Incidence of pregnancy related pulmonary embolism in Spain 2016-2021: an observational population-based retrospective study.

OBJECTIVE: This study aimed to estimate the overall and annual age-standardized incidence of pregnancy-related pulmonary embolism (PE) in Spain from 2016 to 2021, explore the distribution of PE events during pregnancy and the postpartum period, identify potential risk factors, and estimate mortality rates during hospital admission. METHODS: In a retrospective, observational, population-based study, data from the Spanish National Hospital Discharge Database were analyzed to identify women with hospital episodes of pregnancy-related-PE. The primary outcome was the overall and annual age-standardized incidence of pregnancy-related-PE, with secondary aims including the distribution of events during pregnancy and postpartum and the calculation of age-standardized mortality rates during admission. RESULTS: Among 2,178,805 births from 2016 to 2021, 522 women were diagnosed with pregnancy-related PE, yielding an overall age-standardized incidence of 2.83 cases per 10,000 births. A non-significant increasing trend was observed from 2.43 to 4.18 cases per 10,000 births (p = 0.06). Comorbidities were low, with a notable association between PE and SARS-CoV-2 infection during the last two years. The mortality rate among women with pregnancy-related PE was 2.8%, with a higher incidence of PE reported during the postpartum period. CONCLUSION: The incidence of pregnancy-related-PE in Spain exhibits a non-significant increasing trend, with a significant risk of mortality. The association with SARS-CoV-2 infection underscores the importance of vigilant monitoring and management of pregnant women, particularly during pandemics. This study contributes specific data on the incidence and characteristics of pregnancy-related-PE in Spain, emphasizing the need to consider PE in the differential diagnosis and management strategies for pregnant and postpartum women.

Importance of multimodal imaging diagnostics in acute angle closure glaucoma: Case report.

To describe the natural history and management of an acute angle closure secondary to choroidal melanoma. A 70-year-old female presented with pain, elevated intraocular pressure, mature cataract, and angle closure in right eye. With further studies she was found to have a choroidal melanoma causing the acute angle closure. Enucleation was performed and the patient is currently in close postoperative surveillance by ophthalmology and oncology. The importance of early identification and treatment of intraocular tumors to decrease incidence of metastasis. In secondary acute angle-closure glaucoma treatment should be targeted towards resolving the triggering factor of glaucoma.

Temperature dependence of electrical conductivity and variable hopping range mechanism on graphene oxide films.

The rapid development of optoelectronic applications for optical-to-electrical conversion has increased the interest in graphene oxide material. Here, graphene oxide films (GOF) were used as source material in an infrared photodetector configuration and the temperature dependence of the electrical conductivity was studied. GOF were prepared by the double-thermal decomposition (DTD) method at 973 K, with a fixed carbonization temperature, in a pyrolysis system, under a controlled nitrogen atmosphere, over quartz substrates. Graphene oxide films were mechanically supported in a photodetector configuration on Bakelite substrates and electrically contacted with copper wires and high-purity silver paint. Morphological images from the GOF's surface were taken employing a scanning electron microscope and observed a homogeneous surface which favored the electrical contacts deposition. Vibrational characteristics were studied employing Raman spectroscopy and determined the typical graphene oxide bands. GOF were used to discuss the effect of temperature on the film's electrical conductivity. Current-voltage (I-V) curves were taken for several temperatures varying from 20 to 300 K and the electrical resistance values were obtained from 142.86 to 2.14 kΩ. The GOF electrical conductivity and bandgap energy (Eg) were calculated, and it was found that when increasing temperature, the electrical conductivity increased from 30.33 to 2023.97 S/m, similar to a semiconductor material, and Eg shows a nonlinear change from 0.33 to 0.12 eV, with the increasing temperature. Conduction mechanism was described mainly by three-dimensional variable range hopping (3D VRH). Additionally, measurements of voltage and electrical resistance, as a function of wavelength were considered, for a spectral range between 1300 and 3000 nm. It was evidenced that as the wavelength becomes longer, a greater number of free electrons are generated, which contributes to the electrical current. The external quantum efficiency (EQE) was determined for this proposed photodetector prototype, obtaining a value of 40%, similar to those reported for commercial semiconductor photodetectors. This study provides a groundwork for further development of graphene oxide films with high conductivity in large-scale preparation.

Gene-specific promoter methylation is associated with micronuclei frequency in urothelial cells from individuals exposed to organic solvents and paints.

Sufficient epidemiologic evidence has established an etiologic link between bladder cancer risk and occupational exposure as a painter to organic solvents. Currently, it remains to be established whether gene-specific promoter methylation contributes to bladder cancer development, including by enhancing chromosome breakage or loss. We investigated the effect of chronic exposure to organic solvents and paints on DNA methylation profiles in the promoter regions of four genes (GSTP1, p16(INK4a), APC and CDH1) and micronucleus (MN) frequency in exfoliated urothelial cells from voided urine from Colombian male non-smoking car painters and age-matched unexposed individuals. The exposed group had a higher percentage of individuals with >2 MNs/2000 cells compared with the unexposed group (P=0.04). Gene-specific analysis showed a significantly higher percentage of individuals with methylated GSTP1, p16(INK4a) and APC in the exposed group. Poisson regression analysis indicated that exposed individuals with methylated GSTP1 and p16(INK4a) promoters were more than twofold more likely to have an increase in MN frequency as compared with the reference. Finally, among exposed individuals with GSTP1 and p16(INK4a) methylated promoters, those with a greater age had a higher RR of increased MN frequency compared with younger exposed individuals with methylated promoters. These results support the conclusion that gene-specific promoter methylation may increase MN frequency in a dependent or independent interaction with occupational exposure to organic solvents.

Pharmacokinetics, immunogenicity, and efficacy of dimeric TNFR binding proteins in healthy and bacteremic baboon.

Immunogenicity, pharmacokinetics, and therapeutic efficacy of three novel dimeric soluble tumor necrosis factor (TNF)-receptor I constructs [TNF-binding protein (bp)] were evaluated in 28 baboons, 12 of which were healthy and 16 were challenged with a lethal Escherichia coli bacteremia. The three constructs differed only in the number of extracellular domains of the TNF receptor I and were dimerized with polyethylene glycol. Although all three constructs had generally similar pharmacokinetics when administered to a naive animal, they differed quantitatively in their immunogenicity. Antibodies were detected more frequently, and titers were significantly higher (P < 0.05) in both healthy and septic baboons that received the 4.0-domain TNF-bp construct, compared with animals receiving the 2.6-domain construct. When the TNF-bp constructs were administered a second time (21 days later), the half-lives of the three constructs were significantly shorter in animals that had an antibody response after the first injection. In contrast, all three TNF-bp constructs were equally effective at improving outcome, blocking a systemic TNF-alpha response, and attenuating the cytokine responses when administered at a dose of 1.0 mg/kg body wt 1 h before a lethal E. coli infusion. The findings suggest that immunogenicity of TNF-bp constructs can be altered by changing the number of functional domains, without affecting their capacity to neutralize TNF-alpha and to abrogate TNF-mediated pathology.

Gamma interferon production induced by antigens in patients with leprosy and American cutaneous leishmaniasis.

In this study, we measured gamma interferon production in mononuclear cell cultures from patients with diverse forms of leprosy and American cutaneous leishmaniasis. We studied patients with lepromatous, borderline lepromatous, borderline, and borderline tuberculoid forms of leprosy, as well as a Mitsuda-negative contact. In leishmaniasis we studied patients with localized cutaneous, mucocutaneous, and diffuse cutaneous forms of the disease. High correlation was observed between gamma interferon production and lymphocyte proliferation assays in both diseases. Resistant forms of both diseases showed significant reactivity, while the severe progressive forms were characterized by insignificant responses in both assays. Localized cutaneous leishmaniasis is characterized by variability in gamma interferon production, which may be of prognostic value in longitudinal studies.

Leishmania chagasi antigens recognized in cured visceral leishmaniasis and asymptomatic infection.

Active visceral leishmaniasis is associated with antigen-specific immuno-suppression. However, cured patients develop a cellular immune response associated with resistance to reinfection. Recent studies have identified patients with asymptomatic or subclinical infections, which are also accompanied by an immune response. In order to identify subjects immune to Leishmania chagasi, we performed a skin-test survey in an endemic area in eastern Venezuela. The delayed-type hypersensitivity (DTH) response was assessed in patients cured of visceral leishmaniasis, as well as in their relatives and neighbors. Of the latter, 36 (34.2%) of 105 were positive and 26 (24.7%) of 105 gave intermediate responses. The DTH reaction correlated with age. The antigens recognized by a subgroup of cured patients, those with positive skin-test results, and controls (skin-test negative) were assessed by Western blotting with sera, and T cell immunoblotting with peripheral blood mononuclear cells. No consistent differences between the groups were noted in Western blots with L. chagasi antigens. T cell blots were performed on five patients from each group. For the cured patients and skin-test positive contacts, a significant proliferative response to fraction 12 (less than 20.5 kDa) was noted in four of five patients in each group. Cells from three of five cured patients and two of five skin-test-positive patients proliferated in response to fraction 4 (73-115 kDa). The response to other fractions was variable, with only a minority of patients responding to any one fraction. These data suggest that the antigens recognized by patients with evidence of immunity to L. chagasi are quite variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Albendazole therapy in alveolar hydatid disease: a report of favorable results in two patients after short-term therapy.

Albendazole was administered preoperatively to two patients with active alveolar hydatid disease for 58 and 84 days. Vesicles of larval Echinococcus multilocularis obtained from surgical tissues were inoculated into red-backed voles for in vivo testing viability. No proliferation of the larval cestode had occurred when the animals were dissected three months post-inoculation. These findings suggest that short-term therapy with albendazole was effective in killing the larval cestode in these two cases. Albendazole was found to be hepatotoxic but resulting transaminase abnormalities have been reversible. Close monitoring of liver function and hematology is essential in patients under albendazole therapy.

Comparison of serologic tests for the diagnosis and follow-up of alveolar hydatid disease.

Alveolar hydatid disease is a serious and often fatal condition caused by infection with the metacestode form of Echinococcus multilocularis. Sera of 21 patients with histologically confirmed disease were tested by an enzyme-linked immunosorbent assay (ELISA) using a semi-purified E. multilocularis antigen fraction (Em2) and by indirect hemagglutination (IHA) and double diffusion (DD5) tests using antigens prepared from E. granulosus cyst fluid. At diagnosis, sera from all 21 patients were positive by Em2 ELISA, 18 (86%) by IHA, and 5 (24%) by DD5. Em2 ELISA detected an antibody response earlier than IHA in 4 of 9 patients from whom sera were available before diagnosis. Following complete surgical resection, Em2 ELISA converted from positive to negative in serum of 2 of 3 patients, while IHA results did not change. Following incomplete resection, 14 of 15 patients tested remained positive by Em2 ELISA, while 12 remained positive by IHA. Of sera from 361 healthy persons from regions free of E. multilocularis, none were positive by Em2 ELISA, while 8% were positive by IHA. Of sera from 59 patients with non-echinococcal parasitic infections, none were positive by Em2 ELISA, while 31% were positive by IHA. Thus, in comparison with tests using E. granulosus antigens, Em2 ELISA appears to be more sensitive and specific for diagnosing AHD, useful on follow-up of resected patients, and positive earlier in the course of disease.

Metal contamination in illicit samples of heroin.

We analyzed 198 illicit heroin samples from Andalusia (southern Spain) to determine the contents of various metals (cadmium, calcium, copper, iron, manganese and zinc) with a view to investigating a new aspect of the drug purity and the conditions under which the drugs are used by addicts. Calcium was found in 93.4% of the samples and always at high concentrations, which can be ascribed to adulteration of the heroin by addicts with thinners and excipients containing salts of this metal such as calcium bicarbonate. Also, all samples were found to contain variable amounts of zinc and substantial amounts of iron, probably because it is the most common metal found in metal containers used in the extraction of morphine from the opium poppy. Only cadmium and, to a lesser extent, zinc, copper, and iron, are among the metals detected in heroin that can increase the inherent toxicity of the drug while always taking into account the maximum values.

[Acute myocardial infarct in a cocaine-addicted young man]. / Infarto de miocardio agudo en un joven cocainómano.

We present a case of acute myocardial infarction in a 22 year old cocaine user. The absence of coronary artery stenotic lesions, as was seen in the coronary arteriography, and the absence of personal past cardiovascular or family history, suggest a cocaine-induced coronary spasm as responsible for the acute myocardial event.

[Primary meningococcal pericarditis caused by meningococcus serogroup C]. / Pericarditis meningocócica primaria por serogrupo C.

We report the case of a 15-year-old female, with no previous medical history, who presented cardiac tamponade secondary to purulent pericarditis caused by Neisseria meningitidis serogroup C. This microorganism is the etiologic agent in 6-16% of the cases of purulent pericarditis, most in association with previous or concomitant central nervous system involvement (meningitis). Exceptionally, as in this case, the pericarditis is not accompanied by meningitis (Primary Meningococcal Pericarditis). The patient was treated with antibiotics, pericardiocentesis and steroids with excellent response. It is important to point out that meningococcal disease may present in unusual forms which may lead to diagnostic and therapeutics difficulties.

[Regression of left ventricular hypertrophy in hypertensive patients]. / Regresión de la hipertrofia ventricular izquierda en hipertensos.

Left ventricular hypertrophy associated with systemic hypertension differs from left ventricular hypertrophy initiated by other pressure overload diseases. Its development depends not only of hemodynamics aspects but of biochemical factors. Many studies have demonstrated a close link between left ventricular hypertrophy and cardiovascular morbidity and mortality. For that reason the idea of reversal of left ventricular hypertrophy has been a goal of the antihypertensive treatment. From the literature review has been established that the most classes of antihypertensive medications reduce the left ventricular mass, though there is a variation in required duration of treatment. At this point the angiotensin converting enzyme inhibitors, probably because a double effect: hypotensive and blockers of the trophic stimulus of angiotensin II, seemed to be the most potent for reducing the left ventricular mass. Still we don't know if reversal of left ventricular hypertrophy, by the antihypertensive treatment, reduce independently the cardiovascular risk.

[The adult respiratory distress syndrome as a complication of the APSAC treatment of acute myocardial infarct. Apropos a case]. / Síndrome de distrés respiratorio del adulto como complicación del tratamiento del infarto agudo de miocardio con APSAC. A propósito de un caso.

Thrombolytic therapy has shown to be effective in acute myocardial infarction, and its benefits on left ventricular function and later survival are well known. However it is not a therapy free of complications and side effects. Allergic reactions, anafilaxia, hypotension, and several kinds of hemorrhages have been reported. Adult respiratory distress syndrome after streptokinase administration has been also described, and one case, recently communicated, after APSAC therapy. We present the case of a male with acute myocardial infarction who developed adult respiratory distress syndrome after APSAC therapy, with different outcome than the first case published in the literature. Finally, we discussed the mechanisms by means these drugs can produce such a complication.

[Infectious endocarditis of prosthetic valves due to Staphylococcus capitis: a new case]. / Endocarditis infecciosa sobre válvulas protésicas causada por Staphylococcus capitis: un nuevo caso.

We present the case of a male patient with aortic and mitral valve bioprostheses who developed infectious endocarditis due to Staphylococcus capitis, which has recently been described as an agent producing infectious endocarditis in native and prosthetic cardiac valves. The patient's course evolved unfavorably, despite specific antibiotic treatment, leading to the surgical replacement of the valve, which completely resolved the problem. This case points out that, although rare, in infectious endocarditis due to Staphylococcus capitis its pathogenicity is significant.

[A-V conduction block at His bundle level; as the cause of syncopal crisis in patients with normal ECG (author's transl)]. / Bloqueos A-V completos intermitentes de localización intrahisiana, como causa de crisis sincopales con ECG de base normal.

The history, clinical evolution and complementary studies used to identify the diagnostic etiology of syncopal crisis in a series of 5 patients are presented. The crisis consisted of advanced disturbances of the A-V conduction at the level of the His bundle. It is pointed out that although the evolution of the disturbance was intermittent, the surface ECG was normal and neither A-V block nor broadening of the QRS complex were seen. The importance of continued monitorization, whether as out-patients (Holter system) or, in some cases in an Intensive Care Unit, as well as the need to practice electrophysiologic studies in all these cases as the only way of establishing a firm diagnosis, are underlined. The fact that these disturbances do not always lead to an advanced blockage of A-V conduction is discussed as being reminiscent of the prospective and retrospective studies in the similar case of bi-fascicle block.

[Latent chronic constrictive pericarditis. Rapid filling overload for an accurate hemodynamic diagnosis (author's transl)]. / Pericarditis crónica constrictiva latente. Confirmación diagnóstica hemodinámica con sobrecarga volumétrica rápida.

Chest roentgenogram showed a pericardial calcification in a patient with inconspicuous signs of cardiac disease and normal basal pressures in the right cavities. A typical hemodynamic tracing of chronic constrictive pericarditis was obtained with rapid filling overload. The uncommeness of silent chronic constrictive pericarditis is mentioned and the usefulness of rapid filling overload for an accurate hemodynamic diagnosis of this condition is emphasized. Denomination of "latent" chronic constrictive pericarditis for similar cases to this reported is proposed.

[Right ventricular cardiomyopathy: a diagnosis to bear in mind]. / Miocardiopatía ventricular derecha: un diagnóstico a tener en cuenta.

Arrhythmogenic right ventricular cardiomyopathy is a entity of unknown etiology, that is pathologically characterized by right ventricular myocardial atrophy and fibroadipous tissue replacement. We present the case of a 65-year-old male patient with the diagnosis of chronic liver disease, whose study lead a diagnosis of Arrhythmogenic right ventricular cardiomyopathy.

[Plasma homocysteine levels in Spanish patients with coronary artery disease]. / Concentraciones de homocisteína en plasma en pacientes españoles con enfermedad arterial coronaria.

OBJECTIVE: A rise in plasma levels of the amino acid homocysteine (HCY) is a possible risk factor in cardiovascular disease. The mechanisms proposed to explain how HCY can increase the risk of vascular disease include its direct effect on the vascular endothelium and its role in increasing the risk of thrombosis. The present work has been designed to determine HCY levels in patients with coronary artery disease (CAD) residents in the Canary Islands and to establish whether hyperhomocysteinemia can be considered as an risk factor. METHODS: The sample studied consisted of 132 patients with, angiographically demonstrated, CAD and 18 controls with normal coronary arteries. Biochemical parameters determined included: HCY, vitamin B12, vitamin B6, folic acid, creatinine, cholesterol and its fractions, triglycerides, glucose and fibrinogen. RESULTS: Mean levels of HCY were not significantly different between the cases and controls (p = 0.37). In the distribution of HCY levels into quintiles there was no significant association between the quintiles and the occurrence of CAD (p = 0.57). Multiple logistic regression analysis in which the risk factors were compared with quintiles 2, 3, 4 and 5 of HCY did not reveal a significant relation between HCY levels and risk of CAD. CONCLUSIONS: This study questions the previously accepted consideration that hyperhomocysteinemia is a risk factor of CAD. Controlled intervention trials are, therefore, necessary to clarify the possible association between total HCY levels and cardiovascular disease.

Importancia del diagnóstico por imágenes multimodales en glaucoma agudo de ángulo cerrado: reporte de caso / Importance of multimodal imaging diagnostics in acute angle closure glaucoma: Case report

Describir la historia natural y el manejo de un glaucoma de cierre angular agudo secundario a melanoma coroideo.Mujer de 70 años que presenta dolor agudo con presión intraocular elevada y catarata madura y que fue diagnosticada de glaucoma agudo de ángulo cerrado en el ojo derecho. Mediante estudios adicionales de diagnóstico por imagen se descubrió un melanoma coroideo que causaba el cierre agudo del ángulo. Se realizó enucleación, y actualmente la paciente se encuentra en estrecha vigilancia postoperatoria por parte de oftalmología y oncología.Este caso refleja la importancia del diagnóstico y el tratamiento precoz de los tumores intraoculares en la disminución de la incidencia de metástasis y el aumento de la supervivencia. En el glaucoma de ángulo cerrado agudo secundario, el tratamiento debe estar dirigido a resolver el factor desencadenante del glaucoma. (AU)

To describe the natural history and management of an acute angle closure secondary to choroidal melanoma.A 70-year-old female presented with pain, elevated intraocular pressure, mature cataract, and angle closure in right eye. With further studies she was found to have a choroidal melanoma causing the acute angle closure. Enucleation was performed and the patient is currently in close postoperative surveillance by ophthalmology and oncology.The importance of early identification and treatment of intraocular tumors to decrease incidence of metastasis. In secondary acute angle-closure glaucoma treatment should be targeted towards resolving the triggering factor of glaucoma. (AU)