RESUMO
BACKGROUND: Risk scores (RS) evaluate the likelihood of short-term mortality in patients diagnosed with community-acquired pneumonia (CAP). However, there is a scarcity of evidence to determine the risk of long-term mortality. This article aims to compare the effectiveness of 16 scores in predicting mortality at three, six, and twelve months in adult patients with CAP. METHODS: A retrospective cohort study on individuals diagnosed with CAP was conducted across two hospitals in Colombia. Receiver Operating Characteristic (ROC) curves were constructed at 3, 6, and 12 months to assess the predictive ability of death for the following scoring systems: CURB-65, CRB-65, SCAP, CORB, ADROP, NEWS, Pneumonia Shock, REA-ICU, PSI, SMART-COP, SMRT-CO, SOAR, qSOFA, SIRS, CAPSI, and Charlson Comorbidity Index (CCI). RESULTS: A total of 3688 patients were included in the final analysis. Mortality at 3, 6, and 12 months was 5.2%, 8.3%, and 16.3% respectively. At 3 months, PSI, CCI, and CRB-65 scores showed ROC curves of 0.74 (95% CI: 0.71-0.77), 0.71 (95% CI: 0.67-0.74), and 0.70 (95% CI: 0.66-0.74). At 6 months, PSI and CCI scores showed performances of 0.74 (95% CI: 0.72-0.77) and 0.72 (95% CI: 0.69-0.74), respectively. Finally at 12 months, all evaluated scores showed poor discriminatory capacity, including PSI, which decreased from acceptable to poor with an ROC curve of 0.64 (95% CI: 0.61-0.66). CONCLUSION: When predicting mortality in patients with CAP, at 3 months, PSI, CCI, and CRB-65 showed acceptable predictive performances. At 6 months, only PSI and CCI maintained acceptable levels of accuracy. For the 12-month period, all evaluated scores exhibited very limited discriminatory ability, ranging from poor to almost negligible.
Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Curva ROC , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colômbia/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/diagnóstico , Pneumonia/mortalidade , Pneumonia/diagnóstico , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Three-dimensional (3D) geometrical models are potent tools for quantifying complex tissue features and exploring structure-function relationships. However, these models are generally incomplete due to experimental limitations in acquiring multiple (> 4) fluorescent channels in thick tissue sections simultaneously. Indeed, predictive geometrical and functional models of the liver have been restricted to few tissue and cellular components, excluding important cellular populations such as hepatic stellate cells (HSCs) and Kupffer cells (KCs). Here, we combined deep-tissue immunostaining, multiphoton microscopy, deep-learning techniques, and 3D image processing to computationally expand the number of simultaneously reconstructed tissue structures. We then generated a spatial single-cell atlas of hepatic architecture (Hep3D), including all main tissue and cellular components at different stages of post-natal development in mice. We used Hep3D to quantitatively study 1) hepatic morphodynamics from early post-natal development to adulthood, and 2) the effect on the liver's overall structure when changing the hepatic environment after removing KCs. In addition to a complete description of bile canaliculi and sinusoidal network remodeling, our analysis uncovered unexpected spatiotemporal patterns of non-parenchymal cells and hepatocytes differing in size, number of nuclei, and DNA content. Surprisingly, we found that the specific depletion of KCs results in morphological changes in hepatocytes and HSCs. These findings reveal novel characteristics of liver heterogeneity and have important implications for both the structural organization of liver tissue and its function. Our next-gen 3D single-cell atlas is a powerful tool to understand liver tissue architecture, opening up avenues for in-depth investigations into tissue structure across both normal and pathological conditions.
Assuntos
Hepatócitos , Fígado , Camundongos , Animais , Fígado/patologia , Células de Kupffer/patologia , Células Estreladas do Fígado/patologia , Canalículos BiliaresRESUMO
In seismically-active regions, mapping active and potentially-active faults is the first step to assess seismic hazards and site selection for paleoseismic studies that will estimate recurrence rates. Here, we present a comprehensive database of active and potentially-active continental faults in Chile based on existing studies and new mapping at 1:25,000 scale using geologic and geomorphic criteria and digital elevation models derived from TanDEM-X and LiDAR data. The database includes 958 fault strands grouped into 17 fault systems and classified based on activity (81 proved, 589 probable, 288 possible). The database is a contribution to the world compilation of active faults with applications among others in seismic hazard assessments, territorial planning, paleoseismology, geodynamics, landscape evolution processes, geothermal exploration, and in the study of feedbacks between continental deformation and the plate-boundary seismic cycle along subduction zones.
RESUMO
Resumen Se analizó un resultado con alteración cromosómica tomado de una base de datos conformada por un total de 4755 muestras de líquido amniótico extraídos mediante amniocentesis con indicación de su médico tratante, riesgo sérico y edad materna avanzada. En este reporte se presenta la detección de un mosaico de trisomía 21 en líquido amniótico, mediante la técnica de Banda G donde se analizaron 20 metafases. Los resultados obtenidos documentan una composición cromosómica 47, XY+21 y 46, XY con una relación 9:11 respecto a las metafases analizadas, confirmándose así el diagnóstico del Síndrome de Down secundario a mosaico.
Abstract A result with chromosomal alteration was analyzed from a database consisting of a total of 4755 samples of amniotic fluid extracted by amniocentesis with indication of the attending physician, serum risk and advanced maternal age. This report presents the detection of a mosaicism of trisomy 21 in amniotic fluid, using G- Banding where 20 metaphases were analyzed. The results obtained document a chromosomal composition 47, XY + 21 and 46, XY with a 9:11 ratio with respect to the metaphases analyzed, confirming the diagnosis of Down syndrome secondary to mosaicism.
Assuntos
Síndrome de Down , Amniocentese , Líquido Amniótico , MosaicismoRESUMO
La Cirrosis Biliar Primaria (CBP) es una enfermedad hepática colestásica-crónica y progresiva de patogenia autoinmune, que ha aumentado su prevalencia en los últimos años. En el presente trabajo exponemos un caso clínico sobre una paciente femenina con síndrome colestásico, anticuerpos anti-mitocondriales (AMA) positivo y el informe anatomopatológico compatible con CBP cirrosis biliar primaria en tercer estadío. Su tratamiento principal fue farmacológico con ácido ursodeoxicólico (AUDC).
Primary biliary cirrhosis (PBC) is a chronic-cholestatic and progressive liver disease with autoimmune pathogenesis, which has increased in prevalence in recent years. In this paper we present a case of a female patient with cholestatic syndrome, anti-mitochondrial antibody (AMA) positive and the pathology report compatible with PBC primary biliary cirrhosis in the third stage. Her main treatment was with the drug called ursodeoxycholic acid (UDCA).