Search

AIMS: This study aims to assess the prevalence of relative apical sparing pattern (RASP) in patients with severe symptomatic aortic stenosis (AS), referred for surgical aortic valve replacement (AVR), to evaluate its significance, possible relation to amyloid deposition, and persistence after surgery. METHODS AND RESULTS: Prospective study of 150 consecutive patients [age 73 (interquartile range: 68-77), 51% women], with severe symptomatic AS referred to surgical AVR. All patients underwent cardiac magnetic resonance (CMR) before surgery. RASP was defined by [average apical longitudinal strain (LS)/(average basal LS + average mid LS)] > 1 by echocardiography. AVR was performed in 119 (79.3%) patients. Both Congo red and sodium sulphate-Alcian blue (SAB) stain were used to exclude amyloid on septal myocardial biopsy. LV remodelling and tissue characterization parameters were compared in patients with and without RASP. Deformation pattern was re-assessed at 3-6 months after AVR.RASP was present in 23 patients (15.3%). There was no suspicion of amyloid at pre-operative CMR [native T1 value 1053 ms (1025-1076 ms); extracellular volume (ECV) 28% (25-30%)]. None of the patients had amyloid deposition at histopathology. Patients with RASP had significantly higher pre-operative LV mass and increased septal wall thickness. They also had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels [1564 (766-3318) vs. 548 (221-1440) pg/mL, P = 0.010], lower LV ejection fraction (53.7 ± 10.5 vs. 60.5 ± 10.2%, P = 0.005), and higher absolute late gadolinium enhancement (LGE) mass [9.7 (5.4-14.1) vs. 4.8 (1.9-8.6) g, P = 0.016] at CMR. Follow-up evaluation after AVR revealed RASP disappearance in all except two of the patients. CONCLUSION: RASP is not specific of cardiac amyloidosis. It may also be found in severe symptomatic AS without amyloidosis, reflecting advanced LV disease, being mostly reversible after surgery. publishersversion epub_ahead_of_print

Introdução e objetivos: caracterizar os doentes com aterosclerose, uma doença com elevado impacto socioeconómico, na Região de Saúde de Lisboa e Vale do Tejo. Métodos: Estudo observacional transversal, recorrendo ao Sistema de Informação desta Administração Regional de Saúde, com extração de dados clínico-demográficos e de consumo de recursos dos utilizadores adultos com aterosclerose em 2016. A aterosclerose foi definida pela presença de manifestações clínicas, fatores de risco aterotrombóticos e/ou consumo de medicamentos marcadores de aterosclerose. Foram comparados os resultados para a população com e sem manifestações clínicas (testes paramétricos).Resultados: Identificámos 318 692 utilizadores, a maioria (n=224 845 doentes; 71%) sem registo de manifestações clínicas. A subpopulação com manifestações clínicas era mais idosa (72,0±11,5 versus 71,3±11,0 anos), com maior proporção de homens (58,0% versus 45,9%), registo de hipertensão arterial (78,3% versus 73,5%), dislipidemia (55,8% versus 53,5%) e menor proporção de registo de obesidade (18,2% versus 20,8%), em comparação com a população sem manifestações clínicas (p, Introduction and Objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p

Objectives: To determine whether there are differences in the clinical characteristics, management, and outcome of episodes of acute heart failure (AHF) in residents of the Canary Islands, where the climate is subtropical, and episodes in continental Spain. Material and methods: Cases were identified in the registry for Epidemiology of Acute Heart Failure in Emergency Departments and categorized as in the Canary Islands or continental Spain. Data for 38 demographic, baseline, clinical, and therapeutic variables were extracted. We analyzed statistics for in-hospital and 30-day mortality, long hospital stay (more than 7 days), and a composite outcome after discharge (revisits or death within 30 days). The results for island and continental patients were compared and adjusted for between-group differences. Results: A total of 18 390 patients were studied, 697 islanders (3.8%) and 17 673 continental patients (96.2%). Comparisons showed that the islanders were younger; more often women; and more likely to have hypertension, diabetes, and a prior AHF episode. Their New York Heart Association functional class was also likely to be higher. However, their rates of dyslipidemia, valve disease, and functional dependence were lower, and they were also less likely to be on reninangiotensin system blockers. Although the severity of cardiac decompensation was similar in island and continental patients, the islanders received more intravenous treatments in the emergency department and were admitted less often. The adjusted risk of a long hospital stay was higher for the islanders (odds ratio [OR], 2.36; 95% CI, 1.52-3.02) but their risk for mortality and the composite outcome did not differ: in-hospital mortality, OR 0.97 (95% CI, 0.68-1.37); 30-day mortality, OR, 0.9 (95% CI, 0.67-1.27); and the post-discharge composite, OR, 1.19 (95% CI, 0.93-1.53). Conclusion: Baseline patient characteristics and clinical management of AHF episodes differ between the subtropical region and those in southern continental Europe. Hospitalization was required less often, but hospital stays were longer.

info:eu-repo/semantics/publishedVersion

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.

Objectives: To describe the pattern of care usually given to patients with acute heart failure (AHF) who are taking sacubitril/valsartan (SV) and to explore the effects of care characteristics on clinical outcomes. Material and methods: Exploratory study of AHF cases in patients taking SV who were included in the register for the Epidemiology of Acute Heart Failure in Emergency Departments during the sixth period of data collection (EAHFE-6). We extracted baseline and episode variables and information related to SV treatment. We also analyzed associations between the discontinuation of SV therapy and adverse events within 180 days (all-cause mortality) and after discharge (emergency revisits, admission for AHF, death from any cause, or a composite event). Results: . Fifty patients on SV were included. The median time on SV therapy was 81 days (interquartile range, 43-284 days). SV was discontinued in 19 cases (38%; 5 in the emergency department and 14 on the ward). Sixteen records specified the reason for discontinuing SV: renal insufficiency, 4 cases; arterial hypotension, 3; weakness/dizziness, 3; and exacerbated AHF, 3. SV discontinuation was associated with older age, absence of treatment with a betablocker, and hyperkalemia. The EAHFE-6 cases did not reveal significant differences related to SV discontinuation with respect to the rates of adverse events within 180 days or on discharge after the index event. Conclusion: Long-term SV therapy is discontinued in over a third of patients who present with exacerbated AHF even though no association with clinical outcomes could be identified.

To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge.We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death.The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home.Demostrar la eficacia de una intervención integral en la transición de cuidados (Plan de Alta Guiado Multinivel, PAGM) para disminuir eventos adversos a 30 días en ancianos frágiles con insuficiencia cardiaca aguda (ICA) dados de alta desde servicios de urgencias (SU) y validar los resultados de dicha intervención en condiciones reales.Se seleccionarán pacientes 70 años frágiles con diagnóstico principal de ICA dados del alta a su domicilio desde SU. La intervención consistirá en aplicar un PAGM: 1) lista de verificación sobre recomendaciones clínicas y activación de recursos; 2) programación de visita precoz; 3) transmisión de información a atención primaria; 4) hoja de instrucciones al paciente por escrito. Fase 1: ensayo clínico con asignación al azar por conglomerados emparejado. Se asignará de forma aleatoria 10 SU (N = 480) al grupo de intervención y 10 SU (N = 480) al grupo de control. Se compararán los resultados entre grupo de intervención y control. Fase 2: estudio cuasi-experimental. Se realizará la intervención en los 20 SU (N = 300). Se comparará los resultados entre la fase 1 y 2 del grupo de intervención y entre la fase 1 y 2 del grupo de control. La variable principal de resultado es compuesta (revisita a urgencias u hospitalización por ICA o mortalidad de origen cardiovascular) a los 30 días del alta.El estudio valorará la eficacia y factibilidad de una intervención integral en la transición de cuidados para reducir resultados adversos a 30 días en ancianos frágiles con ICA dados de alta desde los SU.

Objective. To determine the rate of adverse events in patients with acute heart failure (AHF) who were discharged from the emergency department (ED) after classification as low risk according to MEESSI score (multiple risk estimate based on the Spanish ED scale), to analyze the ability of the score to predict events, and to explore variables associated with adverse events. Methods. Patients in the EAHFE registry (Epidemiology of Acute Heart Failure in EDs) were stratified according to risk indicated by MEESSI score in order to identify those considered at low risk on discharge. All-cause 30-day mortality and revisits related to AHF within 7 days and 30 days were recorded. The area under the receiver operating characteristic curve (AUC) was calculated for the MEESSI score's ability to predict these events. Associations between 42 variables and 7-day and 30-day revisits to the ED were analyzed by multivariable logistic regression. Results. A total of 1028 patients were included. The 30-day mortality rate was 1.6% (95% CI, 0.9%-2.5%). The 7-day and 30-day revisit rates were 8.0% (95% CI, 6.4%-9.8%) and 24.7% (95% CI, 22.1%-25.7%), respectively. The AUCs for MEESSI score discrimination between patients with and without these outcomes were as follows: 30-day mortality, 0.69 (95% CI, 0.58-0.80); 7-day revisiting, 0.56 (95% CI, 0.49-0.63); and 30-day revisiting, 0.54 (95% CI, 0.50-0.59). Variables associated with 7-day revisits were long-term diuretic treatment (odds ratio [OR], 2.45; 95% CI, 1.01-5.98), hemoglobin concentration less than 110 g/L (OR, 1.68; 95% CI, 1.02-2.75), and intravenous diuretic treatment in the ED (OR, 0.53; 95% CI, 0.31-0.90). Variables associated with 30-day revisits were peripheral artery disease (OR, 1.74; 95% CI, 1.01-3.00), prior history of an AHF episode (OR, 1.42; 95% CI, 1.02-1.98), long-term mineralocorticoid receptor antagonist treatment (OR, 1.71; 95% CI, 1.09-2.67), Barthel index less than 90 points in the ED (OR, 1.48; 95% CI, 1.07-2.06), and intravenous diuretic treatment in the ED (OR, 0.58; 95% CI, 0.40-0.84). Conclusions. Patients with AHF who are at low risk for adverse events on discharge from our EDs have event rates that are near internationally recommended targets. The MEESSI score, which was designed to predict 30-day mortality, is a poor predictor of 7-day or 30-day revisiting in these low-risk patients. We identified other factors related to these events.

Objective. To determine whether chest radiographs can contribute to prognosis in patients with acute heart failure (AHF). Methods. Consecutive patients with AHF were enrolled by the participating emergency departments. Radiographic variables assessed were the presence or absence of evidence of cardiomegaly and pleural effusion and the pulmonary parenchymal pattern observed (vascular redistribution, interstitial edema, and/or alveolar edema). We gathered variables for the AHF episode and the patient's baseline state. Outcomes were in-hospital and 1-year mortality; hospital stay longer than 7 days, and a composite of events within 30 days of discharge (revisit, rehospitalization, and/or death). Crude and adjusted hazard ratios were calculated for the 3 categories of radiographic variables. The variables were also studied in combination. Results. A total of 2703 patients with a mean (SD) age of 81 (19) years were enrolled; 54.5% were women. Cardiomegaly was observed in 1711 cases (76.8%) and pleural effusion in 992 (36.7%). A pulmonary parenchymal pattern was observed in all cases, as follows: vascular redistribution in 1672 (61.9%), interstitial edema in 629 (23.3%) and alveolar edema in 402 (14.9%). The adjusted hazard ratios showed that cardiomegaly lacked prognostic value. However, the presence of pleural effusion was associated with a 23% (95% CI, 2%-49%) higher rate of the 30-day composite outcome; in-hospital mortality was 89% (30%-177%) higher in the presence of alveolar edema, and 1-year mortality was 38% (14%-67%) higher in association with vascular redistribution. The results for the variables in combination were consistent with the results for individual variables. Conclusions: A diagnostic chest radiograph can also contribute to the prediction of adverse events. Pleural effusion is associated with a higher rate of events after discharge, and alveolar edema is associated with higher mortality.

Objective To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Methods and results Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Conclusions Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival.

Arrhythmogenic right ventricular dysplasia is a classic form of chronic myocardial disease with a broad phenotypical spectrum. We report an atypical case of a patient with biventricular arrhythmogenic cardiomyopathy. Although the current diagnosis criteria are the most widely accepted ones, they focus solely on the right ventricular phenotype. The use of late gadolinium enhancement in cardiac magnetic resonance in this patient was essential for the diagnosis and assessment of the left ventricular involvement extent. This tool allows a broader use of current diagnosis criteria for this disease.

Ferramentas automatizadas para teste de sistemas computacionais têm sido desenvolvidas para aplicação em sistemas com saídas tradicionais. Sistemas com saídas complexas, como imagens e sons, ainda constituem um desafio. Este trabalho aplica técnicas de recuperação de áudio baseada em conteúdo no desenvolvimento de extratores de características visando a apoiar o teste de sistemas texto-fala. Os extratores desenvolvidos constituem complementos de um framework para apoiar a criação de oráculos de teste para sistemas com saídas complexas. Os extratores foram validados com sistemas reais e os resultados mostram que a abordagem é promissora para automatização de oráculos de teste para sistemas com saída sonora.

Twitter has become the largest microblogging platform where users can interact between each other expressing opinions, thoughts and feelings related to any topic or source of news in a compressed 280 character message, called tweet. Hashtags are popular keywords used to label these tweets according to its content. This work tries to nd out if the usage of hashtags to label tweets with similar content is accurate enough. To do so, tweets from di erent popular hashtags have been retrieved and processed in order to have a dataset with a content as close to reality as possible. Several embedding methods and learning algorithms have been studied to classify tweets from di erent hashtags based on the content. Results showed that the best performance is achieved when using the Tf-idf embedding method and support vectors machine. The learning algorithm obtained a precision around 90% for classi cation on 10 classes and above 70% when dealing with 100 classes trained on datasets of only 13680 and 143067 samples respectively. The results also indicated that BoW and Tf-idf methods outperformed other state of the art methods for other natural language processing tasks, such as GloVe or Word2Vec. Outgoing

ObjectivesTo analyse time trends in patient characteristics, clinical course, hospitalisation rate, and outcomes in acute heart failure along a 10-year period (2007-2016).MethodsThe EAHFE registry has prospectively collected 13,971 consecutive AHF patients diagnosed in 41 Spanish emergency departments (EDs) at five different time points (2007/2009/2011/2014/2016). Eighty patient-related variables and outcomes were described and statistically significant changes along time were evaluated. We also compared our data with large ED- and hospital-based registries.ResultsCompared to other large registries, our patients were older [80 (10)years], more frequently women (55.5%), and had a higher prevalence of hypertension (83.5%) and a lower prevalence of ischaemic cardiomyopathy (29.4%). De novo AHF was observed in 39.6%. 63.6% showed some degree of functional dependence and 56.1% had preserved left ventricular ejection fraction (LVEF). 56.8% of the patients arrived at the ED by ambulance, 4.5% arrived hypotensive, and 21.3% hypertensive. Direct discharge from the ED home was seen in 24.9%, and internal medicine (32.5%) and cardiology (15.8%) were the main hospital destinations. Triggers for decompensation were identified in 75.4%, the most being frequent infection (35.2%) and rapid atrial fibrillation (14.7%). The AHF phenotypes were: warm/wet 82.0%, warm/dry 6.2%, cold/wet 11.1%, and cold/dry 0.7%. The length of hospitalisation was 9.3 (8.6)days, and in-hospital, 30-day, and 1-year all-cause mortality were 7.8, 10.2 and 30.3%, respectively; and 30-day re-hospitalisation and ED revisit due to AHF were 16.9 and 24.8%, respectively. Thirty-nine of the eighty characteristics studied showed significant changes over time, while all outcomes remained unchanged along the 10-year period.ConclusionsThe EAHFE Registry is the first European ED-based registry describing the characteristics, clinical course, and outcomes of a cohort resembling the universe of patients with AHF. Significant changes were observed over time in some aspects of AHF characteristics and management, but not in outcomes.

OBJECTIVE: The objective was to determine the relationship between short-term mortality and intravenous morphine use in ED patients who received a diagnosis of acute heart failure (AHF). METHODS: Consecutive patients with AHF presenting to 34 Spanish EDs from 2011 to 2014 were eligible for inclusion. The subjects were divided into those with (M) or without IV morphine treatment (WOM) groups during ED stay. The primary outcome was 30-day all-cause mortality, and secondary outcomes were mortality at different intermediate time points, in-hospital mortality, and length of hospital stay. We generated a propensity score to match the M and WOM groups that were 1:1 according to 46 different epidemiological, baseline, clinical, and therapeutic factors. We investigated independent risk factors for 30-day mortality in patients receiving morphine. RESULTS: We included 6,516 patients (mean age, 81 [SD, 10] years; 56% women): 416 (6.4%) in the M and 6,100 (93.6%) in the WOM group. Overall, 635 (9.7%; M, 26.7%; WOM, 8.6%) died by day 30. After propensity score matching, 275 paired patients constituted each group. Patients receiving morphine had a higher 30-day mortality (55 [20.0%] vs 35 [12.7%] deaths; hazard ratio, 1.66; 95% CI, 1.09-2.54; P=.017). In patients receiving morphine, death was directly related to glycemia (P=.013) and inversely related to the baseline Barthel index and systolic BP (P=.021) at ED arrival (P=.021). Mortality was increased at every intermediate time point, although the greatest risk was at the shortest time (at 3 days: 22 [8.0%] vs 7 [2.5%] deaths; OR, 3.33; 95% CI, 1.40-7.93; P=.014). In-hospital mortality did not increase (39 [14.2%] vs 26 [9.1%] deaths; OR, 1.65; 95% CI, 0.97-2.82; P=.083) and LOS did not differ between groups (median [interquartile range] in M, 8 [7]; WOM, 8 [6]; P=.79). CONCLUSIONS: This propensity score-matched analysis suggests that the use of IV morphine in AHF could be associated with increased 30-day mortality.

Background: \ud \ud Age appropriateness of anticoagulants for stroke prevention in atrial fibrillation is uncertain.\ud \ud Objective: \ud \ud To review oral anticoagulants for the treatment of atrial fibrillation in older (age >65 years) people and to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability using the Fit-fOR-The-Aged (FORTA) classification.\ud \ud Methods: \ud \ud We performed a structured comprehensive review of controlled clinical trials and summaries of individual product characteristics to assess study and total patient numbers, quality of major outcome data and data of geriatric relevance. The resulting evidence was discussed in a round table with an interdisciplinary panel of ten European experts. Decisions on age appropriateness were made using a Delphi process.\ud \ud Results: \ud \ud For the eight drugs included, 380 citations were identified. The primary outcome results were reported in 32 clinical trials with explicit and relevant data on older people. Though over 24,000 patients aged >75/80 years were studied for warfarin, data on geriatric syndromes were rare (two studies reporting on frailty/falls/mental status) and missing for all other compounds. Apixaban was rated FORTA-A (highly beneficial). Other non-vitamin K antagonist oral anticoagulants (including low/high-intensity dabigatran and high-intensity edoxaban) and warfarin were assigned to FORTA-B (beneficial). Phenprocoumon, acenocoumarol and fluindione were rated FORTA-C (questionable), mainly reflecting the absence of data.\ud \ud Conclusions: \ud \ud All non-vitamin K antagonist oral anticoagulants and warfarin were classified as beneficial or very beneficial in older persons (FORTA-A or -B), underlining the overall positive assessment of the risk/benefit ratio for these drugs. For other vitamin-K antagonists regionally used in Europe, the lack of evidence should challenge current practice.

Se pretende investigar si es posible establecer la identidad de una persona a partir de las características biofísicas de su electroencefalograma (EEG). El EEG es un registro no invasivo de las corrientes eléctricas generadas por el cerebro. Sus características (forma de onda, potencia y otras) dependen de la personalidad y el aprendizaje, por lo que potencialmente puede ser empleado para distinguir a un sujeto del resto. Estas características conformarán los llamados “vectores de características”. Estos serán introducidos como entrenamiento a una Máquina de Soporte Vectorial, que aprenderá del conjunto de datos. Esta se alimentará, posteriormente, con nuevos vectores de características y se determinará si es capaz de identificar correctamente de que sujeto se trata. Se realiza un estudio con diferentes sujetos y tipos de ondas cerebrales, calculando la tasa de éxito aproximada para cada uno de ellos. Debido a que el estudio ha sido realizado para una pequeña cantidad de individuos, las tasas de error y los resultados a los que se llega, no serán concluyentes. Pero sí demostrarán el potencial del electroencefalograma para establecer la identidad de una persona. The aim is to investigate if it is possible to establish the identity of a person based on the biophysical characteristics of their electroencephalogram (EEG). The EEG is a noninvasive record of the electrical currents generated by the brain. Their characteristics (waveform, power…) depend on personality and learning, so they can potentially be used to distinguish a subject from the rest. These characteristics make up the so-called "feature vectors". These will be introduced as training to a Vector Support Machine, which they learn from the data set introduced. This will be fed later with new vectors of characteristics and will determine if it is able to correctly identify which subject is involved. A study was done with different subjects and types of brain waves, calculating the approximate success rate for each of them. Because the study has been performed for a small number of individuals, error rates and resultsto what is reached, are not conclusive. But it does demonstrate the potential of the electroencephalogram to establish the identity of a person. Universidad de Sevilla. Grado en Ingeniería de las Tecnologías de Telecomunicación

Objectives. To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. Methods. We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. Results. A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. Conclusions. Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased.

Build a speech recognition system for a taxi booking application The topic of this thesis is to built an accurate automatic speech recognition system to be able to recognize speech using Kaldi, an open-source toolkit for speech recognition written in C++ and with free data. First of all, the main process of automatic speech recognition is explained in details on first steps. Secondly, different approaches of training and adaptation techniques are studied in order to improve the recognition accuracy. Furthermore, as data size is a very important point in order to achieve enough recognition accuracy, the role of it, is also studied on this thesis. El tema d'aquesta tesi tracta sobre la construcció d'un sistema de reconeixement automàtic de veu amb Kaldi, una eina de treball per a reconeixement de veu, escrita en C ++. Primer de tot, és explicat en detall tot el procés principal de reconeixement automàtic de veu. En segon lloc, diferents enfocs d'entrenament i adaptació són estudiats amb l'objectiu de millorar la precisió de reconeixement. Addicionalment, com la mida de les dades utilitzades és un factor molt important en l'entrenament i adaptació del sistema acústic per tal obtenir suficient qualitat de reconeixement, el seu paper és també estudiat. El tema de esta tesis trata sobre la construccion de un sistema de reconocimiento automático de voz usando Kaldi, una herramienta de trabajo para reconocimiento de voz, escrita en C++. Primero de todo, es explicado en detalles todo el proceso principal de reconocimiento automático de voz. En segundo lugar, diferentes enfoques de entrenamiento y adaptación son estudiados con el objetivo the mejorar la precisión de reconocimiento. Adicionalmente, como el tamaño de datos usados es un factor muy importante en el entrenamiento y adaptación para obtener suficiente calidad de reconocimiento, su papel es también estudiado.

The use of computational methods to elucidate the ligand-protein binding mechanisms is of utmost importance for the pharmaceutical industry. PELE (Protein Energy Landscape Exploration) software has proved to have good predictive power. We want to further improve it by changing its conformational sampling step.

A Síndrome Hipereosinofílica Idiopática é uma doença rara, de etiologia desconhecida, com manifestações e prognóstico variáveis, que se caracteriza por eosinofilia periférica mantida e disfunção sistémica de órgãos e sistemas. O envolvimento cardíaco é frequente e resulta da lesão directa do miocárdio causada pelos eosinófilos citotóxicos. Os autores descrevem um caso de miocardite eosinofílica, os aspectos clínicos e terapêuticos, bem como, a complexidade diagnóstica., Medicina Interna, Vol. 21 N.º 4 (2014): Outubro/ Dezembro

El síndrome de Smith-Lemli-Opitz (SSLO) es un desorden metabólico autosómico recesivo debido a la síntesis anormal de colesterol y fue descrito por primera vez por Smith, Lemli y Opitz en 1964. Muchos casos de SSLO han sido descritos desde entonces, siendo reconocido como un síndrome malformativo relativamente común. Los individuos afectados tienen dismorfismo, microcefalia, múltiples malformaciones congénitas, retraso mental, agresividad e hiperactividad. La severidad de los defectos físicos se correlaciona con la severidad de la deficiencia de colesterol, la cual es causada por la baja actividad de la 7-dehidrocolesterol reductasa, enzima responsable de la conversión de 7-dehidrocolesterol a colesterol. La ocurrencia de hipotiroidismo en asociación con SSLO es muy inusual. Este constituye el primer caso venezolano en el que se asocian ambas patologías. The Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive metabolic disorder due to an abnormal cholesterol synthesis. It was first described by Smith, Lemli and Opitz in 1964. Many cases of SLOS have been described since then, leading to the recognition as a relatively common malformation syndrome. Affected individuals have dysmorphism, microcephaly, multiple congenital malformations, mental retardation, aggressiveness and hyperactivity. The severity of physical defects correlates with the severity of the cholesterol deficiency, which is caused by an abnormally low activity of 7-dehydrocholesterol reductase, the enzyme responsible for conversion of 7-dehydrocholesterol to cholesterol. The occurrence of hypothyroidism in association with SLOS is very unusual. We describe the first Venezuelan case in which both anomalies are associated.

The coupled electric drives apparatus was designed to mimic dynamic processes as they occur in textile machines, paper mills, strip metal production plants, etc. The goal of the work is to present main system's properties. For this first different system's construction and operation possibilities will be investigated. Then theoretical modelling will be used to describe main structure properties and finally experiments will be designed for evaluation purposes and further modelling results improvement.

La prevalencia del nódulo tiroideo en la población general es de 2 a 7% por palpación y de 19 a 76% por ultrasonido. Su incidencia es más alta con la edad, en personas provenientes de áreas con deficiencia de yodo, en mujeres, y después de exposición a radiación. La importancia del estudio del nódulo tiroideo radica en la necesidad de excluir cáncer, por lo cual, todo nódulo tiroideo >1cm debe ser evaluado. Los nódulos 1cm must be evaluated. However, nodules

La prevalencia del nódulo tiroideo en la población general es de 2 a 7% por palpación y de 19 a 76% por ultrasonido. Su incidencia es más alta con la edad, en personas provenientes de áreas con deficiencia de yodo, en mujeres, y después de exposición a radiación. La importancia del estudio del nódulo tiroideo radica en la necesidad de excluir cáncer, por lo cual, todo nódulo tiroideo >1cm debe ser evaluado. Los nódulos 1cm must be evaluated. However, nodules

Las úlceras del pie en los pacientes diabéticos constituyen un gran problema de salud pública que genera un alto costo para el paciente, sus familiares y los sistemas de salud. Son la principal causa de amputación no traumática de las extremidades inferiores. El pie diabético es considerado un síndrome clínico de origen multifactorial que incluye factores neuropáticos, angiopáticos e infecciosos que producen daño tisular y determinan el pronóstico de la extremidad. En la evaluación del pie diabético resulta clave el reconocimiento de la úlcera, presencia de infección, así como el estado vascular de la extremidad, de allí la importancia del uso de clasificaciones que estandaricen las diversas definiciones, permitan evaluar el curso clínico y los resultados de distintas terapias. El tratamiento del pie diabético debe enfocarse principalmente en los mecanismos patogénicos desencadenantes, ameritando atención multidisciplinaria para lograr el mejor pronóstico para el paciente. El objetivo principal es la implementación de terapia antibiótica que debe ir acompañado de debridamiento quirúrgico, así como, terapia coadyuvante ante la presencia de isquemia y dolor neuropático. En el presente artículo, basados en niveles de evidencia científica y en la práctica clínica de la Unidad de Endocrinología del IAHULA, se presenta el protocolo para el manejo del pie diabético que incluye sistemas de clasificación, evaluación clínica, paraclínica y tratamiento médico y quirúrgico. Foot ulcers in diabetic patients are a major public health problem that generates a high cost to the patient, family and health systems. They are the main cause of non-traumatic amputation of lower limbs. The diabetic foot is considered a clinical syndrome of multifactorial origin, including neuropathic, angiopathic and infectious factors, producing tissue damage and determining the prognosis of the limb. In diabetic foot assessment, it is critical to identify the ulcer, the presence of infection and the vascular status of the limb. For that reason, it is important to use standard classifications with accepted definitions to evaluate the clinical course and the results of different therapies. The diabetic foot treatment should focus primarily on the triggering pathogenic mechanisms, requiering care multidisciplinary to achieve the best outcome for the patient. The main therapies are the initiation of antibiotics along with surgical debridement, and adjuvant therapy for the ischemia and neuropathic pain. In this paper, based on levels of scientific evidence and clinical practice in the Unit of Endocrinology, IAHULA, we present the protocol for the management of the diabetic foot, including classification systems, clinical, paraclinical evaluation and medical and surgical treatment. 176-187 yorgi2000@hotmail.com Cuatrimestral

El conjunto del proyecto se divide en tres grandes fases: Estudios previos, Conceptos y Desarrollo final. Tras el planteamiento del brief y la planificación de tareas en el tiempo, comenzamos con la primera fase de estudios previos. En ella, mediante el estudio de mercado, estudio de MZ del Río, diversos análisis, etc., conocemos cómo se encuentra el sector de la grifería, y obtenemos una serie de Especificaciones de Diseño de Producto, bien sean críticas de obligado cumplimiento o deseables. Tras haber obtenido unas pautas de qué diseñar, y utilizando diversas técnicas creativas, se plantean tres líneas de grifería con estéticas diferentes, además de distintas soluciones funcionales para problemas y mejoras que se quieren implementar. Al ser un proyecto que se realiza para la empresa MZ del Río, son ellos lo que han de seleccionar la línea que más les guste estéticamente y las funcionalidades que quieren que tenga esta línea. Una vez seleccionados los conceptos se desarrollarán hasta obtener un suficiente detalle de los mismos: volumetría, dimensiones, acabados, componentes, interiores, etc. Por último, y para completar el proyecto se plantea una nueva idea de packaging respecto a lo que ya tiene MZ del Río.

El objetivo de este estudio es elaborar una metodología para optimizar el tamaño de la batería (energía almacenada) y del extensor de rango (potencia máxima) aplicable a diferentes tipos de Vehículo Eléctricos de Rango Extendido. Los vehículos eléctricos se presentan como una solución prometedora a los problemas con los que se enfrenta el sector de transporte. Debido a su alta eficiencia los vehículos eléctricos son capaces de reducir considerablemente las emisiones locales y globales, así como reducir la dependencia que el trasporte tiene de los limitados y cada vez más costosos combustibles fósiles. Sin embargo los vehículos eléctricos presentan problemas importantes. La mayor parte de estos problemas derivan del alto precio y baja densidad energética que presentan actualmente las baterías, lo que conlleva a autonomías eléctricas no suficientes para la mayoría de los conductores. Para superar las deficiencias actuales de los vehículos eléctricos y acelerar la electrificación del automóvil los Vehículo Eléctricos de Rango Extendido pueden ser una solución atractiva. En estos vehículos se añade un motor térmico (extensor de rango) al tren de potencia de un vehículo eléctrico, el cual es capaz de recargar las baterías cuando la carga de estas ha sido totalmente consumida. La adición del extensor de rango elimina las limitaciones de autonomía que presentan los vehículos eléctricos y además permite ajustar el tamaño de la batería a la distancia típica recorrida diariamente, reduciendo por lo tanto el coste total del vehículo. Este estudio se ha centrado en analizar los patrones de conducción de los conductores para analizar que características influyen en el tamaño óptimo de la batería de del extensor de rango. Para ello se ha hecho uso de una amplia base de datos de conducción de vehículos. Así mismo se ha adaptado un método de optimización convexa para su utilización en el control y simulación de Vehículos Eléctricos de Rango Extendido. Los resultados del estudio muestran que el tamaño óptimo de la batería es fuertemente dependiente del precio de esta y de la distancia recorrida diariamente, la cual varía según el segmento de mercado sobre el que fijamos el estudio. El tamaño del extensor de rango debe decidirse según las prestaciones deseadas para el vehículo en trayectos largos, debiendo prestar especial atención a los requerimientos esperados en zonas montañosas. El proyecto demuestra que los Vehículos Eléctrico de Rango Extendido son una buena solución para reducir el consumo de combustible, siendo posible reducir el 70 % de uso de combustible con rango eléctricos reducidos (50-70km). Además estos vehículos podrían ser validos para un mayor porcentaje de conductores al no presentar limitaciones de autonomía y ser más competitivos en comparación con los vehículos eléctricos actuales.

Objetivo: El objetivo es dar a conocer un caso de hemihiperplasia aislada. Caso Clínico: Escolar femenina de 7 años de edad con antecedente patológico de tumor de Wilms diagnosticado a los 11 meses, quien es referida a la Unidad de Endocrinología del IAHULA por presentar asimetría congénita del hemicuerpo derecho. Al examen físico se evidencia un peso de 25,500 Kg(P75-90), talla 137 cm(˃P97), índice de masa corporal 13,6 Kg/m2(P25-50), brazada 135 cm. Facies asimétricas, raíz y puente nasal anchos, narinas asimétricas, labios gruesos, paladar alto, asimetría de lengua, encías hipertróficas. Vello púbico y mamas Tanner I, labios mayores asimétricos. longitud de las extremidades inferiores: derecha 74 cm, izquierda 70,5 cm. Escoliosis con asimetría de omóplatos. La radiografía de mano y muñeca izquierda reporta una edad ósea de 8 años. Se solicita eco pélvico que reporta útero de longitud 1,4 cm, antero-posterior 0,8 cm, transversal 1,7 cm, sin alteraciones. Conclusiones: La paciente fue diagnosticada con hemihiperplasia, un crecimiento asimétrico de una o más regiones del cuerpo, y su incidencia se estima en 1 de cada 86.000 nacidos vivos. Esta entidad clínica es de aparición esporádica y ocurre por alteraciones en 11p15, principalmente por disomía uniparental paterna, o por defectos en la metilación de los genes LIT1 y H19, lo cual puede provocar sobreexpresión del IGF-2 causando talla alta y mayor predisposición a neoplasias malignas de estirpe embrionario como tumor de Wilms. Objective: The objective of this paper is to divulge a case of isolated hemyhiperplasia. Clinical Case: A seven-year old schoolgirl with pathological history of Wilms’ tumor, diagnosed at 11 months, was referred to the Endocrinology Unit of Los Andes University Hospital because of congenital asymmetry of right hemicorpus. At clinical examination she exhibited: weight 25.5 kg (P75-90); height 137 cm (>P97); body mass index 13.6 kg/m2 (P25-50); arm span 135 cm; asymmetrical facies; broad radix and nasal bridge; asymmetrical nostrils; thick lips; high palate; asymmetry of the tongue; gingival enlargement; pubic hair and breasts at Tanner stage I; asymmetrical labia majora; unequal length of lower extremities, the right lower limb measuring 74 cm and the left, 70.5 cm; scoliosis and scapular asymmetry. X-ray of left hand and wrist yielded bone age of 8 years. Pelvic ultrasound evaluation revealed uterine length of 1.4 cm, anteroposterior diameter of 0.8 cm, and transverse diameter of 1.7 cm with no alterations. Conclusion: Patient was diagnosed with hemihyperplasia, an asymmetrical growth of one or more regions of the body, whose incidence is estimated at one in 86,000 live births. This condition is sporadic and occurs as a result of alterations at 11p15, mainly due to paternal uniparental disomy or L1T1 and H19 methylation abnormalities, which can cause IGF-2 overexpression, resulting in excessively tall stature and greater propensity to malignant embryonic neoplasia such as Wilm’s tumor.

Objetivo: El objetivo es dar a conocer un caso de hemihiperplasia aislada. Caso Clínico: Escolar femenina de 7 años de edad con antecedente patológico de tumor de Wilms diagnosticado a los 11 meses, quien es referida a la Unidad de Endocrinología del IAHULA por presentar asimetría congénita del hemicuerpo derecho. Al examen físico se evidencia un peso de 25,500 Kg(P75-90), talla 137 cm(˃P97), índice de masa corporal 13,6 Kg/m2(P25-50), brazada 135 cm. Facies asimétricas, raíz y puente nasal anchos, narinas asimétricas, labios gruesos, paladar alto, asimetría de lengua, encías hipertróficas. Vello púbico y mamas Tanner I, labios mayores asimétricos. longitud de las extremidades inferiores: derecha 74 cm, izquierda 70,5 cm. Escoliosis con asimetría de omóplatos. La radiografía de mano y muñeca izquierda reporta una edad ósea de 8 años. Se solicita eco pélvico que reporta útero de longitud 1,4 cm, antero-posterior 0,8 cm, transversal 1,7 cm, sin alteraciones. Conclusiones: La paciente fue diagnosticada con hemihiperplasia, un crecimiento asimétrico de una o más regiones del cuerpo, y su incidencia se estima en 1 de cada 86.000 nacidos vivos. Esta entidad clínica es de aparición esporádica y ocurre por alteraciones en 11p15, principalmente por disomía uniparental paterna, o por defectos en la metilación de los genes LIT1 y H19, lo cual puede provocar sobreexpresión del IGF-2 causando talla alta y mayor predisposición a neoplasias malignas de estirpe embrionario como tumor de Wilms. Objective: The objective of this paper is to divulge a case of isolated hemyhiperplasia. Clinical Case: A seven-year old schoolgirl with pathological history of Wilms’ tumor, diagnosed at 11 months, was referred to the Endocrinology Unit of Los Andes University Hospital because of congenital asymmetry of right hemicorpus. At clinical examination she exhibited: weight 25.5 kg (P75-90); height 137 cm (>P97); body mass index 13.6 kg/m2 (P25-50); arm span 135 cm; asymmetrical facies; broad radix and nasal bridge; asymmetrical nostrils; thick lips; high palate; asymmetry of the tongue; gingival enlargement; pubic hair and breasts at Tanner stage I; asymmetrical labia majora; unequal length of lower extremities, the right lower limb measuring 74 cm and the left, 70.5 cm; scoliosis and scapular asymmetry. X-ray of left hand and wrist yielded bone age of 8 years. Pelvic ultrasound evaluation revealed uterine length of 1.4 cm, anteroposterior diameter of 0.8 cm, and transverse diameter of 1.7 cm with no alterations. Conclusion: Patient was diagnosed with hemihyperplasia, an asymmetrical growth of one or more regions of the body, whose incidence is estimated at one in 86,000 live births. This condition is sporadic and occurs as a result of alterations at 11p15, mainly due to paternal uniparental disomy or L1T1 and H19 methylation abnormalities, which can cause IGF-2 overexpression, resulting in excessively tall stature and greater propensity to malignant embryonic neoplasia such as Wilm’s tumor. 79-84 marcoslimamedical@hotmail.com uzcateguilr@intercable.net.ve, uzcategilr@hotmail.comg maracellymederico@gmail.com

Objetivo: Identificar los factores asociados a la aceptación por parte del paciente de la hospitalización a domicilio directamente desde el servicio de urgencias. Pacientes y métodos: Estudio de cohortes prospectivo observacional de pacientes que, una vez visitados en urgencias, reunían criterios de ingreso en sala convencional, podían responder a una entrevista y disponían de un posible cuidador. Se tomó como variable dependiente la predisposición a aceptar o no un ingreso en hospitalización a domicilio. De cada paciente, como variables independientes se recogieron aspectos demográficos, factores de su estado de salud-comorbilidad y de su enfermedad actual, y percepciones psicosociales relacionadas con la hospitalización a domicilio. La relación entre variables se estableció por análisis de regresión logística múltiple. Resultados: Se realizaron 129 entrevistas. La predisposición a aceptar un ingreso en hospitalización a domicilio fue del 71%. Sólo las percepciones psicosociales del paciente, con independencia de sus aspectos demográficos e incluso de su estado de salud actual y comorbilidad, se relacionaron con la predisposición a aceptar un ingreso en hospitalización a domicilio, en concreto las adecuadas condiciones físicas del domicilio (odds ratio [OR]: 4,31; intervalo de confianza del 95% [IC95%]: 1,18-15,78), la ausencia de miedo por tener que manejar el oxígeno (OR: 5,99; IC95%: 2,05-17,52), la ausencia de miedo a una mala evolución clínica (OR: 6,07; IC95%: 1,94-18,96) y la percepción de una mayor libertad de horarios (OR: 12,61; IC95%: 3,31-48,01). Conclusiones: La hospitalización a domicilio tendría una buena aceptación si se ofreciera directamente en el Servicio de Urgencias como alternativa a la hospitalización convencional. Esta aceptación se asocia a percepciones psicosociales, que deberían tenerse en cuenta al ofrecer esta modalidad asistencial. Aim: To identify the factors associated with patients' acceptance of emergency department discharge directly to hospital-at-home care. Patients and methods: We performed a prospective observational cohort study of patients seen at the emergency department who met the following inclusion criteria: need for hospital admission, ability to be interviewed, and availability of an informal caregiver. The dependent variable was defined as the predisposition to accept or refuse hospital-at-home care. For each patient, the following independent variables were recorded: demographic characteristics, health-related factors, comorbidities, current illness and psychosocial perceptions related to hospital-at-home care. The associations among the variables were tested by means of logistic regression analysis. Results: We included 129 patients. Seventy-one percent would have accepted hospital-at-home care. Acceptance of hospital-at-home care was associated with psychosocial perceptions only, independently of demographic characteristics, current illness severity and comorbidities. These psychosocial perceptions included adequate conditions at home (OR: 4.31; 95% CI: 1.18-15.78), not being afraid of oxygen manipulation (OR: 5.99; 95% CI: 2.05-17.52), lack of fear of a poor outcome (OR: 6.07; 95% CI: 1.94-18.96) and the possibility of enjoying a more flexible schedule (OR: 12.61; 95% CI: 3.31-48.01). Conclusions: Hospital-at-home care would be well accepted by patients if offered in the emergency department as an alternative to conventional hospitalization. Acceptance depends on patients' psychosocial perceptions, which should be assessed before this mode of care is proposed.

A utilização de meios computacionais para visualização no ensino restringia-se, até há pouco, a representações bidimensionais. No entanto, o acréscimo de sofisticação dos computadores e a progressiva democratização dos meios informáticos têm provocado o aparecimento de meios pedagógicos baseados em ambientes gráficos tridimensionais até há pouco só do domínio dos jogos mais elaborados. A realidade virtual é uma tecnologia que pode ser um bom instrumento de ensino e treino porque permite a interacção com modelos tridimensionais numa experiência multisensorial.

A multinuclear (1H, 13C, 17O, 51V) 1D and 2D NMR study of the complexation of l-lactic acid with vanadium(V) and hydrogen peroxide shows that four peroxo complexes are formed in aqueous solution in the pH range 1-7. Two isomeric 2:2:1 (metal:ligand:peroxo) complexes, together with a 2:2:2 species, are found over the entire pH range. At pH values below 2 an additional 1:1:1 complex is formed. The acid was found in all cases to act as a bidentate ligand through the carboxylic and the adjacent hydroxyl groups. To the best of our knowledge, this is the first report of dinuclear peroxovanadium complexes in which one of the metal centres is an oxovanadium centre (2:2:1 species).

We present the «Softsciences» project, a common action undertaken by the Portuguese Physical, Chemical and Mathematical Societies since 1991. Its goal is creating, producing and distributing software for learning Science and Mathematics, at the middle and high school levels. We describe some products we have made and our future plans, for both off- and on-line edition. Experiences like ours promoting a synergy of secondary and tertiary schools to produce discipline-based computational materials are effective means for improving science education

Meso-2,3-dimercaptosuccinic acid (DMSA), which is used as an antidote for heavy metal poisoning and in complexes of 99mTc for diagnostic purposes, forms several complexes with tungsten(VI) in aqueous solutions, as found by 1H, 13C, 17O and 183W NMR spectroscopy. In the pH range ~4-7, there are four complexes in which the acid acts as a bidentate ligand through one carboxyl group and the adjacent sulfhydryl group (a dominant 2:2 species and three 1:2 metal-ligand isomers are proposed) and 2:1 complexes in which the ligand is twisted in order to use the four binding groups. It is proposed that in both the 2:2 and 2:1 cases the S atoms bridge the two W atoms. At lower pH, the acid is again predominantly a tetradentate ligand in m:n associations with the metal (m>n). http://www.sciencedirect.com/science/article/B6TH8-40NG3G0-15/1/148f75794ab8134c22a0790b94e67915

Multinuclear (1H, 13C, 17O, 51V) 1D and 2D NMR spectroscopy has been used to characterize the peroxovanadium(V) complexes of glycolic acid in aqueous solution. One 2:2:2 (metal:ligand:peroxo) complex, together with a 1:1:1 and a 2:2:1 species, are found in the pH range 1-7. The 2:2:2 complex is a monoperoxo (one peroxide unit per vanadium atom) dinuclear species having a V2O3 4+ seven-coordinated metal centre. In this structure, the two vanadium atoms are triple bridged, two of those bridges being formed by oxygen atoms of the hydroxyl group of the acid. The 1:1:1 species has a seven-coordinated VO3+ metal centre. Glycolic acid bonds to the vanadium atoms in a bidentate way, through both the carboxylic and the hydroxyl groups. The peroxo groups are bound in the equatorial plane relative to the apical V=O and the geometry around each vanadium atom is close to pentagonal bipyramidal. The 2:2:1 complex is similar to the 2:2:2 species, except for one of the vanadium centres, which is now a five-coordinated oxovanadium centre. Three additional complexes are found in very small amounts for some pH and concentration conditions. Further support for the proposal of monoperoxovanadium species is given by UV-visible spectroscopy results. http://www.sciencedirect.com/science/article/B6TG5-428111H-J/1/b102dece7ebb3928c267e236534a1c50

Virtual reality is an emerging computer visualization technology which allows educators to place their students in to instructional environments heretofore difficult or impossible to achieve. In order to take full advantage of this technology, a virtual environment, "Virtual Water", is being developed. Virtual reality has been recently employed in a few educational applications, but the project presented here is the first application we know of combining aspects as atomic and molecular orbits, electron densities, water molecular dynamics for the liquid and gaseous phases and phase transitions.

Varias fotografías ilustran la experiencia Se detalla, a modo de unidad didáctica ilustrada, la realización de un belén en el Instituto de Enseñanza Media 'Cervantes', con motivo de la celebración de las fiestas navideñas y sirviendo como resumen de los trabajos del trimestre de los alumnos del primer curso. Se presentan los materiales y la elaboración de los decorados y figuras con plastilina, arcilla o escayola, para así valorar las aptitudes para el modelado de los alumnos. Ministerio Educación CIDE Biblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; biblioteca@mecd.es ESP

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p=0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3days, with an OR (95%CI) at 4–7days or ≥8days of 1.25 (1.04–1.48), p=0.015 and 1.31 (1.11–1.55), p=0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p=0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3days, with an OR (95%CI) at 4–7days or ≥8days of 1.25 (1.04–1.48), p=0.015 and 1.31 (1.11–1.55), p=0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.

Submitted by Paula Guerreiro (passarinho@reitoria.ulisboa.pt) on 2020-03-23T15:44:26Z No. of bitstreams: 1 ULSD734016_td_Joana_Fernandes.pdf: 33813720 bytes, checksum: 61f4f648d78582c40df5e64785d13cee (MD5) Made available in DSpace on 2020-04-08T11:25:33Z (GMT). No. of bitstreams: 1 ULSD734016_td_Joana_Fernandes.pdf: 33813720 bytes, checksum: 61f4f648d78582c40df5e64785d13cee (MD5) Previous issue date: 2019-09 Multicare - Seguros de Saúde, S.A Fundação para a Ciência e a Tecnologia

Introduction: Despite achieving normal epicardial coronary artery flow after primary percutaneous coronary intervention (P-PCI), a significant proportion of patients with acute ST elevation myocardial infarction has a poorer outcome because of microvascular coronary damage and/or dysfunction. Endothelial dysfunction may play a role in this microvascular coronary damage after STEMI, and its evaluation by peripheral arterial tonometry may be useful to predict the extent of microvascular coronary damage and the extent of myocardial infarction. Objectives: To evaluate the relation of early peripheral endothelial dysfunction, as measured by the reactive hyperemia index (RHI, obtained by peripheral arterial tonometry) and the index of microcirculatory resistance (IMR) immediately after P-PCI and to access the relation between RHI and IMR values and: 1) the extent of myocardial infarct evaluated by contrast enhanced cardiac magnetic resonance (ceCMR) and troponin release; 2) the extent of microvascular obstruction (MVO), evaluated by ceCMR and by other available indirect indicators; 3) late (3 months) left ventricular remodelling, measured by echocardiography. Methods: Observational, prospective cohort study. Patients with a first STEMI successfully treated with P-PCI, hemodynamically stable and without contra-indications for adenosine administration were included. After successful P-PCI, IMR was determined, using a pressure-wire. RHI was evaluated acutely and after 24 hours, using EndoPAT; endothelial dysfunction was defined as RHI24 had significantly worse ST resolution and angiographic indicators of microvascular dysfunction. IMR also correlated with infarct mass (r=0.70, p24 had significantly higher peak (p=0.013) and AUC (p=0.003) TnI. LVEF improved significantly only in patients with IMR24, a resolução do ST foi significativamente menor e os indicadores angiográficos de reperfusão foram significativamente piores. O IRM também se correlacionou com a massa de enfarte (r=0,70, p24 tiveram valores significativamente mais elevados de TnI máxima (p=0,013) e ASC de TnI (p=0,003). A FEVE melhorou de forma significativa apenas nos doentes com IMR

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2018-04-03T14:08:36Z No. of bitstreams: 1 MiguelMiranda.pdf: 6238976 bytes, checksum: 196e142f52ea6c07ff68259254cbecec (MD5) Made available in DSpace on 2018-04-05T11:38:56Z (GMT). No. of bitstreams: 1 MiguelMiranda.pdf: 6238976 bytes, checksum: 196e142f52ea6c07ff68259254cbecec (MD5) Previous issue date: 2017