[Pheochromocytoma as a simulator of cardiac pathology]. / Feocromocitoma como simulador de patología cardiaca.

Pheochromocytomas are rare neuroendocrine tumors that can present as hypertensive crises or serious cardiac and cerebrovascular complications that endanger the patient's life. Two unusual cases of adrenergic crises induced by pheochromocytoma with cardiovascular manifestations are presented, one with multiple complications/multiorgan failure, fatal outcome and definitive diagnosis in the post mortem autopsy, and another with a satisfactory evolution after diagnosis and appropriate treatment.

Efectividad de los protocolos de fisioterapia para pacientes con dolor lumbar crónico. Una revisión sistemática / Effectiveness of physiotherapy protocols for patients with chronic low back pain: A systematic review

Introducción: El dolor lumbar crónico es una de las principales causas de incapacidad laboral en el mundo. Requiere un abordaje interdisciplinario para la evolución del paciente. Hasta el momento, no existe consenso en el manejo del dolor lumbar crónico, lo que generó la inquietud de esta revisión sistemática. Objetivo: Identificar la efectividad de los protocolos de fisioterapia en el manejo del dolor lumbar crónico. Metodología: Se realizó una búsqueda sistemática en las bases de datos Pubmed, ScienceDirect, Scopus, Oxford, Wiley, Cochrane Library Plus, PEDro, Epistemonikos, Hinari y LILACS, Google Scholar, Teseo y PROSPERO, desde el inicio de las bases hasta agosto de 2021. Los criterios de selección se definieron según la intervención y el tema del artículo. Resultados: Se incluyeron 26 estudios en la síntesis cualitativa, se excluyeron artículos que no cumplieran con los criterios de inclusión. Se encontró efecto en el control del dolor y la disminución de la discapacidad y las principales intervenciones son: fortalecimiento muscular del Core y miembros inferiores, estiramiento de miembros inferiores, movilidad lumbopélvica y educación o escuela de espalda. La frecuencia en el tratamiento osciló entre 2 y 3 veces por semana durante 5 semanas. Conclusiones: Se encontró mayor efectividad en el tiempo de control del dolor y la disminución de la discapacidad, relacionados principalmente con el fortalecimiento muscular del Core y las estrategias educativas.(AU)

Introduction: Chronic low back pain is one of the main causes of incapacity for work in the world. It requires an interdisciplinary approach for the evolution of the patient. Until now, there is no consensus on the management of chronic low back pain, which generated the concern of this systematic review. Aim: To identify the effectiveness of physiotherapy protocols in the management of chronic low back pain. Methodology: A systematic search was carried out in the Pubmed, ScienceDirect, Scopus, Oxford, Wiley, Cochrane Library Plus, PEDro, Epistemonikos, Hinari and LILACS, Google Scholar, Teseo and PROSPERO databases, from the beginning of the databases until August, 2021. The selection criteria were defined according to the intervention and topic of the article. Results: Twenty-six studies were included in the qualitative synthesis, articles that did not meet the inclusion criteria were excluded. An effect was found in the control of pain and the reduction of disability and the main interventions are: muscular strengthening of the core and lower limbs, stretching of the lower limbs, lumbopelvic mobility and education or back school. The treatment frequency ranged from 2 to 3 times per week for 5 weeks. Conclusions: Greater effectiveness was found in pain control time and disability reduction, mainly related to core muscle strengthening and educational strategies.(AU)

The fundamental role of pH in CH4 bioconversion into polyhydroxybutyrate in mixed methanotrophic cultures.

Climate change and plastic pollution are likely the most relevant challenges for the environment in the 21st century. Developing cost-effective technologies for the bioconversion of methane (CH4) into polyhydroxyalkanoates (PHAs) could simultaneously mitigate CH4 emissions and boost the commercialization of biodegradable polymers. Despite the fact that the role of temperature, nitrogen deprivation, CH4:O2 ratio or micronutrients availability on the PHA accumulation capacity of methanotrophs has been carefully explored, there is still a need for optimization of the CH4-to-PHA bioconversion process prior to becoming a feasible platform in future biorefineries. In this study, the influence of different cultivation broth pH values (5.5, 7, 8.5 and 10) on bacterial biomass growth, CH4 bioconversion rate, PHA accumulation capacity and bacterial community structure was investigated in a stirred tank bioreactor under nitrogen deprivation conditions. Higher CH4 elimination rates were obtained at increasing pH, with a maximum value of 50.4 ± 2.7 g CH4·m-3·h-1 observed at pH 8.5. This was likely mediated by an increased ionic strength in the mineral medium, which enhanced the gas-liquid mass transfer. Interestingly, higher PHB accumulations were observed at decreasing pH, with the highest PHB contents recorded at a pH 5.5 (43.7 ± 3.4 %w·w-1). The strong selective pressure of low pH towards the growth of Type II methanotrophic bacteria could explain this finding. The genus Methylocystis increased its abundance from 34 % up to 85 and 90 % at pH 5.5 and 7, respectively. On the contrary, Methylocystis was less abundant in the community enriched at pH 8.5 (14 %). The accumulation of intracellular PHB as energy and carbon storage material allowed the maintenance of high CH4 biodegradation rates during 48 h after complete nitrogen deprivation. The results here obtained demonstrated for the first time a crucial and multifactorial role of pH on the bioconversion performance of CH4 into PHA.

Middle-age abolishes cardioprotection conferred by thioredoxin-1 in mice.

Thioredoxin-1 (Trx1) has cardioprotective effects on ischemia/reperfusion (I/R) injury, although its role in ischemic postconditioning (PostC) in middle-aged mice is not understood. This study aimed to evaluate if combining two cardioprotective strategies, such as Trx1 overexpression and PostC, could exert a synergistic effect in reducing infarct size in middle-aged mice. Young or middle-aged wild-type mice (Wt), transgenic mice overexpressing Trx1, and dominant negative (DN-Trx1) mutant of Trx1 mice were used. Mice hearts were subjected to I/R or PostC protocol. Infarct size, hydrogen peroxide (H2O2) production, protein nitration, Trx1 activity, mitochondrial function, and Trx1, pAkt and pGSK3ß expression were measured. PostC could not reduce infarct size even in the presence of Trx1 overexpression in middle-aged mice. This finding was accompanied by a lack of Akt and GSK3ß phosphorylation, and Trx1 expression (in Wt group). Trx1 activity was diminished and H2O2 production and protein nitration were increased in middle-age. The respiratory control rate dropped after I/R in Wt-Young and PostC restored this value, but not in middle-aged groups. Our results showed that Trx1 plays a key role in the PostC protection mechanism in young but not middle-aged mice, even in the presence of Trx1 overexpression.

Espiradenoma écrino en muslo de mujer: reporte de un caso

Introducción: El espiradenoma ecrino es un tumor anexial benigno raro que surge de las glándulas sudoríparas écrinas. Comúnmente se presenta como un nódulo de crecimiento lento en la parte superior del tronco y la región de la cabeza y el cuello, principalmente en el rango de edad de 15 a 35 años, sin predominio de género. Por lo general, se presentan como pequeños nódulos solitarios que pueden crecer varios centímetros, a menudo muy dolorosos. El diagnóstico de esta entidad es de suma importancia ya que puede albergar un componente maligno con desenlaces catastróficos, ya que pueden pasar desapercibidos por su gran parecido con lesiones benignas. Caso Clínico: Aquí presentamos el caso de una mujer 41 años que presentó una lesión cutánea de crecimiento similar a un papiloma en la cara externa de tercio superior del muslo, con el diagnóstico de espiradenoma écrino posterior a la extirpación.

Introduction: Eccrine spiradenoma is a rare, benign adnexal tumor arising from the eccrine sweat glands. It commonly presents as a slow-growing nodule on the upper trunk, and head and neck region, mostly in the age bracket of 15 - 35 years, with no gender preference. Typically, they present as small solitary nodules that can grow to several centimeters, often they are strikingly painful. The diagnosis of this entity is extremely important as it can harbour a malignant component with catastrophic outcomes wich may be missed due to its strong resemblance to benign lesions. Case Report: We present the case of a 41-year-old woman who presented with a papilloma-like growth on the upper lateral aspect of the thigh which was diagnosed as eccrine spiradenoma upon excision.

Effect of graphite oxide electrochemically exfoliated over a multimode interference filter.

In this work, we study multimodal interference filters with a graphite oxide coating. Use of the multimodal interference filter shows a distinctive peak in the signal spectrum, and when using the exfoliated graphite coated multimodal interference filter, the signal shows different spectral changes, such as the full width at half maximum of the curve, the maximum power, and central wavelength, which indicates that graphite oxide absorbs part of the energy. In addition, microscope observations when a He-Ne laser is passed through the filter confirm that graphite oxide is adhered to the filter.

Optical fiber pH sensor based on a multimode interference device with polymer overlay.

An optical fiber pH sensor based on a multimode interference structure is presented. The sensitive element is a piece of no-core fiber (NCF) coated with a mixture of polyallylamine hydrochloride and polyacrylic acid by a modified layer-by-layer (LbL) self-assembly method. It is experimentally shown that by reducing the diameter of the NCF by chemical etching, the sensitivity is increased from -0.31n m/p H to -2n m/p H. The sensor exhibits a high linear response of 0.997 over a pH range from 5 to 11.3 with a rapid response time lower than 1 s.

Analysis of the average duration of sick leave due to electrical contact in the primary, secondary and tertiary sectors in Spain (2013-2019).

The analysis of the economic impact of occupational health and safety has been side-lined for many years. Various studies have acknowledged the importance of analysing the seriousness of accidents on the basis of the number of working days lost due to injuries sustained in such accidents in different economic sectors. In this longitudinal comparative study, we analyse the average duration of sick leave associated with 4,098,520 accidents that occurred in Spain between 2013 and 2019, and more specifically with 5724 accidents involving direct and indirect electrical contact. Based on the number of lost workdays, the relationship between the seriousness of electrical accidents and the economic sectors where they occur is explored via contingency tables in which statistical Chi-square value (χ2) was calculated. The main results obtained show that the average duration of sick leave shows an upward year-on-year trend in all three economic sectors. In addition, accidents due to direct and indirect electrical contact occur in all sectors, and the injuries produced in this type of accident are more severe than those produced in the sum of all accidents in Spain. Our figures show that the longest duration of sick leave occurs in the primary sector, followed by the tertiary and the secondary sectors. These results should prompt the competent authorisites to require businesses to maintain the equipment and facilities in good order, and to introduce effective supervision programmes that guarantee compliance with the measures enforced and reduce the serious consequences of electrical accidents.

Impact of the COVID-19 pandemic on the mental health of the general population and health care workers.

The Health Sciences Foundation has assembled a multidisciplinary group around a series of questions about the impact of the COVID-19 pandemic on the mental health of the general population and specific groups within that population, particularly healthcare workers. In the general population, the most prevalent mental disorders have been anxiety, sleep disorders and affective disorders, primarily depression. There has been a considerable increase in suicidal behavior, especially in young women and men over 70 years of age. There has been an increase in alcohol abuse and nicotine, cannabis and cocaine use. In contrast, the use of synthetic stimulants during periods of confinement has decreased. With regard to non-substance addictions, gambling was very limited, pornography consumption increased significantly and there was an increase in compulsive shopping and the use of video games. Particularly vulnerable groups include adolescents and patients with autism spectrum disorders. Healthcare workers suffered an increase in depression, anxiety and post-traumatic stress, especially those who were exposed during the early stages of the pandemic. Female sex, being a nurse, proximity to patients with COVID-19, working in a rural environment and having previous psychiatric or organic illnesses were some of the most frequently repeated factors in various studies in this population group. The media have shown a good degree of knowledge about these problems and have dealt with them frequently and from the point of view of ethics, crisis situations, such as the one experienced, have triggered not only physical but also moral claudications.

The Dominant Anterior Thoracic Artery of the Spinal Cord.

BACKGROUND AND PURPOSE: Dominant radiculomedullary arteries such as the artery of lumbar enlargement and the artery of cervical enlargement are well-documented. However, variability exists as to the size, number, and location of other radiculomedullary arteries contributing supply to the anterior spinal artery. The aim of this anatomic study was to document the prevalence and characteristics of the dominant anterior thoracic artery in cadaveric specimens. MATERIALS AND METHODS: Microsurgical dissection of cadaveric human spinal cord specimens (n = 50) was conducted. The artery of lumbar enlargement was injected with colored latex until the small-caliber arterial vessels were filled. The dominant anterior thoracic artery was identified, injected, and filled with diluted industrial paint. The course, diameter, and location of the dominant anterior thoracic artery, artery of lumbar enlargement, and artery of cervical enlargement were documented. RESULTS: The artery of lumbar enlargement was identified between T3 and L2 in all 50 specimens (100%), and the artery of cervical enlargement was identified in 84% of specimens (42/50). At least 1 dominant anterior thoracic artery distinct from the artery of lumbar enlargement and the artery of cervical enlargement was identified between T1 and T11 in 47 of the 50 specimens (94%). The most frequent origin of the dominant anterior thoracic artery was at the level of T4 on the left. The average size of the dominant anterior thoracic artery was 0.446 mm (range, 0.300-0.759 mm on the left and 0.270-0.569 mm on the right). CONCLUSIONS: A dominant anterior thoracic artery is present in 94% of individuals. Variations of the arterial supply to the anterior thoracic cord are of great importance due to their implications for ischemic events as well as surgical and endovascular procedures.

Agreement between isokinetic eccentric hamstring strength, Nordic hamstring strength and Nordic break-point angle in a sample of trained and healthy individuals.

Different eccentric strength assessments are used to identifying the risk of hamstring injury in athletes. However, there is scarce information to determine the association between Nordic-based measurements and the gold standard measurement of eccentric hamstring strength in an isokinetic dynamometer. To investigate the relationship of different measures of eccentric hamstring strength (break-point angle and eccentric strength during Nordic exercise) with eccentric hamstring peak torque measured with an isokinetic dynamometer. Forty-six participants volunteered to participate in this study. Eccentric peak force in the Smart-Nordic System and break-point angle measured as trunk lowering at >20°/s and >150°/s2 during the Nordic exercise via high-frequency video-analysis were compared to eccentric hamstring peak torque in an isokinetic dynamometer set to produce knee extension at 30°/s. There was a moderate association between peak eccentric strength with the Smart-Nordic and isokinetic eccentric hamstring peak torque (r = -0.65, p < 0.001, 95%CI = [-0.76-(-0.50)]). The association between Nordic break-point angle measured at 20°/s (r = 0.49, p < 0.001, 95%CI = [0.30-0.64]) and at 150°/s2 (r = 0.52, p < 0.001, 95%CI = [0.33-0.66]) presented statistically significant but lower associations with isokinetic eccentric hamstring peak torque. All Nordic-based measurements presented acceptable associations with the gold standard isokinetic eccentric hamstring peak torque. However, peak eccentric force measured on the Smart-Nordic device had a better agreement with eccentric peak torque measured with an isokinetic dynamometer than the video-based measurements.Highlights Peak eccentric force measured on the isometric strain-gauges device had a better agreement with eccentric hamstring peak torque measured with an isokinetic dynamometer than the break-point angle.The Nordic-based measurements are an alternative cost-effective method to assess eccentric muscle strength and weakness when the access to isokinetic dynamometry is not feasible.Caution should be taken with certain variables such as participants body mass, hip position and movement speed when interpreting the results of Nordic-based measurements.

COVID y rellenos faciales ¿realmente debemos preocuparnos? / COVID-19 and Dermal Fillers: Should We Really Be Concerned?

La pandemia por COVID ha causado hoy en día millones de afectados, continuando su aumento a nivel mundial. Junto con la afectación los órganos diana clave (aparato respiratorio, anosmia, diarrea, fiebre, etc.), se han descrito reacciones inmunológicas tardías en los rellenos dérmicos por ácido hialurónico (AH), fundamentalmente a nivel facial. Estas alteraciones aparecen tanto en pacientes positivos para el virus, independientemente de la sintomatología sistémica, como en pacientes que han recibido vacunación frente al SARS-CoV-2. Aunque las reacciones suelen ser autolimitadas y autoresolutivas, es importante saber diagnosticarlas y en ocasiones establecer tratamiento con corticoides, hialuronidasa y/o antibióticos. Aunque no son graves, la Administración de Alimentos y Medicamentos de los Estados Unidos (FDA) las ha clasificado como evento adverso serio. Los mecanismos que originan están reacciones no están completamente dilucidados. Parece que son reacciones de hipersensibilidad retardada tipo IV, favorecidas por estímulos inmunológicos que se activan en presencia de la COVID o de otros virus como la gripe. Sin embargo, dado que los rellenos presentan cada vez mayor durabilidad y a que la pandemia continúa su curso, existiendo nuevas vacunas en desarrollo, es esencial la realización de estudios que describan la evolución a largo plazo tanto de los rellenos de AH, como de otros bioimplantes. Así mismo, es esencial alentar a los médicos de que reporten este tipo de reacciones, aunque no revistan gravedad con el objetivo de poder realizar un registro fidedigno de ellas (AU)

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs — leading to respiratory illness, anosmia, diarrhea, and fever and other complications — delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records (AU)

[Translated article] COVID-19 and Dermal Fillers: Should We Really Be Concerned? / COVID y rellenos faciales ¿realmente debemos preocuparnos?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs – leading to respiratory illness, anosmia, diarrhea, and fever and other complications – delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records (AU)

La pandemia por COVID ha causado hoy en día millones de afectados, continuando su aumento a nivel mundial. Junto con la afectación los órganos diana clave (aparato respiratorio, anosmia, diarrea, fiebre, etc.), se han descrito reacciones inmunológicas tardías en los rellenos dérmicos por ácido hialurónico (AH), fundamentalmente a nivel facial. Estas alteraciones aparecen tanto en pacientes positivos para el virus, independientemente de la sintomatología sistémica, como en pacientes que han recibido vacunación frente al SARS-CoV-2. Aunque las reacciones suelen ser autolimitadas y autoresolutivas, es importante saber diagnosticarlas y en ocasiones establecer tratamiento con corticoides, hialuronidasa y/o antibióticos. Aunque no son graves, la Administración de Alimentos y Medicamentos (FDA) de los Estados Unidos las ha clasificado como evento adverso serio. Los mecanismos que originan estas reacciones no están completamente dilucidados. Parece que son reacciones de hipersensibilidad retardada tipo IV, favorecidas por estímulos inmunológicos que se activan en presencia de la COVID o de otros virus como la gripe. Sin embargo, dado que los rellenos presentan cada vez mayor durabilidad y a que la pandemia continúa su curso, existiendo nuevas vacunas en desarrollo, es esencial la realización de estudios que describan la evolución a largo plazo tanto de los rellenos de AH, como de otros bioimplantes. Así mismo, es esencial alentar a los médicos de que reporten este tipo de reacciones, aunque no revistan gravedad con el objetivo de poder realizar un registro fidedigno de ellas (AU)

Comparison of production-related responses to hyperinsulinemia and hypoglycemia induced by clamp procedures or heat stress of lactating dairy cattle.

Hyperinsulinemia concurrent with hypoglycemia is one of a myriad of physiological changes typically experienced by lactating dairy cows exposed to heat stress, the consequences of which are not yet well defined or understood. Therefore, the objective of this experiment was to separate the production-related effects of hyperinsulinemia with hypoglycemia from those of a hyperthermic environment. Multiparous lactating Holstein cows (n = 23; 58 ± 4 d in milk, 3.1 ± 0.3 lactations) were housed in temperature-controlled rooms and all were subjected to 4 experimental periods as follows: (1) thermoneutral (TN; temperature-humidity index of 65.1 ± 0.2; d 1-5), (2) TN + hyperinsulinemic-hypoglycemic clamp (HHC; insulin infused at 0.3 µg/kg of BW per h, glucose infused to maintain 90 ± 10% of baseline blood glucose for 96 h; d 6-10), (3) heat stress (HS; temperature-humidity index of 72.5 ± 0.2; d 16-20), and (4) HS + euglycemic clamp (EC; glucose infused to reach 100 ± 10% of TN baseline blood glucose for 96 h; d 21-25). Cows were fed and milked twice daily. Feed refusals were collected once daily for calculation of daily dry matter intake, and milk samples were collected at the beginning and end of each period for component analyses. Circulating insulin concentrations were measured in daily blood samples, whereas glucose concentrations were measured more frequently and variably in association with clamp procedures. Rectal temperatures and respiration rates were greater during HS than TN, as expected, and states of hyperinsulinemia and hypoglycemia were successfully induced by the HHC and high ambient temperatures (HS and EC). Feed intake differed based upon thermal environment as it was similar during TN and HHC periods, and declined for HS and EC. Milk production was not entirely reflective of feed intake as it was greatest during TN, intermediate during HHC, and lowest during HS and EC. All milk components differed with the experimental period, primarily in response to the thermal environment. Interestingly, TN baseline glucose concentrations were highly correlated with the change in glucose from TN to HS, and were related to glycemic status during HS. Furthermore, although few in number, those cows that failed to become hypoglycemic during HS tended to have a greater reduction in milk yield. The work presented here addresses a critical knowledge gap by broadening our understanding of the physiological response to heat stress and the related changes in glycemic state. This broadened understanding is fundamental for the development of novel, innovative management strategies as the dairy industry is compelled to become increasingly efficient in spite of global warming.

Tratamiento a distancia de la insuficiencia cardiaca mediante el algoritmo HeartLogic. Registro RE-HEART / Remote heart failure management using the HeartLogic algorithm. RE-HEART registry

Introducción y objetivos HeartLogic es un algoritmo multiparamétrico incorporado a desfibriladores automáticos implantables (DAI). La alerta asociada predice descompensaciones de insuficiencia cardiaca (IC). Nuestro objetivo es analizar la asociación entre alertas y eventos clínicos bajo un protocolo de seguimiento común en un registro multicéntrico. Métodos Se evaluaron la fase 1 (investigadores ciegos al estado de la alerta) y las fases 2 y 3 (tras la activación de HeartLogic, según práctica local y un protocolo común respectivamente). Resultados Se incluyó a 288 pacientes en 15 centros. En fase 1, tras una media de observación de 10 meses, hubo 73 alertas (0,72 alertas/paciente-año), con 8 hospitalizaciones y 2 visitas a urgencias por IC (0,10 eventos/año-paciente). No hubo hospitalizaciones fuera del periodo de alerta. Las fases activas tuvieron una media de seguimiento de 16 (IC95%, 15-22) meses, con 277 alertas (0,89 alertas/año-paciente); 33 se asociaron con hospitalizaciones o muerte por IC, 46 con descompensaciones menores y 78 con otros eventos. La tasa de alertas inexplicables fue 0,39/año-paciente. Fuera del estado de alerta solo hubo una hospitalización y una descompensación menor. La mayoría de las alertas (el 82% en fase 2 y el 81% en fase 3; p=0,861) se gestionaron a distancia. La mediana de NT-proBNP fue superior en estado de alerta que fuera de él (7.378 frente a 1.210 pg/ml; p <0,001). Conclusiones El índice HeartLogic se asoció con descompensaciones de IC y otros eventos relevantes, con baja tasa de alertas inexplicables. Un protocolo estandarizado permitió detectar y actuar a distancia con seguridad sobre las alertas (AU)

Introduction and objectives HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry. Methods We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively). Results We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001). Conclusions The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them (AU)

[Expert opinion on strategies to improve vaccination coverage against seasonal influenza]. / Documento de opinión de expertos para la mejora de la cobertura vacunal frente a la gripe estacional.

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups.

COVID-19 and Dermal Fillers: Should We Really Be Concerned? / COVID y rellenos faciales ¿realmente debemos preocuparnos?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs - leading to respiratory illness, anosmia, diarrhea, and fever and other complications - delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records.