Intranasal Versus Intravenous Dexamethasone to Treat Hospitalized COVID-19 Patients: A Randomized Multicenter Clinical Trial.

BACKGROUND: SARS-CoV2 induces flu-like symptoms that can rapidly progress to severe acute lung injury and even death. The virus also invades the central nervous system (CNS), causing neuroinflammation and death from central failure. Intravenous (IV) or oral dexamethasone (DXM) reduced 28 d mortality in patients who required supplemental oxygen compared to those who received conventional care alone. Through these routes, DMX fails to reach therapeutic levels in the CNS. In contrast, the intranasal (IN) route produces therapeutic levels of DXM in the CNS, even at low doses, with similar systemic bioavailability. AIMS: To compare IN vs. IV DXM treatment in hospitalized patients with COVID-19. METHODS: A controlled, multicenter, open-label trial. Patients with COVID-19 (69) were randomly assigned to receive IN-DXM (0.12 mg/kg for three days, followed by 0.6 mg/kg for up to seven days) or IV-DXM (6 mg/d for 10 d). The primary outcome was clinical improvement, as defined by the National Early Warning Score (NEWS) ordinal scale. The secondary outcome was death at 28 d between IV and IN patients. Effects of both treatments on biochemical and immunoinflammatory profiles were also recorded. RESULTS: Initially, no significant differences in clinical severity, biometrics, and immunoinflammatory parameters were found between both groups. The NEWS-2 score was reduced, in 23 IN-DXM treated patients, with no significant variations in the 46 IV-DXM treated ones. Ten IV-DXM-treated patients and only one IN-DXM patient died. CONCLUSIONS: IN-DMX reduced NEWS-2 and mortality more efficiently than IV-DXM, suggesting that IN is a more efficient route of DXM administration.

Keep Calm and Survive: Adaptation Strategies to Energy Crisis in Fruit Trees under Root Hypoxia.

Plants are permanently facing challenges imposed by the environment which, in the context of the current scenario of global climate change, implies a constant process of adaptation to survive and even, in the case of crops, at least maintain yield. O2 deficiency at the rhizosphere level, i.e., root hypoxia, is one of the factors with the greatest impact at whole-plant level. At cellular level, this O2 deficiency provokes a disturbance in the energy metabolism which has notable consequences on the yield of plant crops. In this sense, although several physiological studies describe processes involved in plant adaptation to root hypoxia in woody fruit trees, with emphasis on the negative impacts on photosynthetic rate, there are very few studies that include -omics strategies for specifically understanding these processes in the roots of such species. Through a de novo assembly approach, a comparative transcriptome study of waterlogged Prunus spp. genotypes contrasting in their tolerance to root hypoxia was revisited in order to gain a deeper insight into the reconfiguration of pivotal pathways involved in energy metabolism. This re-analysis describes the classically altered pathways seen in the roots of woody fruit trees under hypoxia, but also routes that link them to pathways involved with nitrogen assimilation and the maintenance of cytoplasmic pH and glycolytic flow. In addition, the effects of root hypoxia on the transcription of genes related to the mitochondrial oxidative phosphorylation system, responsible for providing adenosine triphosphate (ATP) to the cell, are discussed in terms of their roles in the energy balance, reactive oxygen species (ROS) metabolism and aerenchyma formation. This review compiles key findings that help to explain the trait of tolerance to root hypoxia in woody fruit species, giving special attention to their strategies for managing the energy crisis. Finally, research challenges addressing less-explored topics in recovery and stress memory in woody fruit trees are pointed out.

Correction: Atlantic Bluefin Tuna (Thunnus thynnus) Biometrics and Condition.

[This corrects the article DOI: 10.1371/journal.pone.0141478.].

Atlantic Bluefin Tuna (Thunnus thynnus) Biometrics and Condition.

The compiled data for this study represents the first Atlantic and Mediterranean-wide effort to pool all available biometric data for Atlantic bluefin tuna (Thunnus thynnus) with the collaboration of many countries and scientific groups. Biometric relationships were based on an extensive sampling (over 140,000 fish sampled), covering most of the fishing areas for this species in the North Atlantic Ocean and Mediterranean Sea. Sensitivity analyses were carried out to evaluate the representativeness of sampling and explore the most adequate procedure to fit the weight-length relationship (WLR). The selected model for the WLRs by stock included standardized data series (common measurement types) weighted by the inverse variability. There was little difference between annual stock-specific round weight-straight fork length relationships, with an overall difference of 6% in weight. The predicted weight by month was estimated as an additional component in the exponent of the weight-length function. The analyses of monthly variations of fish condition by stock, maturity state and geographic area reflect annual cycles of spawning and feeding behavior. We update and improve upon the biometric relationships for bluefin currently used by the International Commission for the Conservation of Atlantic Tunas, by incorporating substantially larger datasets than ever previously compiled, providing complete documentation of sources and employing robust statistical fitting. WLRs and other conversion factors estimated in this study differ from the ones used in previous bluefin stock assessments.

Relación de los anticuerpos anti-péptido citrulinado con manifestaciones osteo-articulares en una cohorte de pacientes con esclerodermia / Relationship between anti-cyclic citrullinated protein antibodies and osteoarticular manifestations in a cohort of systemic sclerosis patients

Introducción: la esclerodermia es una alteración autoinmune caracterizada por induración y engrosamiento de la piel. Durante el curso de la enfermedad los pacientes pueden padecer síntomas de afectación musculoesquelética que incluyen artralgias, artritis, pérdida de función articular y discapacidad consecuente. Objetivos: se estudió la relación de las manifestaciones osteo-articulares clínicas y radiológicas con los anticuerpos anti-péptido citrulinado en una cohorte de pacientes con esclerodermia. Materiales y métodos: se evaluó la historia clínica de pacientes con esclerodermia buscando datos con características de la enfermedad, afectación de órgano blanco y síntomas osteo-articulares. A todos los pacientes se les realizó anticuerpos anti-péptido citrulinado de tercera generación y se les tomó radiografía de manos y pies. Resultados: se incluyeron en forma consecutiva 123 pacientes y se analizaron los datos de 100 pacientes. Ochenta y cuatro pacientes con esclerodermia limitada y 16 con esclerodermia difusa. El promedio de edad fue de 55,5 años y la mediana del tiempo de diagnóstico correspondió a 6,9 años. Catorce pacientes presentaron anticuerpos anti-péptido citrulinado positivos (14%), 4 pacientes con esclerodermia difusa y 9 pacientes con esclerodermia limitada. Dieciocho pacientes (18%) presentaron el factor reumatoide IgM positivo y no se observó relación entre la afectación de órgano blanco con los anticuerpos. El 72% de los pacientes presentaron síntomas osteo-articulares, 17 de ellos presentaron artralgias (23,6%). La combinación de artralgias y artritis se observó en 25 (34,7%) de los pacientes. Artralgias, artritis y contracturas en 10 (13,9%) pacientes. Dos pacientes presentaron artritis (2,8%), 3 contracturas (4,2%) y 5 calcinosis (6,9%). Analizando la asociación entre los anticuerpos antiCCP y la afectación clínica articular, no se encontró asociación estadísticamente significativa (p= 0,095). En el análisis radiológico se observó: En las manos con mayor frecuencia resorción ósea u osteolisis (72%). También se observó calcinosis (54%), aumento de tejidos blandos (49%) y contracturas en flexión (31%). En los pies se observó con mayor frecuencia resorción falángica u osteolisis (13%). Además calcinosis (10%), disminución del espacio articular (6%). Se evidenció una asociación de calcinosis con los antiCCP positivos. Conclusión: los hallazgos articulares fueron frecuentes en esta cohorte de pacientes con esclerodermia. La prevalencia de los anticuerpos antiCCP y factor reumatoide fueron de alrededor del 15%. Se observó más alteraciones radiológicas en las manos que los pies probablemente por factores mecánicos. Se observó una asociación de calcinosis en las manos con los antiCCP.

Introduction: scleroderma is an autoimmune disease characterized by induration and thickening of skin. Patients may suffer from musculoskeletal symptoms which include arthralgias, arthritis, loss of articular function and disability. Objectives: we sought to assess any association between radiographic features, osteoarticular manifestations, and anti-CCP antibodies in a cohort of scleroderma patients. Materials and methods: we evaluated the clinical features of patients searching for demographic characteristics, organ system involvement and osteoarticular symptoms. The presence of anti-CCP IgG was evaluated in all patients. Standard radiographs of hands and feet were taken and analyzed. Results: one hundred twenty three consecutive patients were included and 100 patients were analyzed in the present study. Eighty four patients had limited scleroderma and 16 patients had diffuse scleroderma. The mean age was 55.5 years and the median time of diagnostic was 6.9 years. Fourteen patients were positive for presence of anti-CCP (14%), 4 patient for diffuse form and 9 patients for limited form. Eighteen patients were positive for IgM rheumatoid factor test (18%). It was not seen an association between organ involvement and antibodies. Seventy two percent of patients showed osteoarticular symptoms, 17 of them had arthralgias (23.6%), 25 had arthralgias and arthritis (34.7%), and 10 had arhtralgias, arthritis and contractures (13.9%). Two patients showed arthritis (2.8%), three contractures (4.2%) and 5 calcinosis (6.9%). There was no association between the presence of anti-CCP antibodies and osteoarticular manifestations (p= 0.095). Radiographic features seen on hands were osteolysis (72%), calcinosis (54%), increasing of soft tissues (49%) and flexion contractures (31%). On feet was seen osteolysis (13%), calcinosis (10%) and decreasing of articular space (6%). There was association between calcinosis and anti-CCP antibodies. Conclusion: the articular findings were frequently seen in this scleroderma cohort. Prevalence of anti-CCP antibodies and rheumatoid factor was around 15% positive. Hands showed more alterations than feet, probably for mechanistic factors. It was seen an association between hand calcinosis and anti-CCP antibodies.

Cuerpo y Espíritu. Medicina y Creación Literaria / Body and Spirit. Medicine and Literary Creation

Describe o narra facetas de diversos personajes en las que se vínculan experiencias o vivencia del quehacer de la medicina o del médico con la experiencia o vivencia literaria. NarracionesContenido: Presentación. 1) La ballena y el corazón. 2) Palabras a corazón abierto. 3) Dolor de letras. 4) Escritores de blanco. Epílogo. Indice de ilustraciones. Semblanzas