Analysis of Vascular Smooth Muscle Cells from Thoracic Aortic Aneurysms Reveals DNA Damage and Cell Cycle Arrest as Hallmarks in Bicuspid Aortic Valve Patients.

Thoracic aortic aneurysm (TAA) is mainly sporadic and with higher incidence in the presence of a bicuspid aortic valve (BAV) for unknown reasons. The lack of drug therapy to delay TAA progression lies in the limited knowledge of pathophysiology. We aimed to identify the molecular hallmarks that differentiate the aortic dilatation associated with BAV and tricuspid aortic valve (TAV). Aortic vascular smooth muscle cells (VSMCs) isolated from sporadic TAA patients with BAV or TAV were analyzed by mass spectrometry. DNA oxidative damage assay and cell cycle profiling were performed in three independent cohorts supporting proteomics data. The alteration of secreted proteins was confirmed in plasma. Stress phenotype, oxidative stress, and enhanced DNA damage response (increased S-phase arrest and apoptosis) were found in BAV-TAA patients. The increased levels of plasma C1QTNF5, LAMA2, THSB3, and FAP confirm the enhanced stress in BAV-TAA. Plasma FAP and BGN point to an increased inflammatory condition in TAV. The arterial wall of BAV patients shows a limited capacity to counteract drivers of sporadic TAA. The molecular pathways identified support the need of differential molecular diagnosis and therapeutic approaches for BAV and TAV patients, showing specific markers in plasma which may serve to monitor therapy efficacy.

Use of Ozone Therapy in Diabetic Foot Ulcers.

INTRODUCTION: ozone therapy is a therapy composed of ozone. This gas is in the atmosphere with various general effects: direct disinfectant and trophic effects and a systemic antibacterial and antiviral effect. This gas also improves blood circulation, makes glucose metabolism more effective, improves erythrocyte metabolism, and improves fatty acid metabolism. OBJECTIVE: Provide evidence of the effectiveness of ozone therapy in wounds of patients with diabetic foot. Analyze the effectiveness of ozone therapy compared to other treatments to achieve good wound healing in patients with diabetic foot. To study the benefits of the use of ozone therapy in ulcers of patients. Analyze the management of ozone therapy and other treatments to achieve healing of ulcers in patients. METHODOLOGY: A bibliographic review focused on articles published between November 2014 and June 2023 was carried out. The following databases were consulted: Pubmed (Medline), Dialnet, Google Scholar, Web of Science (WOS), Scielo, and Scopus. RESULTS: After applying the article selection criteria and evaluating the quality of the methodology, a total of 17 articles were obtained. The results affirm ozone therapy as promising for the treatment of wounds in patients with diabetic foot. CONCLUSIONS: the evidence has been able to determine that ozone therapy is adequate for the treatment of diabetic foot ulcers. In addition, the therapy has been shown to be effective, safe, and beneficial, with few adverse effects for the treatment of diabetic foot ulcers.

Analysis of the Factors Intervening in the Prehospital Time in a Stroke Code.

INTRODUCTION: Strokes continue to be considered public health problems due to the great social and health impact they entail. They are the second cause of death in the world, with a high incidence and prevalence. They are time-dependent diseases, and more than 80% of cases could be avoidable with greater management of risk factors. OBJECTIVE: to analyze the factors that influence prehospital time in a stroke code. Assess the population's knowledge of stroke symptoms and teach them how to act when a case is suspected. Document the continued training of health professionals for the early identification of patients with a suspected stroke. Demonstrate the importance of calling EMS as the first contact to reduce delays in prehospital time in a stroke. METHODOLOGY: A bibliographic review was carried out focusing on articles published between December 2014 and August 2023. The following databases were consulted: Pubmed (Medline), Dialnet, Google Scholar, Web of Science (WOS), Scielo, Scopus, and ScienceDirect. RESULTS: After applying the article selection criteria and evaluating the quality of the methodology, a total of 18 articles were obtained. The results affirm that the importance of achieving a reduction in prehospital time is based mainly on knowledge of the symptoms and the use of new technologies. CONCLUSIONS: The evidence supports that the prehospital time of action in the stroke code is affected by numerous factors. These factors are determining factors in the time of action to achieve good effectiveness in the treatment of the pathology.

Novel Imaging-Based Biomarkers for Identifying Carotid Plaque Vulnerability.

Carotid artery disease has traditionally been assessed based on the degree of luminal narrowing. However, this approach, which solely relies on carotid stenosis, is currently being questioned with regard to modern risk stratification approaches. Recent guidelines have introduced the concept of the "vulnerable plaque," emphasizing specific features such as thin fibrous caps, large lipid cores, intraplaque hemorrhage, plaque rupture, macrophage infiltration, and neovascularization. In this context, imaging-based biomarkers have emerged as valuable tools for identifying higher-risk patients. Non-invasive imaging modalities and intravascular techniques, including ultrasound, computed tomography, magnetic resonance imaging, intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy, have played pivotal roles in characterizing and detecting unstable carotid plaques. The aim of this review is to provide an overview of the evolving understanding of carotid artery disease and highlight the significance of imaging techniques in assessing plaque vulnerability and informing clinical decision-making.

Donor liquid biopsy and outcomes in kidney transplantation.

Kidney transplantation is the treatment of choice for patients with kidney failure. Priority on the waiting list and optimal donor-recipient matching are guided by mathematical scores, clinical variables and macroscopic observation of the donated organ. Despite the increasing rates of successful kidney transplantation, maximizing the number of available organs while ensuring the optimum long-term performance of the transplanted kidney remains both key and challenging, and no unequivocal markers are available for clinical decision making. Moreover, the majority of studies performed thus far has focused on the risk of primary non-function and delayed graft function and subsequent survival and have mainly analysed recipients' samples. Given the increasing use of donors with expanded criteria and/or cardiac death, predicting whether grafts will provide sufficient kidney function is increasingly more challenging. Here we compile the available tools for pre-transplant kidney evaluation and summarize the latest molecular data from donors that may predict short-term (immediate or delayed graft function), medium-term (6 months) and long-term (≥12 months) kidney function. The use of liquid biopsy (urine, serum, plasma) to overcome the limitations of the pre-transplant histological evaluation is proposed. Novel molecules and approaches such as the use of urinary extracellular vesicles are also reviewed and discussed, along with directions for future research.

Current Trends in Molecular Imprinting: Strategies, Applications and Determination of Target Molecules in Spain.

Over the last decades, an increasing demand for new specific molecular recognition elements has emerged in order to improve analytical methods that have already been developed in order to reach the detection/quantification limits of target molecules. Molecularly imprinted polymers (MIPs) have molecular recognition abilities provided by the presence of a template molecule during their synthesis, and they are excellent materials with high selectivity for sample preparation. These synthetic polymers are relatively easy to prepare, and they can also be an excellent choice in the substitution of antibodies or enzymes in different kinds of assays. They have been properly applied to the development of chromatographic or solid-phase extraction methods and have also been successfully applied as electrochemical, piezoelectrical, and optical sensors, as well as in the catalysis process. Nevertheless, new formats of polymerization can also provide new applications for these materials. This paper provides a comprehensive comparison of the new challenges in molecular imprinting as materials of the future in Spain.

Core-Shell Magnetic Imprinted Polymers for the Recognition of FLAG-Tagpeptide.

FLAG® tag (DYKDDDDK) is a small epitope peptide employed for the purification of recombinant proteins such as immunoglobulins, cytokines, and gene regulatory proteins. It provides superior purity and recoveries of fused target proteins when compared to the commonly used His-tag. Nevertheless, the immunoaffinity-based adsorbents required for their isolation are far more expensive than the ligand-based affinity resin used in combination with the His-tag. In order to overcome this limitation we report herein the development of molecularly imprinted polymers (MIPs) selective to the FLAG® tag. The polymers were prepared by the epitope imprinting approach using a four amino acids peptide, DYKD, including part of the FLAG® sequence as template molecule. Different kinds of magnetic polymers were synthesised in aqueous and organic media also using different sizes of magnetite core nanoparticles. The synthesised polymers were used as solid phase extraction materials with excellent recoveries and high specificity for both peptides. The magnetic properties of the polymers confer a new, effective, simple, and fast method in the purification using FLAG® tag.

Impacto de la COVID-19 sobre los indicadores hospitalarios: análisis de los grupos relacionados por el diagnóstico en un servicio de cirugía vascular / Impact of COVID-19 on key performance indicators: analysis of diagnosis related groups in a vascular surgery department

Objetivos: evaluar el impacto de la pandemia por la COVID-19 sobre una serie de indicadores funcionaleshospitalarios mediante el uso de grupos relacionados por el diagnóstico (GRD). Comparar los resultados del Servicio de Angiología, Cirugía Vascular y Endovascular (ACV) del Hospital Universitario de Cabueñes (HUCAB) con la base de datos del Ministerio de Sanidad.Material y métodos: altas hospitalarias del servicio de ACV del HUCAB durante los años 2019, 2020 y 2021. Se utilizó el sistema all patients refined (APR)-GRD para la codificación de altas. Los indicadores clave estudiados fueron: número de altas, mortalidad, estancia media (EM) y peso medio (PM) del GRD. Se estudiaron los resultados globales por año y en función de los GRD más prevalentes. Los resultados obtenidos se cotejaron con los datos anuales de la codifi cación del conjunto mínimo básico de datos (CMBD) del Ministerio de Sanidad. Se analizó también la EM ajustada por el funcionamiento del estándar (EMAF) y por la casuística (EMAC), el índice de EM ajustada (IEMA), el índice funcional (IF) y casuístico (IC) y el número de estancias evitables.Resultados:el número de altas en 2020 disminuyó un 10 % respecto a 2019. Las altas ligadas a ingresos desde Urgencias aumentaron en el GRD 181 más de un 50 % durante el año 2020 y más del 100 % en el año 2021 con respecto a 2019. Respecto a la mortalidad, no se constató un aumento signifi cativo de forma global. La EM disminuyó un 20 % en 2020 y un 18 % en 2021 respecto a 2019. El PM aumentó de forma progresiva hasta alcanzar una media de 7,7 % en 2021. La EMAF fue superior a la EM estándar y el número de estancias ahorradas fue superior al esperado.Conclusiones: la pandemia por la COVID-19 ha infl uido sobre los indicadores hospitalarios estudiados: han disminuido el número de altas y la EM y ha aumentando el PM de los GRD. El número de estancias evitables ahorradas ha sido mayor que el estándar.(AU)

Objectives: to evaluate the impact of the COVID-19 on the hospital key performance indicators using the diagnosis-related groups (DRG). To compare the results of the Angiology and Vascular Surgery Department of the University Hospital of Cabueñes (HUCAB) with the database of the Ministry of Health.Material and methods: hospital discharges from the Vascular Surgery Department of the HUCAB during theyears 2019, 2020 and 2021. All patients refined (APR)-DRG system was extracted for discharge coding. The hospital key indicators studied were: number of discharges, mortality, mean stay (EM) and mean weight (PM) of the DRG. The overall results per year and according to the most prevalent DRGs were studied. The results obtained were compared with the annual data from the coding of the Minimum Basic Data Set (CMBD) of the Ministry of Health. The configured EM by adjusting the performance of the standard (EMAF) and by the casuistry (EMAC), the index of the adjusted EM (IEMA), the functional index (FI), casuistic index (CI) and the number of avoidable hospital stays were also analyzed. Results: number of discharges: it was 10 % inferior in 2020 compared to 2019. Discharges of the GRD 181 linked to admissions from the Emergency increased more than 50 % during 2020 and more than 100 % in 2021 compared to 2019. Mortality: there was no significant increase. EM: it decreased 20 % in 2020 and 18 % in 2021, compared to 2019. PM: it increased progressively to 7.7% on average in 2021. EMAF: it was superior to standard EM. The number of stays saved was higher than expected. Conclusions: the pandemic of COVID-19 influenced the hospital key performance indicators studied, reducing the number of discharges and ME and increasing the PM of the DRGs. The number of avoidable stays saved was greater than the standard.(AU)

Magnetic Core-Shell Nanoparticles Using Molecularly Imprinted Polymers for Zearalenone Determination.

This paper describes the synthesis of novel molecularly imprinted magnetic nano-beads for the selective extraction (MISPE) of zearalenone mycotoxin in river and tap waters and further analysis by high-performance liquid chromatography (HPLC) with fluorescence detection (FLD). A semi-covalent imprinting approach was achieved for the synthesis of the molecularly imprinted polymers (MIP). The nanoparticles were prepared by covering the starting Fe3O4 material with a first layer of tetraethyl orthosilicate (TEOS) and then with a second layer using cyclododecyl 2-hydroxy-4-(3-triethoxysilylpropylcarbamoyloxy) benzoate. The last was used with a dual role, template and functional monomer after the extraction of the template molecule. The material was characterized by transmission electron microscopy (TEM), X-ray diffraction (XRD) and Fourier transform infrared spectroscopies (FT-IR). The solid phase extraction was optimized in all the steps: loading, washing and elution. The optimal conditions allowed the determination of zearalenone in trace levels of 12.5, 25 and 50 µg L-1 without significant differences between the fortified and found level concentrations.

The Effectiveness of Negative Pressure Therapy: Nursing Approach.

INTRODUCTION: Complex wounds require advanced techniques for their management and care. Wound care costs are high, so healthcare professionals need to be aware of available therapies. Negative pressure therapy is a technology for which more and more data on its effectiveness in complex wounds are being collected. OBJECTIVE: The objectives of this review were to analyze if the application of negative pressure therapy in complex wounds is effective; to compare the effectiveness of negative pressure therapy with other conventional treatments, as well as its combination with other therapies; and to evaluate the quality of life of patients undergoing negative pressure therapy and collect their main characteristics. METHODOLOGY: A bibliographic review focused on articles published between November 2015 and June 2022 was carried out. The following databases were consulted: PubMed (Medline), Google Scholar, Web of Science (WOS), Scielo and Scopus. RESULTS: The most used pressures in the studies coincide at -125 mmHg and in the range of -125 mmHg to -150 mmHg. In the pediatric population, pressure levels vary by age group. A pressure of -75 to -125 mmHg is recommended for children over 12 years of age, and -50 to -75 mmHg is recommended for children under 2 years of age. CONCLUSIONS: Negative pressure therapy stands out for its rapid rate of granulation, the prevention and effective treatment of infections, the variety and malleability of dressings, its various applications and the possibility of using it with other therapies to accelerate wound closure.

Patient Information and Informed Consent for Research in the Elderly: Lessons Learned from a Randomized Controlled Trial.

The informed consent (IC) of subjects participating in experimental studies is the mainstay to comply with the ethical principle of autonomy to ensure that the participation is voluntary. This experience was performed within the context of a single-center randomized clinical trial in elective prosthetic surgery. Obtaining IC in clinical trials is not without difficulties, and especially in the case of vulnerable populations it can be very challenging. This work aimed to identify the difficulties during the IC process for a clinical trial in subjects older than 65 years old and quantify and describe the use of IC in front of a witness. METHODS: This is a mixed methodology study with a qualitative part (focus group with 4 nurses involved in the inclusion of subjects) and a quantitative part describing the characteristics of patients who signed IC forms. RESULTS: The main difficulties identified are related to comprehension, sensory impairments, education level, and time. IC in front of witnesses was used in 20 patients out of 508. CONCLUSIONS: The participation of subjects older than 65 years old in clinical trials requires an adaptation of the process. The use of IC in front of a witness should always be considered in studies including elderly subjects.

Evaluation of Intima-Media Thickness and Arterial Stiffness as Early Ultrasound Biomarkers of Carotid Artery Atherosclerosis.

Carotid atherosclerosis is a major and potentially preventable cause of ischemic stroke. It begins early in life and progresses silently over the years. Identification of individuals with subclinical atherosclerosis is needed to initiate early aggressive vascular prevention. Although carotid plaque appears to be a powerful predictor of cardiovascular risk, carotid intima-media thickness (CIMT) and arterial stiffness can be detected at the initial phases and, therefore, they are considered important new biomarkers of carotid atherosclerosis. There is a well-documented association between CIMT and cerebrovascular events. CIMT provides a reliable marker in young people, in whom plaque formation or calcification is not established. However, the usefulness of CIMT measurement in the improvement of risk cardiovascular models is still controversial. Carotid stiffness is also significantly associated with ischemic stroke. Carotid stiffness adds value to the existing risk prediction based on Framingham risk factors, particularly individuals at intermediate cardiovascular risk. Carotid ultrasound is used to assess carotid atherosclerosis. During the last decade, automated techniques for sophisticated analysis of vascular mechanics have evolved, such as speckle tracking, and new methods based on deep learning have been proposed with promising outcomes. Additional research is needed to investigate the imaging-based cardiovascular risk prediction of CIMT and stiffness.

Inhibition of Sema-3A Promotes Cell Migration, Axonal Growth, and Retinal Ganglion Cell Survival.

Purpose: Semaphorin 3A (Sema-3A) is a secreted protein that deflects axons from inappropriate regions and induces neuronal cell death. Intravitreal application of polyclonal antibodies against Sema-3A prevents loss of retinal ganglion cells ensuing from axotomy of optic nerves. This suggested a therapeutic approach for neuroprotection via inhibition of the Sema-3A pathway. Methods: To develop potent and specific Sema-3A antagonists, we isolated monoclonal anti-Sema-3A antibodies from a human antibody phage display library and optimized low-molecular weight Sema-3A signaling inhibitors. The best inhibitors were identified using in vitro scratch assays and semiquantitative repulsion assays. Results: A therapeutic approach for neuroprotection must have a long duration of action. Therefore, antibodies and low-molecular weight inhibitors were formulated in extruded implants to allow controlled and prolonged release. Following release from the implants, Sema-3A inhibitors antagonized Sema-3A effects in scratch and repulsion assays and protected retinal ganglion cells in animal models of optic nerve injury, retinal ischemia, and glaucoma. Conclusions and Translational Relevance: Collectively, our findings indicate that the identified Sema-3A inhibitors should be further evaluated as therapeutic candidates for the treatment of Sema-3A-driven central nervous system degenerative processes.

Quality Traits of Montanera Iberian Dry-Cured lomito as Affected by Pre-Cure Freezing Practice.

The seasonality to which dry-cured products from Iberian breed pigs finished in Montanera (free-range rearing system with feed based exclusively on ad libitum consumption of natural resources; acorns and grass) are subjected could be overcome by pre-cure freezing. Three sets of Montanera Iberian presas (Serratus ventralis muscle)(n = 15) were established to assess the impact of frozen storage -0, or non-frozen, 3 and 6 months-previous to the technological process of curing-on the quality traits of the dry-cured product Montanera Iberian dry-cured lomito. Similar seasoning and curing processing conditions were applied to all sets. Lower productive performance due to higher weight loss during curing, and lower colour intensity were observed in pre-frozen dry-cured lomitos. The fatty acid profile was more saturated, and the oxidative status increased as a result of pre-cure freezing. On the matter of texture, all parameters were modified, highlighting the higher values of hardness and shear force of pre-frozen dry-cured lomitos. The time that raw material was frozen exerted a slight, thus helping manufacturers to better address the gap between industry and consumer demand with minimal effect on quality traits.

Mutational spectrum of GNAL, THAP1 and TOR1A genes in isolated dystonia: study in a population from Spain and systematic literature review.

OBJECTIVE: We aimed to investigate the prevalence of TOR1A, GNAL and THAP1 variants as the cause of dystonia in a cohort of Spanish patients with isolated dystonia and in the literature. METHODS: A population of 2028 subjects (including 1053 patients with different subtypes of isolated dystonia and 975 healthy controls) from southern and central Spain was included. The genes TOR1A, THAP1 and GNAL were screened using a combination of high-resolution melting analysis and direct DNA resequencing. In addition, an extensive literature search to identify original articles (published before 10 August 2020) reporting mutations in TOR1A, THAP1 or GNAL associated to dystonia was performed. RESULTS: Pathogenic or likely pathogenic variants in TOR1A, THAP1 and GNAL were identified in 0.48%, 0.57% and 0.29% of our patients, respectively. Five patients carried the variation p.Glu303del in TOR1A. A very rare variant in GNAL (p.Ser238Asn) was found as a putative risk factor for dystonia. In the literature, variations in TOR1A, THAP1 and GNAL accounted for about 6%, 1.8% and 1.1% of published dystonia patients, respectively. CONCLUSIONS: There is a different genetic contribution to dystonia of these three genes in our patients (about 1.3% of patients) and in the literature (about 3.6% of patients), probably due the high proportion of adult-onset cases in our cohort. As regards age at onset, site of dystonia onset, and final distribution, in our population there is a clear differentiation between DYT-TOR1A and DYT-GNAL, with DYT-THAP1 likely to be an intermediate phenotype.

Gradiente de presión de pulso posterior y previo a la maniobra de Valsalva como marcador de disfunción sistólica del ventrículo izquierdo / Post- and pre-Valsalva pulse pressure gradient as a marker of left ventricle systolic dysfunction

Resumen: ANTECEDENTES: La insuficiencia cardiaca afecta a 26 millones de personas en todo el mundo. Al evaluar la variación de las cifras de presión arterial y frecuencia cardiaca tras la realización de la maniobra de Valsalva se ha encontrado correlación entre la función ventricular izquierda y el péptido auricular natriurético. OBJETIVO: Determinar si el gradiente de presión de pulso posterior y previo a la maniobra de Valsalva es útil como marcador de disfunción sistólica del ventrículo izquierdo. MATERIAL Y MÉTODO: Estudio de cohorte realizado del 1 de enero al 30 de junio de 2017, en el que se determinó la fracción de eyección del ventrículo izquierdo, propéptido natriurético cerebral, así como la sustracción de presión de pulso posterior y previo a la maniobra de Valsalva, esta variable se determinó como gradiente de presión de pulso pos y pre-Valsalva. RESULTADOS: Se incluyeron 32 pacientes. Una cifra de gradiente menor de 4.22 tuvo correlación negativa con la fracción de eyección del ventrículo izquierdo menor de 50%, con coeficiente de correlación de -0.562 y valor p de 0.001, además de tener un área bajo la curva de 0.71. CONCLUSIONES: El gradiente y la fracción de eyección tuvieron correlación negativa, ésta en el área indeterminada de la función sistólica. Una FEVI menor de 50% implica riesgo de descompensación y de FEVI deprimida.

Abstract: BACKGROUND: Heart failure affects to 26 million people worldwide. The variation of the blood pressure and heart rate values after performing the Valsalva maneuver has been evaluated, finding a correlation between left ventricular function and natriuretic atrial peptide. OBJECTIVE: To determine if post- and pre-Valsalva pulse pressure gradient is useful as marker of left ventricle systolic dysfunction. MATERIAL AND METHOD: A cohort study was done from January 1st to June 30, 2017, determining left ventricular ejection fraction, cerebral natriuretic peptide, as well as the subtraction of post-Valsalva and pre-Valsalva pulse pressure, this variable was determined as pulse pressure gradient. RESULTS: There were included 32 patients. A gradient figure of less than 4.22 had a negative correlation with a left ventricular ejection fraction lesser than 50%, with a correlation coefficient of -0.562 and a p value of 0.001, in addition to having an area under the curve of 0.71. CONCLUSIONS: The gradient and the ejection fraction had a negative correlation, this in the indeterminate area of the systolic function. An LVEF lesser than 50% implies risk of decompensation and a depressed LVEF.

Índice leuco-glucémico asociado con complicaciones en isquemia cerebral aterotrombótica / Leuco-glycemic index associated to complications in atherothrombotic cerebral ischemia

Resumen: OBJETIVO: Evaluar el índice leuco-glucémico (ILG) como marcador pronóstico de mortalidad y complicaciones en pacientes con enfermedad vascular cerebral de tipo isquémico aterotrombótico. MATERIAL Y MÉTODO: Estudio prospectivo efectuado en pacientes con enfermedad vascular de tipo isquémico aterotrombótico durante la fase aguda del infarto, que ingresaron entre enero y diciembre de 2017 al servicio de Medicina Interna del Hospital General Ticomán. Se recolectaron datos clínicos y de laboratorio, incluyendo glucemia y leucograma al ingreso, a partir de los cuales se calculó el ILG y se evaluó su valor pronóstico, así como su relación con las escalas de NIHSS y Rankin y con la mortalidad a 21 días. RESULTADOS: Se incluyeron 72 pacientes. Los pacientes con mayor número de complicaciones durante la hospitalización tuvieron valores superiores de ILG (p = 0.02). Se obtuvo un valor ≥ 900 como punto de corte; los pacientes con valores superiores tuvieron tres veces mayor probabilidad de complicaciones durante la hospitalización (razón de momios = 3.02; IC95%: 1.03 a 9.9; p = 0.04), por lo que el índice leuco-glucémico constituyó un predictor significativo. CONCLUSIONES: El índice leuco-glucémico se relacionó con mayor severidad de enfermedad vascular cerebral en las escalas de NIHSS y Rankin, además, se asoció con complicaciones intrahospitalarias.

Abstract: BACKGROUND: The glycemia and the determination of serum leukocytes on admission have demonstrated prognostic importance in patients with ischemic cerebral vascular disease (CVD). The leuko-glycemic index (ILG) is recently studied as a prognostic marker, but knowledge about its value is lacking. OBJECTIVE: To evaluate the leuko-glycemic index (ILG) as a prognostic marker of mortality and complications in patients with atherothrombotic ischemic stroke. MATERIAL AND METHOD: A prospective study was conducted on patients with atherothrombotic ischemic vascular disease during the acute phase of the infarction, who were admitted to the Internal Medicine Department of the Ticoman General Hospital from January to December 2017. Clinical and laboratory data were collected, including glycemia and leukogram at admission, from which the ILG was calculated and its prognostic value was evaluated, as well as its relationship with the NIHSS and Rankin scales and/or with the 21-day mortality. RESULTS: There were included 72 patients. Patients with a higher number of complications during hospitalization had higher ILG values (p = 0.02). A value ≥ 900 was obtained as a cut-off point; patients with higher values presented a three times higher probability of complications during hospitalization (odds ratio: 3.02, CI95%: 1.03 to 9.9, p = 0.04), so the ILG was a significant predictor. CONCLUSIONS: Leuko-glycemic index was associated with greater severity of cerebral vascular disease in the NIHSS and Rankin scales, and was associated with intrahospital complications.

Síndrome de Wellens, equivalente clínico de estenosis coronaria crítica / Wellens' syndrome, clinical equivalent of critical coronary stenosis

Resumen El infarto agudo de miocardio con elevación del segmento ST es una indicación urgente de cateterismo cardiaco. El síndrome de Wellens es la inversión persistente de la onda T en las derivaciones V2 y V3 con datos clínicos compatibles con angina; la evidencia de este síndrome indica la oclusión crítica de la coronaria descendente anterior; el tratamiento de elección es el cateterismo cardiaco. Se comunica el caso clínico de un paciente con factores de riesgo cardiovascular, con evidencia de síndrome de Wellens tipo B; el reconocimiento y la adecuada toma de decisiones son críticas en estas circunstancias.

Abstract Acute myocardial infarction with ST elevation is an urgent indication for cardiac catheterization. Wellens' syndrome is a persistent reversal of the T wave in leads V2 and V3 with clinical presence compatible with angina; the evidence of this syndrome indicates the critical occlusion of the anterior descending coronary artery, with cardiac catheterization being the treatment of choice. We present the clinical case of a patient with cardiovascular risk factors, with evidence of Wellens' syndrome type B. Recognition and proper decision-making are critical in these circumstances.

Uterine Cervical Length Measurement to Reduce Length of Stay in Patients Admitted for Threatened Preterm Labor: A Randomized Trial.

OBJECTIVE: To study whether knowledge of cervical length (CL) is useful in reducing the length of hospital stay in women admitted because of threatened preterm labor. METHODS: We performed a single-center, parallel, randomized trial at the Hospital Clínic of Barcelona. Inclusion criteria were single pregnancy, gestational age (GA) between 24+0 and 35+6 weeks, Bishop score <6, no parturition within 24-48 h after admission, and no clinical signs of chorioamnionitis, vaginal bleeding, or nonreassuring fetal status. CL measurement was performed 24-48 h after admission. In the control group, the patient and the physician in charge were blinded. In the study group, this information was given; if CL was >25 mm, early discharge within 12-24 h from randomization was recommended. Length of hospital stay was the main outcome. RESULTS: After randomization, 149 patients had complete follow-up (control group, n = 74; study group, n = 75). The mean (SD) length of stay was significantly shorter - 3.0 (2.2) vs. 4.0 (2.0) days (p = 0.004) - in the study group, with a higher proportion of women remaining hospitalized ≤3 days (relative risk [95% confidence interval] 0.43 [0.26-0.70]), with no differences in GA at delivery or preterm birth rate. CONCLUSIONS: Knowledge of CL in women admitted because of threatened preterm labor is useful in reducing length of stay, with no impact on GA at delivery or preterm birth rate.