Magnitude and Determinants of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Household Transmission: A Longitudinal Cohort Study.

BACKGROUND: Households have emerged as important venues for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Little is known, however, regarding the magnitude and determinants of household transmission in increasingly vaccinated populations. METHODS: From September 2020 to January 2022, symptomatic nonhospitalized individuals with SARS-CoV-2 infection by RNA detection were identified within 5 days of symptom onset; all individuals resided with at least 1 other SARS-CoV-2-uninfected household member. These infected persons (cases) and their household members (contacts) were subsequently followed with questionnaire-based measurement and serial nasal specimen collection. The primary outcome was SARS-CoV-2 infection among contacts. RESULTS: We evaluated 42 cases and their 74 household contacts. Among the contacts, 32 (43%) became infected, of whom 5 (16%) were asymptomatic; 81% of transmissions occurred by 5 days after the case's symptom onset. From 21 unvaccinated cases, 14-day cumulative incidence of SARS-CoV-2 infection among contacts was 18/40 (45% [95% confidence interval {CI}, 29%-62%]), most of whom were unvaccinated. From 21 vaccinated cases, 14-day cumulative incidence of SARS-CoV-2 infection was 14/34 (41% [95% CI, 25%-59%]) among all contacts and 12/29 (41% [95% CI, 24%-61%]) among vaccinated contacts. At least 1 comorbid condition among cases and 10 or more days of RNA detection in cases were associated with increased risk of infection among contacts. CONCLUSIONS: Among households including individuals with symptomatic SARS-CoV-2 infection, both vaccinated-to-vaccinated and unvaccinated-to-unvaccinated transmission of SARS-CoV-2 to household contacts was common. Because vaccination alone did not notably reduce risk of infection, household contacts will need to employ additional interventions to avoid infection.

[Late-onset migraine equivalent with prolonged aura and altered brain perfusion]. / Equivalente migrañoso de inicio tardío con aura prolongada y alteración de la perfusión cerebral.

TITLE: Equivalente migrañoso de inicio tardío con aura prolongada y alteración de la perfusión cerebral.

Selective activation of memristive interfaces in TaO x -based devices by controlling oxygen vacancies dynamics at the nanoscale.

The development of novel devices for neuromorphic computing and non-traditional logic operations largely relies on the fabrication of well controlled memristive systems with functionalities beyond standard bipolar behavior and digital ON-OFF states. In the present work we demonstrate for Ta2O5-based devices that it is possible to selectively activate/deactivate two series memristive interfaces in order to obtain clockwise or counter-clockwise multilevel squared remanent resistance loops, just by controlling both the electroforming process and the (a)symmetry of the applied stimuli, and independently of the nature of the used metallic electrodes. Based on our thorough characterization, analysis and modeling, we show that the physical origin of this electrical behavior relies on controlled oxygen vacancies electromigration between three different nanoscopic zones of the active Ta2O5-x layer: a central one and two quasi-symmetric interfaces with reduced TaO2-h(y) layers. Our devices fabrication process is rather simple as it implies the room temperature deposition of only one CMOS compatible oxide-Ta-oxide-and one metal, suggesting that it might be possible to take advantage of these properties at low cost and with easy scability. The tunable opposite remanent resistance loops circulations with multiple-analogic-intermediate stable states allows mimicking the adaptable synaptic weight of biological systems and presents potential for non-standard logic devices.

Artificial chemical and magnetic structure at the domain walls of an epitaxial oxide.

Progress in nanotechnology requires new approaches to materials synthesis that make it possible to control material functionality down to the smallest scales. An objective of materials research is to achieve enhanced control over the physical properties of materials such as ferromagnets, ferroelectrics and superconductors. In this context, complex oxides and inorganic perovskites are attractive because slight adjustments of their atomic structures can produce large physical responses and result in multiple functionalities. In addition, these materials often contain ferroelastic domains. The intrinsic symmetry breaking that takes place at the domain walls can induce properties absent from the domains themselves, such as magnetic or ferroelectric order and other functionalities, as well as coupling between them. Moreover, large domain wall densities create intense strain gradients, which can also affect the material's properties. Here we show that, owing to large local stresses, domain walls can promote the formation of unusual phases. In this sense, the domain walls can function as nanoscale chemical reactors. We synthesize a two-dimensional ferromagnetic phase at the domain walls of the orthorhombic perovskite terbium manganite (TbMnO3), which was grown in thin layers under epitaxial strain on strontium titanate (SrTiO3) substrates. This phase is yet to be created by standard chemical routes. The density of the two-dimensional sheets can be tuned by changing the film thickness or the substrate lattice parameter (that is, the epitaxial strain), and the distance between sheets can be made as small as 5 nanometres in ultrathin films, such that the new phase at domain walls represents up to 25 per cent of the film volume. The general concept of using domain walls of epitaxial oxides to promote the formation of unusual phases may be applicable to other materials systems, thus giving access to new classes of nanoscale materials for applications in nanoelectronics and spintronics.

[Level of satisfaction from patients who undergone an endoscopic procedure and related factors]. / Nivel de satisfacción de pacientes tras un procedimiento endoscópico y factores asociados.

BACKGROUND: Patient satisfaction is a cognitive and emotional evaluation of the patient on the performance of health staff and is based on relevant aspects of their experience in health care. AIM: To determine the satisfaction level of patients after an endoscopic procedure in the gastrointestinal endoscopy service Specialty Hospital National Medical Center La Raza and to evaluate associated factors. MATERIAL AND METHODS: A modified and validated questionnaire was applied to assess patient satisfaction after an endoscopic procedure (mGHAA-9) in patients who underwent a gastroscopy or colonoscopy. Factors that influenced patient satisfaction were assessed. RESULTS: Two-hundred questionnaires were applied (response rate: 89.5%), in 62 men (34.6%) and 117 women (65.4%). Mean patient age was 51.3 years. The average score for the overall group was 30.9 (maximum score of 35). In the overall assessment of satisfaction patients reported 60.9% excellent, very good 29.6%, good 8.9% and 0.6% regular. Factors that influenced patient satisfaction were: waiting time for appointment (OR 3.104), explaining and answering questions (OR 2.961) and waiting time for performing the procedure (OR 2.408) Some factors did not influence on patient satisfaction: Sex: Male 58.1%, female 62.4% (p = 0.63), age 52 vs. 50 years (p = 0.48) and sedation 64.7% vs. 60.5% (p = 0.8) CONCLUSIONS: The level of satisfaction of patients undergoing a gastroscopy or colonoscopy is good. The factors that influence the satisfaction of these patients are related to communication between doctor and patient, and waiting time for the study.

Epitaxial TbMnO(3) thin films on SrTiO(3) substrates: a structural study.

TbMnO(3) films have been grown under compressive strain on (001)-oriented SrTiO(3) crystals. They have an orthorhombic structure and display the (001) orientation. With increasing thickness, the structure evolves from a more symmetric (tetragonal) to a less symmetric (bulk-like orthorhombic) structure, while keeping constant the in-plane compression, thereby leaving the out-of-plane lattice spacing unchanged. The domain microstructure of the films is also revealed, showing an increasing number of orthorhombic domains as the thickness is decreased: we directly observe ferroelastic domains as narrow as 4 nm. The high density of domain walls may explain the induced ferromagnetism observed in the films, while both the decreased anisotropy and the small size of the domains could account for the absence of a ferroelectric spin spiral phase.

Two-dimensional echo Doppler findings in juvenile and adult onset ankylosing spondylitis with long-term disease.

The authors' objective was to determine by 2-dimensional echo Doppler (2DECHO) the cardiac abnormalities in juvenile onset ankylosing spondylitis (JOAS) and adult onset ankylosing spondylitis (AOAS) in male patients with long-term disease. Twenty patients with JOAS, 31 with AOAS, and 20 healthy controls of the same age and gender without cardiopulmonary symptoms were studied. Using 2DECHO, the heart dimensions were determined according to American Society of Echocardiography guidelines. The left ventricle ejection fraction (LVEF) was calculated by Teichholz's formula. Cardiomyopathy was established when 2DECHO had diminished LVEF. Statistics used were the Student t and Fisher test, chi2, and ANOVA. Ninety percent of JOAS and 51% of AOAS patients were B27+ (p=0.005). The disease duration was 19.3 +/- 8.8 years in JOAS and 14.8 +/- 12.8 years in AOAS (p=NS). Age at the time of the study was 30.7 +/- 9.9 years in JOAS vs 40.3 +/- 12.7 in AOAS (p=0.003), and vs 40.2 +/- 17 years in controls (p=NS). There was a higher frequency of cardiomyopathy in AOAS (32.2%) than in JOAS (25%) and the controls (0%) (p=0.01). Patients with JOAS had a higher mitral valve gradient (25%) than AOAS patients (19%, p=NS) and controls (0%, p=0.04). Abnormal aortic ring reflectance was shown in 19% of AOAS vs 0% abnormalities in JOAS and controls (p=0.01). The aortic root diameter was increased in 58% of AOAS, 30% of JOAS, and 0% of controls (p=0.001). The frequency of 2DECHO abnormalities was increased in cardiopulmonary asymptomatic spondylitis patients. Despite the high frequency of B27+, JOAS had a lower frequency of aortic abnormalities than AOAS. Mitral valve gradient was found in JOAS and in AOAS that could contribute to a decreased ejection fraction and to left ventricular dysfunction.

[Myocardial infarction caused by cold beverage drinking after strenuous physical exercise]. / Infarto del miocardio provocado por ingesta de bebida fría inmediatamente después de ejercicio físico intenso.

A case of acute myocardial infarction in a 36 years old patient is presented. Maleness was male, as the only mayor coronary risk factor. He had myocardial infarction associated with ingestion of cold beverage after strenuous physical exercise. A coronariographic study was done postmyocardial infarction, which showed a mild obstruction of the LAD. The most likely cause of the coronary event in this case is coronary spasm and atherosclerosis. A review of the literature on this subject is made.

[Torsade de pointes in myxedema. Report of a case and review of the literature]. / Torsade de pointes en mixedema. Informe de un caso y revisión de la literatura.

A 57 years old female suffered from recurrent attacks of ventricular tachycardia including one episode of torsade de pointes, she had hypothyroidism with myxedema secondary to Sheehan Syndrome, following thyroid replacement therapy the tachyarrhythmia did not relapse and there was no need to give specific antiarrhythmic therapy.

[Arterial embolism. The detection of the central emboligenic source by transthoracic echocardiography. A study of 38 cases]. / Embolia arterial. Detección de fuente embolígena central mediante ecocardiografia transtorácica. Estudio de 38 casos.

38 cases with systemic embolism were studied with transthoracic echocardiography. Patients with previous history of neurologic manifestations or intermittent claudication were excluded. Only patients with good quality echocardiographic studies were included. The goals of the study were: to diagnose intracardiac masses responsible for the embolic episode and to evaluate the study as a guide for medical or surgical therapy in this group of patients in order to prevent new embolic events. In 9 patients an intracardiac mass was identified as responsible for the embolic event, 5 cases located in the left atrium, 2 cases of left ventricular thrombus, 1 case of left atrial myxoma and 1 case of marantic endocarditis. The later two were resected surgically and 3 cases of rheumatic mitral valve disease and 1 case of left ventricular aneurism were corrected surgically. It is concluded that transthoracic echocardiography is a valuable study in this patients not only as a diagnostic tool but as a guide to surgical and medical management.

[Primary meningeal and cerebral lymphoma. Study of a case with 8 years' follow-up]. / Lymphome primitif méningé et cérébral. Etude d'un cas suivi pendant 8 ans.

A primary lymphoma involving the meninges of the frontobasal region, with focal cortical infiltration and prominent cerebral edema, was treated by surgery and radiotherapy. Eight years later the patient died of a recurrence. Morphological and immunohistochemical studies comparing the initial tumor with the recurrent lesion found similar histopathological features.

[Risk of complete auriculoventricular block and cardiological complications in patients with bifascicular block undergoing general surgery]. / Riesgo de bloqueo auriculoventricular completo y complicaciones cardiológicas en pacientes con bloqueo bifascicular sometidos a cirugía general.

26 patients with bifascicular block defined as complete right bundle branch block and left anterior block diagnosed electrocardiographically according to Medrano's criteria, were studied to evaluate the indication for preoperatory pacemaker insertion due to the risk of complete A/V block, other cardiac complications were recorded carefully. 7 patients underwent a prophylactic insertion, due to associated first degree A/V block in 4 cases and in 3 cases due to symptomatic bifascicular block. No instance of complete A/V block was found in the study. The most severe complication recorded was in a patient who presented a myocardial infarction complicated with ventricular Tachycardia. The risk of complete A/V block is low and only a small group of this patients should be considered for a preoperatory pacemaker insertion due to associated risk factors.

[Hemifacial spasm disclosing neurinoma of the hypoglossal nerve]. / Spasme hémifacial révélateur d'un neurinome du nerf hypoglosse.

A hemifacial spasm was symptomatic of a neurinoma of the hypoglossal nerve in a 50 year-old woman. It disappeared after the surgical cure of the tumor. Hemifacial spasm is not mentioned among the 19 cases of neurinoma of the hypoglossal nerve which have been reported up to now. The spasm could have been due to the compression of the 7th nerve by the anterior inferior cerebellar artery, displaced by the tumor.

Cardiovascular manifestations in systemic lupus erythematosus. Prospective study of 100 patients.

One hundred consecutive female patients with active systemic lupus erythematosus (SLE) were studied from the cardiovascular point of view by means of non invasive methods. Seventy percent of the cases presented some type of cardiovascular anomaly. Seventy four percent of the resting electrocardiograms were abnormal as well as 72% of the M mode echocardiograms and 55% of the cardiac X ray series. The most frequent observed complications were: pericarditis and or pericardial effusion (39%), arterial hypertension (22%), ischemic heart disease (16%), myocarditis (14%), congestive heart failure (10%), pulmonary hypertension (9%), valvular heart disease (9%), pleural effusion (7%) and cerebro vascular accident (3%). We analyzed each one of these complications and found of special interest the high incidence of ischemic heart disease which is more frequent than has been hitherto reported. Ischemic heart disease was observed in two types of patients: a) Those with long term steroid therapy. In these, the mechanism seems to be an atherosclerotic disease probably induced by the chronic use of steroids. The management of these cases do not differ from other types of coronary heart disease due to atherosclerosis. b) Those with frank episodes of vasculitis in whom the basic mechanism is an inflammatory process of the coronary arteries and its treatment is fundamentally that of the vasculitis. We consider necessary to study routinely all patients with SLE through non invasive cardiological methods.

[Cardiovascular manifestations in progressive systemic sclerosis]. / Manifestaciones cardiovasculares en la esclerosis sistémica progresiva.

UNLABELLED: We studied 20 consecutive patients with progressive systemic sclerosis from the cardiological point of view through non invasive methods. Sixteen (80%) patients had some kind of cardiovascular complications as shown by any of the used methods. a) SYMPTOMS: fourteen (70%) referred some type of cardiac symptoms. b) PHYSICAL EXAMINATION: eleven (55%) had an abnormal cardiac examination and 10 (50%) had arterial hypertension. c) Electrocardiogram: sixteen (80%) were abnormal. Among them, three cases (15%) had bifascicular block, complication considered up till now as rare. d) Cardiac X Ray Series: Fourteen (70%) were abnormal mainly due to pulmonary fibrosis (55%). e) Echocardiogram: 45% of them showed some kind of abnormality.

[The heart and ankylosing spondylitis]. / El corazón y la espondilitis anquilosante.

UNLABELLED: We studied 40 consecutive patients with Ankylosing Spondylitis from the cardiological point of view through non-invasive methods. Fourteen (35%) patients had some kind of cardiovascular complication as shown by any of the used methods. a) SYMPTOMS: fifteen (37.5%) refered nonspecific chest pain, five (12.5%) dyspnea on exertion and four (10%) frecuent palpitations. b) PHYSICAL EXAMINATION: two patients (5%) had aortic regurgitation and two (5%) mitral valve disease. c) Electrocardiogram: in seven (17.5%), left ventricular hypertrophy was detected, in two (5%) left atrial hypertrophy and in seven (17.5%) some type of conduction disturbance. d) Chest X Ray: six (15%) had left ventricular hypertrophy, one (2.5%) left atrial hypertrophy and two (5%) dilated ascending aorta. e) Echocardiogram: two cases (5%) had aortic dilatation and other two (5%), mitral valve disease. In three patients (7.5%) pericardial effusion was found, which in our series, it is more frecuent than has been reported up until now in the literature.

[Cardiovascular manifestations in mixed connective tissue disease in adults]. / Manifestaciones cardiovasculares en la enfermedad mixta del tejido conectivo en adultos.

Twenty two patients with mixed connective tissue disease (MCTD) were studied with noninvasive cardiovascular techniques. Fifty percent of the cases presented cardiovascular abnormalities which in order of importance were: pericarditis with effusion (28%), myocarditis (14%) and one case; myocardial infarction. Complications of less importance were: supraventricular and ventricular premature beats, enlargement of left and right cardiac chambers, septal hypertrophy and type A paradoxical septal movement. We consider that patients with MCTD should have a routine cardiological evaluation.

[Cardiovascular changes in acromegaly. Prospective study]. / Alteraciones cardiovasculares en la acromegalia. Estudio prospectivo.

We present 38 acromegalyc patients who were studied by non invasive methods to assess the frequency of cardiovascular complications. Seventy one percent of the cases presented some type of cardiovascular alteration. In 68% we observed left ventricular hypertrophy by echocardiography which was the most sensitive method to detect it. In 71% we obtained abnormal electrocardiograms, mainly because of conduction disturbances, being right bundle branch block the most frequent. Half of the cases had pulmonary fibrosis and chronic bronchitis. Arterial hypertension was present in 32%. Diabetes mellitus in 21%. Only 2 cases had coronary heart disease. In 37% of the patients who underwent hypophisectomy we observed regression up to 90% of the cardiac complications except for left ventricular hypertrophy and pulmonary fibrosis. None of the patients has died.

Coincidence of cerebrovascular accident and silent myocardial infarction.

Although it is well known that a myocardial and a cerebral infarction may be coincident, the nature of this association is not clear. The problem is further complicated because the myocardial infarction may be silent. This is a report of 3 patients with cerebral infarct in whom a silent recent myocardial infarction was found. All patients with cerebrovascular disease should be screened for a possible myocardial lesion.