The enigmatic triad, a clinical challenge.

The concomitant occurrence of diabetic ketoacidosis (DKA), hypertriglyceridemia (HTG) and acute pancreatitis (AP) was first described by Nair et al. as "The Enigmatic Triad", because the causal factor of AP is still not fully established. We recently attended a patient with this triad.

Impact of natural selection on global patterns of genetic variation, and association with clinical phenotypes, at genes involved in SARS-CoV-2 infection.

We investigated global patterns of genetic variation and signatures of natural selection at host genes relevant to SARS-CoV-2 infection ( ACE2, TMPRSS2, DPP4 , and LY6E ). We analyzed novel data from 2,012 ethnically diverse Africans and 15,997 individuals of European and African ancestry with electronic health records, and integrated with global data from the 1000GP. At ACE2 , we identified 41 non-synonymous variants that were rare in most populations, several of which impact protein function. However, three non-synonymous variants were common among Central African hunter-gatherers from Cameroon and are on haplotypes that exhibit signatures of positive selection. We identify strong signatures of selection impacting variation at regulatory regions influencing ACE2 expression in multiple African populations. At TMPRSS2 , we identified 13 amino acid changes that are adaptive and specific to the human lineage. Genetic variants that are targets of natural selection are associated with clinical phenotypes common in patients with COVID-19.

Health-care guidelines and policies during the COVID-19 pandemic in Mexico: A case of health-inequalities.

BACKGROUND: Heterogeneous government responses have been reported in reaction to COVID-19. The aim of this study is to generate an exploratory review of healthcare policies published during COVID-19 by health-care institutions in Mexico. Analyzing policies within different health sub-systems becomes imperative in the Mexican case due to the longstanding fragmentation of the health-care system and health inequalities. DATA AND METHODS: Policies purposely included in the analysis were published by four public health institutions (IMSS, ISSSTE, SSA and PEMEX) during the COVID-19 epidemic in Mexico (from February 29th to June 15th, 2020) on official institutional websites. Researchers reviewed each document and classified them into seven policy categories set by the Rapid Research Evaluation and Appraisal Lab (RREAL): public health response, health-care delivery, human resources, health-system infrastructure and supplies, clinical response, health-care management, and epidemiological surveillance. RESULTS: Policy types varied by health institution. The largest number of policies were aimed at public health responses followed by health-care delivery and human resources. Policies were mainly published during the community transmission phase. CONCLUSIONS: The pandemic exposed underlying health-care system inequalities and a reactive rather than prepared response to the outbreak. Additionally, this study outlines potential policy gaps and delays in the response that could be avoided in the future.

Mixed 4f population of Tm adatoms on insulating Cu2N islands.

The electronic properties of Tm and Lu atoms adsorbed on nanoscale Cu2N insulating islands and on a clean Cu(100) surface have been investigated by scanning tunnelling microscopy and spectroscopy, and density functional calculations modelling the electronic structure of the rare earth atoms were performed. While Lu adatoms display the same spectra on both surfaces, tunnelling spectra of Tm on Cu2N indicate a state at ≃0.8 V or ≃1.9 V bias, depending on the 4f population of the adatom, 4f12 or 4f13, which is not present on Tm atoms adsorbed on Cu(100). Although inelastic 4f-spin-flip excitations were not detected, variation of tunnelling through the strongly correlated d-electrons indicates that the insulating layer opens a pathway to access the electronic state of those 4f electrons in the single adatom.

Antiferromagnetic Spin Coupling between Rare Earth Adatoms and Iron Islands Probed by Spin-Polarized Tunneling.

High-density magnetic storage or quantum computing could be achieved using small magnets with large magnetic anisotropy, a requirement that rare-earth iron alloys fulfill in bulk. This compelling property demands a thorough investigation of the magnetism in low dimensional rare-earth iron structures. Here, we report on the magnetic coupling between 4f single atoms and a 3d magnetic nanoisland. Thulium and lutetium adatoms deposited on iron monolayer islands pseudomorphically grown on W(110) have been investigated at low temperature with scanning tunneling microscopy and spectroscopy. The spin-polarized current indicates that both kind of adatoms have in-plane magnetic moments, which couple antiferromagnetically with their underlying iron islands. Our first-principles calculations explain the observed behavior, predicting an antiparallel coupling of the induced 5d electrons magnetic moment of the lanthanides with the 3d magnetic moment of iron, as well as their in-plane orientation, and pointing to a non-contribution of 4f electrons to the spin-polarized tunneling processes in rare earths.

Características de los pacientes con infarto agudo de miocardio sometidos a ventilación mecánica. Datos del registro ARIAM / Patient Characteristics of Acute Myocardial Infarction in Mechanical Ventilation. Data from Spanish Registry ARIAM

Introducción. Aunque la ventilación mecánica se utiliza con relativa frecuencia en el manejo del infarto agudo de miocardio, no existe suficiente información sobre su empleo y la evolución de los pacientes tratados con esta técnica. Pacientes y método. Estudio de cohorte histórica sobre pacientes con infarto agudo de miocardio, incluidos en la base de datos ARIAM. Se comparan las diferencias en las características clínicas y el pronóstico de los pacientes tratados con o sin ventilación mecánica. Resultados. De los 4.143 casos de infarto agudo de miocardio estudiados, 335 (8,1 por ciento) fueron sometidos a ventilación mecánica. Los pacientes con ventilación mecánica eran de mayor edad, en su mayoría mujeres, tenían con más frecuencia infarto de miocardio previo, infartos de localización anterior, Killip III o IV y mayor mortalidad. Además, tenían con más frecuencia diabetes e hipertensión arterial. La mortalidad fue del 65,7 por ciento en los pacientes con ventilación mecánica frente al 5,1 por ciento en los no ventilados. El análisis multivariante demostró que las concentraciones de creatinfosfocinasa superiores a 1.200 unidades, grados Killip III y IV y localización del infarto distinta a inferior fueron factores asociados independientes de necesidad de la técnica. De los 220 casos sometidos a ventilación mecánica que fallecieron, la edad, el porcentaje de sexo femenino, la estancia en la unidad coronaria y el porcentaje de grado Killip IV fue superior, mientras que el porcentaje de grado Killip III era mayor en los supervivientes. El análisis multivariante de los casos sometidos a ventilación mecánica demostró únicamente el grado Killip III como factor explicativo independiente de supervivencia (odds ratio mortalidad 0,26; IC del 95 por ciento: 0,09-0,77). Conclusiones. En un número relevante de casos de infarto agudo de miocardio complicado es preciso aplicar ventilación mecánica, asociándose a una mortalidad muy elevada relacionada con una mayor extensión miocárdica y una peor situación clínica (AU)