Covid persistente y discapacidad / Long covid and disability

La long covid o covid persistente es un problema de salud que supondrá un alto coste oculto atribuible a la pandemia años después porque afecta a la capacidad laboral de muchos trabajadores. Dados los millones de casos de covid-19 en todo el mundo y las investigaciones actuales, que muestran que uno de cada 7 pacientes con covid-19 sigue sintomático a las 12 semanas, es probable que el número de pacientes con covid prolongada sea sustancial. La covid prolongada se caracteriza por secuelas heterogéneas que a menudo afectan a múltiples sistemas y órganos con impacto en el funcionamiento y la capacidad del trabajador. Los trabajadores con síntomas de covid persistente pueden regresar a su ocupación, pero esto implica un enfoque individualizado complejo del impacto de los síntomas en el trabajo, ajustes y modificaciones en el lugar del trabajo. Estos pacientes suelen informar de una afectación multisistémica prolongada y una discapacidad significativa. También debe abordarse el coste psicológico para el trabajador. En una encuesta de la Comunidad de Madrid (desarrollada por los sindicatos CC. OO., SATSE, CSIF, AMYTS) de 2022 se observa que el 24,5% de los afectados por covid prolongada estuvieron enfermos durante más de 12 meses y el 30% de los afectados necesita adaptación a su lugar de trabajo. En España se han reportado más de 10millones de personas infectadas por SARS-CoV-2 desde que comenzó la pandemia, por lo que se calcula que podría haber un millón de personas con covid persistente. Solo en 2021 se produjeron en España más de 2,6 millones de bajas laborales por covid-19, cuya duración media fue de 10 días. Cien millones de personas en todo el mundo padecen covid persistente, pero pocos países los cuentan oficialmente, ni ayudan con el empleo a los afectados... (AU)

Long covid is a health problem that will entail a high hidden cost attributable to the pandemic years after it because it affects the work capacity of many workers. Given the millions of covid-19 cases worldwide and current research showing that one in 7covid-19 patients remain symptomatic at 12 weeks, the number of long covid patients is likely to be substantial. Long covid is characterized by heterogeneous sequelae that often affect multiple systems, organs with an impact on the functioning and capacity of the worker. Workers with long covid symptoms can return to their occupation but this involves a complex individualized approach to the impact of symptoms on work, adjustments and modifications to the workplace. Patients with long covid typically report prolonged multisystem involvement and signicant disability. The psychological cost to the worker must also be addressed. A survey by the Community of Madrid (CCOO, SATSE, CSIF, AMYTS) in 2022 reveals that 24.5% of those affected by long covid were sick for more than 12 months; 30% of those affected by persistent covid need and adaption to their workplace. In Spain, more than 10million people infected with SARS-CoV-2 have been reported since the pandemic began, so it is estimated that there could be one million people with persistent covid. In 2021 alone there were more than 2.6 million sick leave due to covid-19 in Spain, the average duration of which was 10 days. One hundred million people around the world suffer from persistent covid, but few countries officially count them, nor do they help those affected with employment. In advanced countries, like the United States, long covid is treated as a disability,and the number of people with disabilities working or looking for work increased by 1.36 million, an increase of 23%, between January 2021 and January 2022... (AU)

[Long covid and disability]. / Covid persistente y discapacidad.

Long covid is a health problem that will entail a high hidden cost attributable to the pandemic years after it because it affects the work capacity of many workers. Given the millions of covid-19 cases worldwide and current research showing that one in 7covid-19 patients remain symptomatic at 12 weeks, the number of long covid patients is likely to be substantial. Long covid is characterized by heterogeneous sequelae that often affect multiple systems, organs with an impact on the functioning and capacity of the worker. Workers with long covid symptoms can return to their occupation but this involves a complex individualized approach to the impact of symptoms on work, adjustments and modifications to the workplace. Patients with long covid typically report prolonged multisystem involvement and signicant disability. The psychological cost to the worker must also be addressed. A survey by the Community of Madrid (CCOO, SATSE, CSIF, AMYTS) in 2022 reveals that 24.5% of those affected by long covid were sick for more than 12 months; 30% of those affected by persistent covid need and adaption to their workplace. In Spain, more than 10million people infected with SARS-CoV-2 have been reported since the pandemic began, so it is estimated that there could be one million people with persistent covid. In 2021 alone there were more than 2.6 million sick leave due to covid-19 in Spain, the average duration of which was 10 days. One hundred million people around the world suffer from persistent covid, but few countries officially count them, nor do they help those affected with employment. In advanced countries, like the United States, long covid is treated as a disability,and the number of people with disabilities working or looking for work increased by 1.36 million, an increase of 23%, between January 2021 and January 2022. In the United Kingdom, some 200,000 people are not working or are not looking for work due to long-term health problems attributable to long covid, since the pandemic began.

Macrovascular and microvascular type 2 diabetes complications are interrelated in a mouse model.

AIM: Evaluate the development of multiple complications, their interactions, and common mechanisms in the same individual with T2D. MATERIAL AND METHODS: 4-week-old male C57BL/6J mice were divided into: control (n = 6) and T2D (n = 6). T2D was induced through a high-carbohydrate-diet and low doses of streptozotocin. T2D was validated by metabolic parameters. Diabetic neuropathy was evaluated by mechanical and thermal sensitivity tests. We performed a histopathological analysis of the heart, kidney, liver, and parotid salivary glands and changes in bone microarchitecture by µCT. We calculated the relative risk (RR), odd ratios (OR) and Pearson correlation coefficients between the different complications and metabolic features. RESULTS: T2D mice have cardiomyopathy, neuropathy, nephropathy, liver steatosis and fibrosis, structural damage in parotid salivary glands, and bone porosity. RR analysis shows that all complications are interrelated by hyperglycaemia, insulin resistance, obesity, and systemic inflammation. CONCLUSIONS: T2D mice develop multiple complications simultaneously, which are related to each other, and this is associated with metabolic alterations. Our findings open up new approaches for the study and new therapeutic approaches of the pathophysiology of T2D and its complications.

[Characterization of a cohort of pediatric patients with Congenital Adrenal Hyperplasia]. / Caracterización de una cohorte de pacientes pediátricos con Hiperplasia Suprarrenal Congénita.

Congenital adrenal hyperplasia (CAH) is the most common adrenal disorder in childhood. Objecti ve: To describe the clinical and laboratory characteristics of pediatric patients with CAH and perform an exploratory analysis comparing some clinical and laboratory variables according to the types of CAH. PATIENTS AND METHOD: Observational descriptive longitudinal study. Medical records from the pediatric endocrinology outpatients from four institutions in Medellín, Colombia were reviewed. Sociodemographic, clinical (type of CAH, salt-wasting crisis, associated endocrinopathies), labora tory (17-hydroxyprogesterone, testosterone, dehydroepiandrosterone sulfate, androstenedione, cor tisol, and adrenocorticotropic hormone) variables were analyzed. A descriptive statistical analysis was carried out. RESULTS: 132 patients (65% female) were included. The median age at diagnosis was 2 months, 44.7% neonatal diagnosis. Seventy-nine children with classical salt-wasting CAH, 31 with simple virilizing, and 22 with non-classical form were documented. Median 17-OHP at diagnosis was 4820 ng/dl. Sexual differentiation disorder was presented in 47% of patients and 48% presented with adrenal crisis (AC) at diagnosis; the median age of the first AC was 15 days. Ninety-three patients required fludrocortisone and 32 patients presented AC after diagnosis and treatment. Median height/ age (last appointment): -0.49 SD, difference between bone and chronological age: 26 months. More than 60% of patients had elevated androstenedione and/or testosterone at the last appointment. CONCLUSIONS: Sociodemographic and clinical characteristics are similar to those reported in the literature. In 48% of patients, AC was the initial manifestation, making neonatal screening important, as it would allow an early diagnosis. We found virilization in 71% of women in our study. A CAH should be suspected in a newborn with different genitalia.

CD4+ T-cell activation of bone marrow causes bone fragility and insulin resistance in type 2 diabetes.

Type 2 diabetes mellitus (T2DM) causes an increased risk of bone fractures. However, the pathophysiology of diabetic bone fragility is not completely understood. It has been proposed that an inflammatory microenvironment in bone could be a major mechanism by inducing uncontrolled bone resorption, inadequate bone formation and consequently more porous bones. We propose that activated T-cells in the bone marrow cause a pro-inflammatory microenvironment in bone, and cause bone fragility in T2DM. We induced T2DM in C57BL/6 male mice through a hypercaloric diet rich in carbohydrates and low doses of streptozocin. In T2DM mice we inhibited systemic activation of T-cells with a fusion protein between the extracellular domain of Cytotoxic T-Lymphocyte Antigen 4 and the Fc domain of human immunoglobulin G (CTLA4-Ig). We analysed the effects of T2DM or CTLA4-Ig in lymphocyte cell subsets and antigen-presenting cells in peripheral blood and femoral bone marrow; and their effect on the metabolic phenotype, blood and bone cytokine concentration, femoral bone microarchitecture and biomechanical properties, and the number of osteoblast-like cells in the femoral endosteum. We performed a Pearson multiple correlation analysis between all variables in order to understand the global mechanism. Results demonstrated that CTLA4-Ig decreased the number of activated CD4+ T-cells in the femoral bone marrow and consequently decreased TNF-α and RANK-L concentration in bone, notably improved femoral bone microarchitecture and biomechanical properties, increased the number of osteoblast-like cells, and reduces osteoclastic activity compared to T2DM mice that did not receive the inhibitor. Interestingly, we observed that blood glucose levels and insulin resistance may be related to the increase in activated CD4+ T-cells in the bone marrow. We conclude that bone marrow activated CD4+ T-cells cause poor bone quality and insulin resistance in T2DM.

Assessing optical remote sensing for grave detection.

The application of an effective and ready-to-use tool for discovering clandestine graves is crucial for solving a number of cases where disappearance of people is involved. This is the case in Mexico, where the government drug war has resulted in a large number of missing people that has been estimated to be over 40,000 since the year 2006. In this article, we report results from an experimental study on simulated animal graves detection using several techniques from optical remote sensing. Results showed that several spectral indices from hyperspectral and/or multispectral sensors may be used to detect N-enriched vegetation. Thermal imagery was also effective to detect underground voids through differential thermography, although this was only effective for detecting large graves with bare terrain. Lastly, while dense pointclouds reconstructed from oblique aerial photography was able to detect vegetation regrowth over the pits, the terrain subsidence was not sufficiently large to be detected with this technique, even in the case of mechanical removal of vegetation.

Paciente afectado de psoriasis, quien desarrolla una enfermedad ampollar intercurrente: a propósito de un caso

RESUMEN La asociación y coexistencia de psoriasis en placas y penfigoide ampollar (Psoriasis-PA) es una variante clínica poco frecuente. Predomina en el sexo masculino, después de los 60 años de edad. En general, los pacientes ya cuentan con el antecedente de psoriasis y posteriormente se agrega la enfermedad ampollar, con un intervalo promedio de 20 años. Aunque la etiopatogenia aún no se encuentra del todo establecida, se identifican factores desencadenantes tales comoPUVA, fármacos e infecciones. Las opciones terapéuticas consisten en esquemas de monoterapia obiterapia con asociación de corticoesteroides orales e inmunosupresores como el metotrexato (MTX) con evolución favorable en la mayoría de los casos. Se presenta el caso de un paciente masculino, de 52 años de edad con psoriasis vulgar de tres años de evolución y lareciente aparición de penfigoide ampollar.

ABSTRACT The association and coexistence of plaque psoriasis and bullous pemphigoid is a rare clinical variant. It predominates in the male sex, after 60 years old. In general, patients already have a history of psoriasis and then bullous disease is added, with an average interval of 20 years. Although the pathogenesis is not yet fully established, it identifies triggers such as PUVA, drugs, and infections. Therapeutic options consist of monotherapy or combination regimens of systemic corticosteroids and other immunosuppressants such as methotrexate, with favorable evolution in most cases. We present the case of a 52-year-old male patient with 3-year history of vulgar psoriasis and recent appearance of bullous pemphigoid.

Atrapamiento mesentérico como manifestación inicial de metástasis de carcinoma sarcomatoide pleomórfico de pulmón / Mesenteric involvement as the initial manifestation of pleomorphic sarcomatoid lung carcinoma metastasis

Mujer de 69 años no fumadora, que acude a urgencias por dolor abdominal, intolerancia oral y síndrome constitucional. Se solicita TAC identificando adenopatías axilares, mediastínicas y mesentéricas, derrame pleural bilateral, obstrucción ureteral derecha y lesión ósea blástica en D12 compatible con metástasis, sin objetivar tumor primario. La evolución clínica fue desfavorable, precisando nuevo TAC, observándose cambio de calibre en íleon terminal sin visualizar causa obstructiva. Se decide intervención quirúrgica, objetivándose dilatación intestinal, engrosamiento mesentérico, con obstrucción ileal adyacente a válvula íleocecal, secundaria a tumoración mesentérica retroperitoneal, realizándose hemicolectomía derecha. El diagnóstico anatomopatológico fue de metástasis de carcinoma pulmonar tipo sarcomatoide en su variante pleomórfica, hallazgo excepcional por lo infrecuente de la diseminación mesentérica de estos tumores. Había afectación de 15 ganglios mesentéricos, positividad en la citología del derrame pleural y de ganglios axilares. La paciente presentaba una diseminación peritoneal. Dado el mal pronóstico, se decidió quimioterapia paliativa (Carboplatino-Paclitaxel) (AU)

A 69 year-old women, non-smoker, who came to the emergency for abdominal pain, oral intolerance and constitutional syndrome. A CT scan identified axillary, mediastinal and mesenteric lymphadenopathy, bilateral pleural effusion, right ureteral obstruction and blast bone metastasis lesion in D12, without observing a primary tumor. The clinical course was unfavorable, requiring new CT scan, where a change in caliber in terminal ileum was observed without an obstructive cause. Surgical intervention was proposed, intestinal dilation and mesenteric thickening were found, with ileal obstruction adjacent to the ileocecal valve, secondary to a retroperitoneal mesenteric tumor, a right hemicolectomy was performed. The pathological diagnosis was pleomorphic sarcomatoid lung carcinoma metastasis. This finding is exceptional due to the infrequency of the mesenteric dissemination of these tumors. There were involvement of 15 mesenteric lymph nodes, positive cytology of the pleural effusion and axillary lymph nodes. Due to the bad prognosis, palliative chemotherapy (Carboplatin-Paclitaxel) was proposed (AU)

miR-146a rs2431697 identifies myeloproliferative neoplasm patients with higher secondary myelofibrosis progression risk.

Myelofibrosis (MF) occurs as part of the natural history of polycythemia vera (PV) and essential thrombocythemia (ET), and remarkably shortens survival. Although JAK2V617F and CALR allele burden are the main transformation risk factors, inflammation plays a critical role by driving clonal expansion toward end-stage disease. NF-κB is a key mediator of inflammation-induced carcinogenesis. Here, we explored the involvement of miR-146a, a brake in NF-κB signaling, in MPN susceptibility and progression. rs2910164 and rs2431697, that affect miR-146a expression, were analyzed in 967 MPN (320 PV/333 ET/314 MF) patients and 600 controls. We found that rs2431697 TT genotype was associated with MF, particularly with post-PV/ET MF (HR = 1.5; p < 0.05). Among 232 PV/ET patients (follow-up time=8.5 years), 18 (7.8%) progressed to MF, being MF-free-survival shorter for rs2431697 TT than CC + CT patients (p = 0.01). Multivariate analysis identified TT genotype as independent predictor of MF progression. In addition, TT (vs. CC + CT) patients showed increased plasma inflammatory cytokines. Finally, miR-146a-/- mice showed significantly higher Stat3 activity with aging, parallel to the development of the MF-like phenotype. In conclusion, we demonstrated that rs2431697 TT genotype is an early predictor of MF progression independent of the JAK2V617F allele burden. Low levels of miR-146a contribute to the MF phenotype by increasing Stat3 signaling.

Single-Nucleotide Polymorphism Analysis to Select Conserved Regions for an Improved Real-Time Reverse Transcription-PCR Test Specific for Newcastle Disease Virus.

A bioinformatics approach using single-nucleotide polymorphism (SNP) analysis was performed to improve the current real-time reverse transcription-PCR (RRT-PCR) tests for the rapid detection of Newcastle disease virus (NDV). In total, 422 NDV complete genomes were analyzed using the Virus Pathogen Resource to compare the conservation of the primer and probe sequences and to select regions to develop new RRT-PCR tests. The sensitivity and specificity of the three new RRT-PCR tests targeting the nucleoprotein (NP) and polymerase (L) genes were optimized and were compared with established tests for NDV detection. The SNP analysis was also used to identify the number of mismatches between selected primers/probes and the NDV complete genome sequences. The SNP analysis, averaged over the entire primer or probe, showed the primer/probe sequences of three new tests were more conserved than the primer/probe sequences of the commonly used test targeting the matrix (M) gene. The M RRT-PCR test was compared with the new tests on a panel of 46 viruses, comprising 31 NDV isolates. Limit of detection (LOD) varied from 1.3 to 3.7 log 50% egg-infective doses using five isolates from different genotypes by all tests. The two RRT-PCR tests targeting the L and M genes detected three out of five isolates with the lowest LOD. The NP and M RRT-PCR tests had the lowest and highest rates of genetic variants, respectively, among all probes. Because currently used tests are likely to miss some isolates, the availability of validated alternative tests provides alternatives for detection of viral variants that can be rapidly deployed to diagnostic laboratories.

Análisis del polimorfismo de un nucleótido simple para seleccionar regiones conservadas para establecer prueba mejoradas de transcripción reversa y PCR en tiempo real específicas para el virus de la enfermedad de Newcastle. Se llevó a cabo un enfoque bioinformático utilizando el análisis del polimorfismo de un nucleótido simple (SNP) para mejorar las pruebas actuales de transcripción reversa y PCR en tiempo real (RRT-PCR) para la detección rápida del virus de la enfermedad de Newcastle (NDV). Se analizaron un total de 422 genomas completos del virus de Newcastle utilizando la base de datos llamada Recursos en Patógenos Virales (Virus Pathogen Resource) para comparar la conservación de las secuencias de iniciadores y de sondas y para seleccionar regiones adecuadas para desarrollar nuevas pruebas de transcripción reversa y PCR en tiempo real. La sensibilidad y especificidad de las tres nuevas pruebas dirigidas a los genes de la nucleoproteína (NP) y de la polimerasa (L) se optimizaron y se compararon con las pruebas establecidas para la detección del virus de Newcastle. El análisis del polimorfismo de un nucleótido simple también se usó para identificar el número de discrepancias entre los iniciadores y sondas seleccionados con las secuencias completas del genoma del virus de Newcastle. El análisis del polimorfismo de un nucleótido simple, promediado sobre el iniciador o sonda completos, mostró que las secuencias de iniciadores y sondas de las tres pruebas nuevas estaban más conservadas que las secuencias de iniciadores y sondas de la prueba comúnmente utilizada dirigida al gene de la matriz (M). La prueba dirigida para la matriz se comparó con las pruebas nuevas mediante un panel de 46 virus, que comprendió 31 virus de Newcastle. El límite de detección (LOD) mostró un rango de 1.3 a 3.7 logaritmos de dosis infecciosas de embrión de pollo 50% usando cinco aislamientos de diferentes genotipos en todas las pruebas. Las dos pruebas dirigidas a los genes L y M detectaron tres de cinco aislamientos con los límites de detección más bajos. Las pruebas dirigidas a los genes NP y M mostraron las tasas más bajas y las más altas de variantes genéticas, respectivamente, de entre todas las sondas. Debido a que es probable que las pruebas utilizadas actualmente pueden omitir algunos aislamientos, la disponibilidad de pruebas alternativas validadas proporciona alternativas para la detección de variantes virales que se pueden establecer rápidamente en los laboratorios de diagnóstico.

¿Es útil la ecografía como primera prueba diagnóstica en la sospecha de diverticulitis aguda? / Is it useful ultrasonography as the first-line imaging technique in patients with suspected acute diverticulitis?

La demanda creciente de estudios de tomografía computarizada confronta con las restricciones cada vez más claras que imponen la legislación y la buena praxis al empleo de radiaciones ionizantes. Un paradigma de ello es el diagnóstico de la diverticulitis aguda, para el que cada vez más se exigen estudios de tomografía computarizada justificándolos en las necesidades clínicas y una mayor fiabilidad respecto a la ecografía. El presente trabajo revisa la evidencia científica sobre la validez diagnóstica de la ecografía y la tomografía computarizada en el diagnóstico de la diverticulitis aguda de colon

The growing demand for computed tomography studies clashes with the restrictions on the use of ionizing radiation that are being reflected more and more clearly in good practice guidelines and legislation. One paradigmatic example is the diagnosis of acute diverticulitis, for which a increasing amount of computed tomography studies are being demanded with the justification that they are clinically necessary and more reliable than ultrasound studies. The present paper reviews the scientific evidence about the diagnostic validity of ultrasonography and computed tomography in the diagnosis of acute diverticulitis of the colon

Is it useful ultrasonography as the first-line imaging technique in patients with suspected acute diverticulitis? / ¿Es útil la ecografía como primera prueba diagnóstica en la sospecha de diverticulitis aguda?

The growing demand for computed tomography studies clashes with the restrictions on the use of ionizing radiation that are being reflected more and more clearly in good practice guidelines and legislation. One paradigmatic example is the diagnosis of acute diverticulitis, for which a increasing amount of computed tomography studies are being demanded with the justification that they are clinically necessary and more reliable than ultrasound studies. The present paper reviews the scientific evidence about the diagnostic validity of ultrasonography and computed tomography in the diagnosis of acute diverticulitis of the colon.

Armoured exogenous internal control for real-time PCR diagnosis of avian influenza.

An exogenous "armoured" PCR internal control (IC) short RNA was analyzed in conjunction with real-time RT-PCR method for diagnosis of avian influenza. The resistance to nucleases and increased physical stability of the IC was ensured using branched polyethyleneimine (PEI) which was in complex with IC-RNA. The option to add the IC directly to pathological material suspensions allows measurement of the nucleic acids extraction efficiency. Stability of armoured RNA-IC during storage and tissue suspension preparation was shown. The advantage of exogenous "armoured" IC was demonstrated in the experiment with AIV genome detection by qPCR in samples from different species of wild birds. The exogenous IC gave reproducible homogeneous Ct values in all tests.

Presence of Newcastle disease viruses of sub-genotypes Vc and VIn in backyard chickens and in apparently healthy wild birds from Mexico in 2017.

Virulent Newcastle disease viruses (NDV) have been present in Mexico since 1946, and recently, multiple outbreaks have been reported in the country. Here, we characterized eleven NDV isolated from apparently healthy wild birds and backyard chickens in three different locations of Jalisco, Mexico in 2017. Total RNA from NDV was reverse-transcribed, and 1285 nucleotides, which includes 3/4 of the fusion gene, was amplified and sequenced using a long-read MinION sequencing method. The sequences were 99.99-100% identical to the corresponding region obtained using the Illumina MiSeq. Phylogenetic analysis using MinION sequences demonstrated that nine virulent NDV from wild birds belonged to sub-genotypes Vc and VIn, and two backyard chicken isolates were of sub-genotype Vc. The sub-genotype Vc viruses had nucleotide sequence identity that ranged from 97.7 to 98% to a virus of the same sub-genotype isolated from a chicken in Mexico in 2010. Three viruses from pigeons had 96.3-98.7% nucleotide identity to sub-genotype VIn pigeon viruses, commonly referred to as pigeon paramyxovirus, isolated in the USA during 2000-2016. This study demonstrates that viruses of sub-genotype Vc are still present in Mexico, and the detection of this sub-genotype in both chickens and wild birds suggests that transmission among these species may represent a biosecurity risk. This is the first detection and complete genome sequencing of genotype VI NDV from Mexico. In addition, the utilization of an optimized long-read sequencing method for rapid virulence and genotype identification using the Oxford nanopore MinION system is demonstrated.

Age-dependent pathogenesis of clade 2.3.4.4A H5N2 HPAIV in experimentally infected Broad Breasted White turkeys.

Highly pathogenic avian influenza (HPAI) is a viral disease with devastating consequences to the poultry industry as it results in high morbidity, mortality and international trade restrictions. In the present study, we characterized age-related differences in terms of pathology in commercial white broad breasted turkeys inoculated with A/turkey/Minnesota/12582/2015 (H5N2) HPAIV clade 2.3.4.4A, a virus from the largest HPAI poultry outbreak that affected the Unites States in 2014-2015. Turkeys infected at 6-weeks of age showed inapparent to little clinical signs with rapid disease progression, reaching 100% mortality at 3 days post infection (dpi). In contrast, turkeys infected at 16-weeks of age developed ataxia and lethargy and reached 100% mortality by 5 dpi. Infection in the 6-weeks old turkeys resulted in peracute lesions consistent of extensive hemorrhages, edema and necrosis, but inflammation was not prominent. In the 16-weeks old turkeys, necrosis and hemorrhages in tissues were accompanied by a more prominent subacute inflammatory infiltrate. Both age groups showed presence of avian influenza virus (AIV) nucleoprotein (NP) in multiple cell types including neurons, glial cells, ependymal cells, respiratory epithelial cells, air capillary epithelium and pulmonary macrophages, cardiac myocytes, smooth muscle fibers, pancreatic acini and ductal cells. Cells of the vascular walls stained strongly positive for viral antigens, but no positivity was found in the endothelial cells of any organs. These findings indicate that age is a determinant factor in the progression of the disease and delay of mortality during infection with the H5N2 clade 2.3.4.4A HPAI virus in naïve white broad breasted turkeys.

Optimal phase space sampling for Monte Carlo simulations of Heisenberg spin systems.

We present an adaptive algorithm for the optimal phase space sampling in Monte Carlo simulations of 3D Heisenberg spin systems. Based on a golden rule of the Metropolis algorithm which states that an acceptance rate of [Formula: see text] is ideal to efficiently sample the phase space, the algorithm adaptively modifies a cone-based spin update method keeping the acceptance rate close to [Formula: see text]. We have assessed the efficiency of the adaptive algorithm through four different tests and contrasted its performance with that of other common spin update methods. In systems at low and high temperatures and anisotropies, the adaptive algorithm proved to be the most efficient for magnetization reversal and for the convergence to equilibrium of the thermal averages and the coercivity in hysteresis calculations. Thus, the adaptive algorithm can be used to significantly reduce the computational cost in Monte Carlo simulations of 3D Heisenberg spin systems.

Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis.

BACKGROUND: Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. METHODS: For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. RESULTS: Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39-0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50-0.78), major bleeding (risk ratio 0.61, 95% CI 0.39-0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47-0.92), and access site complications (risk ratio 0.66, 95% CI 0.51-0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57-1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59-1.28), stroke (risk ratio 0.77, 95% CI 0.59-1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29-2.02), or amputations (OR 0.75, 95% CI 0.53-1.05). CONCLUSION: Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.

CCR-CARESS score for predicting operative mortality in patients with colorectal cancer.

BACKGROUND: The aim of this study was to assess factors associated with outcomes after surgery for colorectal cancer and to design and internally validate a simple score for predicting perioperative mortality. METHODS: Patients undergoing surgery for primary invasive colorectal cancer in 22 centres in Spain between June 2010 and December 2012 were included. Clinical variables up to 30 days were collected prospectively. Multiple logistic regression techniques were applied and a risk score was developed. The Hosmer-Lemeshow test was applied and the area under the receiver operating characteristic (ROC) curve (AUC, with 95 per cent c.i.) was estimated. RESULTS: A total of 2749 patients with a median age of 68·5 (range 24-97) years were included; the male : female ratio was approximately 2 : 1. Stage III tumours were diagnosed in 32·6 per cent and stage IV in 9·5 per cent. Open surgery was used in 39·3 per cent, and 3·6 per cent of interventions were urgent. Complications were most commonly infectious or surgical, and 25·5 per cent of patients had a transfusion during the hospital stay. The 30-day postoperative mortality rate was 1·9 (95 per cent c.i. 1·4 to 2·4) per cent. Predictive factors independently associated with mortality were: age 80 years or above (odds ratio (OR) 2·76), chronic obstructive pulmonary disease (COPD) (OR 3·62) and palliative surgery (OR 10·46). According to the categorical risk score, a patient aged 80 years or more, with COPD, and who underwent palliative surgery would have a 23·5 per cent risk of death within 30 days of the intervention. CONCLUSION: Elderly patients with co-morbidity and palliative intention of surgery have an unacceptably high risk of death.

Conocimientos en materia de radioprotección en radiólogos del noroeste de España / Radiation protection knowledge among radiologists in northwest Spain

Objetivos: Estimar el nivel de conocimientos de los radiólogos y su implicación en el uso de medidas de radioprotección. Métodos: Se realizó una encuesta anónima y supervisada durante una reunión de trabajo. Resultados: De los 65 cuestionarios facilitados, se devolvieron 63. En líneas generales, los radiólogos consideraron su nivel de conocimientos como bajo, y quedó estadísticamente demostrado (p = 0,018) que el nivel de conocimientos que creían tener guardaba relación con el número de respuestas correctas. También guardaba relación (p < 0,05) con los años de experiencia, y era más alto en aquellos más experimentados. Conclusiones: Hay un importante margen de mejora en el nivel de conocimientos en materia de radioprotección

Objectives: To estimate radiologists¿ level of knowledge of and their implication in radioprotection. Methods: An anonymous and supervised survey was conducted during a work meeting. Results: Of the 65 questionnaires handed out, 63 were returned. In general, the radiologists surveyed considered their level of knowledge to be low, and it was statistically demonstrated (P = 0.018) that the level of knowledge they believed they had was related to the number of correct answers. The level of knowledge that radiologists believed they had was also related (p < 0.05) with the years of experience, and it was higher in the more experienced radiologists. Conclusions: There is an important margin of improvement in knowledge about radiation protection