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S1 File. Statistical analysis of all assessed variables in our cohort and among different treat- ment groups. (PDF) file:///C:/Users/Usuario1/Downloads/journal.pone.0283529.s001-1.pdf, ObjectiveTo assess the clinical outcome (death and/or Intensive Care Unit (ICU) admission) based on the time from hospital admission to the administration of anakinra and the possible usefulness of a "simplified" SCOPE score to stratify the risk of worse prognosis in our cohort of patients with moderate/severe SARS-CoV-2 pneumonia, both vaccinated and unvaccinated, that received anakinra and corticosteroids. In addition, the clinical, analytical, and imaging characteristics of patients at admission are described. MethodsRetrospective cohort study of 312 patients admitted to Hospital Clinico San Cecilio in Granada for moderate/severe pneumonia caused by SARS-CoV-2 that received anakinra and corticosteroids between March 2020 and January 2022. Clinical and analytical data were collected as well as the patient outcome at 30 and 60 days after admission. Three treatment groups were established according to the time from hospital admission to administration of anakinra: early (1st-2nd day), intermediate (3rd-5th day), and late (after the 5th day). ResultsThe median age was 67.4 years (IQR 22-97 years) and 204 (65.4%) were male. The most common comorbidity was hypertension (58%). The median time from the start of symptoms to anakinra administration was 6 days (IQR 5-10) and the SaFi (SaO(2)/FiO(2)) was 228 (IQR 71-471). The cure rate was higher in the early-onset anakinra group versus the late-onset group (73% vs 56.6%). The latter had a higher percentage of deaths (27.4%) and a greater number of patients remained hospitalized for a month (16%). On admission, the patients had elevated C-reactive protein (CRP), ferritin, and D-dimer values and decreased total lymphocytes. Analytical improvement was observed at both 72 hours and one month after treatment. 42 (13.5%) required ICU admission, and 23 (7.3%) orotracheal intubation. At 60 days, 221 (70.8%) were discharged, 87 (27.8%) had died and 4 (1.4%) remained hospitalized. The mean dose of anakinra was 1000 mg (100-2600 mg) with differences found between the dose administered and the clinical outcome. There were no differences in the primary outcome based on vaccination.A simplified SCOPE score at the start of anakinra administration was lower in patients with better clinical evolution. ConclusionsEarly treatment with anakinra and corticosteroids was associated with a better outcome regardless of vaccination status. A simplified SCOPE was found to be a good prognostic tool., SOBI

Background Exercise training (ET) with blood flow restriction (BFR) is becoming increasingly popular, but the majority of BFR ET studies have evaluated skeletal muscle strength and hypertrophy. The favorable effect of BFR ET on skeletal muscle and the vasculature appears to improve aerobic capacity (AC) although conflicting results have been observed.Purpose: The purposes of this systematic review with meta- analysis were to examine the effects of aerobic ET with and without BFR on AC and to compare the effect of low-to-moderate aerobic ET with and without BFR to high-intensity aerobic ET with and without BFR on AC. Study design Systematic Review with Meta-analysis. Methods A comprehensive search for studies examining the effects of aerobic ET with and without BFR on AC was performed. Inclusion criteria were: (a) the study was conducted in healthy individuals, (b) there was random allocation of study participants to training and control groups, (c) BFR was the sole intervention difference between the groups. Results A total of seven studies (5 low-to-moderate ET and 2 high-intensity ET) were included in the meta-analysis providing data from 121 subjects. There was a significant standardized mean difference (SMD) of 0.38 (95% CI = 0.01, 0.75) in AC between the BFR and non-BFR groups of all seven studies (z = 2.01; p = 0.04). Separate analyses of the five low-to-moderate aerobic ET studies found similar results with aerobic ET with BFR eliciting a significantly greater AC (z = 2.47; p=0.01) than aerobic ET without BFR (SMD of 0.57; 95% CI = 0.12, 1.01). Separate analyses of the two high-intensity aerobic ET studies with and without BFR found no significant difference in AC between the groups (SMD of - 0.01; 95% CI = - 0.67, 0.64). Conclusion Aerobic ET with BFR elicits a significantly greater AC than aerobic ET without BFR in healthy young adults. However, low-to-moderate intensity aerobic ET with BFR elicited a greater improvement in AC than aerobic ET without BFR while high-intensity aerobic ET with BFR did not elicit an improvement in AC over high-intensity aerobic ET without BFR. Level of evidence 1a.

Evidence informed management of individuals presenting with subacromial impingement syndrome (SAIS) includes strengthening exercises directed at the shoulder musculature. Patients with subacromial impingement syndrome (SAIS) can present with pain during and after completion of heavy resistance training limiting the applicability of this recommended treatment approach. Blood flow restriction (BFR) training is indicated for patients who have pain while completing heavy resistance training and may represent an important treatment modification for patients with SAIS unable to fully participate in a strengthening exercise program. The purpose of this case series is to describe the inclusion of BFR in the treatment of two patients with SAIS.Two middle aged, non-operative patients with signs and symptoms consistent with SAIS and high levels of irritability were included. Treatment over one month consisted of three commonly used exercises in the treatment of SAIS in conjunction with a standard BFR protocol: 75 reps broken up into sets of 30,15,15,15 with the BFR cuff placed over proximal humerus.Immediate within session improvements beyond measurement error were observed in resting pain and pain pressure thresholds at three sites. At the end of the course of treatment, clinically meaningful improvements were observed in patient reported outcomes including the PENN Score, ASES score, and the patient-specific functional scale. Clinically meaningful improvements and change beyond measurement error were also observed in range of motion and strength which (assessed via a handheld dynamometer).The incorporation of low load resistance training with BFR may be a useful adjunct for treating patients with SAIS to promote exercise-induced hypoalgesia, decrease pain, and increase function in the upper extremity.5.

Introduction: Little evidence appears to exists for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. Patients and Methods: A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed.Results: 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265-0.910; p=0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications.Conclusions: In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients, and may improve their prognosis.

El artículo constituye una reflexión sobre la relevancia antropológica de la acción moral sobre su propio sujeto, más allá de los criterios al uso basados en modelos interpretativos orientados a dilucidar la validez ética de las acciones externas. En este caso, el interés se centra en los efectos que las acciones tienen en el propio sujeto que las realiza, como base para una justificación de la ética desde su propio sujeto. Para ello se toma como referencia de partida un contexto profesional concreto, como es el área financiera.

The central Mérida Andes (Venezuela) landscape is characterized by the presence of well-preserved glacial landforms located between 2400 and 4978 m a.s.l. Geomorphological studies of these glacial landforms significantly contribute to the Venezuelan Andes glaciations reconstructions. However, Last Glaciation (locally called Mérida Glaciation) was poorly reconstructed because of limited chronological data. This dissertation attempts to contribute to the Last Glaciation reconstruction and paleoclimate knowledge since the late Pleistocene. Accordance this necessity, the methodology involved geomorphological analysis and geochronological study. Glacial landforms were dated based on the Terrestrial Cosmogenic Nuclide dating (10Be). This method is suitable for date quartz-rich materials and for the period of interest. To deduce paleoclimate conditions an analysis based on paleo ELA was developed.In the central Mérida Andes different Late Pleistocene glacier dynamics were identified. In the Mucubají and the Mucuchache valleys, successive stages of glacier stop-advance were identified during an overall glacier withdrawal. In the Gavidia and Mifafí valleys, glacier withdrawal was rapid with the highest retreat rates (between 4-7 km/ky). Morphometric features as glaciers bottom valley slopes, accumulation zone topography (glaciers cirques with steep walls), areas and orientation controlled different glaciers dynamics.Glacier advances were evidenced between 2500-4200 m. MIS 3 glaciers advances has been recognized in the Sierra Nevada. These were related to the highest runoff in the north of South America produced by the Intertropical Convergence Zone (ITCZ) and the local warm and wet climate conditions (locally named El Pedregal Interstadial). LGM glacier advances were recorded in Sierra Nevada in the Mucubají and Las Tapias between 3100-3600 m. MIS 2 Glaciers advances mainly occurred during the Oldest Dryas- El Caballo Stadial at around 17 ka. These glaciers advances correlate to the cold temperatures in the North Hemisphere and the coldest temperatures recorded in tropical ice cores.KeywordsTerrestrial cosmogenic nuclides dating, TCN, cosmogenic dating, glacial landforms, Andes Mérida, Venezuela. Pleistocene, Last Glaciation, LGM, paleo ELA, tropic paleoclimate.; Les Andes de Mérida (Venezuela) est caractérisé par la présence de morphologie glaciaire bien préservée entre 2400-4978 m. Les études de ces morphologies glaciares font la contribution pour mieux comprendre et reconstruire la Dernière Glaciation aux Andes Vénézuéliennes. La reconstruction de la Dernière Glaciation (connue dans la région comme Glaciation Mérida) était limitée par la disponibilité de chronologie glaciaire. Cette thèse fait sa contribution à la reconstruction de la Dernière Glaciation et à la connaissance du paléoclimat depuis le Pléistocène Superieur. La méthodologie a involucré l´analyse géomorphologique et l´étude géochronologique. La morphologie glaciaire a été datée avec la technique de nucléides cosmogéniques produits in-situ (10Be). Cette technique est appropriée pour dater les matériels riches en quartz et la période d´intérêt. Les inférences des conditions paleoclimatiques ont été faites sur la base des analyses de la paléo ELA.Des différentes dynamiques glaciares ont été identifiées aux Andes centrales de Mérida. Dans les vallées de Mucubají et Mucuchache, la dynamique a été caractérisée par plusieurs étapes de avancé-arrêt des glaciaires dans un recul général de la glace. Dans les vallées de Gavidia et Mifafí, la disparition des glaciares a été très rapide avec la vitesse de recul plus haute (entre 4-7 km/ky). Divers caractéristiques morpho métriques comme la pente du fond de la vallée, la topographie de la zone d´accumulation (cirques glaciares avec les murs très incliné), des surfaces de la zone d´accumulation et son orientation ont aussi contrôlé les différents dynamiques glaciares.Les avancées des glaciares ont été identifiées entre 2500-4200 m. Les avancées glaciares pendant le MIS 3 ont été reconnues à Sierra Nevada. Ces avancées ont été liées aux hautes précipitations dans le nord de l´Amérique de Sud produites par l´activité de la Zone de Convergence Intertropical. Ces avancées ont été aussi reliées aux conditions plus chaudes et humides dans l´Hémisphère Nord (aussi ces conditions ont été identifiées aux Andes vénézuéliennes et sont connues comme l´Interstadío El Pedregal). Les avancées glaciares pendant le Dernière Maximum Glaciares ont été enregistrées en Sierra Nevada á Mucubají et Las Tapias entre 3100-3600 m. Principalement, les avancées glaciares MIS 2 sont arrivées pendant l´Oldest Dryas-El Caballo Estadío à 17 ka. Ces avancées glaciares ont été reliées aux températures froides dans l´Hémisphère Nord et les températures plus froides enregistrées dans les carottes de glaciares tropicaux.Mots clésDatation par cosmogéniques produits in-situ, morphologie glaciaire, Pléistocène, Dernière Glaciation, LGM, paléo ELA.

Hereditary angioedema (HAE) is an infrequent, recurrent, and potentially lethal disorder caused by a deficiency of C(1) inhibitor or its activity. Abdominal pain secondary to bowel edema is common in these patients. However, a thorough literature search yielded only six previously reported cases of pancreatitis associated with this entity.

El aceite de mora es un ingrediente natural con potencial en la industria cosmética y alimentaria, a su vez puede experimentar degradación oxidativa en condiciones ambientales. Por ello, se extrajo aceite a partir de semillas de mora empleando fluidos supercríticos y, posteriormente, se microencapsuló mediante secado por aspersión y se evaluó la influencia de diferentes condiciones de operación en el rendimiento, y la eficiencia del proceso. Se emplearon como materiales encapsulantes: masterdry, goma arábiga y maltodextrina. Se estudió el tamaño y morfología de las microcápsulas. Se determinó que en el proceso de microencapsulación la temperatura de entrada fue la única variable estadísticamente significativa que afectó el rendimiento y la eficiencia, cuando se usaron como encapsulantes masterdry y goma arábiga. El caudal de alimentación fue estadísticamente significativo sólo para el rendimiento del proceso y lo influenció negativamente cuando se usó maltodextrina. La goma arábiga resultó ser el mejor encapsulante entre los tres estudiados. Se obtuvieron microcápsulas con tamaños entre 8,2 y 14 μm, con superficie continua en las paredes y ausencia de poros. Se comprobó que la microencapsulación con los tres encapsulantes permitió proteger el aceite y conservar mayoritariamente su perfil de ácidos grasos. Blackberry oil is a natural ingredient with potential in cosmetics and food industry, however, it experiences oxidative degradation at ambient conditions. Therefore, oil was obtained from blackberry seeds by supercritical fluid extraction and then was microcapsulated by spray drying. The influence of different operating conditions during freeze-drying towards yield and encapsulation was evaluated. Masterdry, gum arabic and maltodextrin were used as wall materials. Morphology and size of the microcapsules were also studied. Inlet temperature was the only statistically significant variable in process yield and efficiency when gum arabic and masterdry were used. Feed flow rate was statistically significant only for process yield and it was influenced negatively when maltodextrin was used. Gum arabic was the best wall material among the three studied. Microcapsules with sizes between 8.2 and 14 µm were obtained; continuous wall and no apparent cracks were observed. It was also seen that the fatty acid profile was mostly conserved after microencapsulation process carried out with the three wall materials

Hereditary angioedema (HAE) is an infrequent, recurrent, and potentially lethal disorder caused by a deficiency of C(1) inhibitor or its activity. Abdominal pain secondary to bowel edema is common in these patients. However, a thorough literature search yielded only six previously reported cases of pancreatitis associated with this entity.

La pasantía realizada en la División de Cobranzas DIAN Cali comprendió el estudio y análisis de las funciones y procedimientos que ella sigue con el objeto de actualizar los manuales respectivos que ayuden a organizar, agilizar y facilitar las labores de la DIAN, y así el mejoramiento de la entidad. La DIAN Cali en busca de una verdadera modernización, estandarización y optimización de sus procesos, se propuso adelantar el levantamiento y análisis respectivo del Manual de Funciones y de Procedimientos, establecer su mejoramiento, para normalizarlos y con ello ofrecer un mejor servicio a los clientes internos y externos, de forma tal que cada día se afiance como una entidad de ejemplo de la administración pública eficiente. La actualización del Manual de Funciones y Procedimientos también servirá como base para realizar estudios posteriores tales como evaluaciones de desempeño y de salarios Trabajo de grado (Ingeniero Industrial)-- Universidad Autónoma de Occidente, 2002 Pregrado Ingeniero(a) Industrial