Emergency measures to treat patients with coronavirus disease 2019 (COVID-19) and contain the outbreak is the main priority in each of our hospitals; however, these measures are likely to result in ...collateral damage among patients with other acute diseases. Here, we investigate whether the COVID-19 pandemic affects acute stroke care through interruptions in the stroke chain of survival.
A descriptive analysis of acute stroke care activity before and after the COVID-19 outbreak is given for a stroke network in southern Europe. To quantify the impact of the pandemic, the number of stroke code activations, ambulance transfers, consultations through telestroke, stroke unit admissions, and reperfusion therapy times and rates are described in temporal relationship with the rising number of COVID-19 cases in the region.
Following confinement of the population, our stroke unit activity decreased sharply, with a 25% reduction in admitted cases (mean number of 58 cases every 15 days in previous months to 44 cases in the 15 days after the outbreak,
<0.001). Consultations to the telestroke network declined from 25 every 15 days before the outbreak to 7 after the outbreak (
<0.001). The increasing trend in the prehospital diagnosis of stroke activated by 911 calls stopped abruptly in the region, regressing to 2019 levels. The mean number of stroke codes dispatched to hospitals decreased (78% versus 57%,
<0.001). Time of arrival from symptoms onset to stroke units was delayed >30 minutes, reperfusion therapy cases fell, and door-to-needle time started 16 minutes later than usual.
The COVID-19 pandemic is disruptive for acute stroke pathways. Bottlenecks in the access and delivery of patients to our secured stroke centers are among the main challenges. It is critical to encourage patients to continue seeking emergency care if experiencing acute stroke symptoms and to ensure that emergency professionals continue to use stroke code activation and telestroke networks.
Leucine, isoleucine and valine are essential aminoacids termed branched-chain amino acids (BCAA) due to its aliphatic side-chain. In several pathological and physiological conditions increased BCAA ...plasma concentrations have been described. Elevated BCAA levels predict insulin resistance development. Moreover, BCAA levels higher than 2mmol/L are neurotoxic by inducing microglial activation in maple syrup urine disease. However, there are no studies about the direct effects of BCAA in circulating cells. We have explored whether BCAA could promote oxidative stress and pro-inflammatory status in peripheral blood mononuclear cells (PBMCs) obtained from healthy donors. In cultured PBMCs, 10mmol/L BCAA increased the production of reactive oxygen species (ROS) via both NADPH oxidase and the mitochondria, and activated Akt-mTOR signalling. By using several inhibitors and activators of these molecular pathways we have described that mTOR activation by BCAA is linked to ROS production and mitochondrial dysfunction. BCAA stimulated the activation of the redox-sensitive transcription factor NF-κB, which resulted in the release of pro-inflammatory molecules, such as interleukin-6, tumor necrosis factor-α, intracellular adhesion molecule-1 or CD40L, and the migration of PBMCs. In conclusion, elevated BCAA blood levels can promote the activation of circulating PBMCs, by a mechanism that involving ROS production and NF-κB pathway activation. These data suggest that high concentrations of BCAA could exert deleterious effects on circulating blood cells and therefore contribute to the pro-inflammatory and oxidative status observed in several pathophysiological conditions.
Representative diagram of proposed mechanisms involved in BCAA signalling applied for PBMCs Display omitted
•High BCAA concentration induces ROS generation and mitochondrial dysfunction in PBMCs.•High BCAA concentration promotes the activation of NF-κB favoring the expression of cytokines and adhesion molecules and PBMCs migration.•The pro-oxidant and pro-inflammatory actions of BCAA are mediated by the Akt-mTORC1 axis.
En la Argentina, en un contexto económico marcado por los altos niveles de inflación y las fuertes restricciones sobre el mercado de cambios, las inversiones en diversos instrumentos financieros han ...tenido un crecimiento exponencial desde 2020. A través de una estrategia cuanti-cualitativa, este trabajo analiza la expansión de las plataformas financieras digitales para invertir y la creciente incorporación de los inversores legos o amateurs al mercado como un proceso de popularización de las inversiones. Entiende este proceso como resultado de la interacción entre un contexto económico inestable, los cambios en las organizaciones financieras a partir de su digitalización y la amplia circulación social de discursos, conocimientos e ideas que familiarizan al público no experto con los instrumentos de inversión.
Abstract Background Most sudden deaths during sports occur in general population practising recreational sports and according to legislation, a forensic autopsy is required. Most are sudden cardiac ...deaths but the incidence of specific pathologies differs in reported series according to autopsy methods or diagnostic criteria. The purpose of this work is to analyse the pathology of sports-related sudden deaths in a large forensic series from Spain studied according with cardiovascular pathology criteria. Materials and results We have reviewed the sudden deaths occurred during sports studied at our institution between 1995 and 2010 in which a complete autopsy was performed with exhaustive cardiac examination and toxicological analysis. Out of 8862 sudden deaths studied, 168 (1.8%) were related to sports; age was between 9 and 69 (average 36.6 ± 15.6 y); 163 were males and 5 females. Only 3 were professional athletes. Most frequent sports associated to sudden death were cycling (29%), soccer (25.5%), running (8.9%) and gymnastics (6.5%). In 49 cases (29.1%) there were some personal pathological antecedents or familial sudden deaths. Causes of death were: coronary atherosclerotic disease, 85 (50.5%) (74 over 35 years old); arrhythmogenic cardiomyopathy, 13 (7.7%); hypertrophic cardiomyopathy, 12 (7.1%); idiopathic left ventricular hypertrophy, 7 (4.1%); congenital coronary anomalies, 7 (4.1%); myocarditis, 6 (3.5%); aortic stenosis, 5 (2.9%); and other, 11 (6.5%). Myocardial diseases were the most frequent under 35 years old. No cause of death was found in 19 (11.3%) (all under 30 years old) what stresses the necessity of including molecular techniques in forensic autopsies.
Más que un mapa exhaustivo de la literatura argentina del siglo 21 cuya extensión resultaría inabarcable, Gallego Cuiñas se propone trazar “una suerte de escaparate metafórico” (xi) estructurado en ...cuatro capítulos cuyos ejes reflexivos se gestan en un qué, un cómo y un dónde. Estos interrogantes sirven como estrategia para revelar algunas de las conclusiones que la autora ha venido desarrollando a lo largo de su carrera investigadora y de su labor docente dentro de la Universidad de Granada...
Objective
Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among ...patients with acute ischemic stroke (AIS) in southern Spain.
Methods
We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests.
Results
Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients.
Conclusions
The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.
Chronic kidney disease is among the fastest growing causes of death worldwide. An increased risk of all-cause and cardiovascular death is thought to depend on the accumulation of uremic toxins when ...glomerular filtration rate falls. In addition, the circulating levels of several markers of inflammation predict mortality in patients with chronic kidney disease. Indeed, a number of cytokines are listed in databases of uremic toxins and uremic retention solutes. They include inflammatory cytokines (IL-1β, IL-18, IL-6, TNFα), chemokines (IL-8), and adipokines (adiponectin, leptin and resistin), as well as anti-inflammatory cytokines (IL-10). We now critically review the cytokines that may be considered uremic toxins. We discuss the rationale to consider them uremic toxins (mechanisms underlying the increased serum levels and evidence supporting their contribution to CKD manifestations), identify gaps in knowledge, discuss potential therapeutic implications to be tested in clinical trials in order to make this knowledge useful for the practicing physician, and identify additional cytokines, cytokine receptors and chemokines that may fulfill the criteria to be considered uremic toxins, such as sIL-6R, sTNFR1, sTNFR2, IL-2, CXCL12, CX3CL1 and others. In addition, we suggest that IL-10, leptin, adiponectin and resistin should not be considered uremic toxins toxins based on insufficient or contradictory evidence of an association with adverse outcomes in humans or preclinical data not consistent with a causal association.
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