Comparison of visual and passive acoustic estimates of beaked whale density off El Hierro, Canary Islands

Passive acoustic monitoring (PAM) offers considerable potential for density estimation of cryptic cetaceans, such as beaked whales. However, comparative studies on the accuracy of PAM density estimates from these species are lacking. Concurrent, low-cost drifting PAM, with SoundTraps suspended at 200 m depth, and land-based sightings, were conducted off the Canary Islands. Beaked whale density was estimated using a cue-count method, with click production rate and the probability of click detection derived from digital acoustic recording tags (DTags), and distance sampling techniques, adapted to fixed-point visual surveys. Of 32 870 detections obtained throughout 206 h of PAM recordings, 68% were classified as "certain" beaked whale clicks. Acoustic detection probability was 0.15 [coefficient variation (CV) 0.24] and click production rate was 0.46 clicks s - 1 (CV 0.05). PAM density estimates were in the range of 21.5 or 48.6 whales per 1000 km2 [CV 0.50 or 0.44, 95% confidence interval (CI) 20.7-22.4 or 47-50.9), depending on whether "uncertain" clicks were considered. Density estimates from concurrent sightings resulted in 33.7 whales per 1000 km2 (CV 0.77, 95% CI 8.9-50.5). Cue-count PAM methods under application provide reliable estimates of beaked whale density, over relatively long time periods and in realistic scenarios, as these match the concurrent density estimates obtained from visual observations.

Local public health professionals contribution to infodemic management

The digital age we currently live in is characterized by an overwhelming production of information by multiple users. This is particularly relevant in public health areas, where inaccurate information can be a threat to populations' wellbeing. The internet became a field where anyone can produce non validated health information and spread rumors that can drive vaccine hesitancy, non compliance with public health measures and use of ineffective treatments, among other consequences highlighted by the COVID-19 pandemic. Public health professionals must be aware of such relevant concepts, the cognitive theories that support them and the strategies that can be used to monitor, identify, prevent and tackle the spread of health misinformation. However, such an approach should involve not only public health professionals but also journalists, data scientists, social marketeers and behavioural change experts involved in different organizations. Infodemic management is a recent area of research and practice that requires a comprehensive, multidisciplinary capacity building approach focusing behavioural change theories, digital technologies and social media, and community engagement strategies among others. This presentation will provide a brief introduction on main infodemic concepts and cognitive theories, show how infodemic management can overlap common epidemic management and highlight monitoring and social listening strategies and relevant interventions to prevent and tackle misinformation.

Chronic critical illness after hypothermia in trauma patients

Objectives

Chronic critical illness (CCI) is a phenotype that occurs frequently in patients with severe injury. Previous work has suggested that inflammatory changes leading to CCI occur early following injury. However, the modifiable factors associated with CCI are unknown. We hypothesized that hypothermia, an early modifiable factor, is associated with CCI.

Methods

To determine the association of hypothermia and CCI, a secondary analysis of the Inflammation and Host Response to Injury database was performed, and subsequently validated on a similar cohort of patients from a single level 1 trauma center from January 2015 to December 2019. Hypothermia was defined as initial body temperature ≤34.5°C. CCI was defined as death or sustained multiorgan failure ≥14 days after injury. Data were analyzed using univariable analyses with Student’s t-test and Pearson’s χ² test, and logistic regression. An arrayed genomic analysis of the transcriptome of circulating immune cells was performed in these patients.

Results

Of the initial 1675 patients, 254 had hypothermia and 1421 did not. On univariable analysis, 120/254 (47.2%) of patients with hypothermia had CCI, compared with 520/1421 (36.6%) without hypothermia who had CCI, p<0.001. On multivariable logistic regression, hypothermia was independently associated with CCI, OR 1.61 (95% CI 1.17 to 2.21) but not mortality. Subsequent validation in 1264 patients of which 172 (13.6%) were hypothermic, verified that hypothermia was independently associated with CCI on multivariable logistic regression, OR 1.84 (95% CI 1.21 to 2.41). Transcriptomic analysis in hypothermic and non-hypothermic patients revealed unique cellular-specific genomic changes to only circulating monocytes, without any distinct effect on neutrophils or lymphocytes.

Conclusions

Hypothermia is associated with the development of CCI in severely injured patients. There are transcriptomic changes which indicate that the changes induced by hypothermia may be associated with persistent CCI. Thus, early reversal of hypothermia following injury may prevent the CCI.

Level of evidence

III.

Latin American Consensus on management of residual cardiometabolic risk. A consensus paper prepared by the Latin American Academy for the Study of Lipids and Cardiometabolic Risk (ALALIP) endorsed by the Inter-American Society of Cardiology (IASC), the International Atherosclerosis Society (IAS), and the Pan-American College of Endothelium (PACE)

Background:

Hypertension, hyperglycemia, dyslipidemia, overweight, obesity, and tobacco (smoking, chewing, and vaping), together with a pro-inflammatory and procoagulant state, are the main risk factors related to atherosclerotic cardiovascular disease.

Objective and methods:

A group of experts from the Americas, based on their clinical expertise in cardiology, cardiovascular prevention, and cardiometabolic (CM) diseases, joined together to develop these practical recommendations for the optimal evaluation and treatment of residual CM risk factors in Latin America, using a modified Delphi methodology (details in electronic TSI) to generate a comprehensive CM risk reduction guideline, and through personalized medicine and patient-centered decision, considering the cost-benefit ratio The process was well defined to avoid conflicts of interest that could bias the discussion and recommendations.

Results:

Residual risk reduction should consider therapeutic options adapted to specific patient needs, based on five treatment objectives: triglyceride-rich lipoproteins, inflammation, impaired glucose metabolism, high blood pressure, and prothrombotic status. Comprehensive control of all CM risk factors should be a priority to deal with this important public health problem and prevent premature deaths. The recommendations in this paper address the evidence-based treatment of CM risk and are intended for clinical application in Latin American countries.

AB0350 MATERNAL AND FETAL OUTCOME IN MEXICAN WOMEN WITH PRIMARY ANTIPHOSPHOLIPID SYNDROME, SECONDARY ANTIPHOSPHOLIPID SYNDROME AND SYSTEMIC LUPUS ERYTHEMATOSUS WITH ANTIPHOSPHOLIPID ANTIBODIES

Background:

Primary antiphospholipid syndrome (APS) is associated with a higher frequency of maternal-fetal adverse outcomes, with increased risk when APS is associated with systemic lupus erythematosus (SLE).

Objectives:

We compared maternal-fetal complications in patients with primary APS, APS associated with SLE and SLE with anti-phospholipid antibodies (aPLs).

Methods:

Observational, analytical, retrospective, cross-sectional, comparative study, between 2009-2019. Three groups were compared: primary APS, APS associated with SLE and SLE with anti-phospholipid antibodies (aPLs).

Results:

We include 179 pregnant women, 31.8% with primary APS, 35.8% with APS associated with SLE, and 32.4% with SLE and aPLs A history of a higher frequency of abortions was found in APS associated with SLE (62.5%, p <0.001) and thrombosis (61.9%, p <0.001) and aCL IgG + in primary APS (80.7%, p = 0.011). More frequent use during pregnancy of antimalarials is applied in associated APS (81.30%, p <0.001) and aspirin / heparin in primary APS (96.5% / 94.7%, p <0.001). Abortions were observed more frequently in APS associated with SLE (23.80%, p = 0.021) and preeclampsia / HELLP in primary APS (31.6% and 15.8%, p = 0.047) who were also less frequently the use of antimalarial (24% vs. 81.3% vs. 72.4%, p <0.001) compared to the other groups. Table 1

Conclusion:

Patients with APS and SLE have an increased risk of miscarriage whereas those with primary APS have an increased risk for preeclampsia / HELLP. The use of antimalarials could reduce the risk of hypertensive disorders of pregnancy.

References:

[1]Schreiber K, Sciascia S, de Groot PG, et al. Antiphospholipid syndrome. Nat Rev Dis Primers 2018;4:17103.

[2]De Carolis S, Tabacco S, Rizzo F, et al. Antiphospholipid syndrome: An update on risk factors for pregnancy outcome. Autoimmun Rev. 2018;17:956-66.

Table 1.

Comparison between groups of adverse maternal-fetal outcome.

Secondary antiphospholipid syndrome (n=64)Primary antiphospholipid syndrome (n=57)Systemic lupus erythematosus with antiphospholipid antibodies (n=58)PFetal complications48 (76.20%)43 (75.40%)31 (56.40%)0.034Growth restriction9 (14.30%)8 (14%)7 (12.50%)0.955Oligohydramnios6 (9.50%)5 (8.80%)5 (8.90%)0.989Prematurity23 (52.30%)25 (56.80%)19 (42.20%)0.37Abortion15 (23.80%)3 (5.40%)9 (16.10%)0.021Stillbirth7 (11.10%)10 (17.90%)5 (9.10%)0.343Low birth weight20 (52.60%)21 (48.80%)15 (37.50%)0.373Malformations5 (8.10%)0 (0%)0 (0%)0.01Maternal complications40 (63.50%)25 (43.90%)21 (36.80%)0.01Pre-eclampsia.15 (23.80%)18 (31.60%)7 (12.30%)0.046HELLP4 (6.30%)9 (15.8%)2 (3.50%)0.047Premature rupture of membranas7 (11.10%)5 (8.8%)4 (7.10%)0.75Maternal death1 (1.60%)0 (0%)1 (1.80%)0.616

Disclosure of Interests:

None declared

AB0098 ASSOCIATED FACTORS IN ONE-YEAR MORTALITY IN PATIENTS WITH SMALL VESSEL SYSTEMIC VASCULITIS

Background:

The highest mortality rates in patients with small vessel systemic vasculitis occur within the first year after the diagnosis, however associated factors have been scarcely studied in our population.

Objectives:

To identify mortality associated factors at the time of diagnosis in patients with small vessel systemic vasculitis.

Methods:

Retrospective cohort (2009-2020) involving 81 patients diagnosed with systemic small vessel vasculitis. Demographic, clinical and biochemical parameters were studied as potential factors associated with one-year mortality.

Results:

Of the total of patients (n=81), 36 (44.4%) had generalized granulomatosis with polyangiitis, 32 (39.5%) had localized granulomatosis with polyangiitis and 5 (6.2%) had early systemic granulomatosis with polyangiitis, 7 (8.6%) had microscopic polyangiitis and 1 (1.25%) had eosinophilic granulomatosis with polyangiitis. Twenty-two deaths (27%) were observed, 14 of them (63.6%) happened within the first year of diagnosis. The leading cause of death was infection (64%). Patients who died within the first year of diagnosis had a higher frequency of hypoalbuminemia (p=0.05) and also presented hemoglobin lower than 10.8 g/dL (p=0.035) in comparison with those who died after the first year of diagnosis. Remission induction treatment did not differ between both groups.

Conclusion:

Our study suggests that hypoalbuminemia and anemia are factors associated with a higher mortality within the first year after the diagnosis in patients with systemic small vessel vasculitis which contrast with previously reported data. The study design and the reduced number of patients are two major limitations of the study.

References:

[1]Flossmann O, Berden A, Groot K, et al. Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis. 2011;70:488-94.

Disclosure of Interests:

None declared

POS0642 THE IMPACT OF AGE ON DISCONTINUATION OF BIOLOGIC DMARDs IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is the most common autoimmune disease. Older patients treated with biologic DMARDs (bDMARDs) are at a significantly greater risk of adverse effects (AEs) [1]. However, the rate of drug discontinuation because of adverse effects caused by bDMARDs has not differed in elderly compared to younger patients in different registries.

Objectives:

Determine if drug discontinuation of bDMARDs differs by age in patients with rheumatoid arthritis in the Mexican Adverse Events Registry (BIOBADAMEX).

Methods:

BIOBADAMEX is a Mexican ongoing cohort of patients using bDMARDs since 2016. In this analysis we included all patients with diagnosis of RA with at least two assessments. Survival on bDMARDs was estimated using Kaplan-Meier analysis. Predictors of discontinuation, including age older than median age in the sample were investigated by Cox regression analyses.

Results:

Among 743 patients in the registry, 497 had RA diagnosis, from which, 214 had at least two assessments. At baseline, patients had a median (IQR) age of 53.4 (45-61) years old, median disease duration of 10.7 (6-17) months and median DAS28 of 4.7 (3-6). Conventional DMARDS were used by 185 (87%) patients and 94 (44%) patients used corticosteroids. Comorbidities were present in 194 (91%). The most common bDMARDs received at baseline were abatacept 59 (27%), tocilizumab 45(21%), adalimumab 31 (15%) and certolizumab 30 (14%). At the time of analysis, the median bDMARDs treatment duration was 21.0(13-34) months, 128 (59%) had discontinued treatment, 66 for inefficacy, 32 for adverse events and 30 for others. Fig 1 shows discontinuation rate curves in patients younger and older than median age. Cox proportional-hazards demonstrated no significant differences regarding age older than median age (HR 1.1, 95% CI 0.8-1.4, p=0.7), female sex (HR 1.2, 95% CI 0.7-1.9, p=0.44), use of corticosteroids (HR 1.2, 95% CI 0.9-1.6, p=0.20), comorbidities (HR 0.9, 95% 0.6-1.5, p=0.78), DAS28 (HR 0.9, 95% 0.9-1.1, p=0.93) or other factors.

Figure 1.

Discontinuation rate curves in patients younger and older than median age (< 53.4 and >=53.4 years old)

Conclusion:

This analysis did not show a role of age on discontinuation of bDMARDs in Mexican RA patients. Further longitudinal analyses will be performed including more patients to assess retention rate of bDMARDs and identify predictive variables of discontinuation in Mexican population.

References:

[1]Akter R, et al. Can Geriatr J. 2020 May 1;23(2):184-189.

[2]Ikari Y, et al. Medicine (Baltimore). 2020 Dec 24;99(52):e23861.

Disclosure of Interests:

None declared

AB1229 SAFETY OF BIOSIMILAR ETANERCEPT IN THE TREATMENT OF RHEUMATIC DISEASES: DATA FROM THE MEXICAN ADVERSE EVENTS REGISTRY (BIOBADAMEX)

Background:

Access to biosimilar drugs in Mexico started on 2014. Although biosimilar drugs safety has proved comparability to originator drugs on trials, information about its safety on real-life data is limited.

Objectives:

To compare safety in terms of adverse events of biosimilar etanercept (BEt) to originator etanercept (OEt) using information from the Mexican Adverse Events Registry (BIOBADAMEX).

Methods:

BIOBADAMEX is a Mexican cohort that collects the information of biologic and biosimilar drugs used in patients with rheumatic diseases in public and private practice since 2016. Patients enrolled are followed- up yearly. For this study we included patients from 18 to 65 years old who were or are currently in treatment with OEt or BEt and analyzed the frequency of adverse events (AE), the severity and the outcome of these. Baseline time was considered at enrolment to the cohort. We used logistic regression to analyze univariable and multivariable associations.

Results:

At the time of analysis a total of 119 have received treatment with OEt, 38 with BEt. Mean follow up time was 1.35 years. Rheumatoid arthritis (RA) was the most common disease for all the groups followed by ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Both groups had similar baseline characteristics (Table 1). AE occurred in 4 (3.4%) patients with OEt and in 6 (15.8%) with BEt (OR 0.2, 95% CI 0.04-0.7). The most frequent AE in OEt group was allergic reaction, (2(2.5%) of patients), and infections were the most frequent AE in BEt group (2 (5.3%)). Of patients with BEt, 2(5.3%) had severe AE compared to none in the OEt (p=0.012). In the multivariable adjusted analysis comparing development of AE vs no AE including BEt, comorbidities and glucocorticoids, we found that use of BEt (OR 4.6, 95%CI 1.1-19.5) and presence of comorbidities (OR 4.6, 95%CI 1.01-20.5), were associated with AE. Use of glucocorticoids was not significantly associated.

Table 1.

Baseline characteristics

Originator etanercept (n=119)Biosimilar Etanercept(n=38)UnivariableAnalysisaOR(95%CI)Sex (female), n(%)98 (82.4)27 (71.0)1.9 (0.8-4.4)Age, median (IQR)53.6 (45-61)51.3 (43-58)1.0 (0.9-1.0)Body Mass Index, median (IQR)27.5 (23.4-32.5)26.7 (24-29)1.0 (0.9-1.1)Diagnosis, n(%): Rheumatoid arthritis98 (82.4)26 (68)1 Ankylosing spondylitis13 (10.9)9 (24.0)0.3 (0.1-0.9) Psoriatic arthritis8 (6.9)3 (8.0)0.7 (0.1-2.8)Comorbidities, n(%):41 (34.5)14 (40.0)0.3 (0.3-1.5)Use of previous biologic, n(%):95 (79.8)16 (42.1)5.4 (2.5-11.9)Use of steroids, n(%):45 (37.8)22 (57.8)0.4 (0.2-0.9)Use of DMARD, n(%):94 (78.9)35 (92.1)0.3 (0.1-1.1)Adverse eventsb, n(%):4 (3.4)6 (15.8)0.2 (0.04-0.7)Infectionsb, n(%):1 (0.8)2 (5.3)0.15 (0.1-1.7)Allergic reactionsb, n(%):3 (2.5)1 (2.6)0.9 (0.1-9.5)Severeb, n(%):0 (0)2 (5.3)p=0.012c

aUnivariable logistic regression analysis.bCumulative at time of analyses,cChi-square test.

Conclusion:

This preliminary study showed that AE with BEt were more frequent as well as more severe compared to AE presented with OEt in patients with rheumatic diseases using BIOBADAMEX data. Our study suggests that use of BEt and comorbidities are associated with the development of AE. Follow up and inclusion of more participants is going on and will allow us to perform further analyses.

References:

[1]Rugo HS et al. Future Oncol. 2019;15(7):777-790

[2]Moots RJ BioDrugs. 2018;32(3):193-199

Disclosure of Interests:

Vijaya Rivera Teran: None declared, Marcela Pérez Rodríguez: None declared, Deshire Alpizar-Rodriguez: None declared, Fedra Irazoque-Palazuelos Consultant of: Bristol-Myers Squibb, Janssen, Pfizer Inc, Roche and UCB, Sandra Carrilo: None declared, Sandra Sicsik: None declared, David Vega-Morales: None declared, Dafhne Miranda: None declared, angel castillo: None declared, Julio Cesar Casasola: None declared, Cesar Francisco Pacheco Tena: None declared, José Francisco Moctezuma: None declared, Francisco Aceves: None declared, Aleni Paz: None declared, Sergio Duran Barragan: None declared, Leonor Barile: None declared, Natalia Santana: None declared, Daniel Xavier Xibille Friedmann Consultant of: Lilly, Abbvie, Speakers bureau: Lilly, Abbvie

FRI0546 GENDER DIFFERENCES OF RHEUMATIC DISEASES IN MEXICAN POPULATION: DATA FROM THE MEXICAN BIOLOGICS REGISTRY

Background:

Most autoimmune diseases are more prevalent in women. Symptom severity, disease progression, response to therapy and overall survival differ between males and females with rheumatic diseases.

Objectives:

To identify the characteristics of autoimmune diseases presentation and treatment between male and female population using information from the Mexican Adverse Events Registry (BIOBADAMEX).

Methods:

BIOBADAMEX is a Mexican ongoing cohort that collects the information of patients using biologic and biosimilar drugs since 2016. For this study we included all patients enrolled in the registry and compared baseline clinical and disease characteristics, treatment and presence of adverse events between genders. We used logistic regression to analyze univariable associations.

Results:

A total of 655 participants were analysed, of which 82% were female (Table 1). We found women were older with a median of 53 years compared to 46 years in men (OR 1.02, CI 1.0-1.1). Smoking was higher in men (16%) compared to women (5%), (OR 0.3, CI 0.2-0.6). Women had longer disease duration, 9 years compared to 7 years in men (OR 1, CI 1.0-1.1). Rheumatoid arthritis (RA) was more prevalent in women (OR 2.7, CI 1-6.9), while ankylosing spondylitis (AS) and psoriatic arthritis (PsA) were more prevalent in men (OR 0.2, CI 0.1-0.4, and OR 0.3, CI 0.1-0.9 respectively). Women had more comorbidities than men (OR 1.8, CI 1.1-2.8) and used steroids more frequently (OR 1.7, CI 1.1-2.7). Differences in disease activity were not found, however we noticed high activity scores among participants.

Table 1.

Baseline characteristics in the cohort by sex

Womenn=532 (82%)Menn=123 (18%)UnivariableaOR(95%CI)Age, median (IQR)53 (44-60)47 (34-55)1.02 (1.0-1.1)*Body Mass Index, median (IQR)27 (23-31)26 (23-30)1.0 (0.9-1.1)Smoking, n(%)28 (5)18 (16)0.3 (0.2- 0.6)*Disease duration, median (IQR)9 (4-16)7 (2-13)1.0 (1.0-1.1)*Diagnosis, n(%): RA414 (78)37 (30)2.4 (1.0-5.7)* AIJ12 (2)5 (4)0.5 (0.1-1.9) AS37 (7)56 (46)0.1 (0.1-0.4)* PsA19 (4)15 (12)0.3 (0.1-0.8)* SLE17 (3)3 (2)1.2 (0.3-5.2) Others33 (6)7 (6)1Disease Activity indexes, median (IQR) DAS28a4.9 (3.6-5.9)4.9 (3.0-5.9)1.1 (0.9-1.3) BASDAIb4.8 (2.9-8)5.3 (2.8-7.5)0.9 (0.8- 1.1) ASDASc3.2 (1.9-4.5)3.9 (2.5-4.7)0.8 (0.6-1.2) SLEDAId14.5 (5.0-19.5)25 (25.0-31.0)0.6 (0.4-1.1)High blood pressure, n(%)77 (15)14 (12)1.3 (0.7-2.4)Diabetes mellitus, n(%)46 (9)7 (6)1.5 (0.7-3.5)High cholesterol, n(%)41 (8)8 (7)1.2 (0.4-2.6)Other comorbidities, n(%):173 (33)26 (21)1.8 (1.1 -2.8)*Use of previous biologic, n(%):216 (40)44 (36)1.2 (0.8- 1.8)Use of steroids, n(%):215 (42)34 (29)1.7 (1.1 -2.7)*Use of DMARD, n(%):418 (79)89 (72)1.4 (0.9-2.2)Adverse eventsb, n(%):69 (13)14 (11)1.2 (0.7-2.1) Severeb, n(%):12 (17)3 (21)0.8 (0.2-3.1)

Univariable logistic regression analysis. *p<0.05.an=469,bn=99,cn=71,dn=19,

Table 1.

Analysis of association between change (Δ) in FMD and relevant parameters by univariate and multivariate linear regression analysis.

UnivariateRho (p)MultivariateBeta (p)Δ FMD (%)(r2=0.30)ChangeADMA (µmol/l)-0.63 (<0.001)-0.25 (0.01)MDA (nmol/ml)-0.58 (<0.001)-0.18 (0.02)SOD (U/ml)0.48 (<0.001)NSGSH (U/ml)0.02 (0.75)NSHOMA-0.21 (0.001)NSeGFR (ml/min/ 1.73 m2)-0.03 (0.62)NShsCRP (mg/l)-0.45 (<0.001)NSPTX3 (ng/ml)-0.49 (<0.001)-0.21 (0.01)SBP (mmHg)-0.26 (<0.001)NSDBP (mmHg)-0.11 (0.12)NSHemoglobin (g/dl)0.07 (0.32)NSTotal Cholesterol (mg/dl)-0.05 (0.49)NSTriglyceride (mg/dl)-0.11 (0.12)NSLDL (mg/dl)-0.12 (0.07)NSHDL (mg/dl)0.02 (0.82)NSHbA1c (%)-0.26 (<0.001)NSFigure 1.

Scatter-plot graphs between FMD and ADMA, MDA, CuZn-SOD, PTX-3.

Conclusion:

In our study we found sex differences regarding age and disease duration, being higher in women. As expected, the prevalence of RA was higher in women and AS and PsA in men. Overall, women used more steroids than men. An interesting finding was that patients had high disease activity. Future longitudinal analyses will allow us to analyse sex differences in disease progression and treatment response.

References:

[1] Ortona E et al. Ann Ist Super Sanita 2016;52(2):205-12

[2] Ngo ST et al. Front Neuroendocrinol 2014;3(3):347-69

Disclosure of Interests:

Vijaya Rivera Teran: None declared, Deshire Alpizar-Rodriguez: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos Consultant of: Bristol-Myers Squibb, Janssen, Pfizer Inc, Roche and UCB, Dafhne Miranda: None declared, David Vega-Morales: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, angel castillo: None declared, Sergio Duran Barragan: None declared, Omar Muñoz: None declared, Aleni Paz: None declared, Angélica Peña: None declared, Alfonso Torres: None declared, Daniel Xavier Xibille Friedmann Consultant of: Lilly, Abbvie, Speakers bureau: Lilly, Abbvie, Azucena Ramos: None declared, José Francisco Moctezuma: None declared, Francisco Aceves: None declared, Estefania Torres: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Erick Zamora: None declared, Francisco Guerrero: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Cesar Francisco Pacheco Tena: None declared

Prosthetic Valve Endocarditis From Trichosporon asahii in an Immunocompetent Patient

Fungal endocarditis is a rare clinical entity. This report describes an unusual case of fungal endocarditis caused by infection with Trichosporon asahii in a 20-year-old immunocompetent man who received the diagnosis 1 year following biological aortic valve replacement. (Level of Difficulty: Beginner.)

PCBs occurrence in marine bivalves and fish from Todos os Santos Bay, Bahia, Brazil

In order to evaluate contamination by polychlorinated biphenyls (PCBs) in a tropical bay exposed to different anthropogenic pressures, samples of bivalves: mangrove oyster (Crassotrea rhizophorae), mangrove mussel (Mytella guyanensis)and clams (Anomalocardia brasiliana), were collected in different parts of Todos os Santos Bay, Bahia, Brazil. In addition, samples of bivalves and fish, purchased from a seafood market in the city of Salvador were analyzed to evaluate human exposure to PCBs through ingestion. Identification and quantification of PCBs were done by GC/MS after microwave extraction and purification with sulfuric acid. In bivalves, concentrations ranged from <0.08 to 50.1 ng g ^-1 (dry weight), with the highest values being detected in mangrove oyster, followed by clams and mangrove mussel of the Subaé estuary and Madre de Deus/Mataripe; regions known to be impacted by anthropic activities. From the total of the 12 fish species analyzed, only 5 presented levels of PCBs above the detection limit, ranging from 0.23 to 4.55 ng g ^-1 and 0.51 to 26.05 ng g ^-1 by dry weight and lipid weight, respectively. In general, concentrations of PCBs on the bay are lower than in most regions around the world, especially those located in the Northern Hemisphere. Indexes indicated that local biota and seafood from the fish market are not adversely impacted by PCBs and do not represent a risk to human health.

[Impact of the COVID-19 pandemic on ST- elevation myocardial infarction care in Peru]

Purpose

To compare the number of admissions, clinical features and therapeutic outcomes of patients treated for acute ST-segment elevation myocardial infarction (STEMI), before and after the COVID-19 pandemic state of emergency in Peru.

Methods

Observational analytical study of retrospective cohorts, derivated from the PEruvian Registry of ST-segment Elevation Myocardial Infarction II (PERSTEMI II). We compared the patients treated for STEMI, between 45 days before and during the first 45 days of the COVID-19 state of emergency in Peru.

Results

During the first 45 days of the COVID-19 state of emergency, the team found a 59% decrease on the number of admissions for STEMI. There was a larger proportion of patients with high blood pressure and dyslipidemia. We noticed a decreasing trend in the access to reperfusion therapies (73% vs. 66.6%); the fibrinolysis was the most commonly used therapy. The most frequent reason for no reperfusion was the late onset >24 hours (41.7%, p=0.004). There was a trend of time reduction to first medical contact and less ischemia time to reperfusion. A lower incidence of post-infarction heart failure was registered. The mortality was similar in both groups (3.4% vs. 2.7%).

Conclusions

COVID-19 pandemic in Peru has generated a significant reduction of STEMI admissions and a trend in less use of reperfusion therapies. The late onset of patients was the most common reason of not reperfusion.

[Epidemiology of a National Reference Cardiovascular Intensive Care Unit. Results from the RECICA-INCOR Registry]

Background

Cardiovascular intensive care units have evolved in time, from being exclusively dedicated to the care of myocardial infarction patients, to treating complex and varied cardiovascular pathologies. We do not have data about the characteristics of patients in cardiovascular intensive care units in Peru.

Material and Methods

We prospectively evaluated the clinical and epidemiological characteristics of patients admitted between July and November 2018 to the intensive and intermediate care unit of the National Cardiovascular Institute INCOR in Lima, Peru.

Results

A total of 199 patients were enrolled in the study. The median age was 67 years, 20% older than 80 years and 75.8% males. 60% of cases they came from the emergency unit. The most frequent admissions diagnoses were acute coronary syndromes (ACS) (35%) and acutely decompensated heart failure (20%). In-hospital mortality was 4.5%, higher (12%) in patients with readmissions to intensive care.

Conclusions

In this first registry of cardiac critical care in Peru, ACS continues to be the main cause of admission followed by acutely decompensated heart failure. The in-hospital mortality was higher in patients with readmissions to the intensive care unit.

[Relevance of Simpson's grading system for resections in WHO grade I meningiomas]

OBJECT

The aim of this study is to assess if the recurrence rates and recurrence/progression-free survivals (RFS) are different after Simpson's grades I, II, III and IV resections in World Health Organization (WHO) grade I meningiomas.

MATERIAL AND METHODS

A retrospective review was conducted on the data of patients who underwent surgical treatment of WHO grade I meningiomas located in convexity, falx/parasagittal, and skull base (anterior/media/posterior) between June 1991 and December 2011. In Simpson's grade IV resections, surgical treatment was supplemented with radiotherapy/radiosurgery on the tumour remains. A comparison was made on the recurrence rates and RFSs between Simpson's grades I, II, III, and IV resections, both overall and in tumour subsets according to their location.

RESULTS

A total of 208 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson's grades I, II, III, and IV. No significant differences were noted between the different degrees of Simpson in any of the location groups. In convexity meningiomas, the recurrence rates were 7% and 33% in Simpson's grades I and III resections, respectively (P=.131).

CONCLUSIONS

It has been shown that the rates of tumour control in meningiomas are not related to Simpson grades. In falx/parasagittal and skull base meningiomas, more aggressive attempts of tumour resection must be balanced against the risks of damaging critical neurovascular structures. In convexity meningiomas, a Simpson's grade I resection should be attempted first.

Tumor infiltrating immune cells in gliomas and meningiomas

Tumor-infiltrating immune cells are part of a complex microenvironment that promotes and/or regulates tumor development and growth. Depending on the type of cells and their functional interactions, immune cells may play a key role in suppressing the tumor or in providing support for tumor growth, with relevant effects on patient behavior. In recent years, important advances have been achieved in the characterization of immune cell infiltrates in central nervous system (CNS) tumors, but their role in tumorigenesis and patient behavior still remain poorly understood. Overall, these studies have shown significant but variable levels of infiltration of CNS tumors by macrophage/microglial cells (TAM) and to a less extent also lymphocytes (particularly T-cells and NK cells, and less frequently also B-cells). Of note, TAM infiltrate gliomas at moderate numbers where they frequently show an immune suppressive phenotype and functional behavior; in contrast, infiltration by TAM may be very pronounced in meningiomas, particularly in cases that carry isolated monosomy 22, where the immune infiltrates also contain greater numbers of cytotoxic T and NK-cells associated with an enhanced anti-tumoral immune response. In line with this, the presence of regulatory T cells, is usually limited to a small fraction of all meningiomas, while frequently found in gliomas. Despite these differences between gliomas and meningiomas, both tumors show heterogeneous levels of infiltration by immune cells with variable functionality. In this review we summarize current knowledge about tumor-infiltrating immune cells in the two most common types of CNS tumors-gliomas and meningiomas-, as well as the role that such immune cells may play in the tumor microenvironment in controlling and/or promoting tumor development, growth and control.

Low-pressure hydrocephalus: indication for custom-made catheters? Technical report

BACKGROUND

Low-pressure hydrocephalus (LPH) is characterized by ventriculomegaly with persistent low intracranial pressure (ICP). Sub-zero drainage is needed for its management and multiple solutions have been described. Our aim is to report our experience with custom-made peritoneal catheters with larger inner diameter as an alternative treatment option.

METHODS

We made a retrospective review of all patients diagnosed with LPH and treated with custom-made peritoneal catheters at the Virgen del Rocío Pediatric Neurosurgical Unit. Catheters were coated with antibiotic or silver. The inner diameter of ventricular catheters was 1.4 mm; peritoneal catheters were larger than usual (1.9 mm inner diameter).

RESULTS

We identified four patients in whom five custom-made peritoneal catheters were used over a 3-year period. There were two males and the mean age was 10 years (6 months-17 years). In all patients, placement of an EVD was necessary for sub-zero drainage, with maximum negative pressure of -8 cm H20. The mean time of maintenance of EVD was 102 days (10 days-1 year). Finally, three ventriculoperitoneal (VP) valveless systems, one with antigravitation device, and one Pro-GAV VP shunt were placed, all of them with larger custom-made peritoneal catheters. After a mean follow-up period of 2.3 years (6 months-3 years), two patients are completely recovered, one patient is partially dependent for daily activities with good cognitive status, and the last one is a child who died due to his brain tumor.

CONCLUSION

The custom-made peritoneal catheters with larger inner diameter could be a good option for the management of this complex pathology.

Curie transitions for attograms of ferroelectric polymers

Polymer systems having one, two, or three dimensions on the nanometer length scale can exhibit physical properties different from the bulk. The degree of disorder characteristic for large amounts of matter is strongly reduced and changes in symmetry are imposed by means of geometrical confinement. This could be used to induce-through orientation and order-enhancement in the material properties. Experiments on extremely small amounts of matter, however, are naturally characterized by large fluctuations in the measured signals, especially in the case of polymer objects having three dimensions on the nanometer length scale. This imposes the necessity of repeating the measurements until a statistical distribution is obtained. Here we show that investigations on statistical ensembles of attograms of material (1 ag = 10(-18) g) are possible in a single experiment by employing highly ordered arrays of identical, independent, additive nanocontainers. Phase transitions corresponding to attograms of a ferroelectric polymer are measured by this approach. As compared to one- or two-dimensional confinement, significant changes in the Curie transitions are found.

Diagnostic bedside EUS in the intensive care unit: a single-center experience

BACKGROUND

The knowledge of bedside diagnostic EUS in critically ill patients is limited.

OBJECTIVE

To investigate the indications, feasibility, safety, and clinical utility of diagnostic EUS in the intensive care unit (ICU).

DESIGN

Retrospective.

SETTING

Tertiary-care referral teaching hospital.

PATIENTS

All consecutive patients who had EUS done in the ICU within a 6-year period.

INTERVENTION

Bedside EUS and EUS-guided FNA.

MAIN OUTCOME MEASUREMENTS

EUS indications, complications, and impact on management.

RESULTS

A total of 64 EUS procedures were performed in 63 patients (38 men, 25 women; age range 27-78 years); 1 patient underwent 2 separate EUS procedures. EUS was performed while the patients were mechanically ventilated in 70% (45/64) of cases. Indications for EUS included jaundice (n = 24), mass of unknown etiology (n = 25), unexplained pancreatitis (n = 7), and staging of known cancer (n = 3). In 5 cases, EUS was used as an alternative to other imaging modalities because of morbid obesity (n = 3) or contraindication to intravenous contrast material (n = 2). Complications included reversible oxygen desaturation (n = 4), nonsustained ventricular tachycardia (n = 1), and transient hypotension (n = 1). Overall, EUS influenced management in 97% (62/64) of cases.

LIMITATIONS

Retrospective, single-center study.

CONCLUSION

ICU-based EUS can be performed with few intraprocedural complications and can be a valuable diagnostic modality in the ICU setting. It appears to be particularly useful for determining the etiology of jaundice, masses of unknown etiology, and pancreatitis. It may have particular value as a diagnostic technique on selected patients with unstaged cancer and when morbid obesity or the inability to use intravenous contrast material precludes the use of other imaging modalities in the critically ill patient.

Land-Development Dynamics by Morphological Areas: A Case Study of Ribadeo, Northwest Spain

The need to understand land-development processes in order to address the problem derived from urban growth led to the implementation of a number of scientific methods aimed at explaining urban-growth patterns. The dynamics that originate these patterns are complex and may vary across space, such that in small areas there may be various processes operating and producing different kinds of growth. Our aim is to use cluster-analysis techniques to identify zones with similar urban-growth patterns in a coastal rural municipality of the northwest of Spain. Then, the processes that originated the different growth patterns identified from the cluster analysis are characterized using logistic regression techniques. The methodology differentiated three clusters (an urban cluster, a rural cluster, and a rural cluster with urban influence) and characterized the underlying dynamics. This proves that the techniques used in this study constitute a straightforward tool to identify and analyze areas with uniform land-development patterns in order to gain deeper knowledge and produce better regulations and zoning for each area.

Expedited partner therapy for Chlamydia trachomatis at the community pharmacy

OBJECTIVE

Expedited partner treatment (EPT) for uncomplicated Chlamydia trachomatis at the pharmacy is an alternative approach to partner notification that has not yet been evaluated within the UK. The aim of this study was to evaluate EPT for partners using pharmacies in Lothian.

DESIGN

A pilot study over 18 months.

SETTING

Selected healthcare settings and community pharmacies in Lothian, Scotland, UK.

POPULATION

Sexual partners of index cases with uncomplicated C. trachomatis.

METHODS

Index cases with uncomplicated C. trachomatis were given a pharmacy voucher to pass onto sexual partners. Partners could redeem vouchers for free treatment (azithromycin) at one of 90 pharmacies in the area.

MAIN OUTCOME MEASURES

The main outcome measure was the proportion of vouchers redeemed. Secondary outcomes included patient satisfaction, as determined at a telephone follow-up of a subgroup of female index cases from one study site, 1 month later.

RESULTS

In total 577 vouchers were issued to chlamydia-positive index patients of mean age 22.9 years (range 15-47 years). A total of 231 vouchers were redeemed (40%), at a median of 2 days after issue. Only 4% of partners attended a clinic for treatment. Most index patients surveyed reported that partners were satisfied with this method of treatment (48 out of 55; 87%).

CONCLUSIONS

Expedited partner treatment for uncomplicated chlamydia at a pharmacy is a popular choice, and increases options on where, when and how partners are treated.

Influence of silver nanoparticles concentration on the alpha- to beta-phase transformation and the physical properties of silver nanoparticles doped poly(vinylidene fluoride) nanocomposites

This paper describes the processing of silver nanoparticle doped poly(vinylidene fluoride). The effect of the dopant concentration on the alpha- to beta-phase transformation of the polymer as well as in the morphological, thermal, optical and dielectric properties of the nanocomposites was investigated. Spherical silver nanoparticles were incorporated into the poly(vinylidene fluoride) polymeric matrix by the solvent casting method, with different Ag concentrations. Well-dispersed Ag nanoparticles act as nucleation centers, increasing the degree of crystallinity of the nanocomposites. Homogeneous dispersion of silver nanoparticles is demonstrated through the presence of surface plasmon resonance absorption in the nanocomposites. The alpha- to beta-phase transformation was achieved in the polymer matrix and a maximum of approximately equal to 70% of beta-PVDF was reached at 80 degrees C and a stretching ratio of 400%. The dielectric constant of the nanocomposites increases with increasing metal nanoparticle concentration, up to approximately equal to 26 at 0.020 wt% Ag content. The alpha- to beta-phase transformation affects both the dielectric response and the surface plasmon resonance.

Modifications of multi-wall carbon nanotubes with B-containing vapor and their effects on the properties of boron carbide matrix nanocomposites

Multi-wall carbon nanotubes were modified by heating them together with elemental boron powder. B4C crystals grew on the surfaces of the nanotubes, and electron diffraction patterns showed an orientation dependence of the surface B4C and the underlying carbon in the nanotubes. There was no reaction of the nanotubes with solid B2O3 alone. Composites of the modified nanotubes in a B4C matrix showed a small increase of density over sintered B4C.

Association between CD31 expression and histopathologic features in stage IB squamous cell carcinoma of the cervix

This study was undertaken to evaluate the association between the expression of CD31 in the tumor and the histopathologic findings in patients with carcinoma of the cervix. This study included prospectively 30 women, aged 46.6 +/- 10.7 years, with stage IB squamous cell carcinoma of the cervix submitted to radical hysterectomy from November 2001 to September 2002. Samples from the tumor were taken and immunohistochemically evaluated by a monoclonal antibody for CD31. Clinicopathologic characteristics such as stage, tumor size, grade of differentiation, lymphatic vascular space invasion (LVSI), parametrial involvement, and status of pelvic lymph nodes were also recorded. The clinical stage (FIGO) was IB1 in 22 patients (73.3%) and IB2 in 8 patients (26.7%). The expression of CD31 was significantly associated with tumor size and the presence of LVSI, but not with grade of differentiation and vaginal or parametrial involvement (P= 0.03, P= 0.032, P= 0.352, P= 0.208, and P= 0.242, respectively). On univariate analysis, the presence of pelvic lymph node metastasis was influenced by LVSI (P= 0.003) and CD31 expression (P= 0.032). However, on multivariate analysis, the presence of LVSI (P= 0.007) was the only independent predictor of pelvic lymph node metastasis. The CD31 expression in tumor is significantly associated with LVSI and tumor size in patients with early-stage squamous cell carcinoma of the cervix.

Quantitative trait loci for lodging resistance, plant height and partial resistance to mycosphaerella blight in field pea (Pisum sativum L.)

With the development of genetic maps and the identification of the most-likely positions of quantitative trait loci (QTLs) on these maps, molecular markers for lodging resistance can be identified. Consequently, marker-assisted selection (MAS) has the potential to improve the efficiency of selection for lodging resistance in a breeding program. This study was conducted to identify genetic loci associated with lodging resistance, plant height and reaction to mycosphaerella blight in pea. A population consisting of 88 recombinant inbred lines (RILs) was developed from a cross between Carneval and MP1401. The RILs were evaluated in 11 environments across the provinces of Manitoba, Saskatchewan and Alberta, Canada in 1998, 1999 and 2000. One hundred and ninety two amplified fragment length polymorphism (AFLP) markers, 13 random amplified polymorphic DNA (RAPD) markers and one sequence tagged site (STS) marker were assigned to ten linkage groups (LGs) that covered 1,274 centi Morgans (cM) of the pea genome. Six of these LGs were aligned with the previous pea map. Two QTLs were identified for lodging resistance that collectively explained 58% of the total phenotypic variation in the mean environment. Three QTLs were identified each for plant height and resistance to mycosphaerella blight, which accounted for 65% and 36% of the total phenotypic variation, respectively, in the mean environment. These QTLs were relatively consistent across environments. The AFLP marker that was associated with the major locus for lodging resistance was converted into the sequence-characterized amplified-region (SCAR) marker. The presence or absence of the SCAR marker corresponded well with the lodging reaction of 50 commercial pea varieties.