Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in patients with coronavirus disease 2019 (COVID-19). Hypertension and age are the 2 principal ...determinants of arterial stiffness (AS). This study aimed to estimate AS in patients with COVID-19 requiring hospitalization and analyze its association with all-cause in-hospital mortality. This observational, retrospective, multicenter cohort study analyzed 12 170 patients admitted to 150 Spanish centers included in the SEMI-COVID-19 Network. We compared AS, defined as pulse pressure ≥60 mm Hg, and clinical characteristics between survivors and nonsurvivors. Mean age was 67.5 (±16.1) years and 42.5% were women. Overall, 2606 (21.4%) subjects died. Admission systolic blood pressure (BP) <120 and ≥140 mm Hg was a predictor of higher all-cause mortality (23.5% and 22.8%, respectively,
<0.001), compared with systolic BP between 120 and 140 mm Hg (18.6%). The 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that AS and systolic BP <120 mm Hg significantly and independently predicted all-cause in-hospital mortality (adjusted odds ratio ORadj: 1.27,
=0.0001; ORadj: 1.48,
=0.0001, respectively) after adjusting for sex (males, ORadj: 1.6,
=0.0001), age tertiles (second and third tertiles, ORadj: 2.0 and 4.7,
=0.0001), Charlson Comorbidity Index (second and third tertiles, ORadj: 4.8 and 8.6,
=0.0001), heart failure, and previous and in-hospital antihypertensive treatment. Our data show that AS and admission systolic BP <120 mm Hg had independent prognostic value for all-cause mortality in patients with COVID-19 requiring hospitalization.
Background
Venous thrombotic events (VTE) are frequent in COVID-19, and elevated plasma D-dimer (pDd) and dyspnea are common in both entities.
Objective
To determine the admission pDd cut-off value ...associated with in-hospital VTE in patients with COVID-19.
Methods
Multicenter, retrospective study analyzing the at-admission pDd cut-off value to predict VTE and anticoagulation intensity along hospitalization due to COVID-19.
Results
Among 9386 patients, 2.2% had VTE: 1.6% pulmonary embolism (PE), 0.4% deep vein thrombosis (DVT), and 0.2% both. Those with VTE had a higher prevalence of tachypnea (42.9% vs. 31.1%; p = 0.0005), basal O2 saturation <93% (45.4% vs. 33.1%; p = 0.0003), higher at admission pDd (median IQR: 1.4 0.6–5.5 vs. 0.6 0.4–1.2 μg/ml; p < 0.0001) and platelet count (median IQR: 208 158–289 vs. 189 148–245 platelets × 10
9
/L; p = 0.0013). A pDd cut-off of 1.1 μg/ml showed specificity 72%, sensitivity 49%, positive predictive value (PPV) 4%, and negative predictive value (NPV) 99% for in-hospital VTE. A cut-off value of 4.7 μg/ml showed specificity of 95%, sensitivity of 27%, PPV of 9%, and NPV of 98%. Overall mortality was proportional to pDd value, with the lowest incidence for each pDd category depending on anticoagulation intensity: 26.3% for those with pDd >1.0 μg/ml treated with prophylactic dose (p < 0.0001), 28.8% for pDd for patients with pDd >2.0 μg/ml treated with intermediate dose (p = 0.0001), and 31.3% for those with pDd >3.0 μg/ml and full anticoagulation (p = 0.0183).
Conclusions
In hospitalized patients with COVID-19, a pDd value greater than 3.0 μg/ml can be considered to screen VTE and to consider full-dose anticoagulation.
We aimed to develop and validate a prediction model, based on clinical history and examination findings on initial diagnosis of coronavirus disease 2019 (COVID-19), to identify patients at risk of ...critical outcomes.
We used data from the SEMI-COVID-19 Registry, a cohort of consecutive patients hospitalized for COVID-19 from 132 centres in Spain (23rd March to 21st May 2020). For the development cohort, tertiary referral hospitals were selected, while the validation cohort included smaller hospitals. The primary outcome was a composite of in-hospital death, mechanical ventilation, or admission to intensive care unit. Clinical signs and symptoms, demographics, and medical history ascertained at presentation were screened using least absolute shrinkage and selection operator, and logistic regression was used to construct the predictive model.
There were 10 433 patients, 7850 in the development cohort (primary outcome 25.1%, 1967/7850) and 2583 in the validation cohort (outcome 27.0%, 698/2583). The PRIORITY model included: age, dependency, cardiovascular disease, chronic kidney disease, dyspnoea, tachypnoea, confusion, systolic blood pressure, and SpO2 ≤93% or oxygen requirement. The model showed high discrimination for critical illness in both the development (C-statistic 0.823; 95% confidence interval (CI) 0.813, 0.834) and validation (C-statistic 0.794; 95%CI 0.775, 0.813) cohorts. A freely available web-based calculator was developed based on this model (https://www.evidencio.com/models/show/2344).
The PRIORITY model, based on easily obtained clinical information, had good discrimination and generalizability for identifying COVID-19 patients at risk of critical outcomes.
•Proposal of a novel sludge reduction technique.•A new application for biosurfactants in wastewater treatment plants.•52% reduction in sludge disposal maintaining high COD removal.•Area occupied by ...secondary clarifier can be reduced by 39–52%.
Biosurfactants are suitable for application in wastewater treatment systems due to their biodegradability, biocompatibility and low toxicity. In activated sludge systems, they reduce coalescence and disintegrate flakes, enabling more cells to have access to oxygen. At low concentrations, they may act as growth inhibitors. In this study, rhamnolipid was added to a bench scale sequential batch reactor operating in similar conditions as oil refinery wastewater treatment plants. Concentrations from 12 to 50mg rhamnolipid/L were evaluated, the latter being the minimum concentration necessary to reduce sludge disposal. In this concentration, rhamnolipid reduces sludge disposal of up to 52%, maintaining COD removal of 81–97% and good sludge settling properties (SVI 120mL/g) and could also reduce area occupied by secondary clarifier of 39–52%. However, biosurfactant application needs to be optimized, because its cost is even higher than the savings obtained with lower waste disposal.
The progress in pharmacotherapy that has been made in recent years, including the introduction of very effective and safe lipid-lowering and antihypertensive drugs, has not yet translated into the ...expected universal control of blood pressure, lipid disorders and diabetes. In the STRUGGLE FOR Italian- -Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023, experts from five countries recounted several points about the paradigms of cardiological and cardiometabolic care for better control of classical modifiable risk factors in the year 2023. It is believed herein, that the need to intensify treatment, actively search for patients with cardiovascular risk factors, especially with arterial hypertension, hypercholesterolemia and diabetes, should go hand in hand with the implementation of the latest therapy, based on single pill combinations including proven, effective antihypertensive, lipid-lowering and antidiabetic molecules, many of which are listed in the present document. There is a need to use both new technological concepts, completely new drugs, as well as novel treatment concepts such as metabolic treatment in coronary artery disease, try to intensify the fight against smoking in every way, including the available range of drugs and procedures reducing the harm. This approach will provide substantially better control of the underlying cardiovascular risk factors in countries as varied as Italy, Poland, Spain, Uzbekistan and Vietnam.
Immuno-cross-reactivity between
Cryptosporidium parvum and
Eimeria spp. was studied by the indirect fluorescent antibody test (IFAT) and Western blot procedure. Thirty-seven sera from asymptomatic ...(non-diarrheic) cattle, with known coprological (presence–absence of coccidia) and serological data respecting
C. parvum, were tested by IFAT using
Eimeria oocysts as antigen. Most sera (54%) displayed immunofluorescence around the surface of the
Eimeria oocysts. Simultaneously, serum samples from rabbits naturally infected with
Eimeria spp. (
E. magna,
E. intestinalis and
E. residua), but free of
C. parvum infection, were used to investigate the recognition of
C. parvum oocyst antigens by the Western blot procedure. Fractions in the 11.5–94 kDa range, as well as others with molecular masses over 94 kDa, were recognized by sera from rabbits. Sera collected during patency period showed low or moderate reaction with antigenic fractions in the 11.5–25 kDa range. However, 29, 58 and 71 to 75 kDa proteic fractions were moderately or strongly recognized even after rabbits finished oocyst excretion.
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