Manejo de la trombosis venosa cerebral en España: estudio descriptivo MOTIVATE / Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study

Introducción: La trombosis venosa cerebral (TVC) es una causa poco común de ictus que afecta principalmente a adultos jóvenes. Un diagnóstico precoz y preciso puede reducir la tasa y gravedad de las complicaciones. Objetivo: Analizar las características clínicas, manejo y tratamiento de la TVC en diferentes centros de nuestro país. Métodos: Estudio descriptivo retrospectivo multicéntrico de pacientes hospitalizados por TVC entre 2008 y 2017 en 11 centros sanitarios en nuestro país. Resultados: Se incluyeron 256 pacientes, edad media 49,8 ± 18,7 años y el 51% fueron mujeres. Los síntomas más frecuentes fueron: cefalea (73%), déficits focales (50%), crisis epilépticas (33%) y encefalopatía (21%). Las localizaciones más frecuentes fueron: seno longitudinal superior (12,5%), transverso (10,9%) y afectación de dos o más senos o venas (66,4%). La etiología conocida más frecuente fue la trombofilia (24%), siendo la mutación de la protrombina G20210A la más común (19%). El 46% fue tratado con antitrombóticos durante 3-6 meses, el 21% durante un año y un 22,6% de los pacientes requirieron anticoagulación indefinida. En un 5% de los sujetos fue preciso terapia endovascular y un 33% requirió neurocirugía. En relación al pronóstico, el 75% fueron independientes a los 3 meses con una puntuación en la escala de Rankin modificada (mRS) ≤ 2 y la presencia de papiledema (p = 0,03), déficit focal (p = 0,001) y encefalopatía (p < 0,001) se relacionaron significativamente con mal pronóstico (mRS > 3). La tasa de mortalidad intrahospitalaria fue del 4,3% y el 6,3% de los pacientes fallecieron a los 3 meses. Conclusión:La diversidad de factores de riesgo y la presentación variable suponen un desafío en el diagnóstico y tratamiento de la TVC. Para mejorar el pronóstico y reducir la mortalidad es fundamental la instauración de protocolos en el manejo de esta patología.(AU)

Introduction: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. Objective: The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. Methods: We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 11 Spanish centres. Results: We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3-6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P = .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. Conclusion: The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.(AU)

Adaptation of sea turtles to climate warming: Will phenological responses be sufficient to counteract changes in reproductive output?

Sea turtles are vulnerable to climate change since their reproductive output is influenced by incubating temperatures, with warmer temperatures causing lower hatching success and increased feminization of embryos. Their ability to cope with projected increases in ambient temperatures will depend on their capacity to adapt to shifts in climatic regimes. Here, we assessed the extent to which phenological shifts could mitigate impacts from increases in ambient temperatures (from 1.5 to 3°C in air temperatures and from 1.4 to 2.3°C in sea surface temperatures by 2100 at our sites) on four species of sea turtles, under a "middle of the road" scenario (SSP2-4.5). Sand temperatures at sea turtle nesting sites are projected to increase from 0.58 to 4.17°C by 2100 and expected shifts in nesting of 26-43 days earlier will not be sufficient to maintain current incubation temperatures at 7 (29%) of our sites, hatching success rates at 10 (42%) of our sites, with current trends in hatchling sex ratio being able to be maintained at half of the sites. We also calculated the phenological shifts that would be required (both backward for an earlier shift in nesting and forward for a later shift) to keep up with present-day incubation temperatures, hatching success rates, and sex ratios. The required shifts backward in nesting for incubation temperatures ranged from -20 to -191 days, whereas the required shifts forward ranged from +54 to +180 days. However, for half of the sites, no matter the shift the median incubation temperature will always be warmer than the 75th percentile of current ranges. Given that phenological shifts will not be able to ameliorate predicted changes in temperature, hatching success and sex ratio at most sites, turtles may need to use other adaptive responses and/or there is the need to enhance sea turtle resilience to climate warming.

Dissociable Contributions of Basolateral Amygdala and Ventrolateral Orbitofrontal Cortex to Flexible Learning Under Uncertainty.

Reversal learning measures the ability to form flexible associations between choice outcomes with stimuli and actions that precede them. This type of learning is thought to rely on several cortical and subcortical areas, including the highly interconnected orbitofrontal cortex (OFC) and basolateral amygdala (BLA), and is often impaired in various neuropsychiatric and substance use disorders. However, the unique contributions of these regions to stimulus- and action-based reversal learning have not been systematically compared using a chemogenetic approach particularly before and after the first reversal that introduces new uncertainty. Here, we examined the roles of ventrolateral OFC (vlOFC) and BLA during reversal learning. Male and female rats were prepared with inhibitory designer receptors exclusively activated by designer drugs targeting projection neurons in these regions and tested on a series of deterministic and probabilistic reversals during which they learned about stimulus identity or side (left or right) associated with different reward probabilities. Using a counterbalanced within-subject design, we inhibited these regions prior to reversal sessions. We assessed initial and pre-/post-reversal changes in performance to measure learning and adjustments to reversals, respectively. We found that inhibition of the ventrolateral orbitofrontal cortex (vlOFC), but not BLA, eliminated adjustments to stimulus-based reversals. Inhibition of BLA, but not vlOFC, selectively impaired action-based probabilistic reversal learning, leaving deterministic reversal learning intact. vlOFC exhibited a sex-dependent role in early adjustment to action-based reversals, but not in overall learning. These results reveal dissociable roles for BLA and vlOFC in flexible learning and highlight a more crucial role for BLA in learning meaningful changes in the reward environment.

Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study.

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE: The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS: We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres. RESULTS: We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P =  .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION: The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.

4-Hydroxydibenzyl: a novel metabolite from the human gut microbiota after consuming resveratrol.

Resveratrol (RSV) was known to be metabolised by the gut microbiota to dihydroresveratrol, lunularin (LUNU), and (or) 3,4'-dihydroxy-trans-stilbene (DHST). We describe here for the first time that LUNU can be further dehydroxylated, but only at the 3-position, to yield 4-hydroxydibenzyl, a novel metabolite found in human urine after RSV intake in 41 out of 59 healthy participants. In contrast, DHST was not further dehydroxylated, and thus, 4-hydroxy-trans-stilbene was not detected as a gut microbial metabolite of RSV. Faecal in vitro incubations confirmed the in vivo results.

Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. / Manejo de la trombosis venosa cerebral en España: estudio descriptivo MOTIVATE.

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE: The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS: We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 11 Spanish centres. RESULTS: We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3-6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P=.03), focal deficits (P=.001), and encephalopathy (P <.001) showing a statistically significant association with poor prognosis (mRS> 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION: The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.

[Multiple cerebral haemorrhages secondary to disseminated intravascular coagulation in a patient with COVID-19]. / Hemorragias cerebrales múltiples secundarias a coagulación intravascular diseminada en un paciente con COVID-19.

TITLE: Hemorragias cerebrales múltiples secundarias a coagulación intravascular diseminada en un paciente con COVID-19.

Hepatocellular carcinoma in the noncirrhotic liver: Clinical features and outcomes in Veracruz, Mexico. / Carcinoma hepatocelular en hígado no cirrótico: características clínicas y resultados en Veracruz, México.

INTRODUCTION AND AIM: Hepatocellular carcinoma (HCC) is the most frequent primary tumor of the liver. HCC in the noncirrhotic liver accounts for 15-20% of all HCC. Noncirrhotic HCC is a clinically different entity because of the non-neoplastic liver parenchyma involved. Our aim was to describe the presentation, treatment, and predictive survival results of noncirrhotic HCC in Veracruz. MATERIAL AND METHOD: A retrospective study, spanning 13 years, was conducted on patients with noncirrhotic HCC. It analyzed their clinical characteristics, fibrosis/cirrhosis biologic index (NAFLD, MELD, ALBI, APRI, CDS, FIB-4, GUCI, Lok) results, disease treatment, and survival. RESULTS: From a total of 168 cases of HCC, 33 (19.6%) noncirrhotic patients were included in the study. Of those patients, the mean patient age was 67.3 years (51.5% men), 9.1% had hepatitis C virus infection, and 27.3% were alcoholics. Less than 20% of the patients had biologic indexes suggestive of fibrosis/cirrhosis. Mean tumor size was 7.7cm and 42.4% of the patients had alpha-fetoprotein levels>15ng/ml. A total of 52.5% of the tumors were classified as Okuda II and 30.3% of the patients had advanced disease (the Milan criteria). Liver resection was performed on 51.5% of the patients, radiofrequency ablation on 18.2%, and transarterial chemoembolization on 9.1%. The overall 5-year survival rate was 55.4%. Liver resection resulted in the best 5-year survival rate (72.7%). Age>67 years and elevated alpha-fetoprotein levels were associated with poorer survival (P<.05, log-rank). CONCLUSIONS: The characteristics and survival rate of HCC in the noncirrhotic liver were similar to those reported in other studies. Liver resection provided the highest survival rates. The liver fibrosis biologic indexes were not risk factors for survival.

Contrasting evolutionary responses in two co-distributed species of Galaxias (Pisces, Galaxiidae) in a river from the glaciated range in Southern Chile.

Life-history traits are among the most important factors affecting population abundance and genetic diversity of species. Here, we analysed the genetic patterns of two Galaxias species with different life-history traits to investigate how these biological differences impacted their evolution in the Valdivia River basin, Southern Chile. We analysed mitochondrial DNA (mtDNA) sequences from 225 individuals of Galaxias maculatus and 136 of G. platei to compare patterns of genetic diversity, structure and demographic growth across the basin. Galaxias maculatus presented higher genetic diversity and higher genetic structure than G. platei. Demographic analyses showed G. maculatus kept a higher population size over time, with a signal of demographic expansion in the last 250 kyr. Whereas Galaxias platei, exhibited lower, but constant population size over time. Furthermore, haplotype networks revealed higher lineage diversity in G. maculatus with a tendency to occupy different areas of the basin. Coalescent simulations ruled out that genetic differences between species could be explained by stochastic processes (genetic drift), suggesting species-specific biological differences as responsible for the observed genetic differences. We discuss how differences in life-history traits and past glaciations interact to shape the evolutionary history of the two Galaxias species.

Encefalopatía por contraste secundaria a posible daño endotelial tras trombectomía mecánica exitosa / Contrast-induced encephalopathy possibly secondary to endothelial damage after successful mechanical thrombectomy

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Paro Cardiorrespiratorio (PCR) y Reanimación Cardiopulmonar (RCP) en un nuevo escenario: COVID19 / Paro Cardiorrespiratorio (PCR) y Reanimación Cardiopulmonar (RCP) en un nuevo escenario: COVID19

Our country, like the rest of the world, have been facing for a little more than three months, a pandemia caused by a new virus called "SARS-CoV-2", which spread started in Wuhan, China. As this virus has crossed all geographic boundaries, so has done with those related to human wellbeing. We have faced social, economic, epidemiologic, organizational, biologic and clinic challenges. The COVID-19, which is the name the World Health Organization (WHO) gave to the disease caused by this virus, uses to show clinical manifestations similar to those caused by a common flu in the vast majority of cases. Although there is a low percentage of patients who developed a severe clinical profile, that makes necessary an Intensive Care Unit (ICU) admission. This virus has the particular feature of being highly transmissible from one person to another by direct contact, droplets and aerosols generation. This has led the number of infected all around the world to grow in an exponential manner, which remains a real hazard for the available resources needed for personal and community protection. The natural questions that arise from this landscape are: what must be done if a COVID+ or suspected, presents a cardiac arrest (CA) and need cardiopulmonary reanimation (CPR)? Should RCP be started considering the patient prognosis and the resources shortage? It seems worthy to take the risk of becoming infected? Am I really at risk of becoming infected if I participate in performing the CPR maneuvers? Do I have to perform the RCP maneuvers following (ILCOR) guides that I already know or there are some differences? And what I am supposed to do if the CA occurs while the patient is in the prone position? This revision tries to find some of the answers for those questions, based on current publications and published recommendations so far. Certainly, those are scarce in this field and are subject to changes, at least for some months, while the scientific and medical community achieve the consolidated knowledge about the global clinic behavior of this new disease, COVID-19.

Nuestro país y el mundo lleva poco más de tres meses enfrentando una pandemia causada por un nuevo virus, el llamado SARS-CoV-2, cuya propagación se inició en Wuhan, China. Este virus ha atravesado todas las fronteras geográficas, así como las de aquellas áreas que componen el bienestar del ser humano. Nos hemos visto enfrentados a desafíos sociales, económicos, epidemiológicos, organizacionales, biológicos y clínicos. La enfermedad causada por este virus, llamada por la Organización Mundial de la Salud (OMS) COVID-19, se caracteriza fundamentalmente por presentarse como un cuadro clínico parecido a la influenza en la gran mayoría de los casos, sin embargo, existe un porcentaje de ellos que cursa de manera grave, requiriendo cuidados críticos. Tiene, además, la particularidad de ser altamente transmisible entre las personas a través del contacto directo, generación de gotitas y aerosoles principalmente, lo cual ha llevado a un aumento exponencial del número de contagiados en el mundo, poniendo en jaque la capacidad de contar con el recurso necesario suficiente para la protección personal y de la comunidad. Surge naturalmente la interrogante: ¿Qué hacemos si un paciente COVID-19 + o sospechoso presenta un paro cardiorrespiratorio (PCR) y hay que iniciar maniobras de reanimación cardiopulmonar (RCP)? ¿Debemos reanimarlo considerando su pronóstico y la escasez de recursos? ¿Qué probabilidades tengo de contagiarme si participo de las maniobras? ¿Es "costo/efectivo" arriesgarme al contagio? ¿Debo realizar la RCP de acuerdo a los estándares (ILCOR) hasta aquí conocidos o debo considerar modificaciones en el algoritmo? ¿Qué consideraciones debo tener si el PCR se presenta mientras el paciente está en prono? Esta revisión busca responder en parte algunas de estas inquietudes, basándose en la literatura y recomendaciones que hasta ahora se han comunicado. Ciertamente, esta es escasa y está sujeta a sufrir progresivos y permanentes cambios, al menos por un tiempo, mientras logramos consolidar el conocimiento del comportamiento clínico global del COVID-19.

Septicemia por Chromobacterium Violaceum en pediatría / Septicemia due to Chromobacterium Violaceum in pediatrics

Chromobacterium violaceum es una bacteria gram negativa anaerobia facultativa, que se encuentra ampliamente distribuida en el agua y el suelo en regiones tropicales y subtropicales, que se asocia con infecciones respiratorias, gastrointestinales, abscesos hepáticos, meningitis, endocarditis, síndrome hemofagocítico y sepsis fulminante. Se presentan 2 casos en niños: el primero es un varón de 8 años con lesiones en piel, fiebre y adenitis inguinal, que ingresó con un cuadro de sepsis severa, síndrome de distrés respiratorio agudo (SDRA) y falleció a las 3 h del ingreso. De los hemocultivos se aisló Chromobacterium violaceum. El segundo caso, es una niña de 12 años con antecedente de fiebre y adenopatía inguinal secundaria a herida cortopunzante en el pie homolateral, que ingresó con un cuadro de sepsis, con desarrollo de abscesos múltiples profundos. De la colección obtenida de piel y partes blandas y de un aspirado traqueal se aisló Chromobacterium violaceum. Recibió tratamiento antibiótico adecuado y posteriormente fue dada de alta. Se realizó una revisión bibliográfica de esta infección en niños y se encontraron 44 casos en todo el mundo. Algunos de éstos, se relacionaron con inmunodeficiencia de base, como la enfermedad granulomatosa crónica. La infección por esta bacteria es rara y se presenta como un cuadro grave que no responde a antibióticos habituales de uso empírico y tiene una alta tasa de mortalidad (AU)

Chromobacterium violaceum is a facultative anaerobic Gramnegative bacillus, widely distributed in water and soil in tropical and subtropical regions and associated with respiratory and gastrointestinal infections, liver abscesses, meningitis, endocarditis, hemophagocytic syndrome, and fulminant sepsis. Here two pediatric cases are presented: The first was an 8-year-old boy with skin lesions, fever, and inguinal adenitis, who was admitted with severe sepsis, acute respiratory distress syndrome (ARDS) and died three hours after. Chromobacterium violaceum was isolated from blood cultures. The second case was a 12-year-old girl with a history of fever and inguinal adenopathy secondary to a wound in the homolateral foot, who was admitted because of sepsis and multiple deep abscesses. From samples collected from the skin and soft tissues as well as tracheal aspirate Chromobacterium violaceum was isolated. Adequate antibiotic treatment was started and the patient was subsequently discharged. In a review of the literature, 44 cases worldwide were identified. Some of these cases were related to underlying immunodeficiency, such as chronic granulomatous disease. Infection with this bacterium is rare and presents with severe manifestations that do not respond to the common empirical antibiotics and are associated with a high mortality rate (AU)

Influence of an applied current on the vortex matter in a superconducting sample with structural defects.

We show how the inclusion of a structural defect of determined geometry controls the vortex state in a square superconducting sample in the presence of an external magnetic field and a dc current. We simulated the defects by using the deformation parameter τ ( x , y ) , solving the non-lineal time-dependent Ginzburg-Landau equations and using the link variable method, for four different geometries as possible options for the storage vortex, simulating the behavior of a capacitor. We found an exponential dependence of the current in which the first vortex penetrates the sample J → c as a function of the area of a square central defect in the sample. We also show the effect of the defects and the transport current on the magnetization, magnetic susceptibility, vorticity, and magnetic field at the first vortex entry into the sample H 1 and the density of the superconducting electrons.

[Registry of perioperative cardiac arrests in a clinical hospital in the period 2006-2017]. / Registro de paro cardiorrespiratorio perioperatorio en un hospital universitario en el período 2006-2017.

BACKGROUND: Perioperative cardiac arrest (PCA) is a rare but important event in the operating room. AIM: To describe PCA events at a Clinical Hospital in Santiago, Chile. MATERIAL AND METHODS: Registry of PCA that occurred in the operating room (OR) and during procedures not carried out in the OR between September 2006 and November 2017. Precipitating events, type of anesthesia and results of resuscitation maneuvers were described. RESULTS: Eighty events (five outside of the OR) during 170,431 surgical procedures were recorded, resulting in an incidence of 4.4 events per 10,000 interventions. Hypotension/hypoperfusion was the most frequently found preexisting condition (42.5%). The main cause was the presence of preoperative complications (57.5%). Nineteen cases (23.8%) were attributable to anesthesia, with an incidence of 1.11 per 10,000 anesthetic procedures. Survival rate at hospital discharge was 52.5%. The figure for PCA caused by anesthesia was 84.2%. CONCLUSIONS: The incidence of PCA and its survival is similar to that reported abroad. In general, PCA has a better prognosis than other types of cardiac arrest, especially if it has an anesthetic cause.