Prognostic performance of an index based on lactic dehydrogenase and transaminases for patients with liver steatosis and COVID-19.

BACKGROUND: Metabolic associated fatty liver disease (MAFLD) is associated with complications and mortality in patients with coronavirus disease 2019 (COVID-19). However, there are no prognostic scores aimed to evaluate the risk of severe disease specifically in patients with MAFLD, despite its high prevalence. Lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase have been used as markers of liver damage. Therefore, we propose an index based on lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase for the prediction of complications and mortality in patients with MAFLD and COVID-19. AIM: To evaluate the prognostic performance of an index based on lactate dehydrogenase and transaminases (aspartate aminotransferase/alanine aminotransferase) in patients with COVID-19 and MAFLD [liver fibrosis and nutrition (LNF)-COVID-19 index]. METHODS: In this retrospective cohort study, two cohorts from two different tertiary centers were included. The first was the derivation cohort to obtain the score cutoffs, and the second was the validation cohort. We included hospitalized patients with severe COVID-19 and MAFLD. Liver steatosis was evaluated by computed tomography scan. Area under the receiver operating characteristic (ROC) curve analysis and survival analysis were used. RESULTS: In the derivation cohort, 44.6% had MAFLD; ROC curve analysis yielded a LFN-COVID-19 index > 1.67 as the best cutoff, with a sensitivity of 78%, specificity of 63%, negative predictive value of 91% and an area under the ROC curve of 0.77. In the multivariate analysis, the LFN-COVID-19 index > 1.67 was independently associated with the development of acute kidney injury (odds ratio: 1.8, 95% confidence interval: 1.3-2.5, P < 0.001), orotracheal intubation (odds ratio: 1.9, 95% confidence interval: 1.4-2.4, P < 0.001), and death (odds ratio: 2.86, 95% confidence interval: 1.6-4.5, P < 0.001) in both cohorts. CONCLUSION: LFN-COVID-19 index has a good performance to predict prognosis in patients with MAFLD and COVID-19, which could be useful for the MAFLD population.

Natal foraging philopatry in eastern Pacific hawksbill turtles.

The complex processes involved with animal migration have long been a subject of biological interest, and broad-scale movement patterns of many marine turtle populations still remain unresolved. While it is widely accepted that once marine turtles reach sexual maturity they home to natal areas for nesting or reproduction, the role of philopatry to natal areas during other life stages has received less scrutiny, despite widespread evidence across the taxa. Here we report on genetic research that indicates that juvenile hawksbill turtles (Eretmochelys imbricata) in the eastern Pacific Ocean use foraging grounds in the region of their natal beaches, a pattern we term natal foraging philopatry. Our findings confirm that traditional views of natal homing solely for reproduction are incomplete and that many marine turtle species exhibit philopatry to natal areas to forage. Our results have important implications for life-history research and conservation of marine turtles and may extend to other wide-ranging marine vertebrates that demonstrate natal philopatry.

Tabaquismo y trastorno mental grave: conceptualización, abordaje teórico y estudios de intervención / Smoking and severe mental disorders: conceptualization, theoretical approach and intervention studies

El hábito tabáquico es un grave problema de salud en los pacientes con trastorno mental grave. Este trabajo realiza una revisión actualizada de sus bases neurofisiológicas y abordaje terapéutico. Existe una vinculación conocida entre neurotransmisión nicotínica y esquizofrenia sin una propuesta de modelo etiológico. El abordaje terapéutico del tabaquismo en enfermos psiquiátricos requiere formación específica y unidades de tabaquismo o servicios de salud mental preparados. La asociación con consumo de sustancias tóxicas, psicofármacos, comorbilidad psiquiátrica y falta de motivación profesional constituyen factores limitantes. La intervención breve aprovecha el contacto sanitario para explorar la presencia de tabaquismo y valorar la predisposición del paciente a dejar de fumar. El tratamiento utiliza terapia sustitutiva con nicotina, antidepresivos, agonistas del receptor nicotínico y/o intervenciones psicosociales. El tratamiento con bupropion es el más efectivo y seguro, mientras la terapia sustitutiva con nicotina y la vareniclina son también útiles. En la práctica clínica la utilización de farmacoterapia y psicoterapia puede ser la opción más razonable (AU)

Smoking is a serious health problem in patients with severe mental disorder. This paper is an updated review of its neurophysiological basis and therapeutic approach. There is a known link between nicotinic neurotransmission and schizophrenia without a proposed etiological model. The therapeutic approach of smoking in psychiatric patients requires specific training and smoking units or prepared mental health services. The association with substance abuse, psychiatric drugs, psychiatric comorbidity and lack of professional motivation are limiting factors. Brief intervention uses the health contact to explore smoking status and assess the preparation of the patient to stop smoking. Treatment uses nicotine replacement therapy, antidepressants, nicotine receptor agonist and/or psychosocial interventions. Treatment with bupropion is the most effective and safe, while nicotine replacement therapy and varenicline are also useful. In clinical practice the use of pharmacotherapy and psychotherapy may be the most reasonable option (AU)