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2.
Circ Cardiovasc Interv ; 14(2): e009342, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33541099

RESUMO

BACKGROUND: Limited data are available regarding change in the nutritional status after transcatheter aortic valve replacement (TAVR). This study evaluated the prognostic impact of the change in the geriatric nutritional risk index following TAVR. METHODS: TAVR patients were analyzed in a prospective and observational study. To analyze the change in nutritional status, geriatric nutritional risk index of the patients was calculated on the day of TAVR and at 3-month follow-up. The impact of the change in nutritional risk index after TAVR on all-cause mortality, heart failure hospitalization (HF-h), and the composite of all-cause death and HF hospitalization was analyzed using the Cox Proportional Hazards model. RESULTS: Four hundred thirty-three patients were included. After TAVR, 68.4% (n=182) patients with baseline nutritional risk improved compared with 31.6% (n=84) who remained at nutritional risk. The change from no-nutritional risk to nutritional risk after TAVR occurred in 15.0% (n=25), while 85.0% (n=142) remained without risk of malnutrition. During follow-up, 157 (36.3%) patients died and 172 patients (39.7%) were hospitalized due to HF. Patients who continued to be at nutritional risk had a higher risk of mortality (hazard ratio [HR], 2.10 [95% CI, 1.30-3.39], P=0.002), HF-h (HR, 1.97 [95% CI, 1.26-3.06], P=0.000), and the composite of death and HF-h (HR, 2.0 [95% CI, 1.37-2.91], P<0.001). The change to non-nutritional risk after TAVR significantly impacted mortality (HR, 0.48 [95% CI, 0.30-0.78], P=0.003), HF-h (HR, 0.50 [95% CI, 0.34-0.74], P=0.001), and the composite outcome (HR, 0.44 [95% CI, 0.32-0.62], P<0.001). CONCLUSIONS: Remaining at nutritional risk after TAVR confers a poor prognosis and is associated with an increased risk of mortality and HF-h, while the change from risk of malnutrition to non-nutritional risk after TAVR was associated with a halving of the risk of mortality and HF-h. Further studies are needed to identify whether patients at nutritional risk would benefit from nutritional intervention during processes of care of TAVR programs.

3.
mBio ; 12(1)2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563828

RESUMO

Penicillium digitatum is the most aggressive pathogen of citrus fruits. Tryptoquialanines are major indole alkaloids produced by P. digitatum It is unknown if tryptoquialanines are involved in the damage of citrus fruits caused by P. digitatum. To investigate the pathogenic roles of tryptoquialanines, we initially asked if tryptoquialanines could affect the germination of Citrus sinensis seeds. Exposure of the citrus seeds to tryptoquialanine A resulted in a complete inhibition of germination and an altered metabolic response. Since this phytotoxic effect requires the extracellular export of tryptoquialanine A, we investigated the mechanisms of extracellular delivery of this alkaloid in P. digitatum We detected extracellular vesicles (EVs) released by P. digitatum both in culture and during infection of citrus fruits. Compositional analysis of EVs produced during infection revealed the presence of a complex cargo, which included tryptoquialanines and the mycotoxin fungisporin. The EVs also presented phytotoxicity activity in vitro and caused damage to the tissues of citrus seeds. Through molecular networking, it was observed that the metabolites present in the P. digitatum EVs are produced in all of its possible hosts. Our results reveal a novel phytopathogenic role of P. digitatum EVs and tryptoquialanine A, implying that this alkaloid is exported in EVs during plant infection.IMPORTANCE During the postharvest period, citrus fruits can be affected by phytopathogens such as Penicillium digitatum, which causes green mold disease and is responsible for up to 90% of total citrus losses. Chemical fungicides are widely used to prevent green mold disease, leading to concerns about environmental and health risks. To develop safer alternatives to control phytopathogens, it is necessary to understand the molecular basis of infection during the host-pathogen interaction. In the P. digitatum model, the virulence strategies are poorly known. Here, we describe the production of phytotoxic extracellular vesicles (EVs) by P. digitatum during the infection of citrus fruits. We also characterized the secondary metabolites in the cargo of EVs and found in this set of molecules an inhibitor of seed germination. Since EVs and secondary metabolites have been related to virulence mechanisms in other host-pathogen interactions, our data are important for the comprehension of how P. digitatum causes damage to its primary hosts.

4.
Nefrologia ; 2021 Jan 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33422301

RESUMO

BACKGROUND: This study focuses on the main complication associated with peritoneal dialysis, peritonitis. Its relevance derives from its high morbidity, the negative effect it has on the peritoneum as a dialysis membrane and its financial cost. METHODS: Analytical, non-interventional, observational cohort study, whose main objective is the analysis of peritonitis in patients on peritoneal dialysis in Andalusia from 1 January 1999 to 31 December 2017, with a total of 2,904 peritonitis cases. The database used is the Andalusian Autonomous Transplant Coordination Information System (SICATA). OBJECTIVES: To ascertain how the rate of peritonitis is evolving in our community, analyse descriptive data pertaining to patients and peritonitis, ascertain the course of these infectious complications and analyse the factors that influence these cases of peritonitis and their outcomes: germ, hospitalisation and date. RESULTS: The rate of peritonitis decreased progressively during the study period, from 0.7 peritonitis per patient in 1999 to 0.33 at the end of the period. Most infections were treated on an outpatient basis (72.5%). The most common germs were Gram-positive (55.9%), including coagulase-negative staphylococci (28.1%). Most cases of peritonitis progressed to healing (77.8%). The factors that significantly influence the need for hospitalisation and peritonitis progression were the causative germ and associated exit site infection. CONCLUSIONS: In our population, the rate of peritonitis decreased progressively during the study period, meeting guideline recommendations.

5.
Ann Vasc Surg ; 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33493593

RESUMO

OBJECTIVES: This study aims to report the changes and adaptations of a vascular tertiary center during a global pandemic and the impact on its activity and patients. METHODS: We conducted a retrospective cohort study within the Vascular Surgery ward in Centro Hospitalar Universitário Lisboa Norte, Portugal. All data from surgical, inpatient and outpatient activity were collected from February to June 2020 and compared to the same 5-month period in 2018 and 2019. We ran a descriptive analysis of all data and performed statistical tests for the variation of procedures and admissions between February and June 2018 and the same time period in 2020. RESULTS: During the outbreak, our staff had to be readapted. Six nurses were transferred to COVID-19 units (out of a total of 33 nurses) while 1 of the 7 residents was transferred to an intensive care unit and 1 senior surgeon was put on prophylactic leave. In the outpatient clinic, there was an increase in the number of telemedicine consultations with a greater focus on first-time referrals and urgent cases. There was a significant increase in the total number of elective admissions whereas there were significantly less admissions from an emergency setting (+57% and -54%, respectively, P < 0.001). The vascular surgery team performed a total number of 584 procedures between February and June 2020 (-17.8% compared to 2018 and 2019), with a significant increase in the number of endovascular procedures (P < 0.001) and in the use of local and regional anesthesia (P < 0.001), especially in the Angio Suite (+600%, P < 0.001). Comparing with 2018 and 2019, the surgical team performed less outpatient procedures in early 2020. We reported a significant increase in the total number of procedures for patients with a chronic limb-threatening ischemia (CLTI) diagnosis (+21%, P < 0.001). We did not report significant changes in the proportion of other vascular conditions. Regarding mortality, we observed a 16% decrease in the intraoperative mortality (P 0.67). CONCLUSIONS: In this study, we assessed the impact of the COVID-19 outbreak in daily activity during the contingency period. During the outbreak, there was an overall decline in outpatient clinics and inpatient admissions. Nevertheless, and despite the restrictions imposed by the pandemic and health authorities, we managed to maintain most procedures for most vascular diseases, particularly for CLTI urgent cases, without a significant increase in the mortality rate. Stringent protective measures for patient and staff or higher use of endovascular techniques and local anesthesia are some of the successful changes implemented in the department. These learned lessons are to be pursued as the pandemic evolves with future outbreaks of COVID-19, such as the current second outbreak currently spreading through Europe.

7.
J Vasc Surg ; 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33348004

RESUMO

INTRODUCTION: Vascular graft infections are a serious complication in vascular surgery. Correct antibiotic therapy targeted to the most likely infecting species is essential to manage these patients, although bacterial epidemiology and pathogenesis are still not completely understood. We aimed at analyzing the behavior of vascular graft infections and the microbiological patterns of resistance. MATERIAL AND METHODS: A ten-year (2008-2018) single-center retrospective cohort study of all patients admitted with vascular graft infection identified in positive direct graft cultures was performed. An extensive microbiological study was performed analyzing bacterial strains, antibiotic resistance and sensitivity, and prevalence according to each year. RESULTS: Seventy-two vascular graft infections with positive graft cultures occurring in 65 patients were found. Mean age was 67 (SD:9.6) years and 85% were male. Infection related mortality was 11%. Fourteen patients had been submitted to aorto-bi-femoral bypass, 13 to axillo-femoral bypass, 5 to femoro-femoral bypass, 27 to femoro-popliteal bypass, 4 to femoral endarterectomy with synthetic patch angioplasty. The median time from the index procedure to infection was higher in intracavitary versus extracavitary grafts (p= .011). Of all infections, 48 were monomicrobial and 24 were polymicrobial. Gram-negative bacteria were predominantly identified in intracavitary graft infections (54%) whereas in the extracavitary group gram-positive bacteria were most frequent (58%). Multi-resistant bacterial species occurred more frequently in early graft infections (p= .002). Throughout the duration of the study, an overall decrease in gram-positive infections and an increase in gram-negative infections was observed, especially in strains that were extensively drug resistant. A similar progression was found in all nosocomial infections. CONCLUSION: The present study showed that vascular graft infection microbiology changed according to graft locations, time of infection since revascularization surgery and also evolved over the years with similar patterns as all nosocomial infections. This highlights the importance of studying the specific microbiology of each health center and its relationship with vascular graft infections in order to achieve the best treatment possible.

8.
Front Oncol ; 10: 594023, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33224888

RESUMO

The prostatic tumor cells plasticity is involved in resistance to hormone-therapy, allowing these cells to survive despite androgen receptor inhibition. However, its role in taxanes resistance has not been fully established. Gene expression of plasticity-related phenotypes such as epithelial-mesenchymal transition (EMT), stem cell-like and neuroendocrine (NE) phenotypes was studied in vitro, in silico, in circulating tumor cells (CTCs) (N=22) and in tumor samples (N=117) from taxanes-treated metastatic castration-resistant prostate cancer (mCRPC) patients. Docetaxel (D)-resistant cells presented a more pronounced EMT phenotype than cabazitaxel (CZ)-resistant cells. In silico analysis revealed ESRP1 down-regulation in taxane-exposed mCRPC samples. Cell plasticity-related changes occurred in CTCs after taxanes treatment. Tumor EMT phenotype was associated with lower PSA progression-free survival (PFS) to D (P<0.001), and better to CZ (P=0.002). High ESRP1 expression was independently associated with longer PSA-PFS (P<0.001) and radiologic-PFS (P=0.001) in D and shorter PSA-PFS in the CZ cohort (P=0.041). High SYP expression was independently associated with lower PSA-PFS in D (P=0.003) and overall survival (OS) in CZ (P=0.002), and high EZH2 expression was associated with adverse OS in D-treated patients (P=0.013). In conclusion, EMT profile in primary tumor is differentially associated with D or CZ benefit and NE dedifferentiation correlates with adverse taxanes clinical outcome.

9.
Ann Transl Med ; 8(19): 1279, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33178811

RESUMO

Management of asymptomatic carotid disease continues to challenge medical practice and present evidence is often conflicting. Stroke is a significant burden in Public Health and 11% to 15% appear as first neurologic event associated with asymptomatic carotid stenosis. Randomized trials provided support for Guidelines and Recommendations to intervene on asymptomatic stenosis, but at a known cost of a high number of unnecessary operations. Conflicting evidence from natural history studies and the widespread use of proper medical management including risk factors control, lowering-lipid drugs and strict control of arterial hypertension have reduced the incidence of strokes associated to asymptomatic carotid disease challenging established practice. Need to identify vulnerable lesions prone to develop thromboembolic brain events and also vulnerable patients at a higher risk of stroke is necessary and essential to further improve effectiveness of our interventions. After review of published literature on natural history of asymptomatic carotid stenosis, diagnostic methods to identify plaque vulnerability and present-day results of both endarterectomy and stenting, a strategy for management of asymptomatic carotid stenosis is suggested aiming to reduce unnecessary interventions and effectively contribute to stroke prevention.

10.
Artigo em Inglês | MEDLINE | ID: mdl-33181305

RESUMO

Fluoroquinolone use has been associated with collagen disease events, raising safety concerns. We hypothesized that the use of fluoroquinolones is associated with aortic aneurysm (AA) and aortic dissection or aortic rupture (AD/AR). We performed a systematic review with meta-analysis on studies published until March 2019. Seven observational studies were included, comprising 2,851,646 participants. The studies were evaluated regarding their risk of bias. Results on fluoroquinolone use risk comparing with nontreatment and with beta-lactam antibiotic use were extracted. The estimates were pooled through a random-effects model meta-analysis and heterogeneity assessed through the I2 statistic. Sensitivity analysis were performed, grouping studies per design and with exclusion of studies with critical risk of bias. Fluoroquinolone use was associated with a higher risk of AA/AD/AR, comparing with a nontreatment intervention (odds ratio = 2.26; 95%CI 1.93-2.65; I2 = 30%) and comparing with a beta-lactam intervention (odds ratio = 1.56; 95%CI 1.37-1.79; I2 = 0%). This harm effect remained significant when pooling the results for the AD/AR outcome only and across various study designs. Studies comparing with beta-lactam intervention were considered to have a moderate risk of bias, while the remaining ones were classified as having at least a serious risk of bias. All evaluated outcomes had very low Grading of Recommendation, Assessment, Development and Evaluation evidence. Fluoroquinolone use was associated with a significant risk of AA/AD/AR.

12.
J Am Heart Assoc ; 9(21): e017468, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33103575

RESUMO

Background The prevalence of thoracic aortic aneurysms (TAA) in patients with known abdominal aortic aneurysms (AAA) is not well known and understudied. Our aim was to conduct a systematic review and meta-analysis of the overall prevalence of synchronous and metachronous TAA (SM-TAA) in patients with a known AAA and to understand the characteristics of this sub-population. Methods and Results We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) from inception to November 2019 for all population-based studies reporting on the prevalence of SM-TAAs in a cohort of patients with AAA. Article screening and data extraction were performed by 2 authors and data were pooled using a random-effects model of proportions using Freeman-Tukey double arcsine transformation. The main outcome was the prevalence of SM-TAAs in patients with AAAs. Secondary outcomes were the prevalence of synchronous TAAs, metachronous TAAs, prevalence of TAAs in patients with AAA according to the anatomic location (ascending, arch, and descending) and the differences in prevalence of these aneurysms according to sex and risk factors. Six studies were included. The pooled-prevalence of SM-TAA in AAA patients was 19.2% (95% CI, 12.3-27.3). Results revealed that 15.2% (95% CI, 7.1-25.6) of men and 30.7% (95% CI, 25.2-36.5) of women with AAA had an SM-TAA. Women with AAA had a 2-fold increased risk of having an SM-TAA than men (relative risk [RRs], 2.16; 95% CI, 1.32-3.55). Diabetes mellitus was associated with a 43% decreased risk of having SM-TAA (RRs, 0.57; 95% CI, 0.41-0.80). Conclusions Since a fifth of AAA patients will have an SM-TAA, routine screening of SM-TAA and their clinical impact should be more thoroughly studied in patients with known AAA.

13.
Rev Esp Cardiol ; 73(12): 994-1002, 2020 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-33071427

RESUMO

Introduction and objectives: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. Methods: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. Results: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. Conclusions: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

14.
Braz J Cardiovasc Surg ; 35(5): 781-788, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33118744

RESUMO

We performed a review of the literature (until August 01, 2019) on the occasion of the first transcaval approach for transcatheter aortic valve implantation in our hospital. This review focuses mainly on the indications of this alternative access route to the aorta. It may be useful for vascular surgeons in selected cases, such as the treatment of endoleaks after endovascular aneurysm repair and thoracic endovascular aneurysm repair. We describe historical aspects of transcaval access to the aorta, experimental studies, available case series and outcomes. Finally, we summarize the most significant technical aspects of this little-known access.

15.
Rev. bras. cir. cardiovasc ; 35(5): 781-788, Sept.-Oct. 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS, Sec. Est. Saúde SP | ID: biblio-1137328

RESUMO

Abstract We performed a review of the literature (until August 01, 2019) on the occasion of the first transcaval approach for transcatheter aortic valve implantation in our hospital. This review focuses mainly on the indications of this alternative access route to the aorta. It may be useful for vascular surgeons in selected cases, such as the treatment of endoleaks after endovascular aneurysm repair and thoracic endovascular aneurysm repair. We describe historical aspects of transcaval access to the aorta, experimental studies, available case series and outcomes. Finally, we summarize the most significant technical aspects of this little-known access.

16.
Int. j. morphol ; 38(5): 1192-1196, oct. 2020. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1134423

RESUMO

RESUMEN: La comunicación Ulnar-Mediano Palmar Profunda (CUMPP) es la conexión entre la rama profunda del nervio ulnar (NU) y la rama del nervio mediano (NM) que inerva a los músculos tenares como la cabeza superficial del flexor corto del pulgar. Son escasos los trabajos que se ocupan de esta rama comunicante, y su prevalencia es reportada con una amplia variabilidad, en un rango del 16-77 %. Este estudio no probabilístico, descriptivo, transversal, evaluó la frecuencia y características morfológicas de la CUMPP en 106 manos de especímenes cadavéricos frescos no reclamados, a quienes se les practicó necropsia en el Instituto de Medicina Legal de Bucaramanga (Colombia). Se observó rama comunicante CUMPP en 39 especímenes (50,2 %), de los cuales 12 (44,5 %) fueron bilate- rales, 15 (55,6 %) unilaterales, con predominio unilateral derecho para 9 casos (60 %), sobre el izquierdo de tan solo 6 casos (40 %). No se evidenciaron diferencias estadísticamente significativas con relación al lado de presentación (P=0,223). En 21 especímenes (54 %) se observó el tipo IV; mientras que el tipo I fue encontrado en 4 casos (10 %). El promedio de la longitud de la rama comunicante fue de 24,67 DE 6,46 mm; mientras que la distancia del punto proximal de la CUMPP al surco distal del carpo fue de 41,4 DE 2,6 mm. Nuestros hallazgos no son concordantes con lo reportado en la mayoría de estudios previos. Diversos factores como el tamaño de las muestras, las diferentes metodologías de medición y las expresiones fenotípicas de cada grupo de población evaluado, pueden explicar la variabilidad de la CUMPP.


SUMMARY: Deep Palmar Ulnar-Medium Communication (DPUMC) is the connection between the deep branch of the ulnar nerve (UN) and the median nerve (MN) branch, that innervates the thenar muscles as the superficial head of the short flexor of the thumb. Few studies dealing with this communicating branch, and its prevalence is reported with a wide variability in the range of 16-77 %. This non-probabilistic, descriptive, cross-sectional study; evaluated the frequency and morphological characteristics of DPUMC in 106 hands of fresh unclaimed cadaveric specimens, that underwent necropsy at the Institute of Legal Medicine of Bucaramanga (Colombia). DPUMC communicating branch was observed in 39 specimens (50.2 %), of which 12 (44.5 %) were bilateral, 15 (55.6 %) unilateral, with right unilateral predominance for 9 cases (60 %), on the left of only 6 cases (40 %). There were no statistically significant differences in relation to the presentation side (P = 0.223). In 21 specimens (54%), type IV was observed; while type I was found in 4 cases (10%). The average length of the communicating branch was 24.67 SD 6.46 mm; while the distance from the proximal point of the DPUMC to the distal carpal groove was 41.4 SD 2.6 mm. Our findings are not consistent with those reported in most previous studies. Various factors such as sample size, different measurement methodologies and phenotypic expressions of each population group evaluated can explain the variability of the DPUMC.

17.
Enferm Clin ; 2020 Sep 20.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32962908

RESUMO

OBJECTIVE: The aim of our study is to measure the knowledge of nursing students at the University of Jaén about evidence-based recommendation for the prevention of pressure injuries. METHOD: A cross-sectional observational and validation study was carried in 2019, using an online survey. All the students registered on the Nursing Degree programme of the University of Jaén were invited to participate. The psychometric properties of the Pressure Injury Prevention Knowledge questionnaire (PIPK) were tested by a Rasch analysis. With the analysis, the percentage of correct and wrong answers was calculated, the global score and the association with some educational variables. RESULTS: The PIPK questionnaire showed adequate psychometric characteristics (alpha=.89) and good fit to the Rasch model. The average knowledge score on pressure injury prevention obtained was 21.0 (this is 67.7% of the maximum). Higher scores were obtained by the students that had finished some clinical placements; those with more placements; had attended a meeting about pressure injuries and those in a higher year of the programme. CONCLUSIONS: The PIPK questionnaire is a valid and reliable instrument for measuring the knowledge of nursing students about pressure injuries prevention. The nursing students of the University of Jaén obtained a score in the questionnaire higher than 50%.

18.
BJU Int ; 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32916038

RESUMO

OBJECTIVE: To determine the factors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction. METHODS: We performed a search strategy in the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), the Literatura Latino-Americana e do Caribe em Ciências da Saúde database (LILACS), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included patients with malignant ureteric obstruction, who had a JJ catheter insertion. The studies reported the percentage of failure and risk factors, e.g. bladder invasion or deformity of the trigone, hydronephrosis, renal failure, previous radiotherapy, age, obstruction aetiology, and patient's health status. We performed a meta-analysis using R software ('meta' and 'metafor' libraries). RESULTS: We included nine studies that met the inclusion criteria, with 761 patients and an average age of 60.5 years. The studies assessed the time to failure during the first 30 days. The reported failure rate was 32% (95% confidence interval [CI] 21-45%; I2 = 88%). Regarding risk factors for failure, bladder invasion or deformity of the trigone had a hazard ratio (HR) of 4.8 (95% CI 1.28-8.5; I2 = 97.4%); severe hydronephrosis had a HR of 3.92 (95% CI 0.32-7.52; I2 = 93.9%); and age <65 years had a HR of 0.93 (95% CI 0.8-0.9; I2 = 0%). CONCLUSIONS: We found a high probability of failure for endoscopic urinary decompression in patients with malignant ureteric obstruction. Factors such as bladder invasion or deformity of the trigone and age >65 years had an increased risk of failure.

19.
Rev Esp Cardiol (Engl Ed) ; 73(12): 994-1002, 2020 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32917566

RESUMO

INTRODUCTION AND OBJECTIVES: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. METHODS: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. RESULTS: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. CONCLUSIONS: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

20.
J Fish Biol ; 97(6): 1852-1856, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32914519

RESUMO

Five specimens (four females and one male) of the Gorgona guitarfish, Pseudobatos prahli, were sighted during two dives carried out off the western Gulf of Tehuantepec. This document describes the reproductive condition of three adult females captured, two of which had uterine eggs, whereas one had embryos. The sighting and capture of specimens occurred during two Tehuano wind events; the authors, therefore, believe that variations in temperature and dissolved oxygen could have affected P. prahli, leading it to carry out temporal migrations towards coastal shallow waters.

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