Seven- and thirty-day mortality in digoxin poisoning: Results from the DIGITOX study.

BACKGROUND: Digoxin poisonings are relatively common and potentially fatal, requiring immediate therapeutic intervention, with special attention to the patient's hemodynamic status and the presence of electrocardiographic and electrolytic disturbances. OBJECTIVE: To identify factors associated with seven-day and thirty-day mortality in digoxin poisoning. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective, observational, multicenter study was conducted across 15 Hospital Emergency Departments (HED) in Spain. All patients over 18 years of age who presented to participating HEDs from 2015 to 2021 were included. The inclusion criteria encompassed individuals meeting the criteria for digoxin poisoning, whether acute or chronic. OUTCOMES MEASURE AND ANALYSIS: To identify independent factors associated with 7-day and 30-day mortality, a multivariate analysis was conducted. This analysis included variables of clinical significance, as well as those exhibiting a trend (p < 0.1) or significance in the bivariate analysis. MAIN FINDINGS: A total of 658 cases of digoxin poisoning were identified. Mortality rates were 4.5% (30 patients) at seven days and 11.1% (73 patients) at thirty days. Regarding 7-day mortality, the mean age of deceased patients was comparable to survivors (84.7 (8.9) vs 83.9 (7.9) years; p = ns). The multivariate analysis revealed that factors independently associated with 7-day mortality encompassed the extent of dependence assessed by the Barthel Index (BI 60-89 OR 0.28; 95% CI 0.10-0.77; p = 0.014 and BI>90 OR 0.22; 95% CI 0.08-0.63; p = 0.005), the identification of ventricular arrhythmias (OR 1.34; 95% CI 1.34-25.21; p = 0.019), and the presence of circulatory (OR 2.84; 95% CI 1.19-6.27; p = 0.019) and neurological manifestations (OR 2.67; 95% CI 1.13-6.27; p = 0.025). Factors independently associated with 30-day mortality encompassed extent of dependence (BI 60-89 OR 0.37; 95% CI 0.20-0.71; p = 0.003 and BI>90 OR 0.18; 95% CI 0.09-0.39; p < 0.001) and the identification of circulatory (OR 2.13; 95% CI 1.10-4.15; p = 0.025) and neurological manifestations (OR 2.39; 95% CI 1.25-3.89; p = 0.006). CONCLUSIONS: The study identifies the degree of dependency assessed by the Barthel Index and the presence of cardiovascular and neurological symptoms as independent predictors of both 7-day and 30-day mortality. Additionally, the detection of ventricular arrhythmia is also an independent factor for 7-day mortality.

Propiedades psicométricas del “Cuestionario de esquemas desadaptativos tempranos de Young - versión breve” (YSQ-S3) en Colombia / Psychometric properties of the “Young's Early Maladaptive Schemas Questionnaire - Short Version” (YSQ-S3) in Colombia

Este artículo presenta dos estudios que evalúan la validez de constructo y la fiabilidad del “Cuestionario de esquemas desadaptativos tempranos de Young – versión breve” (YSQ-S3; Young, 2005). El primer estudio, con 1004 participantes, mostró que el YSQ-S3 tenía una excelente fiabilidad global ( de Cronbach= 0,97;  = 0,97); mientras que los factores mostraron una fiabilidad de aceptable a buena según el rango en que se ubicaron los coeficientes de fiabilidad mínimo y máximo de las 18 escalas ( de 0,67 a 0,89 y  de 0,67 a 0,86). El análisis factorial confirmatorio (AFC) mostró que el modelo de 18 factores de primer orden correlacionados tenía los mejores índices de ajuste. Además, mediante el AFC con factores de segundo orden, se halló evidencia que respalda la organización jerárquica del instrumento en cinco dominios de segundo orden. El estudio 2, con 806 participantes, replicó exitosamente el mejor modelo del estudio 1 frente a uno alternativo. Se concluye que el YSQ-S3 es un instrumento válido y fiable para la población adulta colombiana.(AU)

This article presents two studies evaluating the construct validity andreliability of the "Young's Early Maladaptive Schema Questionnaire - ShortVersion" (YSQ-S3; Young, 2005). The first study, with 1004 participants, showedthat the YSQ-S3 had excellent overall reliability according (Cronbach’s α= .97; ω=.97); while the factors showed acceptable to good reliability according to therange in which the minimum and maximum reliability coefficients of the 18 scaleswere placed (α from .67 to .89 , and ω from .67 to .86) . Confirmatory factoranalysis (CFA) showed that the model with 18 first-order correlated factors had he best fit indices. In addition, using CFA with second-order factors, evidencewas found to support the hierarchical organization of the instrument into fivesecond-order domains. Study 2, with 806 participants, successfully replicated thebest model of study 1 against an alternative one. It is concluded that the YSQ-S3is a valid and reliable instrument for the Colombian adult population.K EY WORDS : factor structure, validity, reliability, early maladaptive schemas.(AU)

[National Survey on the Activity of Lung Function Laboratories. Effects During the SARS-COV-2 Pandemic]. / Encuesta sobre la actividad de los laboratorios de función pulmonar. Efectos durante la pandemia por SARS-CoV-2.

Introduction: Following the SARS-CoV-2 pandemic in March 2020, pulmonary function testing (PFT) laboratories underwent a transformation, with a reduction in the number of tests or closure in some cases. The aim of this work was to know the activity of PFT in Spain and the modification of this activity due to the pandemic. Material and methods: A protocolised survey was carried out to members of the PFT laboratories through the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Results: Thirty-nine hospitals in Spain responded. The pulmonary function tests most frequently performed in the PFT laboratories were forced spirometry with bronchodilator test (100%), body plethysmography (97.4%), CO transfer capacity (97.4%), respiratory muscle strength measured in the mouth (97.4%), 6-minute walking test (94.7%), measurement of exhaled fraction of nitric oxide (92.3%) and incremental exercise test (71.8%).The pandemic led to a significant decrease in the number of tests (35.4%) during 2020 with subsequent recovery in 2021, without reaching pre-pandemic values.The most important changes were increased examination times, working with personal protective equipment and ventilation of the rooms. The performance of the nasopharyngeal swab for SARS-CoV2 testing prior to the tests was not homogeneous in the PFT laboratories. Conclusions: Most hospitals are sufficiently equipped to perform the most common pulmonary function tests. The pandemic resulted in a loss of activity in all hospitals.

First Report of White Mold Caused by Sclerotinia sclerotiorum on Echeveria gigantea in Mexico.

Echeveria gigantea, native of Mexico (Reyes et al. 2011), holds economic importance as it is marketed as a potted plant and cut flower due to its drought-tolerant capabilities and aesthetic appeal. In September 2023, a field sampling was conducted at the Research Center in Horticulture and Native Plants (18°55'56.6" N, 98°24'01.5" W) of UPAEP University. Echeveria gigantea cv. Quilpalli plants with white mold symptoms were found in an area of 0.5 ha, with an incidence of 40% and severity of 50% on severely affected stems. The symptoms included chlorosis of older foliage, necrosis at the base of the stem, and soft rot with abundant white to gray mycelium and abundant production of irregular sclerotia resulting in wilted plants. The fungus was isolated from 30 symptomatic plants. Sclerotia were collected, sterilized in 3% NaOCl, rinsed with sterile distilled water (SDW), and plated on Potato Dextrose Agar (PDA) with sterile forceps. Subsequently, a dissecting needle was used to place fragments of mycelium directly on PDA. Plates were incubated at 23 °C in darkness. A total of 30 isolates were obtained using the hyphal-tip method, one from each diseased plant (15 isolates from sclerotia and 15 from mycelium). After 6 days, colonies had fast-growing, dense, cottony-white aerial mycelium forming irregular sclerotia of 3.67 ± 1.13 mm (n=100). Each Petri dish produced 32.47 ± 7.5 sclerotia (n=30), after 12 days. The sclerotia were initially white and gradually turned black. The isolates were tentatively identified as Sclerotinia sclerotiorum based on morphological characteristics (Saharan and Mehta 2008). Two isolates were selected for molecular identification. Genomic DNA was extracted using the CTAB protocol. The ITS region and the glyceraldehyde 3-phosphate dehydrogenase (G3PDH) gene were sequenced for two randomly selected isolates (White et al. 1990; Staats et al. 2005). The ITS and G3PDH sequences of the SsEg9 isolate were deposited in GenBank (ITS-OR816006; G3PDH-OR879212). BLAST analysis of the partial ITS (510 bp) and G3PDH (915 bp) sequences showed 100% and 99.78% similarity to S. sclerotiorum isolates (GenBank: MT101751 and MW082601). Pathogenicity was confirmed by inoculating 30 120-day-old E. gigantea cv. Quilpalli plants grown in pots with sterile soil. Ten sclerotia were deposited at the base of the stem, 10 mm below the soil surface. As control treatment, SDW was applied to 10 plants. The plants were placed in a greenhouse at 23 °C and 90% relative humidity. After 16 days, all inoculated plants displayed symptoms similar to those observed in the field. Control plants did not display any symptoms. The fungus was reisolated from the inoculated stems, fulfilling Koch's postulates. The pathogenicity tests were repeated three times. Recently S. sclerotiorum has been reported causing white mold on cabbage in the state of Puebla, Mexico (Terrones-Salgado et al. 2023). To the best of our knowledge, this is the first report of S. sclerotiorum causing white mold on E. gigantea in Mexico. Information about diseases affecting this plant is very limited, so this research is crucial for designing integrated management strategies and preventing spread to other production areas.

The Effects of Acute Deep Seawater Supplementation on Muscle Function after Triathlon.

(1) Background: Trainers and athletes have always sought to reduce the failure of muscle function during long endurance events. However, nowadays, it is a topic that is generating much debate in the scientific field. Currently, deep-sea water (DSW) intake seems to be a suitable hydration alternative for this type of endurance event. Therefore, the aim of this study was to determine whether DSW consumption during a triathlon event could preserve muscle function after exercise. (2) Methods: Nineteen trained male triathletes (age = 39.0 ± 4.25 years; BMI = 23.67 ± 1.81 kg/m2) randomly performed three triathlons, one of them consuming DSW (Totum SPORT 30 AB, Laboratories Quinton International, S.L., Spain), the other consuming isotonic placebo and the last with tap water-hydration. A vertical jump test with countermovement and an isometric muscle strength test were conducted before and after the triathlon test. (3) Results: There was a significant difference between treatment × time during the isometric muscle strength test. Based on the Tukey post hoc analysis, the peak net force decreased statistically in the placebo (p = 0.045) and control conditions (p = 0.026), but not in the experimental condition (p = 0.121). In addition, all of the conditions studied obtained similar results in the countermovement vertical jump after exercise. (4) Conclusions: As a result, consumption of DSW seems to delay the failure of muscle function specifically in isometric exercises but does not improve performance in sports. Thus, DSW does not alter muscle capacity in a negative way; therefore, its consumption may be recommended.

Etiological diagnosis of recurrent acute pancreatitis.

Acute pancreatitis is the leading cause of inpatient care among gastrointestinal conditions. Despite early intervention, one-third of patients experience recurrent acute pancreatitis (RAP). A comprehensive diagnostic approach is warranted to identify and treat underlying factors in order to prevent recurrence. RAP is most frequent among men aged 30-40, smokers, and in those with excessive alcohol consumption. To identify the etiology is paramount to stratify patients according to their individual risk of RAP and for predicting an eventual evolution to chronic pancreatitis. Although the initial management of acute pancreatitis is widely homogeneous according to established guidelines, there are no defined protocols to investigate RAP. In the present editorial article we propose a structured algorithm with precise recommendations to investigate the etiology RAP as part of routine clinical practice. Although there are relevant knowledge gaps in this disease, we believe that our guidance would contribute for a more homogenous diagnostic approach of RAP in clinical practice.

Proteomic analysis revealed that the oomyceticide phosphite exhibits multi-modal action in an oomycete pathosystem.

Phytopathogenic oomycetes constitute some of the most devastating plant pathogens and cause significant crop and horticultural yield and economic losses. The phytopathogen Phytophthora cinnamomi causes dieback disease in native vegetation and several crops. The most commonly used chemical to control P. cinnamomi is the oomyceticide phosphite. Despite its widespread use, the mode of action of phosphite is not well understood and it is unclear whether it targets the pathogen, the host, or both. Resistance to phosphite is emerging in P. cinnamomi isolates and other oomycete phytopathogens. The mode of action of phosphite on phosphite-sensitive and resistant isolates of the pathogen and through a model host was investigated using label-free quantitative proteomics. In vitro treatment of sensitive P. cinnamomi isolates with phosphite hinders growth by interfering with metabolism, signalling and gene expression; traits that are not observed in the resistant isolate. When the model host Lupinus angustifolius was treated with phosphite, proteins associated with photosynthesis, carbon fixation and lipid metabolism in the host were enriched. Increased production of defence-related proteins was also observed in the plant. We hypothesise the multi-modal action of phosphite and present two models constructed using comparative proteomics that demonstrate mechanisms of pathogen and host responses to phosphite. SIGNIFICANCE: Phytophthora cinnamomi is a significant phytopathogenic oomycete that causes root rot (dieback) in a number of horticultural crops and a vast range of native vegetation. Historically, areas infected with phosphite have been treated with the oomyceticide phosphite despite its unknown mode of action. Additionally, overuse of phosphite has driven the emergence of phosphite-resistant isolates of the pathogen. We conducted a comparative proteomic study of a sensitive and resistant isolate of P. cinnamomi in response to treatment with phosphite, and the response of a model host, Lupinus angustifolius, to phosphite and its implications on infection. The present study has allowed for a deeper understanding of the bimodal action of phosphite, suggested potential biochemical factors contributing to chemical resistance in P. cinnamomi, and unveiled possible drivers of phosphite-induced host plant immunity to the pathogen.

Exploiting long read sequencing to detect azole fungicide resistance mutations in Pyrenophora teres using unique molecular identifiers.

Resistance to fungicides is a global challenge as target proteins under selection can evolve rapidly, reducing fungicide efficacy. To manage resistance, detection technologies must be fast and flexible enough to cope with a rapidly increasing number of mutations. The most important agricultural fungicides are azoles that target the ergosterol biosynthetic enzyme sterol 14α-demethylase (CYP51). Mutations associated with azole resistance in the Cyp51 promoter and coding sequence can co-occur in the same allele at different positions and codons, increasing the complexity of resistance detection. Resistance mutations arise rapidly and cannot be detected using traditional amplification-based methods if they are not known. To capture the complexity of azole resistance in two net blotch pathogens of barley we used the Oxford Nanopore MinION to sequence the promoter and coding sequence of Cyp51A. This approach detected all currently known mutations from biologically complex samples increasing the simplicity of resistance detection as multiple alleles can be profiled in a single assay. With the mobility and decreasing cost of long read sequencing, we demonstrate this approach is broadly applicable for characterizing resistance within known agrochemical target sites.

Impact of Lifting Straps on the Relationship Between Maximum Repetitions to Failure and Lifting Velocity During the Prone Bench Pull Exercise.

BACKGROUND: Fastest mean (MVfastest) and peak (PVfastest) velocity of the set have been proposed to predict the maximum number of repetitions to failure (RTF) during the Smith machine prone bench pull (PBP) exercise. HYPOTHESIS: Goodness-of-fit would be higher for individualized compared with generalized RTF-velocity relationships and comparable for both execution equipment conditions (with or without straps), and the MVfastest and PVfastest associated with each RTF would be comparable between execution equipment and prediction methods (multiple- vs 2-point method). STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: After determining the PBP 1-repetition maximum (1RM), 20 resistance-trained male athletes performed 2 sessions randomly, with and without lifting straps, consisting of single sets to failure against the same load sequence (60% to 80% to 70% 1RM). Generalized (pooling data from all subjects) and individualized (separately for each subject using multiple-point or 2-point methods) RTF-velocity relationships were constructed. RESULTS: Individualized RTF-velocity relationships were always stronger than generalized RFT-velocity relationships, but comparable with (MVfastest: r2 = 0.87-0.99]; PVfastest: r2 = 0.88-1.00]) and without (MVfastest: r2 = 0.82-1.00; PVfastest: r2 = 0.89-0.99]) lifting straps. The velocity values associated with each RTF were comparable between execution equipment (P ≥ 0.22), but higher for the multiple-point compared with the 2-point method (P < 0.01). CONCLUSION: The use of lifting straps during the Smith machine PBP exercise does not affect the goodness-of-fit of the RTF-velocity relationships or the velocity values associated with different RTFs. However, caution should be exercised when using different methods. CLINICAL RELEVANCE: The benefits of the RTF-velocity relationships can be extrapolated when using lifting straps, and the 2-point method can also be used as a quick and more fatigue-free procedure. Nevertheless, it is imperative for coaches to ensure that these relationships are reflective of fatigue experienced during training.

The paradigm to overcome in acute decompensated heart failure.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

First Report of Gray Mold Caused by Botrytis cinerea on Dragon Fruit (Hylocereus undatus) in Mexico.

The dragon fruit is native of Mexico, and Puebla is the third-largest producing state (SIAP 2023). In June 2023, field sampling was conducted in El Paraíso, Atlixco (18° 49' 5.275" N, 98° 26' 52.353" W), Puebla, Mexico. The mean temperature and relative humidity were 20 °C and 75% for seven consecutive days. Dragon fruits cv. 'Delight' close to harvest with gray mold symptoms were found in a commercial area of 2 ha, with an incidence of 35 to 40% and an estimated severity of 75% on infected fruit. The symptoms included necrosis at the apex, which later spread throughout the fruit, along with a soft, black rot covered in abundant mycelium and sporulation. The fungus was isolated from 40 symptomatic fruits by disinfesting pieces of necrotic tissue with 3% NaClO for one minute, rinsing with sterile distilled water (SDW), plating on Petri dishes with potato dextrose agar, and incubating at 25 °C in the dark. One isolate was obtained from each diseased fruit by the hyphal-tip method. The colonies were initially white with a growth rate of 1.15-1.32 cm per day and turned gray after 10 days; the mycelium was dense and aerial. Spherical and irregular sclerotia were formed, measuring 0.9-1.4 × 0.6-1.1 mm (n = 100). Each Petri dish produced 56-278 sclerotia (n = 40) after 11 days; these were initially white and gradually turned dark brown. Brown to olive conidiophores were straight, septate, and branched, measuring 1075-1520 × 10-21 µm, with elliptical hyaline to light brown conidia of 6.6-11.5 × 5-8.1 µm (n=100). The isolates were tentatively identified as Botrytis cinerea based on morphological characteristics (Ellis 1971). Two representative isolates were chosen for molecular identification and genomic DNA was extracted by the CTAB protocol. The ITS region and the heat shock protein (HSP60), RNA polymerase binding II (RPB2) and glyceraldehyde 3-phosphate dehydrogenase (G3PDH) genes were sequenced (White et al. 1990; Staats et al. 2005). The sequences of a representative isolate (BcPh5) were deposited in GenBank (ITS-OR582337; HSP60-OR636622; RPB2-OR636623; and G3PDH-OR636621). BLAST analysis of the partial sequences of ITS (479 bp), HSP60 (1006 bp), RPB2 (1126 bp), and G3PDH (907 bp) showed 100% similarity to B. cinerea isolates (GenBank: KM840848, MH796663, MK919495, MF480679). Phylogenetic analysis confirmed that BcPh5 clustered with B. cinerea strains. Pathogenicity was confirmed by inoculating the non-wounded surface of 20 detached dragon fruits cv. 'Delight' using the BcPh5 isolate by depositing 20 µl of a 105 conidia/ml suspension with a sterile syringe. The fruits were placed on the rim of a plastic container and inserted in a moisture box with 2 cm of water at the bottom. The box was covered with a plastic sheet to maintain humidity. Control fruits were inoculated with SDW. The inoculated fruits became covered with abundant white to gray mycelium, and soft rot developed within eight days, while no symptoms were observed on the controls. The fungus was re-isolated from the inoculated fruits as described above, fulfilling Koch's postulates. The pathogenicity tests were repeated three times. Gray mold caused by B. cinerea was also recently reported in Mexico on pomegranate (Hernández et al. 2023) and rose apple (Isodoro et al. 2023). As far as we know, this is the first report of B. cinerea causing gray mold on dragon fruit in Mexico. This research is essential for designing integrated management strategies against gray mold on dragon fruits.

Evaluation of the EasyNAT SARS-CoV-2 assay PCR test for the diagnosis of SARS-CoV-2 infection.

Reverse transcription polymerase chain reaction (RT-PCR) tests are commonly utilized in commercial settings but pose challenges due to labor-intensive procedures and extended response times during peak demand. In contrast, real-time fluorescence and isothermal amplification assays using Crossing Priming Amplification (CPA) offer faster genetic material analysis, eliminate subjectivity, and require less manipulation and personnel training. This study aimed to validate the EasyNAT SARS-CoV-2 Assay, a diagnostic kit based on CPA, using oral and nasopharyngeal samples. The EasyNAT kit was compared to the Xpert Xpress SARS-CoV-2 kit, evaluating 873 samples obtained during routine analysis at the Microbiology Laboratory of the Hospital Costa del Sol (Marbella, Spain). The overall sensitivity and specificity for the EasyNAT SARS-CoV-2 Assay were 79.1% (95%CI 74.5-83.7) and 99.5% (95%CI 98.7-100), respectively; with, validity index of 91.9%, positive predictive value of 98.9%, negative predictive value of 88.9%, positive likelihood ratio of 144.5, negative likelihood ratio of 0.21 and a total Youden Index of 0.79. Notably, sensitivity improved in fresh samples (91.4%), along with a high Youden Index (0.91). The EasyNAT SARS-CoV-2 Assay achieved a higher percentage of concordance in positive samples with Xpert Xpress SARS-CoV-2 when analyzing cycle threshold (Ct) intervals below 30 compared to intervals equal or greater than 30, and demons. In conclusion, the EasyNAT SARS-CoV-2 Assay demonstrated high sensitivity and agreement with Xpert Xpress SARS-CoV-2, particularly in fresh samples or when the signal was detected at Ct intervals below 30, indicating higher viral loads. This makes it suitable for rapid screening in various settings, including those with limited access to conventional molecular laboratory setting.

Urgencias hospitalarias por consumo de alcohol en tiempos de la COVID-19 en la Costa del Sol / Hospital emergencies due to alcohol consumption in times of COVID-19 on the Costa del Sol (Spain)

Fundamentos: el consumo de alcohol es un problema de salud pública que impacta en la esfera de la salud, tanto como a nivel social y económico. Fueron objetivos del presente estudio describir las características de las urgencias hospitalarias relacionadas con consumo de alcohol (rca) en una zona de alto turismo lúdico, y las implicaciones de la pandemia de la covid-19 en dicha actividad .Métodos: se realizó un estudio transversal descriptivo de periodo de la actividad de urgencias rca en el área hospitalaria costa del sol durante los años 2019 a 2021. Se realizó un análisis descriptivo estratificado según el periodo de la pandemia de la covid-19, incluyendo el cálculo de la incidencia de urgencias rca atendidas diariamente. Se realizó análisis descriptivo evaluando diferencias entre los tres periodos mediante el test de ji-cuadrado para variables cualitativas, y el test de kruskal-wallis para las cuantitativas. Resultados: en el periodo de estudio se registraron 479.204 urgencias hospitalarias, de las cuales el 0,51% se identificaron como urgencia rca, con un promedio de 2,2 diarias. Dicha cifra osciló entre 2,7 urgencias diarias en periodo de normalidad, 1 durante el confinamiento y 2,1 en periodo de nueva normalidad. La tasa de urgencias rca del periodo evaluado fue de 16,5 por cada 10.000 habitantes/año. Conclusiones: las personas atendidas por consumo de alcohol de nuestra serie tienen un perfil habitual en cuanto a edad (adulto) y sexo (varones), aunque con un peso relativamente elevado de pacientes extranjeros. Las restricciones por el confinamiento durante la pandemia por la covid-19 tienen un impacto positivo en la atención urgente de pacientes rca, aunque correlacionado con un descenso generalizado de la actividad asistencial no relacionada con la covid-19.(AU)

Background: alcohol consumption is a public health problem that impacts the health, social and economic spheres. The objec-tives of this study were to describe the characteristics of alcohol-related emergencies (ari) in an area of high recreational tourism, and the implications of the covid-19 pandemic on this activity. Methods: a descriptive cross-sectional study of the period of ari emergency activity in the costa del sol hospital area during the years 2019-2021 was carried out. A stratified descriptive analysis was performed according to the covid-19 pandemic period, including the calculation of the incidence of ari emergencies attended daily. Descriptive analysis was performed evaluating differences between the three periods using the chi-square test for qualitative variables, and the kruskal-wallis test for quantitative variables. Results: during the study period, 479,204 hospital emergencies were recorded, of which 0.51% were identified as ari emergen-cies, with an average of 2.2 per day. This figure ranged from 2.7 emergencies per day during normality, 1 during confinement and 2.1 during new normality. The rate of ari emergencies for the period evaluated was 16.5 per 10,000 inhabitants/year. Conclusions: the patients treated for alcohol consumption in our series have a typical profile in terms of age (adult) and sex (male), although with a high relative weight of foreign patients. Restrictions due to confinement during the covid-19 pandemic have a positive impact on the emergency care of ari patients, although correlated with a generalised decrease in non-covid-19 related care activity.(AU)

[Circulatory support with venovenous ECMO in a patient with reperfusion pulmonary edema after pulmonary artery thromboendarterectomy]. / Soporte circulatorio con ECMO venovenoso en paciente con síndrome de reperfusión pulmonar secundario a tromboendarterectomía arterial pulmonar.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a subtype of pulmonary hypertension characterized by the obstruction of pulmonary arteries secondary to chronic thromboembolism. Pulmonary thromboendarterectomy surgery (PTE) is the main treatment for patients with CTEPH, as it removes the chronic thrombi from the pulmonary arteries. Pulmonary reperfusion syndrome is a common complication of the surgery, which involves the development of pulmonary edema in the area where blood perfusion improves after the surgery. The incidence of this syndrome varies from 8 to 91% depending on the criteria used for diagnosis, and it is one of the most serious complications of pulmonary thromboendarterectomy. In such cases, circulatory support with extracorporeal membrane oxygenation (ECMO) has become a valuable therapeutic modality. We present the case of a 60-year-old woman with a history of acute pulmonary embolism due to deep vein thrombosis of the right pelvic limb who was diagnosed later with CTEPH who was admitted for scheduled surgical treatment involving bilateral PTE. However, during the immediate postoperative period, she developed cardiogenic shock and refractory hypoxemia secondary to pulmonary reperfusion syndrome following the surgical procedure. As a result, she required veno-venous ECMO circulatory support for 6 days, leading to resolution of the pulmonary condition and clinical improvement.

La hipertensión pulmonar tromboembólica crónica (HPTEC) es un subtipo de hipertensión pulmonar caracterizada por la obstrucción de las arterias pulmonares secundaria a tromboembolias crónicas. La cirugía de tromboendarterectomía pulmonar (TEAP) es el tratamiento principal para los pacientes con HPTEC, elimina los trombos crónicos de las arterias pulmonares. El síndrome de reperfusión pulmonar es una complicación común de la cirugía, se trata del desarrollo de edema pulmonar en el área en la que la perfusión sanguínea mejora después de la cirugía. La incidencia del síndrome varía del 8 al 91% según los criterios utilizados para diagnosticarlo y es una de las complicaciones más graves de la tromboendarterectomía pulmonar. En tales casos, el soporte circulatorio con oxigenación por membrana extracorpórea (ECMO) se ha convertido en una valiosa modalidad terapéutica. Presentamos el caso de una paciente de 60 años de edad con antecedente de tromboembolia pulmonar aguda secundaria a trombosis venosa profunda de miembro pélvico derecho a quien durante el seguimiento se realizó el diagnóstico de HPTEC e ingresó de manera programada para tratamiento quirúrgico con realización de TEAP bilateral, sin embargo durante el posquirúrgico inmediato presentó choque cardiogénico e hipoxemia refractaria secundarios a síndrome de reperfusión pulmonar, por lo cual requirió soporte circulatorio con ECMO venovenosa durante seis días, con resolución del cuadro pulmonar y mejoría clínica.

[Hospital emergencies due to alcohol consumption in times of COVID-19 on the Costa del Sol (Spain)]. / Urgencias hospitalarias por consumo de alcohol en tiempos de la COVID-19 en la Costa del Sol.

OBJECTIVE: Alcohol consumption is a Public Health problem that impacts the health, social and economic spheres. The objectives of this study were to describe the characteristics of alcohol-related emergencies (ARI) in an area of high recreational tourism, and the implications of the COVID-19 pandemic on this activity. METHODS: A descriptive cross-sectional study of the period of ARI emergency activity in the Costa del Sol Hospital Area during the years 2019-2021 was carried out. A stratified descriptive analysis was performed according to the COVID-19 pandemic period, including the calculation of the incidence of ARI emergencies attended daily. Descriptive analysis was performed evaluating differences between the three periods using the Chi-Square test for qualitative variables, and the Kruskal-Wallis test for quantitative variables. RESULTS: During the study period, 479,204 hospital emergencies were recorded, of which 0.51% were identified as ARI emergencies, with an average of 2.2 per day. This figure ranged from 2.7 emergencies per day during Normality, 1 during Confinement and 2.1 during new normality. The rate of ARI emergencies for the period evaluated was 16.5 per 10,000 inhabitants/year. CONCLUSIONS: The patients treated for alcohol consumption in our series have a typical profile in terms of age (adult) and sex (male), although with a high relative weight of foreign patients. Restrictions due to confinement during the COVID-19 pandemic have a positive impact on the emergency care of ARI patients, although correlated with a generalised decrease in non-COVID-19 related care activity.

OBJECTIVE: El consumo de alcohol es un problema de Salud Pública que impacta en la esfera de la salud, tanto como a nivel social y económico. Fueron objetivos del presente estudio describir las características de las Urgencias hospitalarias relacionadas con consumo de alcohol (RCA) en una zona de alto turismo lúdico, y las implicaciones de la pandemia de la COVID-19 en dicha actividad. METHODS: Se realizó un estudio transversal descriptivo de periodo de la actividad de Urgencias RCA en el Área Hospitalaria Costa del Sol durante los años 2019 a 2021. Se realizó un análisis descriptivo estratificado según el periodo de la pandemia de la COVID-19, incluyendo el cálculo de la incidencia de Urgencias RCA atendidas diariamente. Se realizó análisis descriptivo evaluando diferencias entre los tres periodos mediante el test de Ji-Cuadrado para variables cualitativas, y el test de Kruskal-Wallis para las cuantitativas. RESULTS: En el periodo de estudio se registraron 479.204 Urgencias hospitalarias, de las cuales el 0,51% se identificaron como urgencia RCA, con un promedio de 2,2 diarias. Dicha cifra osciló entre 2,7 urgencias diarias en periodo de Normalidad, 1 durante el Confinamiento y 2,1 en periodo de nueva normalidad. La tasa de Urgencias RCA del periodo evaluado fue de 16,5 por cada 10.000 habitantes/año. CONCLUSIONS: Las personas atendidas por consumo de alcohol de nuestra serie tienen un perfil habitual en cuanto a edad (adulto) y sexo (varones), aunque con un peso relativamente elevado de pacientes extranjeros. Las restricciones por el confinamiento durante la pandemia por la COVID-19 tienen un impacto positivo en la atención urgente de pacientes RCA, aunque correlacionado con un descenso generalizado de la actividad asistencial no relacionada con la COVID-19.

Skin cancer prevention in extreme sports: Intervention in a 24-h race.

INTRODUCTION: Excessive sun exposure and sunburns are the main preventable causes of skin cancer. The growing popularity of outdoor sports in developed countries has motivated the objective of this work to study the risk of photoexposure and the skin cancer prevention needs of athletes in an extreme race and evaluate an intervention targeted at this population. METHODS: An observational study was conducted during the XXIII edition of the 101 km de Ronda race, which consisted of trail running and mountain biking categories. Environmental and personal dosimetry, monitoring of meteorological conditions, evaluation of the athletes' photoprotection and skin examination habits, a dermatological checkup, and a satisfaction questionnaire were performed. RESULTS: The ultra-endurance race was carried out under adverse conditions (maximum ultraviolet index (UVI) = 9.2, temperatures above 30°C, and relative humidity >35%). The mean effective erythema dose received by race athletes (n = 11) was 2959.2 ± 404.2 J/m2 , equivalent to 29.6 standard erythema doses (SED). The CHACES questionnaire (n = 1145) showed a sunburn rate of 58% and poor protective habits: 62.9% of athletes do not usually use sunscreen and 67.2% do not self-examine their skin. Actinic keratoses (4.7%) and suspicious skin cancer lesions (4.2%) were found in dermatologic screening exams (n = 170). On the satisfaction questionnaire (n = 111), this intervention was rated as excellent (95.5%). CONCLUSION: This research highlights the extreme risk of photoexposure that athletes are subjected to during ultra-endurance competitions. In the same way, it shows the need to carry out interventions aimed at the acquisition of healthy photoprotection habits and skin surveillance in this target group.

Do Growers Using Solo Fungicides Affect the Durability of Disease Control of Growers Using Mixtures and Alternations? The Case of Spot-Form Net Blotch in Western Australia.

Growers often use alternations or mixtures of fungicides to slow down the development of resistance to fungicides. However, within a landscape, some growers will implement such resistance management methods, whereas others do not, and may even apply solo components of the resistance management program. We investigated whether growers using solo components of resistant management programs affect the durability of disease control in fields of those who implement fungicide resistance management. We developed a spatially implicit semidiscrete epidemiological model for the development of fungicide resistance. The model simulates the development of epidemics of spot-form net blotch disease, caused by the pathogen Pyrenophora teres f. maculata. The landscape comprises three types of fields, grouped according to their treatment program, with spore dispersal between fields early in the cropping season. In one field type, a fungicide resistance management method is implemented, whereas in the two others, it is not, with one of these field types using a component of the fungicide resistance management program. The output of the model suggests that the use of component fungicides does affect the durability of disease control for growers using resistance management programs. The magnitude of the effect depends on the characteristics of the pathosystem, the degree of inoculum mixing between fields, and the resistance management program being used. Additionally, although increasing the amount of the solo component in the landscape generally decreases the lifespan within which the resistance management program provides effective control, situations exist where the lifespan may be minimized at intermediate levels of the solo component fungicide. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.

Spatial Dependency in Stubble-Borne Pyrenophora teres f. teres and Influence of Sample Support Size on DNA Concentration and Fungicide Resistance Frequency.

Fungicide resistance in foliar fungal pathogens is an increasing challenge to crop production. Yield impacts due to loss of fungicide efficacy may be reduced through effective surveillance and appropriate management intervention. For stubble-borne pathogens, off-season crop residues may be used to monitor fungicide resistance to inform pre-planting decisions; however, appropriate sampling strategies and support sizes for crop residues have not previously been considered. Here, we used Pyrenophora teres f. teres (Ptt) with resistance to demethylase inhibitor fungicides as a model system to assess spatial dependency and to compare the effects of different sampling strategies and support sizes on pathogen density (Ptt DNA concentration) and the frequency of fungicide resistance mutation. The results showed that sampling strategies (hand-picked versus raked) did not affect estimates of pathogen density or fungicide resistance frequency; however, sample variances were lower from raked samples. The effects of differing sample support size, as the size of the collection area (1.2, 8.6, or 60 m2), on fungicide resistance frequency were not evident (P > 0.05). However, measures of pathogen density increased with area size (P < 0.05); the 60 m2 area yielded the highest Ptt DNA concentration and produced the lowest number of pathogen-absent samples. Sample variances for pathogen density and fungicide resistance frequency were generally homogeneous between area sizes. The pattern of pathogen density was spatially independent; however, spatial dependency was identified for fungicide resistance frequency, with a range of 110 m, in one of the two fields surveyed. Collectively, the results inform designs for monitoring of fungicide resistance in stubble-borne pathogens.