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To determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital. Retrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipólito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO2) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors. We included 1418 patients. Median age was 58 years (IQR 47-68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4-13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02-1.03), history of surgery (HR 1.89; 95%CI 1.31-2.74), lower oxygen saturation at admission (HR 4.08; CI95% 2.72-8.05 for SaO2<70% compared to SaO2>94%), the presence of poor general condition (HR 1.81; 95% CI 1.29-2.53), altered state of consciousness (HR 1.58; 95%CI 1.18-2.11) and leukocyte levels (HR 1.01; 95%CI 1.00-1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18-1.76) and azithromycin (HR 1.25; 95%CI 1.03-1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37-0. 86) in comparison to no steroid use. A high mortality was found in our cohort. Low oxygen saturation at admission, age, and the presence of hematological and biochemical alterations were associated with higher mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was probably associated with unfavorable outcomes. The use of corticosteroids at moderate doses was associated with lower mortality.

The cruise industry has evolved rapidly over the past decades, with the building and operation of ever-larger cruise ships being a key factor in this growth. This study examines whether the observed increases in vessel size are supported by the fundamentals of economies of scale, as allegedly occurs with container ships; in other words, we inquire whether increases in ship size imply decreases in the average costs per passenger. We attempt this by developing a detailed cost model for cruise ships, distinguishing among three types of costs: capital costs, operating costs and voyage costs. The quantification of these costs allows the determination of potential savings due to the presence of scale. In parallel, we analyse the sensitivity of each cost category to parameters such as sailing speed and distance travelled. The research provides an assessment of the direction the cruise industry is heading, as regards the scale of vessels in operation: our findings suggest that economies of scale are realised only up to a certain ship size, which today stands at 120,000 gross tons. For larger cruise vessels, average costs (per passenger) increase and dis-economies of scale start to set in.

The representation of women in advertising creative departments has been studied worldwide. The findings have shown a low representation that does not favor the emergence of a critical mass of women, who could contribute with alternative visions to make advertising more inclusive. The underrepresentation, above all, occurs in managerial positions where they do not usually reach 35%. This study aims to update and report quantitatively on the phenomenon of the glass ceiling in Spain. In addition, in order to contextualize the level of segregation, these departments are compared with available international data. The results of a content analysis of the credit forms of 839 Spanish campaigns published in 2019 (a sample of 1,311 creatives) revealed gender dynamics, with a balanced starting group of creatives in non-managerial positions (just over 40% are women), but a figure of just 18% of women in managerial roles A higher glass ceiling effect was also found when European and global data were compared. The results analyzed through the perspective of the proportional representation theory (Kanter, 1977a, 1977b, 1987), suggest the need to raise awareness of gender inequalities within creative departments; this would foster the equality demanded by today’s society, of which advertising should not be oblivious.

Background The maintenance of skeletal muscle plasticity upon changes in the environment, nutrient supply, and exercise depends on regulatory mechanisms that couple structural and metabolic adaptations. The mechanisms that interconnect both processes at the transcriptional level remain underexplored. Nr2f6, a nuclear receptor, regulates metabolism and cell differentiation in peripheral tissues. However, its role in the skeletal muscle is still elusive. Here, we aimed to investigate the effects of Nr2f6 modulation on muscle biology in vivo and in vitro. Methods Global RNA‐seq was performed in Nr2f6 knockdown C2C12 myocytes (N = 4–5). Molecular and metabolic assays and proliferation experiments were performed using stable Nr2f6 knockdown and Nr2f6 overexpression C2C12 cell lines (N = 3–6). Nr2f6 content was evaluated in lipid overload models in vitro and in vivo (N = 3–6). In vivo experiments included Nr2f6 overexpression in mouse tibialis anterior muscle, followed by gene array transcriptomics and molecular assays (N = 4), ex vivo contractility experiments (N = 5), and histological analysis (N = 7). The conservation of Nr2f6 depletion effects was confirmed in primary skeletal muscle cells of humans and mice. Results Nr2f6 knockdown upregulated genes associated with muscle differentiation, metabolism, and contraction, while cell cycle‐related genes were downregulated. In human skeletal muscle cells, Nr2f6 knockdown significantly increased the expression of myosin heavy chain genes (two‐fold to three‐fold) and siRNA‐mediated depletion of Nr2f6 increased maximal C2C12 myocyte's lipid oxidative capacity by 75% and protected against lipid‐induced cell death. Nr2f6 content decreased by 40% in lipid‐overloaded myotubes and by 50% in the skeletal muscle of mice fed a high‐fat diet. Nr2f6 overexpression in mice resulted in an atrophic and hypoplastic state, characterized by a significant reduction in muscle mass (15%) and myofibre content (18%), followed by an impairment (50%) in force production. These functional phenotypes were accompanied by the establishment of an inflammation‐like molecular signature and a decrease in the expression of genes involved in muscle contractility and oxidative metabolism, which was associated with the repression of the uncoupling protein 3 (20%) and PGC‐1α (30%) promoters activity following Nr2f6 overexpression in vitro. Additionally, Nr2f6 regulated core components of the cell division machinery, effectively decoupling muscle cell proliferation from differentiation. Conclusions Our findings reveal a novel role for Nr2f6 as a molecular transducer that plays a crucial role in maintaining the balance between skeletal muscle contractile function and oxidative capacity. These results have significant implications for the development of potential therapeutic strategies for metabolic diseases and myopathies.

Background To determine the percentage of patients who have silicone droplets in the vitreous after treatment with different anti-Vascular Endothelial Growth Factor (anti-VEGF) intravitreal injections (IVI) and how symptomatic they are. Methods One hundred fifty-two eyes of 140 patients who had at least received an IVI were recruited for this study. Data collection included the number and type of IVI (aflibercept, ranibizumab and bevacizumab) and the follow-up time. A complete ophthalmologic examination was carried out and patients were classified in four groups according to the amount of silicone droplets found in dilated fundoscopy (nonexistent, scarce, moderate and abundant). Measurement of intraocular pressure (IOP) was also carried out. An interview was conducted to report the presence and intensity of the symptomatology. Results Silicone oil droplets were reported in 109 eyes (71.7%). A positive correlation was found between the number of IVIs received and the quantity of droplets found, especially when aflibercept was used. Posterior vitreous detachment (PVD) was present in 65.8% of the patients, showing a positive correlation with the number of bubbles. Regarding the symptomatology, 60 eyes (39.5%) had floaters and the disturbance was reported to be 4 out of 10. The group with a moderate amount of silicone droplets had the highest percentage of floaters (60%). No statistical differences in the IOP were found between groups, although the group with abundant droplets had a higher mean IOP. Conclusion A high prevalence of silicone droplets in vitreous of patients who undergo IVI treatment was found. It appears to have little impact on symptomatology and rise of IOP.

A cross-sectional study of microorganisms isolated from mid-stream urine samples obtained from 139 patients with suspected urinary tract infection (UTI) who presented leukocyturia was conducted from April to June 2019 at Saint Joseph Kitgum Hospital (Uganda). All microorganisms were identified by MALDI-TOF mass spectrometry in a laboratory in Spain. Antimicrobial susceptibility was determined on site using the disc diffusion method (Kirby–Bauer test) and these results were subsequently compared with those obtained in Spain using the Becton Dickinson Phoenix M50 device. The overall prevalence of UTI with bacterial growth was 64.0% (n = 89) (95% CI, 56.1–72.0), and 11 presented mixed infection. As a result, 100 microorganisms were isolated. The most common uropathogens were Enterococcus spp. (57%) and Escherichia coli (28%). Nitrofurantoin was the most effective drug (81.7% in Gram-positive and 87.3% in Gram-negative bacteria), followed by imipenem (94.2% and 74.5%, respectively). The highest resistance rates were observed for amoxicillin and ciprofloxacin (66.2% and 44.6%, respectively). Given the increasing trend toward antibiotic resistance, there is a need for bacteriological cultures and continuous surveillance of uropathogen antibiotic susceptibility. Use of amoxicillin and ciprofloxacin as empirical treatments for UTIs should be discontinued in Uganda. The findings of this study may be useful for clinicians, as they may improve empirical treatment.

Roads can experience runoff problems due to the intense rain discharge associated to severe storms. Two advanced tools are combined to analyse the interaction of complex water flows with real terrains. UAV (Unmanned Aerial Vehicle) photogrammetry is employed to obtain accurate topographic information on small areas, typically on the order of a few hectares. The Smoothed Particle Hydrodynamics (SPH) technique is applied by means of the DualSPHysics model to compute the trajectory of the water flow during extreme rain events. The use of engineering solutions to palliate flood events is also analysed. The study case simulates how the collected water can flow into a close road and how precautionary measures can be effective to drain water under extreme conditions. The amount of water arriving at the road is calculated under different protection scenarios and the efficiency of a ditch is observed to decrease when sedimentation reduces its depth.

Palytoxin (PTX) is produced by corals such as zoanthid corals. Here we present a case of bilateral PTX-induced keratoconjunctivitis. A 63-year-old man presented to the emergency department with symptoms of red eye, purulent discharge, and foreign body sensation in both eyes. On slit lamp examination, epithelial defects in both eyes with a ring-shaped corneal stromal infiltrate in the right eye and a marginal stromal infiltrate in the left eye were noted. High-resolution anterior segment optical coherence tomography (HR-AS-OCT) showed stromal hyperreflectivity and Descemet folds. Bacterial, fungal, and amoebic cultures were taken. Empirical treatment with topical dexamethasone as well as antibiotics and systemic doxycycline was started. The next day the patient stated that he had been handling zoanthid coral without gloves and had rubbed his eyes afterward. Bilateral PTX-induced keratoconjunctivitis was diagnosed. His eyes were irrigated abundantly with saline solution, and umbilical cord serum eye drops were added to the treatment. Treatment was tapered according to improvement of the corneal infiltrates and epithelial defects. After four months, the stromal infiltrates were resolved but corneal scars persisted in both eyes. HR-AS-OCT showed anterior stromal hyperreflectivity corresponding to corneal leucomas. PTX can cause ocular adverse effects such as keratolysis and corneal inflammation, and in some cases can lead to corneal perforation. It can also produce systemic adverse effects, hence the importance of the preventive measures when handling corals that can produce this toxin. Keywords: Palytoxin, zoanthid, toxic keratoconjunctivitis, umbilical cord serum eye drops, high-resolution anterior segment optical coherence tomography

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients ( p  = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p  = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p  < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p  < 0.001), diarrhea (66.7% vs 11.5%, p  < 0.001), vomits (71.1% vs 23.1%, p  = 0.001), fatigue (65.9% vs 36%, p  = 0.016), shock (84.4% vs 13.8%, p  < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p  = 0.001). MIS-C group had a lower lymphocyte count ( p  < 0.001) and LDH ( p  = 0.001) but higher neutrophil count ( p  = 0.045), neutrophil/lymphocyte ratio ( p  < 0.001), C-reactive protein ( p  < 0.001) and procalcitonin ( p  < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p  = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p  < 0.001), corticosteroids (80% vs 44.8%, p  = 0.003) and immunoglobulins (51.1% vs 6.9%, p  < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

(1) Background: half-marathon races are popular among recreational runners, with increases in participation among middle-aged and women. We aimed to determine the effects of two half-marathon training programs on hematological and biochemical markers in middle-aged female recreational runners; (2) Methods: ten women (40 ± 7 years) followed moderate intensity continuous training (MICT), based on running volume below 80% V˙O2max, and another ten women followed high intensity interval training (HIIT) at 80%–100% V˙O2max, with less volume, and combined with eccentric loading exercise. Hematology, plasma osmolality, and plasma markers of metabolic status, muscle damage, inflammatory, and oxidative stress were measured before (S1) and after (S2) training and 24 h after the half-marathon (S3); (3) Results: both training programs had similar moderate effects at S2. However, the acute response at S3 induced different alterations. There was a greater decrease in cholesterol and triglyceride levels in MICT and reductions in markers of damage and inflammation in HIIT. Greater variability in some plasma markers at S3 in MICT suggests that there is inter-individual variability in the response to training; (4) Conclusions: HIIT led to better adaptation to the competition maybe because of the repeated exposure to higher oxygen consumption and eccentric loading exercise.