Predictors of poor health-related quality of life among people living with HIV aged ≥60 years in the PISCIS cohort: Findings from the Vive+ project.

INTRODUCTION: Advancements in and accessibility to effective antiretroviral therapy has improved the life expectancy of people living with HIV, increasing the proportion of people living with HIV reaching older age (≥60 years), making this population's health-related quality of life (HRQoL) more relevant. Our aim was to identify the determinants of poor HRQoL in people living with HIV aged ≥60 years and compare them with those of their younger counterparts. METHODS: We used data from the 'Vive+' study, a cross-sectional survey conducted between October 2019 and March 2020, nested within the PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands, Spain. We used the 12-item short-form survey (SF-12), divided into a physical component summary (PCS) and a mental component summary (MCS), to evaluate HRQoL. We used the least absolute shrinkage and selection operator for variable selection and used multivariable regression models to identify predictors. RESULTS: Of the 1060 people living with HIV (78.6% males) who participated in the study, 209 (19.7%) were aged ≥60 years. When comparing older people living with HIV (≥60 years) and their younger counterparts, older people exhibited a worse PCS (median 51.3 [interquartile range {IQR} 46.0-58.1] vs. 46.43 [IQR 42.5-52.7], p < 0.001) but a similar MCS (median 56.0 [IQR 49.34-64.7] vs. 57.0 [IQR 48.9-66.3], p = 0.476). In the multivariable analysis, cognitive function correlated with a PCS (ß correlation factor [ß] -0.18, p = 0.014), and depressive symptoms and satisfaction with social role correlated with an MCS (ß 0.61 and ß -0.97, respectively, p < 0.001) in people living with HIV aged ≥60 years. CONCLUSION: Depressive symptoms, poor cognitive function, and lower satisfaction with social roles predict poorer HRQoL in older people living with HIV. These factors need to be considered when designing targeted interventions.

Bundles reduce anastomosis leak in patients undergoing elective colorectal surgery. A propensity score-matched study.

Background: anastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyse the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle. Methods: Single-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bundle. Results: The bundle group shown fewer complications, especially in Clavien Dindós Grade IV complications (2.3% vs. 6.2% p < 0.01), as well as a lower rate of anastomotic leakage (15.5% vs. 2.2% p < 0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p > 0.05). Conclusions: The implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions. Register study: The study has been registered at clinicaltrials.gov Code: nct04632446.

An assessment of intervention thresholds for high fracture risk in Chile.

Assessment and treatment pathways using FRAX-based intervention thresholds in Chile can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low fracture risk. PURPOSE: The aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Chile based on major osteoporotic fracture (MOF) probabilities derived from FRAX®. METHODS: Intervention and assessment thresholds were derived using methods adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Chile. Age-dependent and hybrid assessment and intervention thresholds were applied to 1998 women and 1122 men age 50 years or more drawn from participants in the National Health Survey 2016-2017. RESULTS: Approximately 12% of men and women had a prior fragility fracture and would be eligible for treatment for this reason. Using age-dependent thresholds, an additional 2.6% of women (0.3% of men) were eligible for treatment in that MOF probabilities lay above the upper assessment threshold. A BMD test would be recommended in 5% of men and 38% of women. With hybrid thresholds, an additional 13% of women (3.6% of men) were eligible for treatment and BMD recommended in 11% of men and 42% of women. CONCLUSION: The application of hybrid intervention thresholds ameliorates the disparity in fracture probabilities seen with age-dependent thresholds. Probability-based assessment of fracture risk, including the use of the hybrid intervention thresholds for Chile, is expected to help guide decisions about treatment.

Influence of nitric oxide signaling mechanisms in cancer.

Nitric oxide (NO) is a molecule with multiple biological functions that is involved in various pathophysiological processes such as neurotransmission and blood vessel relaxation as well as the endocrine system, immune system, growth factors, and cancer. However, in the carcinogenesis process, it has a dual behavior; at low doses, NO regulates homeostatic functions, while at high concentrations, it promotes tissue damage or acts as an agent for immune defense against microorganisms. Thus, its participation in the carcinogenic process is controversial. Cancer is a multifactorial disease that presents complex behavior. A better understanding of the molecular mechanisms associated with the initiation, promotion, and progression of neoplastic processes is required. Some hypotheses have been proposed regarding the influence of NO in activating oncogenic pathways that trigger carcinogenic processes, because NO might regulate some signaling pathways thought to promote cancer development and more aggressive tumor growth. Additionally, NO inhibits apoptosis of tumor cells, together with the deregulation of proteins that are involved in tissue homeostasis, promoting spreading to other organs and initiating metastatic processes. This paper describes the signaling pathways that are associated with cancer, and how the concentration of NO can serve a beneficial or pathological function in the initiation and promotion of neoplastic events.

Cognitive Decline Detection for Alzheimer's Disease Patients Through an Activity of Daily Living (ADL).

There are conventional screening instruments for the detection of cognitive impairment, but they have a reduced ecological validity and the information they present could be biased. This study aimed at evaluating the effectiveness and usefulness of a task based on an activity of daily living (ADL) for the detection of cognitive impairment for an Alzheimer's disease (AD) population. Twenty-four participants were included in the study. The AD group (ADG) included twelve older adults (12 female) with AD (81.75±7.8 years). The Healthy group (HG) included twelve older adults (5 males, 77.7 ± 6.4 years). Both groups received a ADL-based intervention at two time frames separated 3 weeks. Cognitive functions were assessed before the interventions by using the MEC-35. The test-retest method was used to evaluate the reliability of the task, as well as the Intraclass Correlation Coefficient (ICC). The analysis of the test-retest reliability of the scores in the task indicated an excellent clinical relevance for both groups. The hypothesis of equality of the means of the scores in the two applications of the task was accepted for both the ADG and HG, respectively. The task also showed a significant high degree of association with the MEC-35 test (rho = 0.710, p = 0.010) for the ADG. Our results showed that it is possible to use an ADL-based task to assess everyday memory intended for cognitive impairments detection. In the same way, the task could be used to promote cognitive function and prevent dementia.

Unmanned aerial vehicles (UAVs) as a tool for hazard assessment: The 2021 eruption of Cumbre Vieja volcano, La Palma Island (Spain).

Monitoring for assessment of natural disasters, such as volcanic eruptions, presents a methodological challenge for the scientific community. Here, we present Unmanned Aerial Vehicles (UAVs) as a feasible, precise, rapid and safe tool for real time monitoring of the impacts of a volcanic event during the Cumbre Vieja eruption on La Palma Island, Spain (2021). UAV surveys with optical RGB (Red-Green-Blue), thermal and multispectral sensors, and a water sampling device, were carried out in different areas affected by the lava flow, including the upper volcanic edifice and the lava delta formed on the coastal fringe of the island. Our results have provided useful information for the monitoring of the advance of the lava flow and its environmental consequences during the volcanic emergency. Our data shows how La Palma island's growth, with the formation of a new lava delta of 28 ha and a total volume of lava injected into the sea of 5,138,852 m3. Moreover, our Digital Elevation Model (DEM) simulated, with a 70 % accuracy, the probabilistic simulation of the possible path followed by the lava flow in the vicinity of the fissure from which the magma emanates. In addition, significant changes of seawater physical-chemical parameters were registered in coastal surface waters by the in situ seawater samples collected with the automatic water sampling device of our UAV. The first meters of the water column, due to the instant evaporation of the seawater in contact with the hot lava, produce an increase of temperature and salinity of up to 4-5 °C and up to 5 units, respectively.

Consensus on the management of complications of cirrhosis of the liver in pediatrics.

The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications.

Ultrasound-guided percutaneous liver biopsy in children. Five-year experience at a tertiary care center.

INTRODUCTION AND AIMS: Percutaneous liver biopsy with histopathologic analysis is a valuable tool for the diagnosis, prognosis, and treatment evaluation of liver diseases. Its ultrasound-guided performance is useful, making the procedure safer and reducing the risk for complications and hospital stay. Our aim was to describe the indications, histopathologic study, and complications associated with the performance of ultrasound-guided percutaneous liver biopsy in pediatric patients. MATERIAL AND METHODS: The study included 102 ultrasound-guided percutaneous liver biopsies performed on patients <16 years of age, within the time frame of January 2014 and December 2019. The information was obtained from electronic files and histopathologic studies and the data were analyzed through descriptive statistics. RESULTS: A total of 102 procedures were carried out on 99 patients. Mean patient age was 72 months and 58.8% of the patients were female. Over 65% of the indications for liver biopsy included autoimmune hepatitis (23.5%), elevated liver enzymes (21.5%), and chronic liver disease (20.5%). Four patients presented with immediate complications (3.9%), three of which were major (2.9%), concurring with that reported in the international literature. CONCLUSIONS: Our study corroborates the importance of ultrasound-guided liver biopsy in the diagnosis and follow-up of pediatric patients. The procedure also had a low complication rate of only 3.9%.

Ultrasound-guided percutaneous liver biopsy in children. Five-year experience at a tertiary care center. / Biopsia hepática percutánea guiada por ultrasonido en pediatría. Experiencia de 5 años en un centro de tercer nivel.

INTRODUCTION AND AIMS: Percutaneous liver biopsy with histopathologic analysis is a valuable tool for the diagnosis, prognosis, and treatment evaluation of liver diseases. Its ultrasound-guided performance is useful, making the procedure safer and reducing the risk for complications and hospital stay. Our aim was to describe the indications, histopathologic study, and complications associated with the performance of ultrasound-guided percutaneous liver biopsy in pediatric patients. MATERIAL AND METHODS: The study included 102 ultrasound-guided percutaneous liver biopsies performed on patients <16 years of age, within the time frame of January 2014 and December 2019. The information was obtained from electronic files and histopathologic studies and the data were analyzed through descriptive statistics. RESULTS: A total of 102 procedures were carried out on 99 patients. Mean patient age was 72 months and 58.8% of the patients were female. Over 65% of the indications for liver biopsy included autoimmune hepatitis (23.5%), elevated liver enzymes (21.5%), and chronic liver disease (20.5%). Four patients presented with immediate complications (3.9%), three of which were major (2.9%), concurring with that reported in the international literature. CONCLUSIONS: Our study corroborates the importance of ultrasound-guided liver biopsy in the diagnosis and follow-up of pediatric patients. The procedure also had a low complication rate of only 3.9%.

Corticosteroids and tocilizumab reduce in-hospital mortality in severe COVID-19 pneumonia: a retrospective study in a Spanish hospital.

BACKGROUND: There is an urgent need to reduce mortality of COVID-19. We examined if corticosteroids and tocilizumab reduce risk for death in patients with severe pneumonia caused by SARS-CoV-2. METHODS: A retrospective cohort study was performed in a single university hospital. All adult patients admitted with confirmed severe COVID-19 pneumonia from 9 March to 9 April 2020 were included. Severe pneumonia was defined as multi-lobar or bilateral pneumonia and a ratio of oxygen saturation by pulse oximetry to the fraction of inspired oxygen (SpFi)<315. All patients received antiviral and antibiotic treatment. From March 26, patients also received immunomodulatory treatment with corticosteroids (methylprednisolone 250 mg/day for 3 days), or tocilizumab or both. In-hospital mortality in the entire cohort and in a 1:1 matched cohort sub-analysis was evaluated. RESULTS: 255 patients were included, 118 received only antiviral and antibiotic treatment while 137, admitted after March 26, also received immunomodulators. In-hospital mortality of patients on immunomodulatory treatment was significantly lower than in those without [47/137(34.3%) vs. 69/118(58.5%), (p < .001)]. The risk of death was 0.44 (CI, 0.26-0.76) in patients receiving corticosteroids alone and 0.292 (CI, 0.18-0.47) in those treated with corticosteroids and tocilizumab. In the sub-analysis with 202 matched patients, the risk of death was 0.356 (CI 0.179-0.707) in patients receiving corticosteroids alone and 0.233 (0.124-0.436) in those treated with the combination. CONCLUSIONS: Combined treatment with corticosteroids and tocilizumab reduced mortality with about 25% in patients with severe COVID-19 pneumonia. Corticosteroids alone also resulted in lower in-hospital mortality rate compared to patients receiving only antiviral and antibiotic treatment. Corticosteroids alone or combined with tocilizumab may be considered in patients with severe COVID-19 pneumonia.

Altered phase and nonphase EEG activity expose impaired maintenance of a spatial-object attentional focus in multiple sclerosis patients.

Some of the anatomical and functional basis of cognitive impairment in multiple sclerosis (MS) currently remains unknown. In particular, there is scarce knowledge about modulations in induced EEG (nonphase activity) for diverse frequency bands related to attentional deficits in this pathology. The present study analyzes phase and nonphase alpha and gamma modulations in 26 remitting-relapsing multiple sclerosis patients during their participation in the attention network test compared with twenty-six healthy controls (HCs) matched in sociodemographic variables. Behavioral results showed that the MS group exhibited general slowing, suggesting impairment in alerting and orienting networks, as has been previously described in other studies. Time-frequency analysis of EEG revealed that the gamma band was related to the spatial translation of the attentional focus, and the alpha band seemed to be related to the expectancy mechanisms and cognitive processing of the target. Moreover, phase and nonphase modulations differed in their psychophysiological roles and were affected differently in the MS and HC groups. In summary, nonphase modulations can unveil hidden cognitive mechanisms for phase analysis and complete our knowledge of the neural basis of cognitive impairment in multiple sclerosis pathology.

Visual working memory for semantically related objects in healthy adults. / Memoria de trabajo visual para objetos relacionados semánticamente en adultos sanos.

INTRODUCTION: Few studies have examined how manipulating the semantic relationship between objects impacts visual working memory accuracy or reaction time. AIM: To characterize how the semantic relatedness of visual objects impacts working memory accuracy and reaction time in healthy adults using a newly developed mobile-tablet cognitive task. SUBJECTS AND METHODS: A delayed matching to sample paradigm on the tablet task was studied in a sample of 76 community-dwelling adult participants from Spain and Colombia. The tablet task included 80 unique sets of either four or six semantically related or semantically unrelated objects. The accuracy and reaction time of the participants on the task were recorded for analysis. RESULTS: When objects were semantically related, reaction time was greater in the six object sets relative to the four object sets. Age was positively associated with reaction time, but not accuracy across all four task conditions. Participants with fewer years of formal education than the sample median (16 years) exhibited worse response accuracy and slower reaction time on both the four and six semantically related conditions relative to participants with 16 or more years of formal education. CONCLUSIONS: Findings from this study suggest that when objects are semantically related (versus unrelated) and object load is increased, more processing time is needed to determine whether an object was or was not in the encoded set. The results also suggest that greater educational attainment -which likely relates with greater exposure to more technologies- is related with faster and more accurate responses on some task conditions.

TITLE: Memoria de trabajo visual para objetos relacionados semánticamente en adultos sanos.Introducción. Pocos estudios han examinado cómo la manipulación de la relación semántica entre objetos puede influir en el desempeño o el tiempo de reacción en tareas de memoria de trabajo visual. Objetivo. Caracterizar cómo la relación semántica de los objetos afecta el desempeño o el tiempo de reacción en una tarea de memoria de trabajo en adultos sanos utilizando una tarea cognitiva diseñada para el uso con tableta. Sujetos y métodos. Se usó una tarea de emparejamiento demorado (delayed matching to sample) con una muestra de 76 participantes adultos de España y Colombia. La tarea incluyó 80 conjuntos únicos de cuatro o seis objetos relacionados/no relacionados semánticamente. Se registraron las respuestas y el tiempo de reacción de los participantes. Resultados. Cuando los objetos estaban semánticamente relacionados, el tiempo de reacción fue mayor en la condición de seis objetos con respecto a la condición de cuatro objetos. La edad se asoció positivamente con el tiempo de reacción, pero no con la precisión de las respuestas. Los participantes con menos años de educación formal tuvieron un peor de­sempeño y un tiempo de reacción más lento en las condiciones somáticamente relacionadas en relación con los participantes con 16 años o más de educación formal. Conclusión. Los resultados sugieren que, cuando los objetos están semánticamente relacionados y aumenta su número, se necesita más tiempo de procesamiento para determinar si un objeto está o no en el grupo de objetos codificado. Además, un mayor nivel educativo se relaciona con respuestas más rápidas y un mejor desempeño en ciertas condiciones de la tarea.

Penfigoide ampolloso inducido por linagliptina / Bullous pemphigoid induced by linagliptin

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Responsiveness and minimal clinically important difference of the Minnesota living with heart failure questionnaire.

BACKGROUND: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is one of the most widely used health-related quality of life questionnaires for patients with heart failure (HF). The objective of the present study was to explore the responsiveness of the MLHFQ by estimating the minimal detectable change (MDC) and the minimal clinically important difference (MCID) in Spain. METHODS: Patients hospitalized for HF in the participating hospitals completed the MLHFQ at baseline and 6 months, plus anchor questions at 6 months. To study responsiveness, patients were classified as having "improved", remained "the same" or "worsened", using anchor questions. We used the standardized effect size (SES), and standardized response mean (SRM) to measure the magnitude of the changes scores and calculate the MDC and MCID. RESULTS: Overall, 1211 patients completed the baseline and follow-up questionnaires 6 months after discharge. The mean changes in all MLHFQ domains followed a trend (P < 0.0001) with larger gains in quality of life among patients classified as "improved", smaller gains among those classified as "the same", and losses among those classified as "worsened". The SES and SRM responsiveness parameters in the "improved" group were ≥ 0.80 on nearly all scales. Among patients classified as "worsened", effect sizes were < 0.40, while among patients classified as "the same", the values ranged from 0.24 to 0.52. The MDC ranged from 7.27 to 16.96. The MCID based on patients whose response to the anchor question was "somewhat better", ranged from 3.59 to 19.14 points. CONCLUSIONS: All of these results suggest that all domains of the MLHFQ have a good sensitivity to change in the population studied.

Mucormicosis Rinocerebral asociado a Cetoacidosis diabética / Rhinocerebral Mucormycosis associated to diabetic ketoacidosis

Mucormycosis is an infrequent fungal infection This infection is difficult to diagnose and treat and have a high morbility and mortality and affects immunocompromised patients, especially those patients with decompensated diabetes mellitus. We report the case of a 60 years old diabetic patient with poor metabolic control who was admitted for diabetic ketoacidosis and days later present right periorbital swelling and pain, is diagnosed of mucomycosis and is successfully treated with amphoterin B and surgery.

Diabetes mellitus tipo LADA y cetoacidosis: reflexiones a partir de un caso clínico / Latent autoimmune diabetes in adults and ketoacidosis: a clinical case

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Acute Abdomen Secondary to a Spontaneous Perforation of the Biliary Tract, a Rare Complication of Choledocholithiasis.

INTRODUCTION: The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1982, to date only around 70 cases have been reported. Here we present a case of spontaneous perforation of the biliary tract, in a patient with choledocholithiasis, which was treated with ultrasound-guided drainage and ERCP. CASE REPORT: A 51-year-old male was admitted to the emergency room for 15-day evolution jaundice, localized pain in the right flank and hypochondrium of 3days. He had a history of cholecystectomy 15 years ago and 4 episodes of cholangitis, the last one in 2015. A magnetic resonance imaging (MRI) was performed, that showed evidence of choledocholithiasis, in addition to a possible biliary leakage. The patient was treated with ultrasound-guided drainage and ERCP successfully. DISCUSSION: Spontaneous perforation of the biliary tract is a disease entity in which wall of the extrahepatic or intrahepatic duct is perforated without any traumatic or iatrogenic injury. The clinical presentation varies from nonspecific abdominal pain to biliary peritonitis, in most of the cases forming bilomas. Universal management involves decompression of the biliary tree and repair of the leak site. CONCLUSION: The spontaneous perforation of the biliary tract is a disease that represents a diagnostic challenge. The treatment in the patients with SPBT is not well established and has to be individualized for each case, depending on the history of the patient, the site of perforation, the time of evolution, the suspicion of infection, and the patient status.

Dopamine D2 and angiotensin II type 1 receptors form functional heteromers in rat striatum.

Identification of G protein-coupled receptors and their specific function in a given neuron becomes essential to better understand the variety of signal transduction mechanisms associated with neurotransmission. We hypothesized that angiotensin II type 1 (AT1) and dopamine D2 receptors form heteromers in the central nervous system, specifically in striatum. Using bioluminescence resonance energy transfer, a direct interaction was demonstrated in cells transfected with the cDNA for the human version of the receptors. Heteromerization did not affect cAMP signaling via D2 receptors but attenuated the coupling of AT1 receptors to Gq. A common feature of heteromers, namely cross-antagonism, i.e. the blockade of the signaling of one receptor by the blockade of the partner receptor, was tested in co-transfected cells. Candesartan, the selective AT1 receptor antagonist, was able to block D2-receptor mediated effects on cAMP levels, MAP kinase activation and ß-arrestin recruitment. This effect of candesartan, which constitutes a property for the dopamine-angiotensin receptor heteromer, was similarly occurring in primary cultures of neurons and rat striatal slices. The expression of heteromers in striatum was confirmed by robust labeling using in situ proximity ligation assays. The results indicate that AT1 receptors are expressed in striatum and form heteromers with dopamine D2 receptors that enable drugs selective for the AT1 receptor to alter the functional response of D2 receptors.