We aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation.
This is a ...multicenter, observational study from a prospectively collected database of consecutive COVID-19 patients admitted to 36 Spanish and Andorran intensive care units (ICUs) who received HFNO on ICU admission during a 22-week period (March 12-August 13, 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation. We used multivariable logistic regression and mixed effects models. A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated.
From a total of 259 patients initially treated with HFNO, 140 patients (54%) required invasive mechanical ventilation. Baseline non-respiratory Sequential Organ Failure Assessment (SOFA) score odds ratio (OR) 1.78; 95% confidence interval (CI) 1.41-2.35, and the ROX index calculated as the ratio of partial pressure of arterial oxygen to inspired oxygen fraction divided by respiratory rate (OR 0.53; 95% CI: 0.37-0.72), and pH (OR 0.47; 95% CI: 0.24-0.86) were associated with intubation. Hospital site explained 1% of the variability in the likelihood of intubation after initial treatment with HFNO. A predictive model including non-respiratory SOFA score and the ROX index showed excellent performance (AUC 0.88, 95% CI 0.80-0.96).
Among adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.
Studies have shown that triggering receptor expressed on myeloid cells-1 (TREM-1) is the mediator and activator of neutrophils and monocytes after stimulation with lipopolysaccharide (LPS), ...heat-inactivated Gram (−) bacteria, Gram (+) bacteria or fungi. Different studies have measured the expression of TREM-1 in patients with bacterial infections and critical states. The purpose of this study was to evaluate the expression of TREM-1 in circulating maternal leukocytes in premature rupture of the membranes (PRM). Two groups of patients were included in this case control study: pregnant women with PRM and healthy controls. All patients were free of any infection, including cervix and urinary tract. Although all patients expressed TREM-1 to some extent, there was no statistically significant difference in the expression of different cellularities in both groups; except for the mononuclear leukocytes (p < 0.05). In this study, TREM-1 was not altered in PRM.
Necrobiosis lipoidica (NL) is a rare chronic granulomatous dermatitis that usually appears in the lower extremities. It affects about 0.3-1.2% of diabetic patients, the majority of whom have type 1 ...diabetes. The etiology and pathogenesis of this disorder are still unclear. NL is characterized by skin rash that usually affects the shins. The average onset is 30 years, with females being affected more commonly. There are very few reported cases of necrobiosis lipoidica in children.
We report a case of a 16 year old girl affected by type 1 diabetes mellitus (15 years disease duration) who developed an erythematous nodular rash on the lower extremities and interscapular area. In the suspect of necrobiosis lipoidica, a skin biopsy was performed (lower extremities and interscapular area). The microscopic evaluation of the pretibial lesions was suggestive of necrobiosis lipoidica. The smaller lesions in the interscapular area showed signs of perivascular dermatitis which could be consistent with early stages of necrobiosis lipoidica. Local treatment with tacrolimus determined a progressive improvement of the lesions.
In patients with T1DM, diagnosis of NL of the lower legs is usually unequivocal. However, diagnosis may be more challenging in the presence of lesions with recent onset and/or atypical clinical presentation and unusual site. In these cases, NL must always be taken in consideration in order to avoid misdiagnosis, wrong/late treatment decisions and progression to ulceration.
The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and ...mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE.
A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued.
Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval CI: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio HR 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences.
In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings.
Sanofi and Rovi, Sanofi Spain.
INTRODUCTION
Anemia is the most frequent cytopenia in lower-risk MDS. Erythropoietic-stimulating agents (ESAs) are commonly used in these patients. The use of ÒclassicalÓ parameters (EPO and ferritin ...levels) and the revised IPSS (IPSS-R) has been proposed1 (SantiniÕs score) to predict response to ESAs and overall survival (OS) among patients with lower risk MDS by IPSS and a favorable Nordic group score2.
OBJECTIVES
The main objective of the study was to evaluate overall response rate (ORR) to ESAs and OS according to the proposed SantiniÕs score in an independent and large cohort of anemic lower risk MDS patients receiving treatment with ESAs.
METHODS
Data from 530 anemic patients with low/int1 risk IPSS de novo MDS (according to FAB and WHO criteria) and sufficient follow-up data available were recorded in Spresas3 (SPanish Registry of Erythropoietic Stimulating Agents Study from GESMD). Two hundred and twenty six patients (42.6% of the patients) were selected according to specific criteria regarding the published SantiniÕs score1: Hb level </=10 g/dL, serum erythropoietin (EPO) <500 mU/mL and ESA (EPO alfa or B 40000-60000IU/week, or darbepoetin 150-300 ug/week). Applying 1 point to each of the following unfavorable variables for response to ESA, EPO>200mU/mL(=1), serum ferritin (SF) >350 ng/mL(=1) and IPSS-R very low=0, low=1, intermediate=2 and high=3) yielded a score ranging from 0 to 5. ESAs response rate and overall survival were analysed according to these score. Response to treatment was evaluated according to IWG 2006 response criteria and a multivariate logistic regression analysis was used to identify independent predictors of erythroid response (ER). OS were defined as the time between diagnosis and the corresponding event or last follow up (Feb 2015) and were analyzed using univariable and multivariable Cox proportional hazards regression methods.
RESULTS
Median age was 77 years (interquartile range IQR 25%-75%: 71-83 y), median Hb level at start of treatment was 10 g/dL (IQR25-75: 9-10), median EPO level was 90 (IQR25-75: 27,25-108) and median ferritin level was 338,5 (IQR25-75: 146,5-568,75). Among 139 patients with this data available, 85 patients (61,1%) were RBC transfusion dependent before ESAs treatment. Median time from diagnosis to ESAs treatment was 82 (IQR25-75: 27-353) days. According to the IPSS, 68.6% (N=155) and 31.4% (N=71) were in low and Int-1 risk groups, respectively. Regarding IPSS-R, 23% (N=52), 66.8% (N=151), 9.7% (N=22) and 0.4% (N=1) were in very low, low, intermediate and high risk, respectively. ORR to ESA treatment was 71.2% (N=161), with a median duration of response of 2.06 years. Prognosis factors of ER showed a trend toward to a higher ER among patients in the lower IPSS-R (P>0.05), low IPSS (p=0.039) and lower EPO levels (p<0.0001) while in multivariate analysis EPO level was confirmed as most significant variable associated to ER (p<0.001).
According to SantiniÕs score, 11.5%(N=26), 42.9%(N=97), 25.8%(N=81), 8%(N=18) and 1.8%(N=4) of the patients were in the 0, 1, 2 3 and 4 score. Erythroid response was better for patients in the lower scores, with response rates of 73.1%, 82.5%, 65.4%, 50% and 0%, for patients in 0, 1, 2, 3 and 4 score, respectively (p<0.001, figure 1). After a median follow up of 3.1 years, median OS from diagnosis was 4.99 years. Interestingly, median OS from diagnosis was clearly related to SantiniÕs score (10.7 years, 6.7y, 4.9y, 3.7y and 6.7y for patients with 0, 1, 2, 3, and 4 points, respectively, p=0.041, Figure 2) whereas median OS from start of ESAs showed also some trend (p=0.26).
CONCLUSIONS
The present study confirms that SantiniÕs score is useful to identify patients with a higher probability of response to ESAs and better OS among lower risk MDS patients with an expected favorable response to ESA according to Nordic group score.
Spresas study was partly supported by Janssen
1.-Santini et al, Blood 122(13), 2013.
2.-Hellstršm-Lindberg, Br J Haematol 120(6), 2003.
3.-D'ez Campelo, EHA 2015 meeting, P244.
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Díez Campelo:Novartis: Research Funding, Speakers Bureau; Janssen: Research Funding; Celgene: Research Funding, Speakers Bureau. Off Label Use: Use of erythropoietic stimulating agents for anemia in patients with myelodysplastic syndromes. Ramos:JANSSEN: Honoraria, Membership on an entity's Board of Directors or advisory committees; AMGEN: Consultancy, Honoraria; NOVARTIS: Consultancy, Honoraria; CELGENE: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Falantes:Celgene: Honoraria. Garcia:Celgene: Research Funding. Sanz:JANSSEN CILAG: Honoraria, Research Funding, Speakers Bureau.
RESUMEN Objetivo Sintetizar la información científica relevante sobre la evaluación del desarrollo del lenguaje en niños sordos prelocutivos durante los primeros seis años de vida, con el fin de ...determinar si es suficientes para confirmar la presencia de algún desarrollo de lenguaje en esta población, o si se requiere un enfoque más integral. Estrategia de investigación Se realizó una revisión estructurada de la literatura científica en las siguientes bases de datos: PubMed, Lilacs, Ibecs, Trip DataBase, Cochrane library, Clinical Trial y Nice. Criterios de selección revisiones sistemáticas, evaluaciones de tecnologías sanitarias, ensayos clínicos aleatorizados, estudios observacionales de cohorte y casos - controles; incluyendo publicaciones sobre evaluación de cualquier aspecto del desarrollo de lenguaje, cualquier intervención y en cualquier idioma, se excluyeron si únicamente evalúan audición o habla, sordera central, súbita, transitoria, sordoceguera, con otras discapacidades o con trastornos del espectro autista. Análisis de datos se usó la metodología GRADE para analizar la calidad de la evidencia. Resultados es factible realizar evaluaciones del desarrollo de lenguaje a niños sordos prelocutivos. Se obtiene una calidad de la evidencia moderada que sugiere cierta confianza en los resultados de las evaluaciones, siempre y cuando vengan acompañadas de una apreciación integral de otros elementos lingüísticos. Conclusión los resultados de las evaluaciones de lenguaje deben sostenerse, en mayor medida, en datos sobre el lenguaje receptivo y expresivo, y que cuyas evidencias pueden enriquecerse al adjuntar evaluaciones de elementos lingüísticos formales tanto de la modalidad oral como gestual, y de los componentes pragmáticos de los procesos comunicacionales.
ABSTRACT Purpose To synthesize the relevant scientific information regarding the assessment of language development in prelingually deaf children during their first six years of life, in order to determine whether it is sufficient to confirm the presence of some language development in this population, or if a more integrated approach would be more appropriate. Research strategies A structured review of the relevant scientific literature was carried out in the following databases: PubMed, Lilacs, Ibecs, Trip DataBase, Cochrane library, Clinical Trial and Nice. Selection criteria Systematic reviews, health technology assessments, randomized clinical trials, observational cohorts and case-control studies; including publications of assessments concerning any aspect of language development or any intervention in any language. Evaluations related exclusively to hearing and speech, to central, sudden or transient deafness, to deaf-blindness, to further disabilities or to autism spectrum disorders, were excluded. Data analysis GRADE methodology was used to analyze evidence quality. Results It is possible to evaluate the language development of prelingually deaf children. A moderate quality of evidence was obtained, suggesting that the evaluations’ results are fairly trustworthy, provided that the assessments are conducted within an integrated approach of other linguistic elements. Conclusion The results of the language evaluations must be supported mostly by receptive and expressive language data, and the found evidence can be improved by combining the assessments of the formal linguistic elements of both oral and gestural modalities with the pragmatic components of the communication process.
El tipo de peligros y eventos peligrosos en las cuencas de abastecimiento, dependen de los usos del suelo a su alrededor. La atrazina es un contaminante orgánico aplicado ampliamente como plaguicida ...y es un peligro químico potencial presente en las fuentes de agua, que causa contaminación del agua y efectos negativos en la vida acuática y la salud humana, debido a su alta solubilidad y persistencia en el suelo. Sin embargo, para los países en desarrollo, el seguimiento y la cuantificación de la atrazina pueden resultar complejos y costosos; por tanto, para contribuir a establecer estrategias de evaluación de riesgos en las cuencas de abastecimiento de agua, se evaluó el uso potencial de una técnica fácil, rápida y de bajo costo como la absorbancia ultravioleta (UV) para identificar la presencia de atrazina. Se conformaron muestras de agua destilada y superficial dopadas con atrazina, y se correlacionaron con el indicador de espectro típico UV para materia orgánica (longitud de onda--lambda: 200-300 nm), siendo el rango óptimo 203-223 nm; UV.sub.223 fue más adecuado que UV.sub.254, el cual se utiliza más para identificar la presencia de materia orgánica natural, lo que demuestra que UV.sub.223 es una herramienta complementaria, útil para la evaluación del riesgo químico por la presencia de atrazina en los sistemas de suministro de agua potable.
El artículo da cuenta de un estudio internacional realizado entre octubre de 2011 y enero de 2012, como fundamento para el diseño y elaboración de un material audiovisual (spot) con el objeto de ...sensibilizar y visibilizar la problemática del Chagas. La investigación, de carácter cualitativo, recogió los datos de 38 encuestas, respondidas por personas afectadas y especialistas en la temática. La información para cada grupo se ordenó según aspectos que las personas asociaban con la palabra Chagas, y dificultades, retos, desafíos y logros vinculados. Para cada punto se presenta un análisis de las respuestas, relatos y anécdotas relacionadas. Las conclusiones refuerzan la necesidad de conocer y dar a conocer las dificultades que viven las personas afectadas por el Chagas, considerando que se trata de una realidad que tiene diversas manifestaciones dependiendo del contexto.
This paper presents an international study that was conducted between October 2011 and January 2012, in which a video (spot) to boost awareness and raise the profile of Chagas disease issues was designed and developed. This study was of qualitative nature and analyzed information that was gathered from 38 questionnaires that had been answered by individuals affected by the disease and by specialists on this disease. The information from each group was classified according to factors that they associated with the word Chagas, along with the difficulties, adversities, challenges, objectives and achievements relating to the disease. The responses, reports and anecdotes relating to each of these factors were analyzed. The conclusions emphasize the need to know and make known the difficulties that people affected by Chagas disease experience, bearing in mind that the realities are manifested differently depending on the context.
O artigo apresenta um estudo internacional realizado entre outubro de 2011 e janeiro de 2012, no qual se baseou o desenho e elaboração de um vídeo (spot) que tinha como objetivo a sensibilização e promoção da visibilidade da problemática vinculada à doença de Chagas. A pesquisa, de caráter qualitativo, analisou a informação recolhida por meio de 38 questionários respondidos por pessoas afetadas e especialistas sobre a doença. A informação, para cada um dos dois grupos, foi classificada de acordo com os aspectos que as pessoas associavam com a palavra Chagas, e as dificuldades, adversidades, desafios e conquistas vinculadas com a doença. Para cada um dos referidos aspectos, apresenta-se uma análise das respostas, relatos e anedotas. As conclusões reforçam a necessidade de se conhecer e divulgar as dificuldades vividas pelas pessoas afetadas pela doença de Chagas, tendo em mente que se trata de uma realidade que se manifesta de forma diversa dependendo do contexto.
Questo volume raccoglie i contributi della Giornata Internazionale di Studi organizzata nell’ambito della 16a edizione del programma Restituzioni 2013, dal Centre Jean Bérard e da Banca Intesa ...Sanpaolo in collaborazione con il MANN e l’Università degli Studi di Milano, in occasione del restauro di due vasi del MANN. Con l’obiettivo principale di restituire ai due vasi una unitarietà di lettura, oltre a garantirne il consolidamento e il miglioramento delle precarie condizioni di conservazione, sono stati programmati dal Laboratorio di Restauro del MANN significativi interventi conservativi, realizzati da Raffaele D’Aniello, Pasquale Festinese, Antonio Guerra, Antonio Marroccella, con la direzione di Luigia Melillo e il coordinamento di Mariateresa Operetto. Questo libro vuole rendere omaggio al sapere del collezionista, del restauratore, del vasaio e del pittore che, attraverso le loro produzioni dall’antichità ad oggi costituiscono parte del patrimonio del MANN. La sfida è stata quella di ricostruire, sulla scia di pubblicazioni recenti che presentano la storia completa di singoli vasi italioti, la biografia e l’autopsia delle opere attraverso un’analisi a 360 gradi, annullando i confini tra i periodi e le conoscenze attraverso il confronto tra i vecchi e i nuovi restauri e le indagini condotte nei documenti conservati in magazzini e archivi. A proposito di “savoir-faire antichi”, il cratere e la loutrophoros oggi esposti nella sezione Magna Grecia rappresentano straordinari documenti archeologici della qualità artigianale raggiunta dai ceramisti e ceramografi apuli nel IV secolo a.C.: a questi manufatti di pregio le comunità dell’antica Puglia si affidavano per affermare, attraverso la scelta delle forme vascolari e delle loro raffigurazioni, i valori, le credenze e le esigenze di affermazione sociale. Essi costituiscono, quindi, una fondamentale fonte di conoscenza del mondo antico: la lettura della forma e delle immagini proposte nei diversi contributi qui presentati ne mostrano la complessità e l’importanza.
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