In this work, we conducted a careful study of the mortar and paint in the Roman wall painting housed by the triclinium of the so-called Domus in the Road Safety Education Park of Córdoba, Spain. A ...combination of X-ray diffraction, Raman and X-ray fluorescence spectroscopies allowed the different substances used to obtain the pigments present in the painting to be identified. The painting was found to contain five different colours (red, yellow, blue, green and white) in various hues. The red pigment was obtained from hematite and the yellow pigment from goethite. The blue pigment, which was the least abundant, was prepared from Egyptian blue, and the green pigment from green earths. Finally, the white pigment came from lime. The binders used were identified by infrared spectroscopy and gas chromatography with mass spectrometry detection. The painting fragments studied contained vestiges of bee wax or its decomposition products, which suggests that the paint was applied encaustically.
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•New, useful information about the pigments used by local artists of the time•Raman technique allows to unequivocally identify the chemical composition of pigments.•The most abundant colour in the paintings was red in various hues.•The technique used by the artists is the encaustic.
The necropolis of Camino Viejo de Almodóvar (Córdoba, southern Spain) is one of several burial grounds dating from Roman
Corduba
. In this work, we used various optical and laser techniques, ...including optical microscopy, scanning electron microscopy in combination with energy-dispersive spectroscopy and micro-Raman (μ-Raman) spectroscopy to identify the pigments used in wall painting fragments unearthed in excavations at the site. The results thus obtained were confirmed and supplemented by using X-ray fluorescence spectroscopy. The experimental evidence provided by these techniques allowed us to identify the materials used to obtain the pigments, namely: lime, hematite, cinnabar, goethite, Egyptian blue, coal and green earth.
•New, useful information about the pigments used by artists of the time.•Spectroscopic techniques allow to unequivocally identify the chemical composition of pigments.•The most abundant colour in the ...paintings was red in various hues.•The techniques used by the artists is mezzo fresco and secco (with organic binders).
Fragments of a wall painting from a High Roman Empire building in Córdoba, southern Spain, were examined. The aim was not to extract archaeological information, but rather to precisely identify the materials from which the pigments were obtained and how they were applied. The mortar receiving the pigments was also analysed. Determinations were done by using X-ray fluorescence (XRF), micro-Raman (μ-Raman) and Fourier transform infrared (FT-IR) spectroscopies, X-ray diffraction (XRD) and scanning electron microscopy coupled to energy dispersive X-ray spectroscopy (SEM–EDS). The XRF technique allowed chemical elements to be identified and, in combination with SEM–EDS, their spatial distribution in the fragments to be elucidated. Similarly, μ-Raman spectroscopy and XRD allowed the chemical species in the mortar to be identified. The pigments found were typical of the Roman colour palette used in Hispania and included various types of ochre (yellow and red), mixtures containing green earths, white (calcium carbonate), black (carbon) and precious materials such as cinnabar and Egyptian blue. The mortar was found to have been prepared in the traditional manner from limestone and sand. The pigments were applied in solution or suspended in lime water, a technique that was latter named mezzo fresco. By exception, cinnabar and Egyptian blue were applied with the secco technique and the aid of an organic binder. Some fragments contained several paint layers. In any case, the paint was invariably applied directly on an unprimed wall.
Abstract
BACKGROUND AND AIMS
Among patients with chronic kidney disease, the incidence and prevalence of nonvalvular atrial fibrillation (NVAF) increases as renal function decreases, detecting a ...prevalence of up to 27% in hemodialysis patients. However, its prevalence among patients on peritoneal dialysis (PD) has been less studied.
The aim of the study is to analyse the prevalence of NVAF and characteristics related to its management in PD patients older than 18 years.
METHOD
An observational, cross-sectional, multicenter and retrospective study was carried out through a survey and request for variables sent through a Google questionnaire to PD units in our country. A total of 1403 patients from 30 PD units were included.
RESULTS
The mean prevalence of NVAF in the study was 13.2%, median 11.7% (interquartile range: 6.1–19.4). A total of 60% of the centers had a prevalence >10%.
A total of 57.6% (n = 17) used the CHADS2 or CHAS2-VASC score to calculate the risk of stroke/thromboembolism in their patients with NVAF. A total of 43.3% (n = 13) do not use it. In these cases, 15.3% (n = 2) do not calculate it because they treat all patients with NVAF and the remaining 84.6% (n = 11) do not use it because the cardiologist uses it and delegates it to them.
Regarding the decision to start anticoagulant treatment in NVAF: in 60% of the centers (n = 18) the cardiologist indicates anticoagulation, in 36.7% (n = 11) the indication is made jointly (cardiologist and nephrologist) and only in 3.3% (n = 1) the indication is made by the nephrologist.
A total of 72.5% of the patients with NVAF (135/186) received anticoagulant treatment. Of these, 28 (20.7%) received direct-acting anticoagulants and 107 (79.3%) received acenocoumarol. Among direct-acting anticoagulants, the most frequent regimens were: apixaban 2.5 mg/12 h (86%), and edoxaban 30 mg/24 h (7%). A total of 5.9% (11/186) of patients with NVAF did not receive anticoagulant or antiplatelet treatment.
A total of 90% of the centers (n = 27) are familiar with the technique of percutaneous appendage closure for the treatment of NVAF, but it is not available in five of them. This technique has been performed in 17 of the patients with NVAF.
CONCLUSION
The prevalence of NVAF in PD patients is high. The management of these patients is carried out mainly by cardiologists with little participation of nephrologists. Most patients receive anticoagulant treatment with coumarin drugs. The data from this analysis, as well as the limited data from the literature, indicate that an adequate format, a consensus document, as well as more data from observational studies (and especially from randomized controlled trials) are needed to adequately address this common complication in patients with DP.
Olfactory and gustatory dysfunctions (OGD) are a frequent symptom of coronavirus disease 2019 (COVID-19). It has been proposed that the neuroinvasive potential of the novel SARS-CoV-2 could be due to ...olfactory bulb invasion, conversely studies suggest it could be a good prognostic factor. The aim of the current study was to investigate the prognosis value of OGD in COVID-19. These symptoms were recorded on admission from a cohort study of 5868 patients with confirmed or highly suspected COVID-19 infection included in the multicenter international HOPE Registry (NCT04334291). There was statistical relation in multivariate analysis for OGD in gender, more frequent in female 12.41% vs 8.67% in male, related to age, more frequent under 65 years, presence of hypertension, dyslipidemia, diabetes, smoke, renal insufficiency, lung, heart, cancer and neurological disease. We did not find statistical differences in pregnant (
p
= 0.505), patient suffering cognitive (
p
= 0.484), liver (
p
= 0.1) or immune disease (
p
= 0.32). There was inverse relation (protective) between OGD and prone positioning (0.005) and death (< 0.0001), but no with ICU (0.165) or mechanical ventilation (0.292). On univariable logistic regression, OGD was found to be inversely related to death in COVID-19 patients. The odds ratio was 0.26 (0.15–0.44) (
p
< 0.001) and
Z
was − 5.05. The presence of anosmia is fundamental in the diagnosis of SARS.CoV-2 infection, but also could be important in classifying patients and in therapeutic decisions. Even more knowing that it is an early symptom of the disease. Knowing that other situations as being Afro-American or Latino-American, hypertension, renal insufficiency, or increase of C-reactive protein (CRP) imply a worse prognosis we can make a clinical score to estimate the vital prognosis of the patient. The exact pathogenesis of SARS-CoV-2 that causes olfactory and gustative disorders remains unknown but seems related to the prognosis. This point is fundamental, insomuch as could be a plausible way to find a treatment.
Abstract
Background
the coronavirus disease 2019 (COVID-19) is characterized by poor outcomes and mortality, particularly in older patients.
Methods
post hoc analysis of the international, ...multicentre, ‘real-world’ HOPE COVID-19 registry. All patients aged ≥65 years hospitalised for COVID-19 were selected. Epidemiological, clinical, analytical and outcome data were obtained. A comparative study between two age subgroups, 65–74 and ≥75 years, was performed. The primary endpoint was all cause in-hospital mortality.
Results
about, 1,520 patients aged ≥65 years (60.3% male, median age of 76 IQR 71–83 years) were included. Comorbidities such as hypertension (69.2%), dyslipidaemia (48.6%), cardiovascular diseases (any chronic heart disease in 38.4% and cerebrovascular disease in 12.5%), and chronic lung disease (25.3%) were prevalent, and 49.6% were on ACEI/ARBs. Patients aged 75 years and older suffered more in-hospital complications (respiratory failure, heart failure, renal failure, sepsis) and a significantly higher mortality (18.4 vs. 48.2%, P < 0.001), but fewer admissions to intensive care units (11.2 vs. 4.8%). In the overall cohort, multivariable analysis demonstrated age ≥75 (OR 3.54), chronic kidney disease (OR 3.36), dementia (OR 8.06), peripheral oxygen saturation at admission <92% (OR 5.85), severe lymphopenia (<500/mm3) (OR 3.36) and qSOFA (Quick Sequential Organ Failure Assessment Score) >1 (OR 8.31) to be independent predictors of mortality.
Conclusion
patients aged ≥65 years hospitalised for COVID-19 had high rates of in-hospital complications and mortality, especially among patients 75 years or older. Age ≥75 years, dementia, peripheral oxygen saturation <92%, severe lymphopenia and qSOFA scale >1 were independent predictors of mortality in this population.
Objectives
To assess the Usefulness of oral anticoagulation therapy (OAT) in patients with coronary artery aneurysm (CAA).
Background
Data on the most adequate antithrombotic CAA management is ...lacking.
Methods
Patients included in CAAR (Coronary Artery Aneurysm Registry, Clinical Trials.gov: NCT02563626) were selected. Patients were divided in OAT and non‐OAT groups, according to anticoagulation status at discharge and 2:1 propensity score matching with replacement was performed. The primary endpoint of the analysis was a composite and mutual exclusive endpoint of myocardial infarction, unstable angina (UA), and aneurysm thrombosis (coronary ischemic endpoint). Net adverse clinical events, major adverse cardiovascular events, their single components, cardiovascular death, re‐hospitalizations for heart failure, stroke, aneurysm thrombosis, and bleeding were the secondary ones.
Results
One thousand three hundred thirty‐one patients were discharged without OAT and 211 with OAT. In the propensity‐matched sample (390 patients in the non‐OAT group, 195 patients in the OAT group), after 3 years of median follow‐up (interquartile range 1–6 years), the rate of the primary endpoint (coronary ischemic endpoint) was significantly less in the OAT group as compared to non‐OAT group (8.7 vs. 17.2%, respectively; p = .01), driven by a significant reduction in UA (4.6 vs. 10%, p < .01) and aneurysm thrombosis (0 vs. 3.1%, p = .03), along with a non‐significant reduction in MI (4.1 vs. 7.7%, p = .13). A non‐significant increase in bleedings, mainly BARC type 1 (55%), was found in the OAT‐group (10.3% in the non‐OAT vs. 6.2% in the OAT group, p = .08).
Conclusion
OAT decreases the composite endpoint of UA, myocardial infarction, and aneurysm thrombosis in patients with CAA, despite a non‐significant higher risk of bleeding.
There is limited information on the presenting characteristics, prognosis, and therapeutic approaches of young patients hospitalized for coronavirus disease 2019 (COVID-19). We sought to investigate ...the baseline characteristics, in-hospital treatment, and outcomes of a wide cohort < 65 years admitted for COVID-19. Using the international multicenter HOPE-COVID-19 registry, we evaluated the baseline characteristics, clinical presentation, therapeutic approach, and prognosis of patients < 65 years discharged (deceased or alive) after hospital admission for COVID-19, also compared with the elderly counterpart. Of the included 5746 patients, 2676 were < 65 and 3070 ≥ 65 years. All risk factors and several parameters suggestive of worse clinical presentation augmented through increasing age classes. In-hospital mortality rates were 6.8% and 32.1% in the younger and older cohort, respectively (p < 0.001). Among young patients, mortality, access to ICU and treatment with IMVwere positively correlated with age. Contrariwise, over 65 years of age this trend was broken so that only the association between age and mortality was persistent, while the rates of access to ICU and IMV started to decline. Younger patients also recognized specific predictors of case fatality, such as obesity and gender. Age negatively impacts on mortality, access to ICU and treatment with IMV in patients < 65 years. In elderly patients only case fatality rate keeps augmenting in a stepwise manner through increasing age categories, while therapeutic approaches become more conservative. Besides age, obesity, gender, history of cancer, and severe dyspnea, tachypnea, chest X-ray bilateral abnormalities, abnormal level of creatinine and leucocyte among admission parameters seem to play a central role in the outcome of patients younger than 65 years.
Dysnatremia is associated with increased mortality in patients with community-acquired pneumonia. SARS-COV2 (Severe-acute-respiratory syndrome caused by Coronavirus-type 2) pneumonia can be fatal. ...The aim of this study was to ascertain whether admittance dysnatremia is associated with mortality, sepsis, or intensive therapy (IT) in patients hospitalized with SARS-COV2 pneumonia. This is a retrospective study of the HOPE-COVID-19 registry, with data collected from January 1
through April 31
, 2020. We selected all hospitalized adult patients with RT-PCR-confirmed SARS-COV2 pneumonia and a registered admission serum sodium level (SNa). Patients were classified as hyponatremic (SNa <135 mmol/L), eunatremic (SNa 135-145 mmol/L), or hypernatremic (SNa >145 mmol/L). Multivariable analyses were performed to elucidate independent relationships of admission hyponatremia and hypernatremia, with mortality, sepsis, or IT during hospitalization. Four thousand six hundred sixty-four patients were analyzed, median age 66 (52-77), 58% males. Death occurred in 988 (21.2%) patients, sepsis was diagnosed in 551 (12%) and IT in 838 (18.4%). Hyponatremia was present in 957/4,664 (20.5%) patients, and hypernatremia in 174/4,664 (3.7%). Both hyponatremia and hypernatremia were associated with mortality and sepsis. Only hyponatremia was associated with IT. In conclusion, hyponatremia and hypernatremia at admission are factors independently associated with mortality and sepsis in patients hospitalized with SARS-COV2 pneumonia.
https://clinicaltrials.gov/ct2/show/NCT04334291, NCT04334291.
•Prevalence of mayor adverse cardiovascular events (MACE) was 7.8 % following one year of COVID-19 hospitalization.•Age, history of cardiovascular disease, hypertension, increased troponin serum ...levels at admission and acute renal failure during hospitalization were identified as predictors of MACE and combined in a clinical score.•HOPE-2 clinical score classified patients into three risk categories and the observed MACE rates were 1.9 %, 9.4 % and 26.3 % for low- intermediate and high-risk patients, respectively.
Long-term consequences of COVID-19 are still partly known.
To derive a clinical score for risk prediction of long-term major cardiac adverse events (MACE) and all cause death in COVID-19 hospitalized patients.
2573 consecutive patients were enrolled in a multicenter, international registry (HOPE-2) from January 2020 to April 2021 and identified as the derivation cohort. Five hundred and twenty-six patients from the Cardio-Covid-Italy registry were considered as external validation cohort. A long-term prognostic risk score for MACE and all cause death was derived from a multivariable regression model.
Out of 2573 patients enrolled in the HOPE-2 registry, 1481 (58 %) were male, with mean age of 60±16 years. At long-term follow-up, the overall rate of patients affected by MACE and/or all cause death was 7.8 %. After multivariable regression analysis, independent predictors of MACE and all cause death were identified. The HOPE-2 prognostic score was therefore calculated by giving: 1–4 points for age class (<65 years, 65–74, 75–84, ≥85), 3 points for history of cardiovascular disease, 1 point for hypertension, 3 points for increased troponin serum levels at admission and 2 points for acute renal failure during hospitalization. Score accuracy at ROC curve analysis was 0.79 (0.74 at external validation).
Stratification into 3 risk groups (<3, 3–6, >6 points) classified patients into low, intermediate and high risk. The observed MACE and all-cause death rates were 1.9 %, 9.4 % and 26.3 % for low- intermediate and high-risk patients, respectively (Log-rank test p < 0.01).
The HOPE-2 prognostic score may be useful for long-term risk stratification in patients with previous COVID-19 hospitalization. High-risk patients may require a strict follow-up.
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