BACKGROUND Complete resection of an arteriovenous malformation (AVM) is considered a curative treatment. In this paper the authors discuss two possibilities in the event of hemorrhage after ...satisfactory resection of an AVM: recurrence or remnant. OBSERVATIONS A 33-year-old female patient was diagnosed with an incidental right frontal AVM that was microsurgically resected and whose postoperative angiography showed no remnant. Eight years later, she presented with an episode of headache and speech arrest. Magnetic resonance imaging showed bleeding in the previous surgical site, and a new angiography revealed the presence of a vascular blush not seen previously. The patient did not show the most frequently associated factors for recurrence described in the literature, which are hemorrhage on presentation and deep venous drainage. In addition, factors related to undetected vascular remnants, such as preoperative hemorrhage and early postoperative angiography, were absent. LESSONS Considering the characteristics of the case, we believe that the most likely explanation is the development of a de novo vascular formation secondary to factors not yet elucidated. Preexisting views on AVM formation, the curative value of resection, and long-term follow-up in certain patients should be reevaluated.
To analyse the effect of oxygen fraction reduction (O2 14%, equivalent to 3250 m) on Q-CPR and rescuers' physiological demands.
A quasi-experimental study was carried out in a sample of 9 Q-CPR ...proficient health care professionals. Participants, in teams of 2 people, performed 10 min CPR on a Laerdal ResusciAnne mannequin (30:2 compression/ventilation ratio and alternating roles between rescuers every 2 min) in two simulated settings: T21-CPR at sea level (FiO2 of 21%) and T14 – CPR at 3250 m altitude (FiO2 of 14%). Effort self-perception was rated from 0 (no effort) to 10 (maximum demand) points.
Quality of chest compressions was good and similar in both conditions (T21 vs T14). However, the percentage of ventilations with adequate tidal volume was lower in altitude than at sea level conditions (35.9 ± 25.2% vs. 54.7 ± 23.2%, p = 0.035). The subjective perception of effort was significantly higher at simulated altitude (5 ± 2) than at sea level (3 ± 2) (p = 0.038). Maximum heart rate during the tests was similar in both conditions; however, mean oxygen saturation was significantly lower in altitude conditions (90.5 ± 2.5% vs. 99.3 ± 0.5%, p < 0.001).
Although performing CPR under simulated hypoxic altitude conditions significantly increases the physiological demands and subjective feeling of tiredness compared to sea level CPR, trained rescuers are able to deliver good Q-CPR in such conditions, at least in the first 10 min of resuscitation.
The Iberian hare (Lepus granatensis Rosenhauer, 1856) has the western distribution limit in the south of the dorsal galega. This work provides new data on the status of the species over 16 years of ...sampling. Indices of relative abundance of Iberian hare were determined in the dorsal galega through night censuses carried out in each season. During the years 2006-2020, a total of 2,500 km was gone down along forest tracks in the Suido and Faro de Avión mountain ranges, spread over 196 days. The relative abundance for the hare ranged between 0.07 and 0.30 ind/km for the Faro de Avión with an average of 0.18 ± 0.06 ind/km, and between 0.02 and 0.22 ind/km for the Suido, with an average of 0.07 ± 0.06 ind/km. The monitoring along the years of the studied population supports scientific decision-making for conservation and hunting management purposes.
The Iberian hare (Lepus granatensis Rosenhauer, 1856) has the western distribution limit in the south of the dorsal galega. This work provides new data on the status of the species over 16 years of ...sampling. Indices of relative abundance of Iberian hare were determined in the dorsal galega through night censuses carried out in each season. During the years 2006-2020, a total of 2,500 km was gone down along forest tracks in the Suido and Faro de Avión mountain ranges, spread over 196 days. The relative abundance for the hare ranged between 0.07 and 0.30 ind/km for the Faro de Avión with an average of 0.18 ± 0.06 ind/km, and between 0.02 and 0.22 ind/km for the Suido, with an average of 0.07 ± 0.06 ind/km. The monitoring along the years of the studied population supports scientific decision-making for conservation and hunting management purposes.
La liebre ibérica (Lepus granatensis Rosenhauer, 1856) tiene su límite de distribución occidental al sur de la dorsal galega. En el presente trabajo se aportan nuevos datos sobre la situación de esta especie tras 16 años de muestreos. Se calcularon los índices de abundancia relativa de liebre ibérica en la dorsal galega
mediante censos nocturnos realizados estacionalmente. En los años 2006-2020 se recorrieron un total de 2.500 km por pistas forestales en las sierras de Suído y Faro de Avión, con un total de 196 jornadas de trabajo. La abundancia relativa de liebre ibérica osciló entre 0,07 y 0,30 ind/km para Faro de Avión, con una media de 0,18 ± 0,06 ind/km, y entre 0,02 y 0,22 ind/km para Suído con una media de 0,07 ± 0,06 ind/km. El trabajo realizado ha permitido el seguimiento continuo de la población de liebres durante estos años, lo que facilitará la toma de decisiones eficientes en cuanto a su conservación y gestión.
To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease.
Data from the ...EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality.
6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity.
NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.
Highlights * Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of ...SARS-CoV-19 still remain to be defined. * We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs. * We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation. Author Affiliation: (a) Hospital Clinic, Barcelona, Spain (b) Hospital Clinico San Carlos, Madrid, Spain (c) Hospital General de Alicante, Spain (d) Hospital Universitario de Canarias, Tenerife, Spain (e) Hospital Universitario Severo Ochoa de Leganes, Madrid, Spain (f) Hospital General Universitario Reina Sofia, Murcia, Spain (g) Complejo Asistencial de Soria, Spain (h) Hospital Universitario Rey Juan Carlos, Madrid, Spain (i) Hospital San Pedro, Logrono, Spain (j) Hospital de Leon, Spain (k) Hospital de la Princesa, Madrid, Spain (l) Hospital Clinico San Carlos, Madrid, Spain (m) Hospital de Fuenlabrada, Madrid, Spain (n) Hospital Clinico Universitario Lozano Blesa, Spain (o) Hospital Clinico Universitario de Salamanca, Spain (p) Complejo Hospitalario Universitario de A Coruna, Spain (q) Hospital Universitario de Bellvitge de l'Hospitalet de Llobregat, Barcelona, Spain (r) Hospital de la Vega Baja de Orihuela, Alicante, Spain (s) Hospital Virgen de los Lirios de Alcoy, Alicante, Spain (t) Hospital Francesc de Borja de Gandia, Valencia, Spain (u) Hospital Doctor Peset, Valencia, Spain (v) Hospital la Fe, Valencia, Spain (w) Hospital Reina Sofia, Murcia, Spain (x) Hospital General de Albacete, Spain (y) Hospital del Vinalopo de Elche, Alicante, Spain (z) Hospital de Torrevieja, Alicante, Spain (aa) Hospital Universitari de Vic, Barcelona, Spain (ab) Hospital General de Alicante, Spain (ac) Hospital Marina Baixa de Villajoyosa, Alicante, Spain (ad) Hospital Arnau de Vilanova, Valencia, Spain (ae) Hospital Clinic de Barcelona, Spain (af) Hospital Universitario LucusAugusti, Lugo, Spain (ag) Hospital de Henares, Madrid, Spain (ah) Hospital Comarcal El Escorial, Madrid, Spain (ai) Hospital Universitario de Burgos, Spain (aj) Hospital Costa del Sol de Marbella, Malaga, Spain (ak) Hospital de Lliria, Valencia, Spain (al) Hospital de Requena, Valencia, Spain (am) Hospital Clinico de Valencia, Spain (an) Hospital Universitario La Ribera, Valencia, Spain (ao) Hospital del Mar, Barcelona, Spain (ap) Hospital Universitario La Paz, Madrid, Spain (aq) Hospital Santa Tecla, Tarragona, Spain (ar) Hospital Rio Hortega, Valladolid, Spain (as) Hospital General de Elche, Alicante, Spain (at) Hospital Universitario Central Asturias, Oviedo, Spain (au) Hospital de Parla, Madrid, Spain (av) Hospital Virgen de la Luz, Cuenca, Spain (aw) Hospital Joan XXIII, Tarragona, Spain (ax) Hospital Universitario de Canarias, Tenerife, Spain (ay) Clinica Universidad Navarra, Madrid, Spain (az) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (ba) Hospital Juan Ramon Jimenez, Huelva, Spain (bb) Hospital Doctor Josep Trueta, Girona, Spain (bc) Clinica Sagrada Familia, Barcelona, Spain (bd) Hospital Severo Ochoa de Leganes, Madrid, Spain (be) Hospital GermansTrias i Pujol de Badalona, Barcelona, Spain (bf) Hospital Universitario Sant Joan, Alicante, Spain (bg) Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain (bh) Hospital Nuestra Senora del Prado de Talavera de la Reina, Toledo, Spain (bi) Hospital Valle de los Pedroches de Pozoblanco, Jaen, Spain (bj) Hospital Regional Universitario de Malaga, Spain (bk) Hospital Lluis Alcanyis de Xativa, Valencia, Spain (bl) Hospital Alvaro Cunqueiro de Vigo, Pontevedra, Spain (bm) Consorci Hospitalari de Terrassa, Barcelona, Spain (bn) Hospital de Denia, Alicante, Spain (bo) Hospital de Gijon, Asturias, Spain (bp) Hospital Virgen de la Arrixaca, Murcia, Spain (a) Emergency Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain (b) Emergency Department, Hospital General de Alicante, University Miguel Hernandez, Elche, Alicante, Spain (c) Emergency Department, Hospital General UniversitarioReina Sofia, Murcia, Spain (d) Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain (e) Emergency Department, Hospital UniversitarioSevero Ochoa, Universidad Alfonso X, Madrid, Spain (f) Emergency Department, Hospital Clinico San Carlos, IDISSC, Univesdad Complutense, Madrid, Spain * Corresponding author at: Emergency Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia, Spain. Article History: Received 27 August 2020; Revised 18 December 2020; Accepted 24 January 2021 Byline: Oscar Miro omiro@clinic.cat (a,*), Pere Llorens (b), Sonia Jimenez (a), Pascual Pinera (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Francisco Javier Martin-Sanchez (f), Juan Gonzalez del Castillo (f), Oscar Miro (a), Sonia Jimenez (a), Juan Gonzalez del Castillo (b), Francisco Javier Martin-Sanchez (b), Pere Llorens (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Pascual Pinera Salmeron (f), Fahd Beddar Chaib (g), Enrique del Hoyo Pelaez (g), Belen Rodriguez Miranda (h), Alejandra Sanchez Arias (h), Noemi Ruiz de Lobera (i), Marta Iglesias Vela (j), Laura Hernando Lopez (j), Carmen del Arco Galan (k), Guillermo Fernandez Jimenez (k), E. Jorge Garcia Lamberechts (l), Marcos Fragiel (l), Maria Jesus Dominguez (m), Maria Eugenia Barrero Ramos (m), Jose Maria Ferreras Amez (n), Belen Arribas Entrala (n), Angel Garcia Garcia (o), Marta Fuentes de Frutos (o), Ricardo Calvo Lopez (p), Javier Jacob-Rodriguez (q), Ferran Llopis-Roca (q), Maria Carmen Ponce (r), Napoleon Melendez (s), Maria Jose Fortuny Bayarri (t), Francisco Jose Salvador Suarez (t), Maria Luisa Lopez Grima (u), M*. Angeles Juan Gomez (u), Javier Millan (v), Jose A. Sanchez Nicolas (w), Paula Lazaro Aragues (w), Francisco Javier Lucas-Imbernon (x), Francisco Javier Lucas-Galan (x), Blas Jimenez (y), Blas Jimenez (z), Rigoberto del Rio (z), Lluis LLauger Garcia (aa), Begona Espinosa (ab), Ana Belen Paya (ab), Juan Miguel Porrino (ac), Maria Rosales Maestre (ac), Maria Jose Cano Cano (ad), Rosa Sorando Serra (ad), Carlos Cardozo (ae), Juan Jose Lopez Diaz (af), Martin Ruiz Grinspan (ag), Cristobal M. Rodriguez Leal (ag), Sara Gayoso Martin (ah), Silvia Ortiz Zamorano (ah), Maria Pilar Lopez Diaz (ai), Carmen Aguera Urbano (aj), Elisa Delgado Padial (aj), Ana Peiro Gomez (ak), Elena Gonzalo Bellver (ak), Laura Ejarque Martinez (al), Maribel Marzo Lambies (al), Jose Noceda (am), Jose Vicente Braso Aznar (an), Jose Luis Ruiz Lopez (an), Alfons Aguirre Tejedo (ao), Isabel Cirera Lorenzo (ao), Alejandro Martin Quiros (ap), Elena Munoz del Val (ap), Enrique Martin Mojarro (aq), Brigitte Silvana Alarcon Jimenez (aq), Virginia Carbajosa (ar), Susana Sanchez Ramon (ar), Matilde Gonzalez Tejera (as), Pablo Herrero Puente (at), Desire Maria Velarde Herrera (at), Francisco Javier Teigell Munoz (au), Juan Carlos Reparaz Gonzalez (au), Felix Gonzalez Martinez (av), Diana Moya Olmeda (av), Anna Palau (aw), Patricia Eiroa Hernandez (ax), Marcos Exposito Rodriguez (ax), Nieves Lopez Laguna (ay), Maria Garcia-Uria (ay), Josep Guardiola (az), Polo Higa Sansome (az), Maria Jose Marchena Gonzalez (ba), EissaJaloud Saavedra (ba), Maria Adroher (bb), Ester Soy Ferrer (bb), Arturo Huertas (bc), Raquel Torres Garate (bd), Beatriz Valle Borrego (bd), Josep Maria ModolDeltell (be), Samuel Olmos Soto (be), Elena Diaz Fernandez (bf), Jose Pavon Monzo (bg), Nayra Cabrera Gonzalez (bg), Ricardo Juarez (bh), Jorge Pedraza Garcia (bi), Manuel Salido (bi), Miguel Moreno Fernandez (bj), Carles Perez (bk), Maria Teresa Maza Vera (bl), Raquel Rodriguez Calveiro (bl), Josep Tost (bm), Antonio Barcelo (bn), Rosario Carrio (bo), Eva Quero Moto (bp)
