Search

Relatively high opal concentrations are measured in equatorial Atlantic sediments from the most recent deglaciation. To shed light on their causes, seven cores were analyzed for their content of siliceous (diatom, silicoflagellates, radiolarians, phytoliths, and sponge spicules) and calcareous (coccolithophores) microfossils. An early deglacial signal is detected at the time of rising boreal summer insolation ca. 18 ka by the coccolithophores. The surface freshening is likely due to the rain belt associated with the intertropical convergence zone (ITCZ), implying its southward shift relatively to its present‐day average positioning. The diatom assemblages corresponding to the following increase in diatom abundances ca. 15.5 ka suggest the formation of a cold tongue of upwelled water associated with tropical instability waves propagating westward. Such conditions occur at present during boreal summer, when southerly trade winds are intensified, and the ITCZ shifts northward. The presence of the diatom Ethmodiscus rex (Wallich) Hendey and the coccolithophore Florisphera profunda indicates a deep thermocline and nutrient enrichment of the lower photic zone, revealing that Si‐rich southern sourced water (SSW) likely contributed to enhanced primary productivity during this time interval. The discrepancies between the maximum opal concentrations and siliceous marine microfossils records evidence the contribution of freshwater diatoms and phytoliths, indicative of other processes. The definition of the nature of the opal record suggests successive productivity conditions associated with specific atmospheric settings determining the latitudinal ITCZ positioning and the development of oceanic processes; and major oceanic circulation changes permitting the contribution of SSW to marine productivity at this latitude. Key Points: Microfossil evidence for the contribution by Si‐rich southern‐sourced water to enhanced primary productivity in the equatorial AtlanticThe position of the intertropical convergence zone plays a role in determining the different productivity conditionsOpal accumulation does not necessarily reflect solely diatom burial [ABSTRACT FROM AUTHOR]

Planktonic foraminifera δ18O and Mg/Ca ratios are widely considered as a powerful proxy to reconstruct past seawater‐column temperature. Due to the complex interpretation of planktonic foraminifera δ18O data in regard to past seawater temperatures, temperature determination based on the foraminifera shell Mg/Ca ratio is believed to be more accurate. Scarce Mg/Ca calibration data exists for coastal upwelling regions, resulting in incoherent results of past seawater reconstructions. The current study along the NW Iberia coastal upwelling system intends to define the best Mg/Ca temperature equation for the most representative species of this region (Neogloboquadrina incompta, Globigerina bulloides, and Globorotalia inflata). Seawater temperature from δ18O and Mg/Ca of these three planktonic foraminifera species was compared with the surface sediments alkenone derived SST and with the in situ temperatures measured at the depths where these foraminifera species currently live and calcify. The equations that better reflect each species calcification depth were selected as our regional equations for δ18O and Mg/Ca temperature reconstructions. The δ18O‐estimated temperatures for surface sediment specimens were comparable with in situ seawater‐column temperature measurements, whereas the Mg/Ca derived temperatures seem to underestimate in situ values, in special for G. bulloides from samples affected by stronger coastal upwelling. The G. bulloides δ18O and Mg/Ca estimated temperatures from samples located offshore, further from coastal upwelling influence, are comparable to surface sediment alkenone derived temperatures. Our study shows that in upwelling areas, regional calibration of planktonic foraminifera Mg/Ca temperature equations is necessary for reliable interpretations of high‐resolution past temperature variability in these important environments. Plain Language Summary: To reconstruct past seawater temperatures from foraminifera shells' Mg/Ca content, implies the use of calibration equations. Most of the existing equations do not include samples from coastal upwelling areas. In this work, we have calibrated both δ18O and Mg/Ca measured in the planktonic foraminifer's dominant species in surface sediments from NW Iberian margin. We used in situ temperatures, at the depths where these foraminiferal species currently live and calcify, and the alkenone‐derived temperature for the same sediments. δ18O estimated temperatures are equivalent to in situ seawater column temperatures, while Mg/Ca derived temperatures seem to underestimate in situ values, in special for G. bulloides in samples close to the coast, under stronger coastal upwelling influence. However, outside upwelling influence results are comparable to alkenone‐derived temperatures. Our study shows that to estimate past temperatures from planktonic foraminifera Mg/Ca, with confidence, regional calibrations are necessary, in particular for coastal upwelling systems. Key Points: To define the appropriate δ18O and Mg/Ca paleotemperature equations to be used in the most abundant planktonic foraminifera species preserved in the ocean floor at the NW Iberia coastal upwelling systemδ18O‐temperatures mirror in situ temperatures while the Mg/Ca‐temperatures underestimate the observed values, especially for G. bulloides, under stronger coastal upwelling influenceG. bulloides δ18O and Mg/Ca estimated temperatures are comparable to surface sediment alkenone‐temperatures for samples located offshore, without a strong coastal upwelling [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the association between Stevens-Johnson syndrome (SJS)/ toxic epidermal necrolysis (TEN) and antiepileptics including the most recently authorized drugs. METHODS: In the Spanish Pharmacovigilance database, we searched for spontaneous reports of SJS or TEN associated with antiepileptic drugs and analysed: a) reporting odds ratio (ROR), b) age and gender of the patient, c) evolution, d) latency and recovery periods and e) presence or absence of other suspected drugs. RESULTS: A total of 84 reports of SJS and 80 of TEN related to 9 antiepileptic drugs were studied. Reports were mainly associated with phenytoin (SJS: 28; TEN: 43), lamotrigine (SJS: 37; TEN: 20) and carbamazepine (SJS: 14; TEN: 16). Other antiepileptic drugs involved were: valproate, phenobarbital, oxcarbazepine, levetiracetam, primidone and gabapentin. Patients were of a median age of 40 [1-87] and 57.3% of them were women. Cases related to phenytoin were more common in older men and to lamotrigine in younger women. The latency period of SJS and TEN did not exceed the first month of treatment and, in most of the analysed reports, the outcome was recovery. CONCLUSIONS: Our observations support the association of SJS or TEN with phenytoin, carbamazepine, valproate or phenobarbital and enlighten the role of lamotrigine and others such as oxcarbazepine or levetiracetam. [ABSTRACT FROM AUTHOR]

Imiquimod is an immunomodulator of the imidazoquinoline group which possesses antiviral and antitumour activities. Although its mechanism of action has not been entirely elucidated yet, imiquimod 5% cream has been shown to be an efficient, long-lasting and safe therapy for multiple actinic keratoses in non-immunosuppressed patients and in transplant recipients. We report the case of a 44-year-old patient with a third renal transplant who developed an acute tubular necrosis confirmed by renal biopsy after the use of imiquimod 5% cream. The result of a literature search revealed a wide variety of side effects attributable to the use of imiquimod. [ABSTRACT FROM AUTHOR]

The author report a study of allergic contact dermatitis in 329 Portugunese children of 14 years or younger,170 children (64 male and 106 females) reacted to 1 or more allergens. Most of these were in the 11-14 years group. The main allergens were nickel , thimerosal, cobalt , mercury, fragrance-mix and potassium dichromate. Nickel reactivity predominated in females over the whole group, but a greater number of males younger than 5 years reacted to nickel. The number of positive reactions increased with age, but this was not accompanied by an increase in the % of relevant tests 12 children, all of then 13 or 14 years-old, had an occupational allergic contact dermatitis. [ABSTRACT FROM AUTHOR]

Abstract Background Interaction programs involving dolphins and patients with various pathologies or developmental disorders (e.g., cerebral palsy, intellectual impairment, autism, atopic dermatitis, post-traumatic stress disorder, depression) have stimulated interest in their beneficial effects and therapeutic potential. However, the true effects observed in different clinical and psycho-educational setups are still controversial. Results An evaluation protocol consisting of the Childhood Autism Rating Scale (CARS), Psychoeducational Profile-Revised (PEP-R), Autism Treatment Evaluation Checklist (ATEC), Theory of Mind Tasks (ToM Tasks) and a custom-made Interaction Evaluation Grid (IEG) to evaluate behavioural complexity during in-pool interactions was applied to 10 children diagnosed with Autism Spectrum Disorders. The ATEC, ToM Tasks and CARS results show no benefits of the dolphin interaction program. Interestingly, the PEP-R suggests some statistically significant effects on ‘Overall development score’, as well as on their ‘Fine motor development’, ‘Cognitive performance’ and ‘Cognitive verbal development’. Also, a significant evolution in behavioural complexity was shown by the IEG. Conclusions This study does not support significant developmental progress resulting from the dolphin interaction program.

To better understand sources and transport of particulate material in the NW Iberian coastal upwelling system, a mooring line dotted with an automated PPS 4/3 sediment trap was deployed off Cape Silleiro at the base of the photic zone. The samples were collected from November 2008 through June 2012 over sampling periods of 4–12 days. Our study represents the first automated sediment trap database for the NW Iberian margin. The magnitude and composition of the settling material showed strong seasonal variability with the highest fluxes during the poleward and winter mixing periods (averages of 12.9±9.6 g m −2 d −1 and 5.6±5.6 g m −2 d −1 respectively), and comparatively lower fluxes (3.6±4.1 g m −2 d −1 ) for the upwelling season. Intensive deposition events registered during poleward and winter mixing periods were dominated by the lithogenic fraction (80±3%). They were associated to high energy wave-driven resuspension processes, due to the occurrence of south-westerly storms, and intense riverine inputs of terrestrial material from Minho and Douro rivers. On the other hand, during the spring - summer upwelling season, the share of biogenic compounds (organic matter, calcium carbonate (CaCO3), biogenic silica (bSiO2)) to downward fluxes was higher, reflecting an increase in pelagic sedimentation due to the seasonal intensification of primary production and negligible river inputs and wave-driven resuspended material. Otherwise, the large variations of biogenic settling particles were mainly modulated by upwelling intensity, which by means of upwelling filaments ultimately controlled the offshore transport of the organic carbon fixed by primary producers towards the adjacent ocean. Based on the average downward flux of organic carbon (212 mg C m −2 d −1 ) and considering an average primary production of 1013 mg C m −2 d −1 from literature, we estimated that about 21% of the fixed carbon is vertically exported during the upwelling season. [ABSTRACT FROM AUTHOR]

Paleoclimate reconstructions suggest that the complex variability within the Greenland stadial 1 (GS-1) over western Europe was governed by coupled ocean and atmospheric changes. However, few works from the North Atlantic mid-latitudes document both the GS-1 onset and its termination, which are often considered as single abrupt transition events. Here, we present a direct comparison between marine (alkenone-based sea surface temperatures) and terrestrial (pollen) data, at very high resolution (28 years mean), from the southwestern Iberian shelf record D13882. Our results reveal a rather complex climatic period with internally changing conditions. The GS-1 onset (GS-1a: 12890-12720 yr BP) is marked by a progressive cooling and drying; GS-1b (12720-12390 yr BP) is the coldest and driest phase; GS-1c (12390-12030 yr BP) is marked by a progressive warming and increase in moisture conditions; GS-1 termination (GS-1d: 12030-11770 yr BP) is marked by rapid switches between cool wet, cold dry and cool wet conditions. Although hydroclimate response was very unsteady throughout the GS-1 and in particular during its termination phase, the persistence of an open temperate and Mediterranean forest in southwestern Iberia during the entire episode suggests that at least some moisture was delivered via the Westerlies. We propose coupled ocean and atmospheric mechanisms to reproduce these scenaria. Changes in the strength of the Atlantic Meridional Overturning Circulation (AMOC) as well as variations in the North Atlantic sea-ice growth have favoured the displacement of the polar jet stream's latitudinal position and contributed to a complex spatial pattern and strength of the Westerlies across western Europe. • Highlights of the Quaternary Science Reviews paper by Naughton et al.. • GS-1 in SW Iberia is a complex climatic period with four main phases. • Hydroclimate was very unsteady throughout the GS-1 event and in particular during its termination phase. • Ocean and atmospheric changes contributed to a complex spatial pattern of the Westerlies across Western Europe. [ABSTRACT FROM AUTHOR]

Analyzes the processes controlling the formation of the sediment record of diatoms, coccolithophores and planktic foraminifera. Modification of the phytoplankton assemblages; Increase in microorganism fluxes in the deeper traps; Correlation between the phytoplankton composition and hydrographic conditions.

Epithelioid hemangioendothelioma (EHE) is a rare neoplasm derived from the vascular endothelium. Although it can occur anywhere in the body, few cases have been described in the oral cavity. We report a 47-year-old woman presenting with a painful ulcerated lesion on the mandibular gingiva, suggestive of a traumatic decubitus ulcer. Histology and immunohistochemistry confirmed the diagnosis of epithelioid hemangioendothelioma. A literature review of EHE of mandibular gingiva was done. Pubmed were searched from 1975 through June 2024 using the following search terms: epithelioid hemangioentothelioma, vascular tumor, oral cavity and mandibular gingiva. Relevant manuscripts were selected and the results were used to update a narrative overview of the diagnosis and management of this entity. We found 38 cases of EHE in the oral cavity, of which 16 were located on the gingiva. Most of them were located on the mandibular gingiva as painless swelling, unlike our case. 70 % of the cases presenting in the mandibular gingiva had bone resorption on imaging. However, only half of those located in the maxillary gingiva had this bone resorption. Only 2 cases located in the mandibular gingiva presented recurrence and 1 of them debuted with nodal metastases after a 7-year follow-up. The clinical and histological diagnosis of EHE is complex and must be confirmed by immunohistochemistry. Upon diagnosing this entity, we should perform an excision with clear margins and conduct long-term follow-up due to the risk of local and distant recurrence. Key words: Epithelioid hemangioendothelioma, Gingival pathologies, Oral cavity, Mandibular Diseases, CD31, Immmunohistochemical markers, Vascular tumor., Competing Interests: Declared none., (Copyright: © 2024 Medicina Oral S.L.)

Background and Aim: Pulmonary regurgitation is the most common complication in repaired tetralogy of Fallot patients. Severe chronic pulmonary regurgitation can be tolerated for decades, but if not treated, it can progress to symptomatic, irreversible right ventricular dilatation and dysfunction. We investigated clinical associations with pulmonary valve replacement among patients with significative pulmonary regurgitation and how interventional developments can change their management., Methods: All adult patients with repaired tetralogy of Fallot who were followed at an adult CHD Clinic at a single centre from 1980 to 2022 were included on their first outpatient visit. Follow-up was estimated from the time of correction surgery until one of the following events occurred first: pulmonary valve replacement, death, loss to follow-up or conclusion of the study., Results: We included 221 patients (116 males) with a median age of 19 (18-25). At a median age of 33 (10) years old, 114 (51%) patients presented significant pulmonary regurgitation. Among patients with significant pulmonary regurgitation, pulmonary valve replacement was associated with male gender, older age at surgical repair, and longer QRS duration in adulthood. Pulmonary valve replacement was performed in 50 patients, including four transcatheter pulmonary valve implantations, at a median age of 34 (14) years., Conclusion: Pulmonary regurgitation affects a large percentage of tetralogy of Fallot adult patients, requiring a long-term clinical and imaging follow-up. Sex, age at surgical repair and longer QRS are associated with the need of PVR among patients with significative pulmonary regurgitation. Clinical practice and current literature support TPVI as the future gold standard intervention.

New Findings: What is the central question of this study? How are dynamic cerebral autoregulation and brain vasoreactivity influenced by severe aortic stenosis and its surgical treatment? What are the main findings and their importance? Dynamic cerebral autoregulation is preserved in the long term in patients with severe aortic stenosis and does not change after surgical aortic valve replacement. However, carbon dioxide vasoreactivity is impaired in these patients., Abstract: Surgical aortic valve replacement (SAVR) alters the natural course of severe aortic stenosis (AS). In this study, we aimed to determine the effects of the disease on dynamic cerebral autoregulation and vasoreactivity (VR) and to assess their changes after SAVR. We recruited 23 patients diagnosed with severe AS eligible for SAVR and 15 healthy matched controls. AS patients had lower mean VR to CO 2 (P = 0.005) than controls, but dynamic cerebral autoregulation was preserved. Cerebral haemodynamics showed no significant change after SAVR. Patients with smaller baseline aortic valve areas presented with smaller low frequency phase changes after surgery (P = 0.016). Severe AS does not seem to impact dynamic cerebral autoregulation but does reduce VR to CO 2 . SAVR does not alter cerebral autoregulation nor vasoreactivity., (© 2022 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Postoperative chylothorax can be a serious complication. We report on the case of a neonate who had a postoperative chylothorax immediately after esophageal surgery that did not respond to conservative measures or the first two attempts of surgical management of chylothorax. Lastly, a successful pleuroperitoneal shunt was placed and the patient was discharge at 3-months-old. A pleuroperitoneal shunt is usually the last surgical option but may be a curative measure.

The present study aimed to evaluate the association between obesity and COVID-19 mortality and length of stay in ICU patients, and how these associations were modified by age groups. We performed a retrospective multicenter cohort study with data obtained from a hospital-based registry. The sample consisted of 8183 ICU hospitalized patients who tested positive for SARS-CoV-2. Cox proportional models were used to evaluate the association between BMI categories and COVID-19 mortality and generalized linear models for the length of stay in the ICU. After adjusting for confounders, those in the younger group with severe obesity had an increased risk of COVID-19 mortality compared to those with normal/overweight (HR 1.27; 95% CI 1.01-1.61). An increased risk of death was also observed for patients with underweight (HR 3.74; 95% CI 1.39-10.07). For patients aged ≥ 60 year, mild/moderate obesity was associated with reduced mortality risk (HR 0.87; 95% CI 0.78-0.97). For the age group < 60 year, the length of stay in ICU for those patients with severe obesity was 35% higher compared to the normal/overweight category (e β 1.35; 95% CI 1.21-1.51). Conversely, for the survivors in the underweight category, the length of stay in ICU was 51% lower compared to the normal/overweight group (e β 0.49; 95% CI 0.31-0.78). In the age group ≥ 60 year, mild/moderate obesity was associated with an increased length of stay in the ICU (e β 1.10; 95% CI 1.01-1.21), adjusting for confounders. These findings could be helpful for health professionals to identify subgroups at higher risk for worse outcomes., (© 2022. The Author(s).)

We report the clinical case of a 38 weeks gestational age neonate, antenatally diagnosed with a left large macrocystic pulmonary malformation conditioning dextrocardia. At birth, he presented with respiratory distress requiring non-invasive ventilation with high-flow nasal cannula (HFNC). A left inferior lobectomy was performed via thoracotomy on day 21 of life. Histological features of the lesion were compatible with congenital pulmonary airway malformation (CPAM) type I with muci- nous cell clusters. No surgical complications were reported and the neonate was discharged six days after surgery. Follow-up two months after surgery was unremarkable.

There is limited evidence about the real-world survival of apremilast in patients with psoriasis, especially over the long term. To evaluate the long-term survival of apremilast and its predictive factors when used to treat psoriasis. A retrospective hospital-based study, including data collected from 104 patients. Survival curves were estimated using the Kaplan-Meier estimator. Proportional hazard Cox regression models were used for multivariate analysis. The average duration of the treatment before discontinuation was 28.82 months (95% CI, 22.08-35.57 months) and the median was 12 months (95% CI, 2.68-21.31 months). The retention rates were 51% (1 year), and 33% (5 years). The survival study revealed statistically significant differences between patients with PASI<10 and those in the PASI≥10 group (log-rank test, p < 0.001). The 5-year prevalences were 64% for patients with a PASI of <10 and 5% for those with an index ≥10. In the PASI < 10-patient group, the retention rates were 77% (1 year) and 64% (5 years). Furthermore, 66% of patients who continued apremilast treatment for more than 2 years were receiving off-label doses (30 mg/day). Apremilast may be a suitable and efficient alternative for the treatment of psoriasis patients in the PASI<10 group., (© 2022 Wiley Periodicals LLC.)

Objectives: We aimed to evaluate the relationship between social distancing, stroke admissions and stroke mortality during the COVID-19 pandemic, while accounting for the rate of COVID-19 admissions., Methods: We performed a longitudinal analysis of a multicenter, prospective, hospital-based registry of intensive care units from 19 hospitals from Brazil, comprising a 14-month period of the COVID-19 pandemic. We investigated whether the daily rate of admissions (DRA stroke ) and daily mortality rate for stroke were associated with the social distancing index (SDI), taking into account the daily rate of admissions for COVID-19 (DRA COVID ) in univariate and multivariate regression models. We also compared the clinical characteristics of patients with stroke admitted before and during the pandemic., Results: We found that DRA stroke decreased significantly in association with a strong rise in the SDI during the early months of the pandemic. However, in the latter period of the pandemic, only minor changes were observed in the SDI, and still, DRA stroke was inversely associated with the DRA COVID . Throughout the pandemic, higher SDI and DRA COVID were associated with higher in-hospital mortality for stroke., Conclusions: The severity of surges of the COVID-19 pandemic were independently and persistently associated with declines in stroke admissions, even during periods when social distancing policies were not intensified., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to assess the safety of the most frequently used biologic disease-modifying antirheumatic drugs in  rheumatoid arthritis patients in clinical practice., Method: A retrospective longitudinal observational study was performed. Clinical information was obtained from the electronic health records of patients diagnosed and treated for rheumatoid arthritis, who had received at least one biologic disease-modifying antirheumatic drug  dispensed between 2001 and 2013 from a third-level Hospital pharmacy. Adverse reactions during biologic disease-modifying antirheumatic  drugs treatments were analysed, as well as the reasons for treatment  discontinuation. A disproportionality analysis (odds ratio with 95% confidence interval) was performed to compare adverse drug reactions related  o different system organ classes, the period between the drug start date and  the reaction start date (latency period), and previous knowledge of the adverse reactions., Results: In total, 210 patients were included in the analysis (73% women, median age 47 years), with 399 prescriptions for biologic  diseasemodifying antirheumatic drugs and 1,515 adverse reactions potentially  related to them. The increased frequency of adverse reactions for  each system organ class related to each biologic disease-modifying  antirheumatic drug was as follows: general disorders and administration site disturbances with infliximab (2.3 [1.3-4.0]), infections (1.6 [1.3-2.1]) and immune system reactions with etanercept (4.2 [1.2-14.6]), hepatobiliary  disorders with adalimumab (2.1 [1.2-3.6]), ophthalmic adverse  reactions  (1.9 [1.2-3.1]) and cardiac disorders (2.9 [1.0-8.4]) with rituximab,  and blood and lymphatic system disorders with tocilizumab (2.9 [1.8-4.7])  and abatacept (3.0 [1.6-5.8)]. The mean latency period was 5 to 33 months.  Most adverse reactions were related to adalimumab (93.6%; P &lt; 0.01),  whereas the fewest adverse reactions were related to tocilizumab (55.2%; P &lt;  0.01). Most treatment withdrawals related to adverse reactions were identified  during the first year of biologic disease-modifying antirheumatic drugs  treatment., Conclusions: Tumour necrosis factor α inhibitors were associated with general  disorders and administration site disturbances, infections and immune system reactions, and hepatobiliary abormalities, whereas  ontumour necrosis factor α inhibitors were associated with cardiac disorders as  well as blood and lymphatic system disorders. Treatment  ithdrawals mainly occurred during the first year of treatment. Most of the  adverse reactions have been previously described., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

This large atrial mass was removed from a 33-yearold patient admitted to the emergency department for severe venous congestion. Its hard texture, grayish discolouration and wall infiltration prompted radical excision and partial atrial reconstruction. Histopathology was compatible with a thrombus, discarding malignancy.

Introduction and Objectives: COVID-19 pandemic forced a change in health care resources and provision due to the emergence of a new group of patients, requiring extraordinary protective measures and the adoption of new organization for the treatment of urgent or priority COVID-19 negative patients. We reviewed our practice during the first pandemic period to evaluate our surgical outcomes and identify if patients COVID-19 negative submitted to thoracic surgery had an increased risk of being infected or die., Methods: We retrospectively reviewed our surgical results between 11th March and 15th May 2020. Thirty patients underwent thoracic surgery at the Department of Cardiothoracic Surgery of Centro Hospitalar Universitário de São João., Results: None of the patients was COVID-19 positive and cross-transmission of the disease was not recognized. The majority of patients were admitted from home, with a high priority indication, namely an oncological disease. There was only one case of in-hospital mortality., Conclusion: During the first wave of the pandemic it was safe to be admitted and submitted to thoracic surgery at CHUSJ. Our patients, including oncological patients, received the adequate surgical treatment without an increase of risk of death or infection.

Background: Covid-19 was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. Responses to this crisis integrated resource allocation for the increased amount of infected patients while maintaining an adequate response to other severe and life-threatening diseases. Though cardiothoracic patients are at high risk for Covid-19 severe illness, postponing surgeries would translate to increased mortality and morbidity. We reviewed our practice during the initial time of the pandemic, with emphasis on safety protocols., Methods: From 11 March to 15 May 2020, 148 patients underwent surgery at the Department of Cardiothoracic Surgery of Centro Hospitalar Universitário de São João. The clinical characteristics of the patients were retrospectively registered, along with novel containment and infection prevention measures targeting the new coronavirus., Results: The majority of adult cardiac patients were operated on an emergency basis. Hospital mortality was 1.9% (n = 2 patients). Most adult thoracic patients were admitted from home, with a diagnosis of neoplastic disease in 60% of patients. Hospital mortality was 3.3% (1 patient). Fifteen children underwent cardiothoracic surgery. There was no mortality. The infection prevention procedures applied, totally excluded the transmission of Covid-19 in the department., Conclusion: While guaranteeing a prompt response to emergent, urgent, and high priority cases, novel safety measures in individual protection, patients circuits, and preoperative diagnoses of symptomatic and asymptomatic infection were adopted. The surgical results corroborate that it was safe to undergo cardiothoracic surgery during the initial time of the Covid-19 pandemic. The new policies will be maintained while the virus stays in the community., (© 2020 Wiley Periodicals LLC.)

Rapid changes in ocean circulation and climate have been observed in marine-sediment and ice cores over the last glacial period and deglaciation, highlighting the non-linear character of the climate system and underlining the possibility of rapid climate shifts in response to anthropogenic greenhouse gas forcing. To date, these rapid changes in climate and ocean circulation are still not fully explained. One obstacle hindering progress in our understanding of the interactions between past ocean circulation and climate changes is the difficulty of accurately dating marine cores. Here, we present a set of 92 marine sediment cores from the Atlantic Ocean for which we have established age-depth models that are consistent with the Greenland GICC05 ice core chronology, and computed the associated dating uncertainties, using a new deposition modeling technique. This is the first set of consistently dated marine sediment cores enabling paleoclimate scientists to evaluate leads/lags between circulation and climate changes over vast regions of the Atlantic Ocean. Moreover, this data set is of direct use in paleoclimate modeling studies.

Pulmonary sequestration (PS) is a rare congenital malformation, even more when its arterial supply is a coronary artery. We present a case of a 68-year-old man admitted in the emergency room with an acute coronary syndrome and no evidence of significant coronary disease. Instead, he had an abnormal branch from the circumflex coronary artery nourishing a mass in the left lower pulmonary lobe. A coronary steal phenomenon was proposed to explain the clinical presentation. An anterior left thoracotomy with ligation of the abnormal branch and atypical resection of the lung segment comprising the sequestration was performed.

Objective: The aim of our study was to analyse the perceptions of the public on medicine information and safety and on consumer reporting of suspected adverse drug reactions (ADR)., Methods: A voluntary survey was conducted in a population ≥18 years of age in Asturias, a region in northern Spain. The survey was designed to be completed in a face-to-face street interview or completed independently by the public. The survey consisted of structured questions organised in four sections: (1) demographic data, (2) use of medicines, (3) reading and understanding of the patient information leaflet (PIL) and (4) awareness and perception about consumer reporting of ADR., Key Findings: A total of 402 surveys were given and analysed; 295 were completed independently and 107 were completed in street interviews. Of the population surveyed, 82.3% had taken some drug(s) in the previous 3 months, although only 62.4% had performed so by medical prescription. A quarter of respondents claimed that they never read the PIL of medicines, 12.7% that they sometimes read it, and 61.4% that they always read this information. A high percentage (82.8%) of respondents reported that they were not aware of consumer reporting of ADR, and 86.1% stated their agreement with this option., Conclusions: The public has great interest in useful information about all aspects involved in the use of medicines. This includes consumer reporting of suspected ADR, which is still unknown to many people., (© 2018 Royal Pharmaceutical Society.)

Objective: The objective of this study was to analyse the characteristics of  medicines subject to additional monitoring. We assessed the following aspects:  the criteria applied to approve a medicine as being subject to additional  monitoring; the authorized dispensing conditions; the pharmacological groups to which they belong; and their post-authorisation safety., Method: We analysed the list published by the European Medicines Agency in  January 2017 (EMA/245297/2013 Rev.41). Information for the analysis was  obtained from the web sites of the European Medicines Agency and the Spanish  Agency of Medicines and Medical Devices., Results: We assessed 316 medicines subject to additional monitoring. The most  common criterion used to assign a medicine as being subject to additional  monitoring was it being a new active substance (n = 197 [62.3%]). Other  common criteria were requiring a post-authorisation safety study (n = 52  [16.5%]) and being a biologic medicine but not a new active substance (n = 49  [15.5%]). Regarding dispensing conditions, nearly 66% of these medicines were authorized under restricted conditions. Until January 2017, the Spanish Agency  of Medicines and Medical Device published 14 safety reports related to medicines subject to additional monitoring., Conclusions: The group of medicines subject to additional monitoring mainly  includes new active substances. The most common pharmacological group is antineoplastic and immunomodulating agents. The postauthorisation safety  study has already produced information published by the Spanish Agency of  Medicines and Medical Devices., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: To analyse STOPP/START criteria found most frequently in the studies carried out in Spain, in order to identify the main areas of potentially inappropriate prescribing., Methods: A literature review was carried out on the original studies performed in Spain that applied the original version of the STOPP/START criteria and that described the most common STOPP and/or START criteria found. In each study, a weighted analysis was performed on the criteria found, by assigning 5 points to the criterion in first position, 4 points to the criterion in second position, and so on to fifth criterion. The total points of each analysed criterion were then obtained., Results: A total of 19 original studies analysing STOPP criteria were selected, 14 of them also studying all START criteria. From the total of studies, 11 were developed in out-of-hospital care, and 8 in hospital care. The STOPP criterion with the highest weighted assessment was B7 (long-term, long-acting benzodiazepines), followed by J (any duplicate drug class prescription). The START criterion with the highest weighted assessment was F4 (statin therapy in diabetes mellitus if coexisting major cardiovascular risk factors present), followed by E3 (calcium and vitamin D supplement in patients with known osteoporosis: previous fragility fracture, acquired dorsal kyphosis)., Conclusions: The most common areas of potentially inappropriate prescribing are well defined, and suggest a particular intervention in some specific therapeutic points., (Copyright © 2018 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background Coxibs cardiovascular (CV) safety continues being a current issue after rofecoxib worldwide withdrawal in 2004. Objective To evaluate the cardiovascular and gastrointestinal (GI) risk of coxibs through case/non-case study. Setting The Spanish Pharmacovigilance System for Human Use Drugs (FEDRA) and the Uppsala Monitoring Centre (VigiBase) databases. Method We identified adverse drug reactions (ADRs) cases reported under the MedDRA system organ classes of "cardiac disorders", "vascular disorders", "nervous system disorder" and "gastrointestinal disorders". Disproportionality was considered when the following criteria were met simultaneously: proportional reporting ratio (PRR) ≥ 2, 95% confidence interval lower limit of reporting odds ratio (ROR) > 1, Chi square test (χ 2 ) ≥ 4; and number of ADR reports (n rep.) > 3. Main outcome measure Potential disproportionality between cardiovascular and GI ADRs as reported to FEDRA and VigiBase and the use of coxibs. Results We found association between coxibs and CV-ADRs in FEDRA [PRR 2.11 (95% CI 1.97-2.27); ROR 2.53 (95% CI 2.29-2.89); χ 2 367.81; n rep., 561] and VigiBase [PRR 2.67 (95% CI 2.64-2.71); ROR 3.26 (95% CI 3.20-3.31); χ 2 23,950.93; n rep., 21,047]; and between coxibs and GI-ADRs in VigiBase [PRR 2.91 (95% CI 2.84-2.97); ROR 3.08 (95% CI 3.01-3.16); χ 2 8762.82; n rep. 6954]. No association was found between coxibs and GI-ADRs in FEDRA. Conclusion The association found support a potential coxibs class effect in terms of cardiovascular safety. Classical NSAIDs GI risk may be higher than that for coxibs.

Objectives: The goal of this study was to compare the stentless Freedom Solo® (FS) and the stented Trifecta® (TF) aortic bioprostheses with regard to haemodynamic profile, left ventricular mass regression and early and late postoperative outcomes and survival., Methods: A longitudinal cohort study of consecutive patients undergoing aortic valve replacement (2009-16) with either the FS or TF at 1 centre was performed. Local databases and national records were queried. Prosthesis haemodynamics and left ventricular dimensions were obtained from postoperative echocardiograms. After propensity score matching (21 covariates), the Kaplan-Meier and competing risk analyses were performed for survival and the combined outcome of structural valve deterioration and endocarditis, respectively. Haemodynamics and mass regression were assessed by a mixed-effects model including propensity score as a covariate., Results: From a total sample of 397 patients with the FS and 525 TF bioprostheses with a median follow-up time of 4.0 (2.2-6.0) and 2.4 (1.4-3.7) years, respectively, a matched sample of 329 pairs was obtained. Matched groups showed no differences in survival (hazard ratio = 1.04, 95% confidence interval = 0.69-1.56) or cumulative hazards of combined outcome (subdistribution hazard ratio = 0.54, 95% confidence interval = 0.21-1.39). Although the TF showed an improved haemodynamic profile, no difference was found in mass regression. Patients with TF bioprostheses had higher rates of prolonged mechanical ventilation, whereas patients with the FS bioprosthesis showed higher rates of thrombocytopenia., Conclusions: The TF showed an improved haemodynamic profile compared to the FS, but this did not translate into further reverse remodelling. Postoperative outcomes and survival rates were comparable for both bioprostheses. Long-term follow-up is needed for comparisons with classical bioprosthesis models.

Background: New models of aortic bioprostheses have proven excellent early haemodynamic profile, but their mid and long-term performance warrants further systematic assessment. The aim of this study is to report clinical and haemodynamic performance of St. Jude Medical Trifecta bioprosthesis during 5 years of implantation., Methods: We performed a single centre, retrospective, observational and descriptive study including all 556 individuals who underwent aortic valve replacement (AVR) with the Trifecta bioprosthesis (between July of 2011 and June of 2016). Survival and re-intervention were censored in February 2017. Postoperative ambulatory echocardiographic data was available for 490 patients. A complete clinical follow-up was available in 463 individuals (mean follow-up time, 27±17 months)., Results: In our sample the mean age was 73±9 years, 57.6% were male and median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 2.9 (interquartile range, 1.6-5.8). There were 301 (54.1%) combined procedures, mostly coronary artery bypass grafting in 170 (30.6%). Overall 30-days mortality was 5.4% (n=30) and cumulative survival at 5-years was 72.3%. There were 23 (4.3%) permanent pacemaker implantations. During follow-up, 5 (0.9%) patients presented non-structural valve dysfunction (NSVD) and 4 (0.8%) underwent reoperation due to prosthesis endocarditis. At the first ambulatory evaluation transvalvular mean gradient and effective orifice area (EOA) were 10.9±4.1 mmHg and 2.0±0.5 cm 2 , respectively. Severe patient-prosthesis mismatch (PPM) was observed in 5 (1.1%) individuals and moderate in 52 (11.3%)., Conclusions: In a "real-world" clinical setting, our findings support the good overall mid-term haemodynamic and safety profile of the Trifecta bioprosthesis., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Objective: To analyze potentially inappropriate prescribing (PIP) using the 2014 version of STOPP criteria., Materials and Methods: Prescriptions were analyzed by using invoicing data and electronic medical records., Results: At least one STOPP criterion was observed in 9 out of every 10 patients. The most common STOPP criteria found were: "any drug prescribed without an evidence-based clinical indication" and "any drug prescribed beyond the recommended duration, where treatment duration is well defined"., Conclusion: The high prevalence of PIP found seems to be due to the inclusion of new criteria related to indication of medication and duration of treatments.
.

Introduction: To compare stentless Freedom Solo and stented Trifecta aortic bioprostheses regarding hemodynamic profile, left ventricular mass regression, early and late postoperative outcomes and survival., Methods: Longitudinal cohort study of consecutive patients undergoing aortic valve replacement (from 2009 to 2016) with either Freedom Solo or Trifecta at one centre. Local databases and national records were queried. Postoperative echocardiography (3-6 months) was obtained for hemodynamic profile (mean transprosthetic gradient and effective orifice area) and left ventricle mass determination. After propensity score matching (21 covariates), Kaplan-Meier analysis and cumulative incidence analysis were performed for survival and combined outcome of structural valve deterioration and endocarditis, respectively. Hemodynamics and left ventricle mass regression were assessed by a mixed- -effects model including propensity score as a covariate., Results: From a total sample of 397 Freedom Solo and 525 Trifecta patients with a median follow-up time of 4.0 (2.2- 6.0) and 2.4 (1.4-3.7) years, respectively, a matched sample of 329 pairs was obtained. Well-balanced matched groups showed no difference in survival (hazard ratio=1.04, 95% confidence interval=0.69-1.56) or cumulative hazards of combined outcome (subhazard ratio=0.54, 95% confidence interval=0.21-1.39). Although Trifecta showed improved hemodynamic profile compared to Freedom Solo, no differences were found in left ventricle mass regression., Conclusion: Trifecta has a slightly improved hemodynamic profile compared to Freedom Solo but this does not translate into differences in the extent of mass regression, postoperative outcomes or survival, which were good and comparable for both bioprostheses. Long-term follow-up is needed for comparisons with older models of bioprostheses.

The carcinoid syndrome is a rare clinical entity, coursing with a slow evolution. Patients typically present flush, diarrhea and acute asthma attacks, which often delays the diagnostic until there is cardiac involvement, with more pronounced symptoms. We report the clinical case of a 62 years-old male, with a known significant tricuspid valve disorder. While waiting for cardiac surgery, he presented with an acute abdominal condition, which allowed the detection of a carcinoid syndrome. He underwent surgical excision of the primary tumor (right hemicolectomy), removal of hepatic metastases, and tricuspid valve replacement.

Objective: [corrected] To evaluate similarities and differences in safety among proton pump inhibitors (PPIs) under the usual conditions of prescription., Methods: A search of spontaneous reports on adverse reactions associated with these drugs and registered between January 1, 2004 and December 31, 2004 was undertaken in the Spanish Pharmacovigilance System Database. We compared the frequency of reports with the consumption of PPIs, and analyzed the organ and system distribution for each PPI. Of the organ and system groups more commonly affected, diarrhea, myalgia, abnormal vision and hepatitis were selected for further analysis., Results: Nearly 8 times more reports for omeprazole compared to other drugs were found but a similar difference was observed in their consumption. Skin and appendage disorders were more frequently reported for omeprazole and rabeprazole, the urinary, female reproductive and endocrine systems for lansoprazole, musculoskeletal for omeprazole and esomeprazole, vision for pantoprazole, rabeprazole and esomeprazole, gastrointestinal tract for omeprazole and lansoprazole and liver and biliary systems for omeprazole, lansoprazole and pantoprazole. Myalgia appears more often in younger patients than diarrhea, abnormal vision or hepatitis and shows longer periods of latency and recovery. The four adverse reactions analyzed were mainly reversible., Conclusion: A direct relationship was found between consumption and the number of reports. Some organ and system groups were affected by more than one PPI and this showed a specific pattern of group toxicity to these pharmacological agents. Some reports involved only lansoprazole and these require further analysis.

Purpose: To analyse the type and main features of the hepatotoxicity induced by steroidal and non-steroidal antiandrogens spontaneously reported by physicians, pharmacists and nurses. This analysis could increase the information related to these adverse reactions mainly available from the published isolated cases., Methods: Using the Spanish Pharmacovigilance database we searched for spontaneous reports recorded since the date of approval of each antiandrogen up to the present time. We analysed the frequency of liver disorders, the preferred terms coded, the presence of other hepatotoxic drugs, and the characteristics of cases of hepatitis., Results: Liver disorders were the most common adverse reactions associated with flutamide and bicalutamide, but not with cyproterone acetate. 'Hepatitis' and 'cholestatic hepatitis' were the most frequent terms coded. In 38% of the reports related to cyproterone acetate, 18% of those related to flutamide and 33% of those related to bicalutamide the patient had simultaneously received other hepatotoxic drugs. The disproportionality analysis of hepatitis showed a strong association with flutamide and a weak association with bicalutamide and cyproterone acetate. Mean doses of flutamide and bicalutamide were very close to their defined daily dose (DDD) to treat prostate cancer, although in the case of cyproterone acetate it was slightly higher. The latency period of hepatitis was between 3 and 10 months for the three antiandrogens, and the recovery period was shorter (0.5-3 months). The majority of the reported cases of hepatitis evolved favourably., Conclusion: Our results highlight the hepatotoxic potential of flutamide compared to cyproterone acetate. The data related to bicalutamide should be cautiously considered due to the smaller number of reports., (Copyright (c) 2005 John Wiley & Sons, Ltd.)

Introduction: Hepatotoxicity is a serious adverse reaction potentially induced by all antiandrogens. We have reviewed here the published cases of hepatotoxicity induced by steroidal and nonsteroidal antiandrogens, and compared the type and characteristics of liver damage., Methods: Using two different databases: MEDLINE and IDIS (Iowa Drug Information Service), we searched for published cases of liver injury induced by antiandrogens. Analysis was made of the type of hepatotoxicity, therapeutic indication, other pharmacological treatments and evolution. Mean values of latency and recovery periods of the adverse reactions and liver function tests were also evaluated., Results: Hepatitis was the most common type of hepatotoxicity reported, and was associated with all antiandrogens. This adverse reaction does not seem to be dependent on the patients age, therapeutic indication or the dose prescribed. Hepatitis showed a longer latency period for cyproterone acetate than for flutamide. Some transaminase levels were significantly higher for flutamide than for cyproterone acetate, although the evolution was no worse in the cases reported for flutamide. We also found occasional reports of hepatocellular carcinoma and hepatic cirrhosis suspected of being induced by cyproterone acetate., Conclusion: Although there are differences in the clinical features of hepatotoxicity induced by steroidal and nonsteroidal antiandrogens, these do not predict which patients will develop hepatotoxicity during treatment or evolution. Serial liver function tests are required for early detection of liver damage., (2004 S. Karger AG, Basel.)