[Reinterpretation of the Malpighian body in light of the existence of a single glomerular arteriole (Trabucco and Marquez)]. / Reinterpretación de la estructura del corpúsculo de Malpighi en función de la existencia de una sola arteriola glomerular (Trabucco y Márquez).

INTRODUCTION: In 1842 William Bowman described the microvascular system of the Malpighian body. Electron microscopic studies definitively revealed the spatial structure of its mesangial-capillary-epithelial component. In 1952-54 Trabucco and Marquez challenged the ideas of Bowman, demonstrating the existence of a single glomerular arteriole. Our study supports the finding of a single glomerular arteriole, leading to a definitive interpretation of the Malpighian body structure. MATERIALS AND METHODS: Serial histological studies were carried out of the vascular pole in a case of oligomeganephrotic renal hypoplasia and the immunohistochemical study of embryonal glomerular development (15 embryos aged between 7 and 11weeks), with alpha-actin (smooth muscle marker), CD31 and CD34 (endothelial markers) and CD10 (podocyte marker). RESULTS: The study of the glomerular vascular pole in the case of oligomeganephrotic renal hypoplasia supports the existence of a single glomerular arteriole. Our immunohistochemical study confirmed this finding and provided data on the morphogenesis of the mesangial-capillary-epithelial component of the Malpighian body. CONCLUSIONS: There exist a single glomerular arteriole. Mesangial and endothelial cells originating from a single glomerular arteriole interact with an epithelial component derived from the nephrogenic vesicle which then generate the lobular glomerular tuft, providing the basis for a definitive interpretation of the structure of the Malpighian body. There is no scientific base to the interpretation of the glomerular microvascular system as having two glomerular arterioles with an intercalated capillary network.

Systemic thrombosis in a large cohort of COVID-19 patients despite thromboprophylaxis: A retrospective study.

BACKGROUND: Incidence of thrombotic events associated to Coronavirus disease-2019 (COVID-19) is difficult to assess and reported rates differ significantly. Optimal thromboprophylaxis is unclear. OBJECTIVES: We aimed to analyze the characteristics of patients with a confirmed thrombotic complication including inflammatory and hemostatic parameters, compare patients affected by arterial vs venous events and examine differences between survivors and non-survivors. We reviewed compliance with thromboprophylaxis and explored how the implementation of a severity-adjusted protocol could have influenced outcome. METHODS: Single-cohort retrospective study of COVID-19 patients admitted, from March 3 to May 3 2020, to the Infanta Leonor University Hospital in Madrid, epicenter of the Spanish outbreak. RESULTS: Among 1127 patients, 80 thrombotic events were diagnosed in 69 patients (6.1% of the entire cohort). Forty-three patients (62%) suffered venous thromboembolism, 18 (26%) arterial episodes and 6 (9%) concurrent venous and arterial thrombosis. Most patients (90%) with a confirmed thrombotic complication where under low-molecular-weight heparin treatment. Overt disseminated intravascular coagulation (DIC) was rare. Initial ISTH DIC score and pre-event CRP were significantly higher among non-survivors. In multivariate analysis, arterial localization was an independent predictor of mortality (OR = 18, 95% CI: 2.4-142, p < .05). CONCLUSIONS: Despite quasi-universal thromboprophylaxis, COVID-19 lead to a myriad of arterial and venous thrombotic events. Considering the subgroup of patients with thrombotic episodes, arterial events appeared earlier in the course of disease and conferred very poor prognosis, and an ISTH DIC score ≥ 3 at presentation was identified as a potential predictor of mortality. Severity-adjusted thromboprophylaxis seemed to decrease the number of events and could have influenced mortality. Randomized controlled trials are eagerly awaited.

Colangiocarcinoma hiliar y sarcoidosis ganglionar periportal. Una asociación excepcional / Hilar cholangiocarcinoma and periportal lymph node sarcoidosis. An exceptional association

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[Impact of the management of a cardiac unit on cardiac care delivery. Evolution of clinical effectiveness indicators]. / Efecto de la gestión de un servicio de cardiología en la atención del paciente cardiológico. Evolución de los indicadores asistenciales.

INTRODUCTION AND OBJECTIVES: Cardiac care is one of the most important and rapidly rising costs in the healthcare system. Therefore, any improvement can produce significant savings. We analyze the evolution of classical clinical effectiveness indexes in a cardiac unit after a change in clinical management. METHODS: We reviewed overall clinical effectiveness indexes and the most significant DRGs of a cardiac unit and general hospital between 1992 and 2000. A change in management (optimization of time for studies, responsibility of professionals for tasks, close follow-up, and preventive problem management) was introduced in September 1995 by team members without a parallel change in the hospital. Clinical effectiveness indexes were compared before and after the organizational change and compared with the rest of the hospital. RESULTS: There was a progressive improvement in clinical effectiveness indexes in the hospital (reduction of 22% in length of stay). On the other hand, a significant improvement was also noted in the cardiac unit starting the month after implementing the new management strategy (reduction of 54% in the duration of the hospital stay; 9.74 days preintervention vs 4.97 days postintervention; p < 0.001). Improvement has been progressive throughout the years of follow-up. Overall indexes and specific DRG indicators improved. CONCLUSIONS: A change in management strategy can have a significant impact on cardiac care and improve clinical effectiveness. Therefore, the attitude of a small team can have a significant impact on healthcare.

Efecto de la gestión de un servicio de cardiología en la atención del paciente cardiológico. Evolución de los indicadores asistenciales / Impact of the management of a cardiac unit on cardiac care delivery. Evolution of clinical effectiveness indicators

Introducción y objetivos. La asistencia cardiológica supone un coste importante y progresivamente creciente del sistema sanitario. Su optimización puede, por tanto, conllevar un importante ahorro. Se analiza la evolución de los indicadores de hospitalización en un servicio de cardiología en el que se aplica un cambio de gestión.Métodos. Se revisan los indicadores de hospitalización globales y los de los grupos relacionados por el diagnóstico (GRD) más representativos del servicio entre los años 1992 y 2001. En septiembre de 1995 se inicia el proceso de reorganización (optimización de demoras, responsabilización del personal en determinadas actividades, seguimiento y solución de problemas) por iniciativa del propio servicio, y sin cambio simultáneo en el resto del hospital. Se comparan los indicadores asistenciales antes y después de la intervención, así como con la evolución seguida por el resto del hospital.Resultados. El hospital mejora progresivamente en los indicadores asistenciales (reducción del 22 por ciento en estancia media). El servicio de cardiología presenta una mejoría desde el mes siguiente a la aplicación de las medidas (reducción del 54 por ciento en estancia media; 9,74 días preintervención frente a 4,97 días postintervención; p < 0,001).La mejoría aparece tanto en los indicadores globales, como en los específicos de los GRD seleccionados.Conclusiones. La aplicación de sencillas medidas de gestión puede conseguir una mejora en la eficiencia de la asistencia cardiológica, con la consiguiente optimización de recursos. La actitud de un grupo reducido de profesionales puede tener un impacto significativo en la asistencia sanitaria (AU)