Efficacy of a supervised exercise training program on five-year readmission rates in patients with acute coronary syndrome. A randomised controlled trial / Eficacia de un programa de entrenamiento con ejercicio supervisado sobre los reingresos a los 5 años en pacientes con síndrome coronario agudo. Ensayo clínico controlado y aleatorizado

Introduction and objectives: Exercise-based cardiac rehabilitation programmes can reduce mortality but their effects on readmission rates are unclear. The primary aim was to evaluate the efficacy of a supervised exercise-based cardiac rehabilitation programme on cardiac readmissions in patients with acute coronary syndrome at five years. Methods: We conducted an open, controlled, randomized, hospital-based clinical trial. Patients were assigned either to the control group (CG) who received standard care or to the intervention group (IG) who participated in a supervised exercise programme (3h per week of supervised exercise training for 10 weeks). Patients were evaluated at 5 years. Results: Seventy-six patients [41 CG, 35 IG, mean age 59.2 (SD 10.4), 82.9% men] were included. Cardiac readmission rates at 5 years were 24% in the CG compared to 9% in the IG (p=0.068), and readmission rates for all causes were 42% in the CG and 23% in the IG (p=0.085). Emergency care for cardiac disease was required more frequently in the CG (17% vs 11%, p=0.486). IG patients performed more regular and intensive exercise (62% vs. 33%, p=0.088). In both groups there were significant deterioration in systolic and diastolic blood pressure, body mass index, waist circumference, HbAc1, triglycerides, LDL and diet, and a significant increase in HDL. Conclusions: Patients who participated in the supervised exercise training programme were readmitted less often than controls for cardiac disease and for all causes at 5 years, the reduction was clinically meaningful although not statistically significant. Control of cardiovascular risk factors deteriorated in both groups.(AU)

Introducción y objetivos: Los programas de rehabilitación cardíaca basados en ejercicio físico pueden reducir la mortalidad, pero sus efectos en los reingresos hospitalarios no son concluyentes. El objetivo principal fue evaluar la eficacia de un programa de rehabilitación cardíaca supervisado basado en ejercicio en los reingresos cardíacos en pacientes con cardiopatía isquémica a los 5 años. Métodos: Ensayo clínico aleatorizado, abierto, controlado y de ámbito hospitalario. Los pacientes se asignaron al grupo control (GC), que recibió atención estándar, o al grupo intervención (GI), que participó en un programa de ejercicio supervisado (3 h por semana durante 10 semanas). Los pacientes fueron evaluados a los 5 años. Resultados: Setenta y seis pacientes (41 GC, 35 GI, edad media 59,2 [DE 10,4], 82,9% hombres) fueron incluidos. Los reingresos cardíacos a los 5 años fueron del 24% en el GC frente al 9% en el GI (p=0,068) y los reingresos por todas las causas fueron del 42% en el GC y el 23% en el GI (p=0,085). El GC asistió más a urgencias por motivo cardíaco (17% vs 11%; p=0,486). El GI realizó más ejercicio regular e intensivo (62% vs 33%; p=0,088). En ambos grupos hubo un deterioro significativo de presión arterial sistólica y diastólica, el índice de masa corporal, el perímetro abdominal, HbAc1, los triglicéridos, LDL y dieta, y un aumento significativo de HDL. Conclusiones: Los pacientes que participaron en el programa de entrenamiento de ejercicio supervisado fueron readmitidos con menos frecuencia que los controles por enfermedad cardíaca y por todas las causas a los 5 años; la reducción fue clínicamente relevante, aunque no estadísticamente significativa. El control de los factores de riesgo cardiovascular se deterioró en ambos grupos.(AU)

Efficacy of a supervised exercise training program on five-year readmission rates in patients with acute coronary syndrome. A randomised controlled trial.

INTRODUCTION AND OBJECTIVES: Exercise-based cardiac rehabilitation programmes can reduce mortality but their effects on readmission rates are unclear. The primary aim was to evaluate the efficacy of a supervised exercise-based cardiac rehabilitation programme on cardiac readmissions in patients with acute coronary syndrome at five years. METHODS: We conducted an open, controlled, randomized, hospital-based clinical trial. Patients were assigned either to the control group (CG) who received standard care or to the intervention group (IG) who participated in a supervised exercise programme (3h per week of supervised exercise training for 10 weeks). Patients were evaluated at 5 years. RESULTS: Seventy-six patients [41 CG, 35 IG, mean age 59.2 (SD 10.4), 82.9% men] were included. Cardiac readmission rates at 5 years were 24% in the CG compared to 9% in the IG (p=0.068), and readmission rates for all causes were 42% in the CG and 23% in the IG (p=0.085). Emergency care for cardiac disease was required more frequently in the CG (17% vs 11%, p=0.486). IG patients performed more regular and intensive exercise (62% vs. 33%, p=0.088). In both groups there were significant deterioration in systolic and diastolic blood pressure, body mass index, waist circumference, HbAc1, triglycerides, LDL and diet, and a significant increase in HDL. CONCLUSIONS: Patients who participated in the supervised exercise training programme were readmitted less often than controls for cardiac disease and for all causes at 5 years, the reduction was clinically meaningful although not statistically significant. Control of cardiovascular risk factors deteriorated in both groups.

Degradation of gaseous volatile organic compounds (VOCs) by a novel UV-ozone technology.

In this study, a UV-assisted ozonation (UV/O3) process for the degradation of VOCs emissions with a final scrubbing phase was implemented to evaluate the removal efficiency of toluene and to prevent the release of polluting intermediates of the single-step process. Inlet toluene concentration and applied voltage were varied in order to investigate several operating conditions. The results highlighted that at higher inlet concentration the abatement of toluene was lower, while increase in ozone concentration led to an increase of the degradation efficiencies. The additional water scrubbing step enhanced the abatement of UV/O3 up to 98.5%, due to the solubilisation of ozone and by-products in the process water and, thus, the further oxidation of the contaminants within this phase. A maximum Elimination Capacity (ECmax) of 22.6 g m-3 h-1 was achieved with the UV/O3 + Scrubbing. The combined system boosted higher performance and stability compared to the stand-alone (UV/O3) process along with a more economical and environmental sustainability.

Laboratory evidence that dinotefuran, pyriproxyfen and permethrin combination abrogates Leishmania infantum transmissibility by sick dogs.

Dogs are reservoir hosts of leishmaniasis caused by Leishmania infantum and transmitted by phlebotomine vectors. The effect of dinotefuran, pyriproxyfen and permethrin spot-on solution (Vectra®3D, Ceva Santé Animale, Libourne, France) on Leishmania transmissibility by naturally infected dogs via reared Phlebotomus perniciosus, was assessed. Dogs affected by leishmaniasis were submitted to xenodiagnosis and 6 infecting >10% of insects were treated topically on day 0. Antifeeding, insecticidal and anti-transmissibility effects were evaluated through xenodiagnoses performed on days 1, 7 and 28, using individual pre-treatment parameters as control. Feeding and mortality rates were assessed at 24 h, whereas promastigote infection, maturation and burden were assessed up to 96 h post blood meal (potentially infectious rate). On day 1, the anti-feeding efficacy was >95% in 4 dogs, insecticidal efficacy 100% in 4 dogs, and anti-transmissibility effect 100% in 6 dogs. Efficacy rates recorded on day 7 were very similar to day 1. On day 28, anti-feeding and insecticidal efficacy values were much broader, ranging 32.6-100% and 7.7-94.4%, respectively. Potentially infectious insects were recorded from two dogs, with sharp decrease in transmissibility rate as compared with pre-treatment condition. Altogether, Vectra®3D abrogated by >98% the potential Leishmania transmissibility by the examined pool of infected dogs over 1 month.

Rol del virus papiloma humano en cabeza y cuello

Resumen El virus papiloma humano (VPH) es un virus de ADN circular doble hebra con alrededor de 200 genotipos. Este virus se relaciona a distintas lesiones tumorales que afectan cabeza y cuello, incluyendo lesiones malignas escamosas causadas por genotipos de alto riesgo como VPH-16 y VPH-18. Esta revisión tiene por objetivo determinar el rol del VPH en distintas patologías, haciendo distinción entre lesiones benignas y malignas, y con particular énfasis en aquellas en que se ha demostrado una asociación causal con el virus, tales como papilomatosis laríngea y carcinoma escamoso orofaríngeo. Además, se analizarán los mecanismos moleculares de daño, métodos de detección y de prevención como la vacunación contra el virus. Es necesario conocer la relevancia del VPH en nuestra especialidad, ya que su determinación puede tener implicancias en cuanto al manejo y pronóstico de los pacientes.

Abstract Human papillomavirus (HPV) is a double stranded circular DNA virus with around 200 genotypes. This virus is related to different tumor lesions that affect the head and neck, including malignant squamous lesions caused by high-risk genotypes such as HPV-16 and HPV-18. The objective of this review is to determine the role of HPV in different pathologies, distinguishing between benign and malignant lesions, and with particular emphasis on those in which a causal association with the virus has been demonstrated, such as laryngeal papillomatosis and oropharyngeal squamous carcinoma. In addition, molecular damage mechanisms, detection and prevention methods such as vaccination against the virus will be analyzed. It is necessary to know the relevance of HPV in our specialty, since its determination may have implications in terms of patient management and prognosis.

A Crystallographic Snapshot of SARS-CoV-2 Main Protease Maturation Process.

SARS-CoV-2 is the causative agent of COVID-19. The dimeric form of the viral Mpro is responsible for the cleavage of the viral polyprotein in 11 sites, including its own N and C-terminus. The lack of structural information for intermediary forms of Mpro is a setback for the understanding its self-maturation process. Herein, we used X-ray crystallography combined with biochemical data to characterize multiple forms of SARS-CoV-2 Mpro. For the immature form, we show that extra N-terminal residues caused conformational changes in the positioning of domain-three over the active site, hampering the dimerization and diminishing its activity. We propose that this form preludes the cis and trans-cleavage of N-terminal residues. Using fragment screening, we probe new cavities in this form which can be used to guide therapeutic development. Furthermore, we characterized a serine site-directed mutant of the Mpro bound to its endogenous N and C-terminal residues during dimeric association stage of the maturation process. We suggest this form is a transitional state during the C-terminal trans-cleavage. This data sheds light in the structural modifications of the SARS-CoV-2 main protease during its self-maturation process.

Fístula de líquido cefalorraquídeo después de hisopado nasofaríngeo en pandemia COVID-19. A propósito de dos casos

Resumen Uno de los pilares fundamentales en el manejo de la pandemia por SARS-CoV2 es la detección temprana de la presencia del virus en pacientes. El método más utilizado es mediante hisopado nasofaríngeo para amplificar ácidos nucleicos mediante reacción en cadena de polimerasa (PCR). Las complicaciones asociadas a la técnica de hisopado aún no están completamente caracterizadas. Hasta ahora hay un caso reportado internacionalmente de fístula de líquido cefalorraquídeo poshisopado nasofaríngeo. Presentamos dos casos de fístula posterior a dicho examen: el primer caso un paciente de género femenino con sospecha de hipertensión intracraneal idiopática, cuya brecha se reparó quirúrgicamente; el segundo caso un paciente de género masculino con antecedente de hidrocefalia y meningitis neonatal que, al estudio por rinorraquia, se encuentra un meningoencefalocele en el receso frontal derecho, también reparado quirúrgicamente.

Abstract One of the cornerstones in the management of coronavirus pandemic is the early identification of virus presence in patients. The most used test is the nasopharyngeal swab, used to amplify nucleic acids through polymerase chain reaction. Complications with this test have not been completely characterized. Until now, only one international report of cerebrospinal fluid leak has been reported. We present two cases of leak after nasopharyngeal swab test: the first case corresponded to an adult feminine gender patient with suspected idiopathic intracranial hypertension, whose gap was surgically repaired; the second case adult male patient with medical history of hydrocephalus and neonatal meningitis who was further studied for rhinoliquorrhea that showed a meningoencephalocele occupying the right frontal recess.

Clinical application of lung ultrasound score on COVID-19 setting: a regional experience in Southern Italy.

OBJECTIVE: We aimed to assess the correlation between LUS Soldati proposed score and clinical presentation, course of disease and the possible need of ventilation support/intensive care. PATIENTS AND METHODS: All consecutive patients with laboratory confirmed SARS-CoV-2 infection and hospitalized in two COVID Centers were enrolled. All patients performed blood gas analysis and lung ultrasound (LUS) at admission. The LUS acquisition was based on standard sequence of 14 peculiar anatomic landmarks with a score between 0-3 based on impairment of LUS picture. Total score was computed with their sum with a total score ranging 0 to 42, according to Soldati LUS score. We evaluated the course of hospitalization until either discharge or death, the ventilatory support and the transition in intensive care if needed. RESULTS: One hundred and fifty-six patients were included in the final analysis. Most of patients presented moderate-to-severe respiratory failure (FiO2 <20%, PaO2 <60 mmHg) and consequent recommendation to invasive mechanic ventilation (CPAP/NIV/OTI). The median ultrasound thoracic score was 28 (IQR 18-36) and most of patients could be ascertained either in a score 2 (40%) or score 3 pictures (24.4%). The bivariate correlation analysis displayed statistically significant and high positive correlations between the LUS score and the following parameters: ventilation (rho=0.481, p<0.001), lactates (rho=0.464, p<0.001), dyspnea (rho=0.398, p=0.001) mortality (rho=0.410, p=0.001). Conversely, P/F (rho= -0.663, p<0.001), pH (rho = -0.363, p=0.003) and pO2 (rho = -0.400 p=0.001) displayed significant negative correlations. CONCLUSIONS: LUS score improve the workflow and provide an optimal management both in early diagnosis and prognosis of COVID-19 related lung pathology.

Next-generation of instrumental odour monitoring system (IOMS) for the gaseous emissions control in complex industrial plants.

Odour emissions from complex industrial plants may cause potential impacts on the surrounding areas. Consequently, the validation of effective tools for the control of the associated environmental pressures, without hindering economic growth, is strongly needed. Nowadays, senso-instrumental methods by using Instrumental Odour Emissions Systems (IOMSs) is among the most attractive tool for the continuous monitoring of environmental odours, allowing the possibility of obtaining real-time information to support the decision-making process and proactive approach. The systems complexity and scarcity of real data limited their wider full-scale employment. The study presents an advanced prototype of IOMS for the continuous classification and quantification of the odours emitted in ambient air by complex industrial plants, to continuously control the plants emissions with backwards approach. The IOMS device was designed and optimized and included the system for the automatic control of the conditions inside the measurement chamber. The designed operational procedures were presented and discussed. Results highlighted the influence of temperature and air flow rate for the measurement repeatability. Accurate prediction model was created and optimized and resulted able to distinguish 3 different industrial odour sources with accuracy approximately equal to 96%. The models were optimized thanks to the software features, which allowed to automatically apply the designed statistical procedures on the identified dataset with different pre-processing approach. The usefulness of having a fully-developed and user-friendly flexible system that allowed to select and automatically compare different settings options, including the different feature extraction methods, was demonstrated in order to identify the best prediction model.

The city turned off: Urban dynamics during the COVID-19 pandemic based on mobile phone data.

Due to the rapid expansion of the COVID-19 pandemic, many countries ordained lockdowns, establishing different restrictions on people's mobility. Exploring to what extent these measures have been effective is critical in order to better respond to similar future scenarios. This article uses anonymous mobile phone data to study the impact of the Spanish lockdown on the daily dynamics of the Madrid metropolitan area (Spain). The analysis has been carried out for a reference week prior to the lockdown and during several weeks of the lockdown in which different restrictions were in place. During these weeks, population distribution is compared during the day and at night and presence profiles are obtained throughout the day for each type of land use. In addition, a spatial multiple regression analysis is carried out to determine the impact of the different land uses on the local population. The results in the reference week, pre-COVID-19, show how the population in activity areas increases in each time slot on a specific day and how in residential areas it decreases. However, during the lockdown, activity areas cease to attract population during the day and the residential areas therefore no longer show a decrease. Only basic essential commercial activities, or others that require the presence of workers (industrial or logistics) maintain some activity during lockdown.

Evaluación pretrasplante en otorrinolaringología / Pretransplant evaluation in otolaryngology

Resumen Los pacientes trasplantados presentan mayor vulnerabilidad a complicaciones infecciosas, no solo debido al uso de drogas inmunosupresoras, sino que también, a las enfermedades subyacentes que presentan y a la falla de órganos primarios. A pesar de que las infecciones otorrinolaringológicas no son frecuentes en estos pacientes, es importante establecer un adecuado estudio y tratamiento de ellas. A través del siguiente artículo se aportan directrices en el estudio pretrasplante desde un enfoque otorrinolaringológico, generando recomendaciones de acuerdo a la patología del paciente y el órgano a trasplantar. Si bien, las recomendaciones se realizan según evaluación rinosinusal, otológica y faringoamigdalina, una adecuada anamnesis y examen físico son los pilares de la evaluación pretrasplante en otorrinolaringología, reservándose el estudio con imágenes para aquellos pacientes con alteraciones sospechosas.

Abstract Transplanted patients have higher frequency of infectious complications, not only due to the use of immunosuppressive drugs, but also the underlying diseases that present and the failure of primary organs. Although ear, nose and throat (ENT) infections are not frequent in these patients, it is important to establish an adequate study and treatment of them. Through the following article, guidelines are provided in the pretransplant study from an ENT approach, generating recommendations according to the pathology of the patient and the organ to be transplanted. Although, the recommendations are made according to rhinosinusal, otological and pharyngotonsiline evaluation, adequate anamnesis and physical examination are the pillars of the pretransplant evaluation in otolaryngology, reserving the study with images for patients with suspicious alterations.

False negative chest X-Rays in patients affected by COVID-19 pneumonia and corresponding chest CT findings.

Due to the wide availability, rapid execution, low cost, and possibility of being acquired at the patient's bed, chest X-Ray is a fundamental tool in the diagnosis, follow-up and evaluation of the treatment effectiveness of patients with pneumonia, also in the context of COVID-19 infection. However, false negative cases are possible. We report 4 cases of false negative chest X-Rays, in patients who were diagnosed positive for COVID-19 by real-time transverse-transcript-polymerase chain reaction (RT-PCR), and executed chest unenhanced CTs just after the X-Rays, demonstrating signs of COVID-19 pneumonia.

Prevalence of Proteinuria in Owned Dogs from Italy: A Multicentric Study.

Even though proteinuria is related to different causes, when it is persistent and associated with inactive urinary sediment, it is primarily due to kidney disease. Early detection of proteinuria allows us to identify several pathological conditions. The aim of the study was screening a canine population not known as being proteinuric, by the urinary dipstick. The study was carried out in seven Italian veterinary clinics during a period of six weeks. Dogs were enrolled with no restriction of sex or age. Females in estrus, dogs with signs of genitourinary diseases, or those previously diagnosed with proteinuric nephropathy were excluded. Dogs were considered "nonproteinuric" (NP) in case of negative dipstick test or "suspected proteinuric" (SP), if positive at the dipstick. When possible, proteinuria was confirmed by UPC ratio. A total of 1156 dogs were evaluated: 414 were from northern Italy and 742 from southern Italy. Based on dipstick test, 655 (56.6%) dogs were NP, while 501 (43.3%) were SP. Among the NP dogs 225 out of 414 (54.3%) were in northern Italy and 430 of 742 (57.9%) in southern Italy. One hundred eighty-nine of 414 (45.7%) SP dogs were identified in northern Italy and 312 of 742 (42.1%) in southern Italy. No statistical difference was found between the North and the South of Italy. UPC was available in 412 out of 501 SP samples: proteinuria was confirmed in 263 (63.86%) samples. Results from our study showed a high percentage of suspected proteinuric dogs, apparently not affected by renal diseases, together with the absence of statistically significant differences based on geographical area.

Manejo endoscópico de osteoma etmoidal con extensión orbitaria: a propósito de un caso / Endoscopic manegement of frontoethmoidal osteoma: on case subject

El osteoma es el tumor más frecuente de los senos paranasales, habitualmente asintomático debido a su lento crecimiento, sin embargo, pueden desarrollarse síntomas dependiendo del tamaño, localización y extensión, con potencial compromiso de órbita y cerebro. La cirugía está indicada en casos sintomáticos pudiendo realizarse abordaje externo, endoscópico o combinado. Presentamos un caso de osteoma etmoidal con compromiso orbitario resuelto, manejado por medio de la cirugía endoscópica nasal, con apoyo de navegación.

The osteoma is the most common tumor of the paranasal sinuses, is usually asymptomatic because of their slow growth, however, may develop symptoms depending on the size, location and extent, with potential compromise of orbit and brain. Surgery is indicated in symptomatic cases, with external, endoscopic or combined approach. We present a case of ethmoidal osteoma with orbital involvement managed by endoscopic image guided surgery.

Nuevo método para evaluar el Test Subjetivo Vertical / New method for assessing Subjective Visual Vertical Test

Introducción: La prueba Visual Subjetiva Vertical (SVV por sus siglas en inglés) corresponde a una prueba de bajo costo y complejidad que permite el estudio de la función vestibular "estática". En el año 2009 se valida la Prueba del Balde con igual confianza, sensibilidad y especificidad, que la prueba de domo. Sin embargo, diversos factores impresionan disminuir su precisión. Objetivo: Proponer un nuevo método utilizando un programa computacional y una interfaz pantalla-paciente, que permita disminuir la influencia de variables y aumentar la precisión de la evaluación. Material y método: En 43 voluntarios sin historia de patología vestibular y en 32 pacientes con patología vestibular se compararon los resultados de la aplicación de SVV en dos modalidades: prueba del balde tradicionalyuna prueba computarizada propuesta en el presente artículo. Resultados: En nuestro estudio el SVV con balde muestra 57% de sensibilidad y 90% de especificidad, mientras el SVV digital tiene 74% de sensibilidad y 93% de especificidad, el cual también presentó significativamente una menor desviación estándar. Conclusión: En suma, el SVV computarizado arroja un resultado más preciso que SVV con balde, con mejor utilidad clínica al tener mayor de discriminación con mejores perfiles de sensibilidad/especificidad.

Background: Subjective Visual Vertical Test (SVV) is a low-cost and simple evaluation that allows the physician to study the static vestibular function of a patient. In 2009 the Bucket Test was validated as a high confidence, sensitivity and specificity comparable to the hemispheric dome testing device. Although, its result can be affected by multiple variables. Aim: To propose a new method to evaluate SVV using a computer software interface, that allows a reduction ofvariables therefore increasing its precision. Material and method: In a sample of 43 volunteers with no previous history of vestibular pathologies and 32 patients with diagnosed vestibular pathologies we compared the results of 2 different modules of SVV testing: a traditional bucket test and a computerized test proposed in the present article. Results: Bucket test SVV for this research showed a sensitivity of 57% and a specificity of 90%, meanwhile Computerized SVV had a sensitivity of 74% and a specificity of 93%, which also presented a significant smaller standard deviation. Conclusion: In summary, digital SVV testing grants more accurate result in comparison to the Bucket Test, with a better clinical performance due to an improved discriminatory capacity with better Sensitivity/Specificity profiles.