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Purpose To evaluate the association between latency duration and perinatal outcomes in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation, and to assess the role of gestational age at PPROM and amniotic fluid volume. Methods This retrospective cohort study included pregnancies complicated by PPROM before 34 weeks of gestation managed expectantly at a tertiary care center. Latency duration was defined as the interval from membrane rupture to delivery. Composite neonatal and pregnancy adverse outcomes were analyzed using latency-based time-to-event methods. Cox proportional hazards models were used to assess the independent associations of gestational age at PPROM and amniotic fluid pocket with adverse pregnancy and neonatal outcomes. Results A total of 278 pregnancies were included in the final analysis. Latency duration was strongly associated with gestational age at PPROM, with progressively shorter latency observed at more advanced gestational ages. Larger residual amniotic fluid pockets were independently associated with prolonged latency. In latency-based Cox models, gestational age at PPROM was significantly associated with both pregnancy-adverse and neonatal composite outcomes. In contrast, latency duration itself and residual amniotic fluid volume were not independently associated with adverse neonatal outcomes after accounting for gestational age variables. Conclusions In pregnancies complicated by PPROM before 34 weeks of gestation, gestational age at membrane rupture is the principal determinant of latency duration and perinatal outcomes. Latency should be interpreted as a gestational-age-dependent phenomenon rather than an independent predictor of neonatal risk, supporting individualized expectant management that prioritizes gestational age advancement while balancing maternal risk.

SARS-CoV-2 (COVID-19) patients who develop acute respiratory distress syndrome (ARDS) can suffer acute lung injury, or even death. Early identification of severe disease is essential in order to control COVID-19 and improve prognosis. Oxidative stress (OS) appears to play an important role in COVID-19 pathogenesis; we therefore conceived a study of the potential discriminative ability of serum biomarkers in patients with ARDS and those with mild to moderate disease (non-ARDS). 60 subjects were enrolled in a single-centre, prospective cohort study of consecutively admitted patients: 29 ARDS/31 non-ARDS. Blood samples were drawn and marker levels analysed by spectrophotometry and immunoassay techniques. C-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin were significantly higher in ARDS versus non-ARDS cases at hospital admission. Leukocytes, LDH, ferritin, interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) were also significantly elevated in ARDS compared to non-ARDS patients during the hospital stay. Total thiol (TT) was found to be significantly lower in ARDS. Conversely, D-dimer, matrix metalloproteinase-9 (MMP-9) and advanced glycosylated end products (AGE) were elevated. Leukocytes, LDH, CRP, ferritin and IL-6 were found to be significantly higher in non-survivors. However, lymphocyte, tumour necrosis factor beta (TGF-β), and TT were lower. In summary, our results support the potential value of TT, ferritin and LDH as prognostic biomarkers for ARDS development in COVID-19 patients, distinguishing non-ARDS from ARDS (AUCs = 0.92; 0.91; 0.89) in a fast and cost-effective manner. These oxidative/inflammatory parameters appear to play an important role in COVID-19 monitoring and can be used in the clinical management of patients.

Purpose Obesity increases the risk of complications and technical difficulty in ventral hernia repair. Preoperative weight loss is recommended to mitigate these risks, but the implementation of different strategies in routine practice remains poorly described. This study aimed to characterize the use of dietary counseling, pharmacotherapy, and bariatric surgery within a structured optimization pathway and provide preliminary insights into surgical outcomes in obese versus non-obese patients. Methods In this retrospective, single-center study, obese patients with ventral hernia were managed with dietary counseling, pharmacotherapy, or bariatric surgery between April 2018 and April 2023. We evaluated implementation, weight loss achieved, eligibility for elective repair, and adherence. Surgical outcomes were descriptively analyzed in obese patients with and without preoperative weight loss and compared to non-obese patients. Results Of 175 obese patients, 148 (84.6%) received dietary counseling, 15 (8.6%) pharmacotherapy, and 12 (6.8%) bariatric surgery. Median weight loss was highest after bariatric surgery (20.7%), followed by dietary counseling (4.6%) and pharmacotherapy (4.4%). Surgical eligibility rates were 83%, 44%, and 13%, respectively. Among 165 patients who underwent hernia repair, postoperative complications were more frequent in obese patients, regardless of preoperative weight loss, than in non-obese patients. Recurrence was numerically higher in patients without preoperative weight loss, though not statistically significant. Conclusion A structured optimization pathway facilitated the use of diverse weight loss strategies before hernia repair in obese patients. Bariatric surgery achieved the greatest weight loss and eligibility. However, complications remained common, underscoring the need for individualized, multidisciplinary prehabilitation strategies.

Background and objectives: the COVID-19 pandemic underscored the necessity of understanding the factors influencing susceptibility and disease severity, as well as a better recovery of functional status, especially in postcritical patients. evidence regarding the efficacy of vitamin D supplementation in reducing the severity of COVID-19 is still insufficient due to the lack of primary robust trial-based data and heterogeneous study designs. the principal aims of our study were to determine the impact of vitamin D deficiency or insufficiency on complications during intensive care unit (icu) stay, as well as its role in muscle mass and strength improvement as well as morphofunctional recovery during a multispecialty 6-month follow-up program based on adapted nutritional support and specific physical rehabilitation. as a secondary objective, we compared the association mentioned above between patients with sarcopenic obesity and non- sarcopenic obesity. methods: this prospective observational study included 94 outpatients postcritical COVID-19. two weeks after hospital discharge, patients were divided into sufficient (≥30 ng/mL), insufficient (20.01–29.99 ng/mL), or deficient (≤20 ng/mL) vitamin D levels. the differences in in-hospital complications and morphofunctional parameters including phase angle (PhA), body cell mass (BCM), handgrip strength (HGS), timed get-up-and-go (UAG), 6 min walk test (6MWT), and proinflammatory biochemical variables were analyzed. Incremental (Δ) changes in these parameters were also analyzed at the end of follow-up according to vitamin D levels and the presence vs. absence of sarcopenic obesity. A multivariate linear regression analysis was performed to detect possible confounding factors in the impact analysis of vitamin D changes on functional recovery in patients with obesity. Results: A total of 36.2% of patients exhibited vitamin D deficiency, 29.8% vitamin D insufficiency, and only 32.9% showed sufficient levels at hospital discharge. A total of 46.8% of patients had obesity, and 36.1% had sarcopenic obesity. Vitamin D deficiency was associated with longer hospital stays (p = 0.04), longer ICU stays (p = 0.04), more days of invasive mechanical ventilation (IMV) (p = 0.04), lower skeletal muscle mass/weight (SMM/w) (p = 0.04) and skeletal muscle index (SMI) (p = 0.047), higher fat mass percentage (FM%) (p = 0.04), C-reactive-protein (CRP) (p = 0.04), and glycated hemoglobin (HbA1c) (p = 0.03), and better performance in R-HGS (p = 0.04), UAG (p = 0.03), and 6MWT (p = 0.034) when compared with those with normal vitamin D levels. At six months, Δvitamin D significantly correlated with ΔHbA1c (p = 0.002) and CRP (p = 0.049). Patients with normal vitamin D values showed better recovery of ΔSMI (p = 0.046), ΔSMM/w (p = 0.04), ΔR-HGS (p = 0.04), and ΔUAG (p = 0.04) compared to those with abnormal vitamin D levels, and these improvements in ΔR-HGS and ΔUAG were greater in the subgroup of sarcopenic obesity compared than in nonsarcopenic obesity (p = 0.04 and p = 0.04, respectively). Multivariate regression analysis detected that these results were also attributable to a longer hospital stay and lower ΔCRP in the subgroup of patients with sarcopenic obesity. Conclusions: Vitamin D deficiency was associated with longer hospital stays, longer VMI requirement, worse muscle health, and a higher degree of systemic inflammation. Furthermore, normal vitamin D levels at the end of the follow-up were associated with better morphofunctional recovery in postcritical COVID-19, particularly in patients with sarcopenic obesity partly due to a higher degree of inflammation as a result of a longer hospital stay.

Aortic valve disease (AVD) is a common condition that leads to pressure and/or volume overload in the left ventricle. Aortic valve replacement is the standard treatment, as no pharmacological therapies are currently available. The incidence of AVD is increasing in developed countries, making the discovery of new biomarkers for early detection crucial. The importance of mitochondria in heart function is well established, and various cardiovascular pathologies are associated with mitochondrial dysfunction. In this cross-sectional study, we evaluated for the first time the role of mitochondria in AVD, aiming to identify new pathways involved in the disease and discover potential biomarkers. We recruited 17 patients diagnosed with AVD and scheduled for aortic valve replacement, and 22 healthy controls. Plasma levels of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) and mitochondrial open reading frame of the 12S rRNA type-c peptide (MOTS-c) were measured by ELISA. We observed significantly reduced levels of both proteins in patients, suggesting that substantial mitochondrial dysfunction occurs in AVD patients, independent of sex or age, but directly related to the disease. Mitochondria may represent a promising target for studying new pathways involved in AVD. We propose PGC1α and MOTS-c as potential plasma biomarkers for AVD detection. Further studies, including early-stage patients, are necessary to confirm the significance of our findings.

La bula de la Santa Cruzada constituyó uno de los ingresos más originales de la Real Hacienda. Se trataba de las limosnas que aportaban los fieles para obtener indulgencias, exenciones de ayunos y otros privilegios espirituales y, por tanto, de una renta eclesiástica, que, en virtud de las negociaciones de la corona con la Santa Sede, fue cedida a la monarquía católica. En 1574 comenzó de manera formal la predicación de la bula en el virreinato. En el artículo se analiza cómo se administró este ramo fiscal entre 1574 y 1659, periodo que se caracterizó por el sistema de asientos generales, así denominados porque el contrato abarcaba todos los obispados de Nueva España, Guatemala y Filipinas; se ofrecen datos sobre los tesoreros, la recaudación, las condiciones de los asientos y se reflexiona sobre las oportunidades que ofrecían estos convenios. The Bull of the Crusade was one of the most original sources of income for the Real Hacienda. It consisted of alms provided by the faithful in exchange for indulgences, exemptions from fasting, and other spiritual privileges; this church rent was handed over to the Catholic monarchy after negotiations between the Crown and the Holy See. The predication of the bull in the viceroyalty began officially in 1574; this work examines how this revenue was levied from that year until 1659, a period characterized by the system of asientos generales (general entries), thus called because the contract included all the bishoprics in New Spain, Guatemala, and the Philippines. The author provides data on treasurers, collections, and entry conditions, and reflects on the opportunities opened by these arrangements.

Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Prospective cohort study. Multidisciplinary outpatient clinic. Patients with severe COVID-19 pneumonia, post- ICU admission. A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.

: The aim of this study was to evaluate the association between amniotic fluid volume at preterm prelabor rupture of membranes (PPROM) diagnosis and latency, short-term delivery risk, and perinatal outcomes across different gestational ages. : This retrospective cohort study included singleton pregnancies with PPROM before 34 weeks' gestation managed at a tertiary referral center. Amniotic fluid (AF) volume was categorized according to the deepest vertical pocket (≤20 mm vs. >20 mm). Fetal and neonatal outcomes were analyzed as predefined composite outcomes. Latency to delivery was assessed using Kaplan-Meier estimates. Multivariable Cox regression models were used to evaluate associations after adjustment for clinically relevant confounders. : A total of 263 pregnancies were included, of which 66.5% had an AF pocket ≤ 20 mm at presentation. Lower AF volume was associated with a higher incidence of the fetal composite outcome (74.3% vs. 52.3%, < 0.001) and a higher short-term risk of delivery across gestational-age strata. In multivariable analysis, AF pocket > 20 mm remained independently associated with lower risk of fetal composite outcome. AF volume was not associated with overall latency to delivery (Spearman ρ = 0.03, = 0.598). Although lower AF volume was associated with higher crude neonatal morbidity, this association was attenuated after adjustment for gestational age. : Reduced AF volume at PPROM presentation was associated with adverse fetal outcomes and higher short-term delivery risk, whereas neonatal morbidity was mainly driven by gestational age at delivery. AF volume should therefore be interpreted as a contextual prognostic marker rather than an isolated determinant of outcome.