stability or decrease in ERI (group 1), at comparable dose of dialysis, nutritional and iron intakes and inflammatory profiles; in group 2 without a significant effect of CI on PTH reduction the levels of ERI and ESA dosis were more elevated. CONCLUSION: A treatment by calcimimetic improves the control of anemia by ESA in CHP and interferes positively on a cause of secondary resistance to ESA represented by SHPT. The mechanism of these effects could be linked to the decreased of bone marrow fibrosis and inflammation and to the triptych formed by the reduction in iPTH, CaxP and phosphate.

Fatores de risco cardiovascular em pacientes portadores do virus da imunodeficiência humana (VIH) / Cardiovascular risk factors in patients infected with human immunodeficiency virus (HIV)

Objetivo: Avaliar alterações no perfil metabólico em pacientes VIH positivo, correlacionadas ou não com o aumento do risco para doenças cardiovasculares. Métodos: Avaliados 58 pacientes do Núcleo de Síndrome da Imunodeficiência Adquirida do Hospital Universitário Antônio Pedro, portadores do virus da Imunodeficiência humana tipo I (VIH-1), com acompanhamento ambulatorial há pelo menos seis meses ou com diagnóstico dessa infecção nesse período. Foram realizados exames para avaliar: perfil lipídico, glicemia de jejum, TOT (teste de tolerância à glicose), TGO, TGP, creatinina, dosagem de hormónios tireoideanos (TSH, T4L), PCRus, carga viral, relação CD4/CD8 e leucograma. Também realizados: eletrocardiograma, ecocardiograma transtorácico e Doppler de carótida. Resultados: Ao eletrocardiograma, a alteração mais comum foi a de repolarização ventricular difusa (ARV), apenas 1 paciente apresentou, ao ecocardiograma: aumento de VE,...