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Dry anaerobic digestion (dry-AD) is an attractive process for solid wastes such as agri-food waste. However, some limitations mainly associated to lack of effective mixing, can hinder the methane production capacity of the systems. Bulking agent (BA) has been proposed as a solution to the compaction issues in systems without mechanical agitation, such as leaching bed reactors. However, effects of BA are still not clear, and, thus, the factors to consider for its dose has not been optimized yet. This work studies the effect of BA in dry-AD. Two substrates with different characteristics were proposed as models, bean peel as a lignocellulosic substrate and a mixture of food waste as a readily biodegradable substrate. Inert plastic rings were used as BA at different BA:S ratios. Assessed BA:S ratio did not affect the performance of methane production for the lignocellulosic waste, but it did significantly affect to the easily biodegradable substrate, showing up to a 28% of methane production increase. This result could be due to the presence of lignocellulosic compounds in the bean peel, behaving like a natural BA. In assays with an increased bed height, the compaction of the system was more severe, resulting in the rapid acidification of the processes. At these conditions, the positive effect of BA addition was more marked, allowing methane production and no acidification of the system. Thus, the addition of BA is a suitable strategy for improving methane production or stability in dry-AD systems without requiring the stirring of the systems., Competing Interests: Declaration of Competing Interest 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 © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid-term mortality compared with other interventions. In low- and middle-income countries (LMIC), where no other type of short-term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT)., Objective: To assess the outcomes of adult patients using VA-ECMO as a direct BTT in an LMIC and compare them with international registries., Methods: We conducted a single-center study analyzing consecutive adult patients requiring VA-ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA-ECMO implantation were evaluated., Results: Of 86 VA-ECMO, 22 (25.5%) were implanted as initial BTT strategy, and 52.1% of them underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in 81% for CS, and the most common underlying condition was coronary artery disease (31.8%). Overall, in-hospital mortality for VA-ECMO as BTT was 50%. Survival to discharge was 83% in those who underwent HT and 10% in those who did not, p < .001. In those who did not undergo HT, the main cause of death was hemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA-ECMO was 6 days (IQR 3-16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry, in-hospital survival after HT was 66.7%; the United Network of Organ Sharing registry estimated post-transplant survival at 73.1% ± 4.4%, and in the French national registry 1-year posttransplant survival was 70% in the VA-ECMO group., Conclusions: In adult patients with cardiogenic shock, VA-ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA-ECMO. We present a single center experience with results comparable to those of international registries., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Trichomes are well-known efficient plant defense mechanisms to limit arthropod herbivory, especially in Solanaceae. The present study aims to evaluate the impact of trichome types on the development, survival and dispersal of Tetranychus urticae, and the phytoseiid predatory mite Typhlodromus (Anthoseius) recki. Six Solanum lycopersicum cultivars and two wild Solanum species, S. cheesmaniae and S. peruvianum, presenting contrasting densities and types of trichomes, were considered. Cultivars and species were characterized by counting each trichome type on leaves, petioles and stems. Mites stuck on petiole and stem and alive mites on the leaflet used for mite release and in the whole plant were counted three weeks after T. urticae plant infestation. Tetranychus urticae settlement and dispersal were differently affected by trichomes. Trichome types V and VI did not affect settlement and dispersal, whereas trichome types I and IV on the petiole had the highest impacton mites. Trichomes on leaves slightly affected mite establishment, there appears to be a repellent effect of trichome types I and IV. The low densities of both T. urticae and its predator detected for the cv. Lancaster could not be clearly associated to the trichome types here considered. The predator did not seem to be affected by plant characteristics, but rather by T. urticae numbers on the plant. The trichome traits unfavorable to T. urticae, did not affect the predator which showed high efficiency to control this pest on all the plant genotypes considered, but at a favorable predator:prey ratio (1:1). Altogether, these results are encouraging for the use of T. (A.) recki as a biological control agent of T. urticae regardless of the trichome structure of the tomato cultivars, but other conditions should be tested to conclude on practical implementations., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objectives: Veno-arterial Extracorporeal membrane oxygenation (VA ECMO) is a salvage intervention in patients with cardiogenic shock (CS), and cardiac arrest (CA) refractory to standard therapies. The design of ECMO Teams has achieved the standardization of processes, although its impact on survival and prognosis is unknown., Objective: We aimed to analyze whether the creation of an ECMO Team has modified the prognosis of patients undergoing VA ECMO for refractory CS or CA., Materials and Methods: . We conducted a single-center retrospective cohort study. Patients with refractory CS or CA who underwent VA ECMO were divided in two consecutive periods: from 2014 to April 2019 (pre-ECMO T) and from May 2019 to December 2022 (Post ECMO T). The main outcomes were survival on ECMO, in-hospital survival, complications, and annual ECMO volume., Results: Eighty-three patients were included (36 pre-ECMO T and 47 post-ECMO T). The mean age was 53 +/-13 years. The most common reason for device indication was different: postcardiotomy shock (47.2%) pre-ECMO T and refractory cardiogenic shock (29.7%) post-ECMO T. The rate of extracorporeal cardiopulmonary resuscitation was 14.5%. The median duration of VA ECMO was longer after ECMO team implementation: 8 days (IQR 5-12.5) vs. five days (IQR 2-9, p=0.04). Global in-hospital survival was 45.8% (38.9% pre-ECMO T vs. 51.1% post-ECMO T; p=0.37), and the survival rate from VA ECMO was 60.2% (55.6% pre-ECMO T vs 63.8% post-ECMO T; p= 0.50). The volume of VA ECMO implantation was significantly higher in the post-ECMO team period (13.2 +/3.5 per year vs. 6.5 +/-3.5 per year, p: 0.02). The rate of complications was similar in both groups., Conclusions: After the implementation of an ECMO team, there was no statistical difference in the survival rate of patients treated with VA ECMO. However, a significant increase in the number of patients supported per year was observed after the implementation of this multidisciplinary team. Post-ECMO T, the most common reason for device indication was cardiogenic shock, with longer run times and a higher rate of extracorporeal cardiopulmonary resuscitation., Competing Interests: Conflictos de interés Ninguno

This paper describes the implementation of a level control strategy in a laboratory-scale flotation system. The laboratory-scale system consists of a bank of three flotation tanks connected in series, which mimics a flotation system found in mineral processing plants. Besides the classical feedback control strategy, we have also included a feedforward strategy to better account for process disturbances. Results revealed that the level control performance significantly improves when a feedforward strategy is considered. This methodology uses peristaltic pumps for level control, which has not been extensively documented even though: (1) peristaltic pumps are commonly used in laboratory-scale systems, and (2) the control implementation is not as straightforward as those control strategies that use valves. Therefore, we believe that this paper, which describes a proven methodology that has been validated in an experimental system, can be a useful reference for many researchers in the field.•Preparation of reagents to ensure that the froth stability of the froth layer is representative of an industrial flotation froth.•Calibration of instruments - convert the electrical signal from PLCs to engineering units.•Tuning PI parameters using SIMC rules by performing step-changes in each flotation cell., Competing 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., (© 2023 The Author(s).)

Worldwide, the tomato russet mite (TRM), Aculops lycopersici (Eriophyidae), is a key pest on cultivated tomato in addition to infesting other cultivated and wild Solanaceae; however, basic information on TRM supporting effective control strategies is still lacking, mainly regarding its taxonomic status and genetic diversity and structure. As A. lycopersici is reported on different species and genera of host plants, populations associated with different host plants may constitute specialized cryptic species, as shown for other eriophyids previously considered generalists. The main aims of this study were to (i) confirm the TRM taxonomic unity of populations from different host plants and localities as well as the species' oligophagy, and (ii) to advance the understanding of TRM host relationship and invasion history. For this purpose, we evaluated the genetic variability and structure of populations from different host plants along crucial areas of occurrence, including the area of potential origin, based on DNA sequences of mitochondrial (cytochrome c oxidase subunit I) and nuclear (internal transcribed spacer, D2 28S) genomic regions. Specimens from South America (Brazil) and Europe (France, Italy, Poland, The Netherlands) were collected from tomato and other solanaceous species from the genera Solanum and Physalis. Final TRM datasets were composed of 101, 82 and 50 sequences from the COI (672 bp), ITS (553 bp) and D2 (605 bp) regions, respectively. Distributions and frequencies of haplotypes (COI) and genotypes (D2 and ITS1) were inferred; pairwise genetic distance comparisons, and phylogenetic analysis were performed, including Bayesian Inference (BI) combined analysis. Our results showed that genetic divergences for mitochondrial and nuclear genomic regions from TRM associated with different host plants were lower than those observed in other eriophyid taxa, confirming conspecificity of TRM populations and oligophagy of this eriophyid mite. Four haplotypes (cH) were identified from the COI sequences with cH1 being the most frequent, representing 90% of all sequences occurring in all host plants studied (Brazil, France, The Netherlands); the other haplotypes were present exclusively in Brazilian populations. Six variants (I) were identified from the ITS sequences: I-1 was the most frequent (76.5% of all sequences), spread in all countries and associated with all host plants, except S. nigrum. Just one D2 sequence variant was found in all studied countries. The genetic homogeneity among populations highlights the occurrence of a highly invasive and oligophagous haplotype. These results failed to corroborate the hypothesis that differential symptomatology or damage intensity among tomato varieties and solanaceous host plants could be due to the genetic diversity of the associated mite populations. The genetic evidence, along with the history of spread of cultivated tomato, corroborates the hypothesis of a South American origin of TRM., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Infections due to Ehrlichia, Anaplasma, Dirofilaria, Mycoplasma, Babesia and Hepatozoon continue to be highly prevalent in dogs, especially in tropical and subtropical areas, where vectors of many of them are present. However, many clinical aspects of dogs have not been characterized in detail, including assessing the haematological alterations associated with them, particularly in Colombia and Latin America. A group of 100 dogs with Ehrlichia, Anaplasma, Dirofilaria, Mycoplasma, Babesia and Hepatozoon infections/exposure were assessed by blood smear serology (SNAP4DX) and PCR in Pereira, Colombia. We performed blood counts to evaluate anaemia, leukopenia/leukocytosis, neutropenia, neutrophilia, lymphopenia/lymphocytosis, monocytosis, eosinophilia, and thrombocytopenia, among other alterations. Bivariate analyses were performed on Stata®14, with significant p < 0.05. From the total, 85% presented ≥1 infection (past or present), 66% with coinfections (≥2 pathogens) (Ehrlichia 75%), and 89% presented clinical alterations. A total of 100% showed anaemia, 70% thrombocytopenia, 61% monocytosis, and 47% neutropenia, among other alterations. Additionally, 11% presented pancytopenia and 59% bicytopenia. The median platelet count was lower in infected dogs (126,000 cells/μL) versus non-infected (221,000 cells/μL) (p = 0.003). Thrombocytopenia was higher among infected dogs (75%) versus non-infected (40%) (p = 0.006), with a 91% positive predictive value for infection. Median neutrophil count was lower in infected dogs (6591 cells/μL) versus non-infected (8804 cells/μL) (p = 0.013). Lymphocytosis occurred only among those infected (27%) (p = 0.022). Leukopenia was only observed among infected dogs (13%). Pancytopenia was only observed among infected dogs. Ehrlichiosis and other hematic infections have led to a significant burden of haematological alterations on infected dogs, including pancytopenia in a tenth of them, most with thrombocytopenia and all anemic.

Objective: The purpose of the present study was to compare survival outcomes in propensity score-matched patients aged 70 years or greater receiving a bilateral internal thoracic artery graft with patients receiving a single internal thoracic artery graft., Methods: Among 4083 consecutive patients with isolated coronary artery bypass grafting who underwent operation between January 2001 and December 2018, we identified 1300 patients aged 70 years or greater; of these, 968 received a bilateral internal thoracic artery (bilateral internal thoracic artery group) and 332 received a single internal thoracic artery (single internal thoracic artery group). Propensity score matching was used to reduce the preoperative patient differences. The 10-year survival and postoperative complications were compared between the 2 groups., Results: A Kaplan-Meier curve at 10 years of follow-up showed that crude survival was significantly superior in patients with bilateral internal thoracic artery grafts than in patients with single internal thoracic artery grafts (67.0% ± 2.5% vs 56.0% ± 3.4%, respectively; P < .016). In the actuarial survival, estimates for propensity score-matched patients with a bilateral internal thoracic artery showed a significantly higher rates of survival than patients with a single internal thoracic artery by the end of follow-up (66.0% ± 5.3% vs 53.0% ± 3.9%, respectively; hazard ratio, 0.64; 95% confidence interval, 0.44-0.94; P = .022, univariable Cox Model and multivariable analysis hazard ratio, 0.66; 95% confidence interval, 0.45-0.97; P = .036 Cox model). Postoperative complications were all similar between the single internal thoracic artery and bilateral internal thoracic artery groups., Conclusions: The use of bilateral internal thoracic artery grafting in older patients improves 10-year survival, with similar postoperative morbidity. This surgical technique might have beneficial effects in survival in patients aged more than 70 years. Its use could be considered more frequently., (Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Tick-borne diseases (TBD) and dirofilariosis are currently not under surveillance in most Latin American countries. In addition, there is a significant lack of studies describing the current situation in most endemic areas, including Colombia. Therefore, seroprevalence studies are crucial for understanding the epidemiology of these vector-borne diseases., Methods: A serosurvey for TBD and dirofilariosis among 100 dogs was carried out in the municipality of Pereira, located in the Coffee-Triangle region, Colombia. Samples were tested using a rapid assay test system (SNAP® 4Dx®); based on an enzyme immunoassay technique' screening for antibodies to Anaplasma phagocytophilum/platys (sensitivity 99.1%)' Borrelia burgdorferi s.l. (98.8%), and Ehrlichia canis/ewingii (96.2%) by using specific antigens and checking for Dirofilaria immitis antigen based on specific antibodies (99.2%). Bivariate analyses were performed on Stata®14, significant p  < 0.05., Findings: Global seroprevalence to the selected vector-borne pathogens was 74% (95%CI 65-83%). The highest seroprevalence was found for E. canis/ewingii (74%), followed by A. phagocytophilum/platys (16%). Seropositivity for Borrelia spp. and Dirofilaria spp. was 0%. All Anaplasma spp. seropositive dogs showed co-detection of Ehrlichia spp. (16%). Seroprevalence was significantly higher among dogs from families of lower socioeconomic status/level (I, 86%), followed by level II (74%), and III (36%) ( p  = 0.001). All dogs exhibiting anorexia (12%) were invariably seropositive (100%) ( p  = 0.029). Seroprevalence was higher among those showing mucocutaneous paleness (95%) compared to those without paleness (68%) ( p  = 0.013) (OR = 9.3; 95%CI 1.18-72.9). There was high variability in seroprevalence through the studied areas, ranging from 0% (La Libertad Park) up to Combia, Cesar Nader, Las Brisas and Saturno localities (100%) ( p  = 0.033)., Interpretation: Given the high seroprevalence obtained in an area with documented ticks, there is a potential risk of zoonotic transmission to humans. Further seroprevalence studies in humans are needed to assess the prevalence of infections. Poverty is highly associated with these tick-borne pathogens in Pereira, as shown in the present study., Competing Interests: None., (© 2022 The Authors.)

Several surveys were conducted between 2010 and 2012 in the Brazilian range Serra do Espinhao, a highly biodiverse region extending more than 1000 km in the states of Bahia and Minas Gerais. We report in this paper eight species of the genus Neoseiulus Hughes collected on natural, non-cultivated, vegetation. Two of these species are described, illustrated and proposed as new taxa, N. cipoensis sp. nov. and N. diamantinus sp. nov. New morphological information as well as host-plants and geographical distribution are provided for six additional species, N. benjamini (Schicha), N. californicus (McGregor), N. goiano Demite, Cavalcante Lofego, N. idaeus Denmark Muma, N. melinis Lofego Moraes, and N. tunus (De Leon).

Background and Aims: Atrial fibrillation frequently occurs in the postoperative period of cardiac surgery, associated with an increase in morbidity and mortality. The scores POAF, CHA2DS2-VASc and HATCH demonstrated a validated ability to predict atrial fibrillation after cardiac surgery (AFCS). The objective is to develop and validate a risk score to predict AFCS from the combination of the variables with highest predictive value of POAF, CHA2DS2-VASc and HATCH models., Methods: We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data. The study included consecutive patients undergoing cardiac surgery in 2010-2016. The primary outcome was the development of new-onset AFCS. The variables of the POAF, CHA2DS2-VASc and HATCH scores were evaluated in a multivariate regression model to determine the predictive impact. Those variables that were independently associated with AFCS were included in the final model., Results: A total of 3113 patients underwent cardiac surgery, of which 21% presented AFCS. The variables included in the new score COM-AF were: age (≥75: 2 points, 65-74: 1 point), heart failure (2 points), female sex (1 point), hypertension (1 point), diabetes (1 point), previous stroke (2 points). For the prediction of AFCS, COM-AF presented an AUC of 0.78 (95% CI 0.76-0.80), the rest of the scores presented lower discrimination ability (P < 0.001): CHA2DS2-VASc AUC 0.76 (95% CI 0.74-0.78), POAF 0.71 (95% CI 0.69-0.73) and HATCH 0.70 (95% CI: 0, 67-0.72). Multivariable analysis demonstrated that COM-AF score was an independent predictor of AFCS: OR 1,91 (IC 95% 1,63-2,23)., Conclusion: From the combination of variables with higher predictive value included in the POAF, CHA2DS2-VASc, and HATCH scores, a new risk model system called COM-AF was created to predict AFCS, presenting a greater predictive ability than the original ones. Being necessary future prospective validations., Competing Interests: None

Introduction: High leuko-glycaemic index (LGI) (> 2000) has been associated with poor prognosis in many critical care settings. However, there is no evidence of LGI's prognostic value in the postoperative period of coronary artery bypass grafting (CABG). This study aims to analyze the prognostic value of LGI in the postoperative period of CABG., Methods: Single-center retrospective analysis of prospectively collected data was performed. Consecutive adult patients undergoing CABG between 2007 and 2019 were included. Blood glucose levels and white blood cells count were evaluated in the immediate postoperative period. LGI was calculated by multiplying both values and dividing them by 1,000 and analyzed in quartiles. Receiver operating characteristic curve was used to determine the best cutoff value. The primary combined endpoint was in-hospital mortality, low cardiac output (LCO), or acute kidney injury (AKI). Secondary endpoints included in-hospital death, AKI, atrial fibrillation, and LCO., Results: The study evaluated 3,813 patients undergoing CABG (88.5% male, 89.8% off-pump surgery, aged 64.6 years [standard deviation 9.6]). The median of LGI was 2,035. Presence of primary endpoint significantly increased per LGI quartile (9.2%, 9.7%, 11.8%, and 15%; P<0.001). High LGI was associated with increased occurrence of in-hospital mortality, LCO, AKI, and atrial fibrillation. The best prognostic cutoff value for primary endpoint was 2,000. In a multivariate logistic regression model, high LGI was independently associated with in-hospital death, LCO, or AKI., Conclusion: High LGI was an independent predictor of inhospital mortality, LCO, or AKI in postoperative period of CABG. It was also associated with higher in-hospital death.

The superfamily Eriophyoidea constitute a group of phytophagous mites of particular economic and evolutionary interest due to their intimate association with host plants and their agricultural importance as harmful or beneficial organisms. Studies on the Eriophyoidea fauna in Brazil started in the early 1900s with botanical works on cecidias and were continued with researchers looking for and reporting on eriophyid mites causing damage to agricultural crops. Therefore, in this annotated checklist, we compile information from just over a century on eriophyid mites reported or described from Brazil. Its purpose is to facilitate plant protection strategies and guide future work on this important group of phytophagous mites. In addition to taxonomy, we present information on host plants and general aspects of cecidia attributed to eriophyoid mites but without genus/species identification. Compilation was based on: i) literature, including papers, books, theses and congress/symposium publications; ii) specimens deposited in mite collections in Brazil. On each species we present: i) suprageneric/generic classification, synonyms and previous genus/era assignments, including references on original and/or additional descriptions; ii) type host plant and other host(s) plant(s) found in the country; iii) host relationships and remarks on symptoms; iv) localities of occurrences at States/Federal District and municipal levels; and v) host plant status in Brazil as well as biomes where they occur or are cultivated. A total of 234 valid eriophyoid mite species are recorded: 196 Eriophyidae, 20 Diptilomiopidae and 18 Phytoptidae, distributed in 92 genera. Host plants comprised 233 species, belonging to 141 genera and 56 plant families. Four new reports of eriophyoid mites in Brazil are presented based on specimens deposited in reference collections. A new combination is presented for Propeaciota secundum (Flechtmann, Amrine Stasny) in the genus Khanthongella. In addition, data on observations and descriptions of 67 cecidias attributed to eriophyoid mites in five states and on 21 plant families are presented. Geographically, the distribution of species reports of eriophyoids around Brazil is highly uneven, with more than 64% of species (151 spp.) in the Southeast region, which surely reflects a lack of research elsewhere. Regarding host plant specificity, 77.7% are reported on only one host species, 88.9% on one host genus and 98.3% on one host family. Regarding host status 64.1% of species are exclusively associated with native host plants, 27% with naturalized or exotic cultivated host plants, and 6.4% from both native and naturalized or exotic host plants.

Objectives: To evaluate the accuracy of predicted prosthesis-patient mismatch (PPM) regarding actual PPM measured postoperatively. To assess the association between PPM and prosthetic valve dysfunction., Methods: Retrospective cohort study including adult patients after aortic valve replacement surgery with a biological prosthesis. Predicted PPM status was determined using mean reference effective orifice area indexed to total body surface (iEOA), without considering reference standard deviations. Postoperative PPM status was determined by measuring iEOA within the first 60 postoperative days. Prosthetic valve dysfunction was defined as thrombosis, pannus, valve degeneration, and/or disruption., Results: 205 patients were enrolled between January 2003 and June 2017: predicted PPM was absent in 52 patients (25.4%), moderate in 137 patients (66.8%), and severe in 16 patients (7.8%). After surgery, the actual postoperative iEOA was measured: 53 (25.9%) did not have PPM, 73 had moderate PPM (35.6%), and 79 had severe PPM (38.5%). Predicted PPM identified the presence of hemodynamically significant actual postoperative PPM (OR = 2.56; 95%CI 1.30-5.05; P = .006), though not its degree of severity. Prosthetic valve dysfunction was more frequent among patients with hemodynamically significant PPM (53.9% vs. 11.3%; P < .001), compared to those without PPM. The association between PPM and prosthetic valve dysfunction was maintained after adjusting for gender, age, and ever-smoking (OR = 9.03; P < .001). The incidence of thrombosis or pannus was also nonsignificantly higher in patients with moderate or severe PPM., Conclusions: Predicted PPM identifies the presence, possibly not the severity, of actual postoperative PPM. Moderate or severe PPM is associated with prosthetic valve dysfunction. Actual postoperative prosthesis-patient mismatch measured within 60 postoperative days showed a distinctive hemodynamic profile and presented a stronger association with prosthetic valve dysfunction than predicted prosthesis-patient mismatch. A. Echocardiographic follow-up in patients according to the actual postoperative PPM measured within 60 postoperative days. B. Prediction of prosthetic valve dysfunction based on preoperative predicted PPM or on actual postoperative PPM within 60 postoperative days. PPM: prosthesis-patient mismatch. OR: Odds ratio., (© 2021 Wiley Periodicals LLC.)

At the time of this writing (July 6, 2020), the mortality rate reported for COVID-19 in Argentina was <2%. Also, the country's critical care beds are ≤63% occupied. This achievement results from the excellent coordination and action by the Argentine Ministry of Health together with the 23 provinces and the Autonomous City of Buenos Aires of the nation for now., Materials and Methods: Regarding cardiovascular care for patients over 65 years of age, a more accurate analysis could be performed when two comparative half-yearly periods corresponding to the years 2019 and 2020 (pandemic time) were compared. The data collected regarding this age range revealed issues that had not previously been evaluated in our country. That undoubtedly proposes a different solution for the future based on a strict scientific analysis., Results: The ratio of patients who received stents to those that underwent coronary surgery was 6 to 1, while the ratio of patients who had off-pump surgery to those that underwent minimally invasive surgery was 69 to 1., Conclusion: An Argentinian perspective regarding cardiovascular care is good because the country has an excellent level of qualified medical training in its cardiac surgery and interventional cardiology services, as well as healthcare infrastructure distributed throughout the country, which will undoubtedly be able to respond to the new challenges posed by the post-pandemic period., (© 2021 Wiley Periodicals LLC.)

Objective: The present study was conducted to investigate the obesity paradox and assess the effect of body mass index (BMI) on early and late clinical outcomes after cardiac surgery., Design: Cohort study with a retrospective analysis of prospectively collected data., Design: Single-institution cardiology medical center., Participants: The study comprised consecutive patients undergoing cardiac surgery from January 2009 to January 2019. Patients were divided into the following 4 groups defined by BMI: underweight (UW) (≤18.5 kg/m 2 ): 0.5%, n = 27; normal weight (18.5-25 kg/m 2 ): 25.7%, n = 1,393; overweight (OW) (>25-30 kg/m 2 ): 44.7%, n = 2,423; and obese (OB) (≥30 kg/m 2 ): 29.1%, n = 1,576., Interventions: No interventions., Measurements and Main Results: A multivariate analysis was used to compare clinical outcomes among the different BMI groups. Overall 1-year survival of patients in the BMI categories was determined by the Kaplan-Meier method and compared using the log rank test. The study included 5,419 patients. The BMI groups were significantly different regarding presurgical variables. Mortality according to BMI exhibited a reverse J-shaped relationship: 7.4% in the UW group, 5.2% in the normal weight group, 3.2% in the OW group, and 4.3% in the OB group (p = 0.016). Low- cardiac- output syndrome and bleeding were more frequent in the UW group, whereas mediastinitis and hyperglycemia were more common in the OB group. After adjusting for other risk factors, BMI was not an independent predictor of in-hospital mortality. One-year follow-up was completed in 95% of the patients, and the analysis of long-term mortality did not show a difference among the BMI categories (p log rank = 0.16)., Conclusion: OW patients had a lower mortality and better outcomes after cardiac surgery. However, when other preoperative variables were taken into account, BMI did not have independent effect on in-hospital and 1-year mortality., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Veno-arterial extracorporeal membrane oxygenation may be used to support patients with refractory cardiogenic shock. Many patients can be successfully weaned, the ability of some medications to facilitate weaning from veno-arterial extracorporeal membrane oxygenation were reported. To date, there are limited studies investigating the impact of levosimendan on veno-arterial extracorporeal membrane oxygenation weaning. The objective of this systematic review and meta-analysis was to assess the effects of levosimendan on successful weaning from veno-arterial extracorporeal membrane oxygenation and survival in adult patients with cardiogenic shock., Methods: We performed a systematic review and meta-analysis (PubMed, the Cochrane Library, and the International Clinical Trials Registry Platform published from the year 2000 onwards) investigating whether levosimendan offers advantages compared to standard therapy or placebo, in cardiogenic shock adult patients treated with veno-arterial extracorporeal membrane oxygenation. The primary outcome was veno-arterial extracorporeal membrane oxygenation successful weaning, whereas secondary outcome was all-cause mortality at the longest follow-up available. We pooled risk ratio and 95% confidence interval using fixed and random effects models according to the heterogeneity., Results: A total of five non-randomized clinical trials comprising 557 patients were included, 299 patients for levosimendan and 258 patients for control groups. The pooled prevalence of veno-arterial extracorporeal membrane oxygenation successful weaning was 61.4% (95% confidence interval 39.8-82.9%), and all-cause mortality was 36% (95% confidence interval 29.6-48.8%). There was a significant increase in veno-arterial extracorporeal membrane oxygenation successful weaning with levosimendan compared to the controls (risk ratio = 1.42 (95% confidence interval 1.12-1.8), p for effect = 0.004, I 2  = 71%). A decrease risk of all-cause mortality in the levosimendan group was also observed, risk ratio = 0.62 (95% confidence interval 0.44-0.88), p for effect = 0.007, I 2  = 36%., Conclusion: The use of levosimendan on adult patients with cardiogenic shock may facilitate the veno-arterial extracorporeal membrane oxygenation weaning and reduce all-cause mortality. Few articles of this topic are available, and prospective, randomized multi-center trials are warranted to conclude decisively on the benefits of levosimendan in this setting.

Introduction: Postoperative atrial fibrillation (POAFib) occurs in 20 to 40% of patients following cardiac surgery, and is associated with an increased perioperative morbidity and mortality. We aimed to develop and validate a simple clinical risk model for the prediction of POAFib after cardiac surgery., Methods: An analytical single center retrospective cohort study was conducted, including consecutive patients undergoing cardiac surgery between 2004 and 2017 with POAFib. To create the predictive risk score, a logistic regression model was performed using a random sample of 75% of the population. Coefficients of the model were then converted to a numerical risk score, and three groups were defined: low risk (≤1 point), intermediate risk (2-5 points) and high risk (≥6 points). The score was validated using the remaining 25% of the patients. Discrimination was evaluated through the area under the curve (AUC) ROC, and calibration using the Hosmer-Lemeshow (HL) test, calibration plots, and ratio of expected and observed events (E/O)., Results: Six thousand five hundred nine patients underwent cardiac surgery: 52% coronary artery bypass grafting (CABG), 20% valve surgery, 14% combined (CABG and valve surgery) and 12% other. New-onset AF occurred in 1222 patients (18.77%). In the multivariate analysis, age, use of cardiopulmonary bypass pump, severe reduction in left ventricular ejection fraction (LVEF), chronic renal disease and heart failure were independent risk factors for POAFib, while the use of statins was a protective factor. The NOPAF score was calculated by adding points for each independent risk predictor. In the derivation cohort, the AUC was 0.71 (CI95% 0.69-0.72), and in the validation cohort the model also showed good discrimination (AUC 0.67 IC 0.64-0.70) and excellent calibration (HL P = 0.24). The E/O ratio was 1 (CI 95%: 0.89-1.12). According to the risk category, POAFib occurred in 5% of low; 11% of intermediate and 27.7% of high risk patients in the derivation cohort (P <0.001), and 5.7%; 12.6%; and 23.6% in the validation cohort respectively (P <0.001)., Conclusion: From a large hospitalized population, we developed and validated a simple risk score named NOPAF, based on clinical variables that accurately stratifies the risk of POAFib. This score may help to identify high-risk patients prior to cardiac surgery, in order to strengthen postoperative atrial fibrillation prophylaxis.

Antecedentes Y Objetivos: El sistema de calificación APACHE II permite predecir la mortalidad intrahospitalaria en terapia intensiva. Sin embargo, no está validado para cirugía cardíaca, ya que no posee buena capacidad diferenciadora. El objetivo es determinar el valor pronóstico de APACHE II en el postoperatorio de procedimientos cardíacos., Materiales Y Métodos: Se analizó en forma retrospectiva la base de cirugía cardíaca. Se incluyó a pacientes intervenidos entre 2017 y 2018, de los cuales se calculó la puntuación APACHE II. Se utilizó curva ROC para determinar el mejor valor de corte. El punto final primario fue mortalidad intrahospitalaria. Como puntos finales secundarios se evaluó la incidencia de bajo gasto cardíaco (BGC), accidente cerebrovascular (ACV), sangrado quirúrgico y necesidad de diálisis. Se realizó un modelo de regresión logístico multivariado para ajustar a las variables de interés., Resultados: Se analizó a 559 pacientes. La media del sistema de calificación APACHE II fue de 9.9 (DE 4). La prevalencia de mortalidad intrahospitalaria global fue de 6.1%. El mejor valor de corte de la calificación para predecir mortalidad fue de 12, con un área bajo la curva ROC de 0.92. Los pacientes con APACHE II ≥ 12 tuvieron significativamente mayor mortalidad, incidencia de BGC, ACV, sangrado quirúrgico y necesidad de diálisis. En un modelo multivariado, el sistema APACHE II se relacionó de modo independiente con mayor tasa de mortalidad intrahospitalaria (OR, 1.14; IC95%, 1.08-1.21; p < 0.0001)., Conclusiones: El sistema de clasificación APACHE II demostró ser un predictor independiente de mortalidad intrahospitalaria en pacientes que cursan el postoperatorio de cirugía cardíaca., Background and Objectives: The APACHE II score allows predicting in-hospital mortality in patients admitted to intensive care units. However, it is not validated for patients undergoing cardiac surgery, since it does not have a good discriminatory capacity in this clinical scenario. The aim of this study is to determine prognostic value of APACHE II score in postoperative of cardiac surgery., Materials and Methods: The study was performed using the cardiac surgery database. Patients undergoing surgery between 2017 and 2018, with APACHE II score calculated at the admission, were included. The ROC curve was used to determine a cut-off value The primary endpoint was in-hospital death. Secondary endpoints included low cardiac output (LCO), stroke, surgical bleeding, and dialysis requirement. A multivariable logistic regression model was developed to adjust to various variables of interest., Results: The study evaluated 559 patients undergoing cardiac surgery. The mean of APACHE II Score was 9.9 (SD 4). The prevalence of in-hospital death was 6.1%. The best prognostic cut-off value for the primary endpoint was 12, with a ROC curve of 0.92. Patients with an APACHE II score greater than or equal to 12 had significantly higher mortality, higher incidence of LCO, stroke, surgical bleeding and dialysis requirement. In a multivariate logistic regression model, the APACHE II score was independently associated with higher in-hospital death (OR, 1.14; 95CI%, 1.08-1.21; p < 0.0001)., Conclusions: The APACHE II Score proved to be an independent predictor of in-hospital death in patients undergoing postoperative cardiac surgery, with a high capacity for discrimination., (Copyright: © 2020 Permanyer.)