Impact of a pulmonary embolism response team (PERT) in the prognosis of patients with acute symptomatic pulmonary embolism

BACKGROUND

The effect of a pulmonary embolism response team (PERT) in the short-term prognosis of patients with acute symptomatic pulmonary embolism (PE) lacks clarity. We therefore aimed at evaluating the effect of a PERT team on short-term mortality among patients with acute PE.

METHODS

We retrospectively reviewed consecutive patients with acute symptomatic PE enrolled in a single-center registry between 2007 and 2022. We used propensity score matching to compare treatment effects for patients with similar predicted probabilities of receiving management by the PERT team. The primary outcome was all-cause mortality within 30 days following the diagnosis of PE. The secondary outcome was 30-day PE-related mortality.

RESULTS

Of the 2,902 eligible patients who had acute symptomatic PE, 223 (7.7%; 95% confidence interval [CI], 6.7%-8.7%) were managed by the PERT team. Two hundred and seven patients who were treated by the PERT were matched with 207 patients who were not. Matched pairs did not show a statistically significant lower all-cause (odds ratio [OR], 1.09; 95% CI, 0.63-1.89) or PE-related death (OR, 1.30; 95% CI, 0.47-3.62) for PERT management compared with no PERT management through 30 days after diagnosis of PE.

CONCLUSIONS

Our results suggest that multidisciplinary care of patients with acute symptomatic PE by a PERT team is not associated with a significant reduction in short-term all-cause or PE-related mortality.

Impacto sociofamiliar del ordeño mecánico en economías campesinas productoras de leche

Implementar innovaciones tecnológicas genera alteraciones en la cotidianidad de quienes participan en los procesos productivos, por lo que el objetivo de este ejercicio fue examinar el impacto sociofamiliar del ordeño mecánico en economías campesinas productoras de leche, en donde el uso de esta herramienta ha aumentado en los últimos años. Para esto se realizó un estudio con 40 campesinos en aspectos económicos, familiares, de desarrollo humano y psicosociales, expresados en 25 variables analizadas con un modelo de ecuaciones estructurales. Los efectos se explicaron por las tres dimensiones iniciales, descartando la influencia del componente psicosocial. Se concluye que hay una cultura de trabajo del mayor esfuerzo posible que explica las percepciones de los campesinos sobre esta herramienta, enfocándose en el incremento de ingresos, la reducción de costos, la disminución del trabajo diario en la producción lechera y la reducción de riesgos de enfermedad laboral. Se observa un reemplazo de los saberes ancestrales y el fortalecimiento del capital social.

Evaluation of canine leishmaniosis vaccine CaniLeish® under field conditions in native dog populations from an endemic Mediterranean area-A randomized controlled trial

Dog vaccination is considered an effective way of reducing Leishmania infantum infection incidence in the canine population, as well as its transmission to humans. However, the use of partially effective vaccines can have the detrimental effect of "masking" vaccinated asymptomatic carriers, capable of harbouring the parasite and transmitting it to naïve individuals. After eight years on the European market, few studies have been released on CaniLeish® vaccine safety and efficacy. The present study, a one-year randomized CaniLeish® vaccine field trial, was performed in a canine leishmaniosis endemic area and included animals selected from a native dog population (n = 168). No severe adverse reactions were observed in vaccinated dogs (n = 85). Cases of active L. infantum infection were detected by serological, molecular and clinical follow-up of dogs. One-year post-vaccination, no differences in number or severity of L. infantum active infections were observed between study groups (n = 4 in each group). Vaccine-induced cellular immunity, assessed through interferon-γ quantification, showed significantly higher levels of this cytokine one-month post-vaccination in the vaccine group (p < 0.001), but no differences were observed after nine months between trial groups (p = 0.078). These results fail to support the reported CaniLeish® efficacy in the prevention of active L. infantum infection in dogs from endemic areas and naturally exposed to the parasite.

Estudio exploratorio sobre la producción y comercialización de carne de cerdo en el Valle de Aburrá, Antioquia (Colombia)

En los últimos años, el agronegocio porcino creció significativamente a nivel nacional y departamental. Esta cadena productiva está conformada por proveedores de insumos, productores primarios, comercializadores, agroindustria, comercio mayorista, comercio minorista y consumidores. Este estudio caracterizó los agentes del mercado que interactúan a lo largo de la cadena productiva, y además cuantificó los márgenes de comercialización de la carne de cerdo en la subregión del Valle de Aburrá, departamento de Antioquia. Se aplicó muestreo no probabilístico a conveniencia. Adicionalmente, se aplicó una encuesta a 30 productores y entrevista semiestructurada a cinco agentes de mercadeo. Se encontraron dos circuitos de comercialización principales: productor–expendedor de carne y productor–intermediario–expendedor de carne. Los precios pagados a los agentes que interactúan en el circuito de la carne de cerdo en el Valle de Aburrá presentan tendencia al alza. El precio pagado por el consumidor final al expendedor de carne crece en mayor proporción que los precios pagados a la intermediación y al productor primario.

Estudio exploratorio de la calidad de vida en el trabajo de ordeñadores de sistemas de producción de leche

La política comercial se ha orientado hacia una mayor apertura e integración de mercados globales, lo que ha creado en el sector lechero la necesidad de ser cada vez más competitivo. La gestión de talento humano constituye el factor clave para la creación de ventajas y el desarrollo de la estrategia empresarial. El objetivo fue explorar la calidad de vida en el trabajo y los factores asociados a la calidad de vida en el trabajo de ordeñadores en lecherías especializadas. Se encuestaron 66 colaboradores de labores de ordeño en sistemas de producción de leche de Antioquia, Colombia. Para el análisis estadístico se construyeron dos ecuaciones estructurales mediante análisis de factor exploratorio y confirmatorio; adicionalmente se analizó la variable “deseo de permanecer” mediante un análisis de partición recursiva y árboles de regresión. Los resultados mostraron en general un buen nivel de calidad de vida laboral. Además, se encontró que la variable percepción de riesgo es la que influye principalmente en la intención de cambiar de trabajo, mientras que la similitud salarial frente a otras fincas de la zona marca la intención de permanencia en el trabajo actual. Este trabajo esclarece un punto de partida en el diagnóstico de elementos de gestión humana, que permita mejorar la toma de decisiones, el desempeño productivo y la competitividad de los sistemas agropecuarios.

Continuation of low-molecular-weight heparin treatment for cancer-related venous thromboembolism: a prospective cohort study in daily clinical practice

Essentials Low-molecular-weight heparin (LMWH) injections for venous thromboembolism (VTE) may be burdensome. Patients with active cancer and confirmed VTE were included to evaluate LMWH continuation. The cumulative incidence of discontinuation was 21% after a median period of 90 days. One out of five patients discontinued LMWH injections because of side effects.

SUMMARY

Background Current guidelines recommend low-molecular-weight heparin (LMWH) monotherapy for 3-6 months as the first-line treatment for cancer-associated venous thromboembolism (VTE). However, although daily administration of LMWH injections over a course of several months may be burdensome, the number of patients who stop treatment because of LMWH side-effects is unknown. Objectives To evaluate the continuation rate and complications of daily LMWH injections in patients with cancer-associated VTE. Methods Consecutive patients with active cancer and objectively confirmed symptomatic proximal deep vein thrombosis and/or pulmonary embolism, treated at three Dutch hospitals and one Spanish hospital, were included to evaluate continuation LMWH therapy during LMWH treatment. Patients were excluded when they received other anticoagulants, were lost to follow-up, or experienced a venous catheter-associated thrombosis. Results A total of 372 patients were analyzed during LMWH treatment for a maximum of 180 days. The cumulative incidence of discontinuation was 21% (95% confidence interval [CI] 17-25) after a median period of 90 days (interquartile range 60-120 days). Only female sex was found to be significantly associated with premature LMWH discontinuation (odds ratio 1.6; 95% CI 1.03-2.5). Thirty patients (8.1%) developed recurrent VTE, 30 patients (8.3%) suffered a major bleed, and 106 patients (28%) died. Conclusion Our study reveals that one of five patients with cancer-associated VTE stopped LMWH injections because of side-effects. This finding provides relevant background information for current clinical trials investigating the efficacy and safety of direct oral anticoagulants as compared with LMWH.