Search

En España, los sistemas sanitarios están transferidos a las Comunidades Autónomas (CC.AA.), constituyendo 19 sistemas sanitarios con gestión y recursos diferenciados. Durante la primera onda epidémica de la COVID-19 se objetivaron diferencias en los sistemas de declaración y en las tasas de letalidad (TL) entre las CC.AA. El objetivo de este estudio fue analizar las TL por CC.AA. durante la segunda onda epidémica (del 20 de julio al 25 de diciembre de 2020) y su relación con la prevalencia de la infección.

La neumonía adquirida en la comunidad (NAC) continúa siendo una causa importante de morbimortalidad en adultos. El objetivo de este trabajo es actualizar la guía práctica de prevención de la NAC mediante vacunación en España desarrollada en 2016 y actualizada en 2018, en función de las vacunas y las evidencias disponibles mediante revisión bibliográfica y opinión de expertos. La llegada de la COVID-19 como nueva causa de NAC y la reciente aprobación y disponibilidad de cuatro vacunas seguras y eficaces constituyen el cambio más significativo. Las vacunas frente al neumococo, la gripe, la tosferina y la COVID-19 pueden contribuir a disminuir la carga de enfermedad por NAC y sus complicaciones asociadas. La evidencia disponible avala las indicaciones prioritarias establecidas en esta guía, y sería recomendable tratar de lograr una difusión e implementación amplia en la práctica clínica rutinaria de estas recomendaciones.

En Euskadi, dos casos de COVID-19 fueron diagnosticados el 28 de febrero de 2020. El 14 de marzo el Gobierno español estableció el estado de alarma. La única información acerca del número de casos de COVID-19 eran los confirmados por RT-PCR. Lanzamos una herramienta de vigilancia basada en la web para estimar el número mínimo de casos sintomáticos de COVID-19 y generar información útil para la toma de decisiones en salud pública.

El síndrome geriátrico de fragilidad física es un síndrome médico de causas y agentes múltiples, caracterizado por pérdida de fuerza/resistencia y disminución de la función fisiológica, que aumenta la vulnerabilidad individual para desarrollar dependencia o muerte.

El aumento de infecciones de transmisión sexual (ITS) subraya la necesidad de herramientas de diagnóstico rápido y mínimamente invasivas. El objetivo fue evaluar la correlación entre muestras vaginales y endocervicales para el diagnóstico de ITS.

La neumonía adquirida en la comunidad (NAC) continúa siendo una causa importante de morbimortalidad en adultos. El objetivo de este documento es actualizar la guía práctica de prevención de la NAC mediante vacunación en España desarrollada en 2016 en función de las vacunas y evidencias disponibles mediante revisión bibliográfica y opinión de expertos. Las vacunas frente al neumococo y la gripe continúan siendo las principales herramientas preventivas disponibles frente a la NAC, y pueden contribuir a disminuir la carga de enfermedad por NAC y sus complicaciones asociadas. La evidencia disponible avala las indicaciones prioritarias establecidas en esta guía, y sería recomendable tratar de lograr una difusión e implementación amplia en la práctica clínica rutinaria de estas recomendaciones.

e-ASTROGAM (‘enhanced ASTROGAM’) is a breakthrough Observatory space mission, with a detector composed by a Silicon tracker, a calorimeter, and an anticoincidence system, dedicated to the study of the non-thermal Universe in the photon energy range from 0.3 MeV to 3 GeV – the lower energy limit can be pushed to energies as low as 150 keV for the tracker, and to 30 keV for calorimetric detection. The mission is based on an advanced space-proven detector technology, with unprecedented sensitivity, angular and energy resolution, combined with polarimetric capability. Thanks to its performance in the MeV–GeV domain, substantially improving its predecessors, e-ASTROGAM will open a new window on the non-thermal Universe, making pioneering observations of the most powerful Galactic and extragalactic sources, elucidating the nature of their relativistic outflows and their effects on the surroundings. With a line sensitivity in the MeV energy range one to two orders of magnitude better than previous generation instruments, e-ASTROGAM will determine the origin of key isotopes fundamental for the understanding of supernova explosion and the chemical evolution of our Galaxy. The mission will provide unique data of significant interest to a broad astronomical community, complementary to powerful observatories such as LIGO-Virgo-GEO600-KAGRA, SKA, ALMA, E-ELT, TMT, LSST, JWST, Athena, CTA, IceCube, KM3NeT, and LISA.

A broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units.

Hierarchical Beta zeolites with different Si/Al molar ratios, synthesized by crystallization of silanized protozeolitic units, were investigated in the liquid-phase Beckmann rearrangement of cyclohexanone and cyclododecanone oximes. The hierarchical Beta samples contain mesopores with sizes in the range 2.0–6.0 nm, as well as the typical zeolite micropores, showing a great contribution of the mesopore/external surface area (300–328 m2g−1) to the BET surface area (706–763 m2g−1) and increased Lewis acidity compared to conventional Beta zeolites. Diffusional and steric limitations were found to strongly influence the oxime Beckmann rearrangement as enhanced conversions were obtained with the hierarchical Beta zeolites. The largest differences between conventional and hierarchical Beta zeolites were denoted with the bulkier oxime, i.e.in the rearrangement of cyclododecanone oxime. In this case, two stages are clearly observed in the evolution of the oxime conversion along the reaction time, with a plateau being reached at long reaction times due to deactivation by product inhibition. Hierarchical Beta zeolites exhibited superior performance in both stages compared to reference samples. These results indicate that the use of hierarchical Beta zeolites for oxime Beckmann rearrangement leads to significant improvements in the catalytic behavior compared to conventional Beta samples due to a number of factors: faster intracrystalline diffusion, availability of non-sterically hindered mesopore/surface area and lower deactivation through product inhibition.

Describir el grado de conocimiento de los profesionales de atención primaria sobre la práctica del chemsex, sus potenciales efectos secundarios y la profilaxis pre-exposición (PrEP) contra el VIH.

La neumonía adquirida en la comunidad (NAC) es una causa importante de morbimortalidad en adultos. La incidencia anual de NAC en adultos en España varía entre 3 y 14 casos por 1.000 habitantes. Las guías clínicas actuales se centran básicamente en el abordaje terapéutico de la NAC más que en su prevención. El objetivo de este estudio es desarrollar y proponer una guía práctica de prevención de la NAC mediante vacunación en España en función de las vacunas y las evidencias disponibles.

La incorporación de nuevos fármacos al arsenal terapéutico, la actualización de las guías de práctica clínica y los hallazgos fisiopatológicos recientemente comunicados hacen que el manejo y conocimiento de la urticaria sea un tema de candente actualidad. La Sección territorial andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en los pacientes con urticaria. Presentamos un enfoque centrado en el paciente, y en el que se muestra su devenir en el sistema sanitario y la interrelación entre la atención primaria y hospitalaria, garantizando un punto clave, su continuidad asistencial.

Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity—a key feature of quality.

Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.

Accretion of matter onto black holes is universally associated with strong radiative feedback and powerful outflows. In particular, black-hole transients have outflows whose properties are strongly coupled to those of the accretion flow. This includes X-ray winds of ionized material, expelled from the accretion disk encircling the black hole, and collimated radio jets. Very recently, a distinct optical variability pattern has been reported in the transient stellar-mass black hole V404 Cygni, and interpreted as disrupted mass flow into the inner regions of its large accretion disk. Here we report observations of a sustained outer accretion disk wind in V404 Cyg, which is unlike any seen hitherto. We find that the outflowing wind is neutral, has a large covering factor, expands at one per cent of the speed of light and triggers a nebular phase once accretion drops sharply and the ejecta become optically thin. The large expelled mass (>10−8solar masses) indicates that the outburst was prematurely ended when a sizeable fraction of the outer disk was depleted by the wind, detaching the inner regions from the rest of the disk. The luminous, but brief, accretion phases shown by transients with large accretion disks imply that this outflow is probably a fundamental ingredient in regulating mass accretion onto black holes.

Las lesiones cutáneas benignas representan un motivo de consulta frecuente, tanto en atención primaria como en las consultas de dermatología. Sin embargo, existe una amplia variabilidad en el acceso de los usuarios al diagnóstico y tratamiento de las lesiones cutáneas benignas, debido principalmente a que no se establecieron criterios explícitos y homogéneos para el abordaje de los pacientes con lesiones benignas. Con el objetivo principal de reducir la variabilidad en la atención a las personas con lesiones quísticas o tumorales benignas la Sección Territorial Andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en este tipo de lesiones.

ABSTRACTNeither breakpoints (BPs) nor epidemiological cutoff values (ECVs) have been established for Candidaspp. with anidulafungin, caspofungin, and micafungin when using the Sensititre YeastOne (SYO) broth dilution colorimetric method. In addition, reference caspofungin MICs have so far proven to be unreliable. Candidaspecies wild-type (WT) MIC distributions (for microorganisms in a species/drug combination with no detectable phenotypic resistance) were established for 6,007 Candida albicans, 186 C. dubliniensis, 3,188 C. glabratacomplex, 119 C. guilliermondii, 493 C. krusei, 205 C. lusitaniae, 3,136 C. parapsilosiscomplex, and 1,016 C. tropicalisisolates. SYO MIC data gathered from 38 laboratories in Australia, Canada, Europe, Mexico, New Zealand, South Africa, and the United States were pooled to statistically define SYO ECVs. ECVs for anidulafungin, caspofungin, and micafungin encompassing ≥97.5% of the statistically modeled population were, respectively, 0.12, 0.25, and 0.06 μg/ml for C. albicans, 0.12, 0.25, and 0.03 μg/ml for C. glabratacomplex, 4, 2, and 4 μg/ml for C. parapsilosiscomplex, 0.5, 0.25, and 0.06 μg/ml for C. tropicalis, 0.25, 1, and 0.25 μg/ml for C. krusei, 0.25, 1, and 0.12 μg/ml for C. lusitaniae, 4, 2, and 2 μg/ml for C. guilliermondii, and 0.25, 0.25, and 0.12 μg/ml for C. dubliniensis. Species-specific SYO ECVs for anidulafungin, caspofungin, and micafungin correctly classified 72 (88.9%), 74 (91.4%), 76 (93.8%), respectively, of 81 Candidaisolates with identified fksmutations. SYO ECVs may aid in detecting non-WT isolates with reduced susceptibility to anidulafungin, micafungin, and especially caspofungin, since testing the susceptibilities of Candidaspp. to caspofungin by reference methodologies is not recommended.

Con el objetivo de contribuir al desarrollo de una regulación profesional más específica, el presente estudio se centró en identificar diferencias y similitudes entre las competencias de la supervisora de enfermería y la enfermera clínica especialista en una unidad de cuidados intensivos.

Conocer las variables asociadas a una mejora funcional y su relación con el índice de Montebello (IM) en pacientes con fractura de cadera.

Ultraviolet and X-ray photoelectron spectroscopies in combination with density functional theory (DFT) calculations were used to study the change in the work function (Φ) of graphene, supported by quartz, as induced by adsorption of hexaazatriphenylene–hexacarbonitrile (HATCN). Near edge X-ray absorption fine structure spectroscopy (NEXAFS) and DFT modeling show that a molecular-density-dependent reorientation of HATCN from a planar to a vertically inclined adsorption geometry occurs upon increasing surface coverage. This, in conjunction with the orientation-dependent magnitude of the interface dipole, allows one to explain the evolution of graphene Φ from 4.5 eV up to 5.7 eV, rendering the molecularly modified graphene-on-quartz a highly suitable hole injection electrode.

Origin-destination (O-D) trip matrices that describe the patterns of traffic behavior across a network are the primary data input used in principal traffic models and, therefore, a critical requirement in all advanced systems supported by dynamic traffic assignment models. However, because O-D matrices are not directly observable, the current practice consists of adjusting an initial or seed matrix from link flow counts that are provided by an existing layout of traffic-counting stations. The availability of new traffic measurements provided by information and communication technologies (ICT) allows more efficient algorithms, namely for real-time estimation of O-D matrices that are based on modified Kalman filtering approaches to exploit the new data. The quality of the estimations depends on various factors such as the penetration of the ICT devices, the detection layout, and the quality of the initial information. The feasibility of real-time applications depends on the computational performance of the proposed algorithms for urban networks of sensitive size. This paper presents the results of a set of computational experiments with a microscopic simulation of the network of Barcelona's central business district that explore the sensitivity of the Kalman filter estimates in relation to design factor values.

La talla baja es un motivo de consulta cada vez más frecuente que el pediatra debe pesquisar. En la evaluación debe incluir una historia clínica completa, examen físico con una correcta evaluación auxiológica y un seguimiento adecuado de la velocidad de crecimiento. De esta forma, los exámenes complementarios irán orientados a confirmar una sospecha diagnóstica. A pesar de que la mayoría de los pacientes tendrá una talla baja idiopática o variante normal, en alrededor de un 5% estaremos frente a patología. El enfoque terapéutico, debe estar siempre orientado a la causa. Existen terapias que pueden mejorar la estatura final pero tienen indicaciones precisas y no están exentas de complicaciones. Un estilo de vida saludable y un ambiente psicosocial favorable, permitirán que el niño desarrolle al máximo su potencial genético.

Although national guidelines on biologic agents for treating moderate to severe psoriasis in adults have been published in several countries, increased knowledge on the practical aspects of their implementation is required.

Origin–destination (O-D) trip matrices that describe the patterns of traffic behavior across a network are the primary data input used in principal traffic models and, therefore, a critical requirement in all advanced systems supported by dynamic traffic assignment models. However, because O-D matrices are not directly observable, the current practice consists of adjusting an initial or seed matrix from link flow counts that are provided by an existing layout of traffic-counting stations. The availability of new traffic measurements provided by information and communication technologies (ICT) allows more efficient algorithms, namely for real-time estimation of O-D matrices that are based on modified Kalman filtering approaches to exploit the new data. The quality of the estimations depends on various factors such as the penetration of the ICT devices, the detection layout, and the quality of the initial information. The feasibility of real-time applications depends on the computational performance of the proposed algorithms for urban networks of sensitive size. This paper presents the results of a set of computational experiments with a microscopic simulation of the network of Barcelona's central business district that explore the sensitivity of the Kalman filter estimates in relation to design factor values.

The primary data input used in principal traffic models comes from origin-destination (O-D) trip matrices, which describe patterns of traffic behavior across a network. O-D matrices are a critical requirement in advanced traffic management or information systems that are supported by dynamic traffic assignment models. However, because O-D matrices are not directly observable, current practice adjusts an initial seed matrix from link flow counts that are provided by an existing layout of traffic-counting stations. The adequacy of the detection layout is critical to determining the quality of the adjusted O-D matrix. The usual approaches to the detection layout problem assume that detectors are located at network links. This paper proposes a modified set that formulates the link detection layout problem with side constraints and presents a new metaheuristic tabu search algorithm with high computational efficiency. Emerging information and communication technologies (ICT), especially those based on the detection of the electronic signature of onboard devices (such as Bluetooth devices), allow the location of sensors at intersections. To take into account explicitly how these ICT sensors operate, this paper proposes a new formulation of a node-covering problem with side constraints, which for practical purposes can be efficiently solved with standard professional solvers such as CPLEX.

The primary data input used in principal traffic models comes from origin–destination (O-D) trip matrices, which describe patterns of traffic behavior across a network. O-D matrices are a critical requirement in advanced traffic management or information systems that are supported by dynamic traffic assignment models. However, because O-D matrices are not directly observable, current practice adjusts an initial seed matrix from link flow counts that are provided by an existing layout of traffic-counting stations. The adequacy of the detection layout is critical to determining the quality of the adjusted O-D matrix. The usual approaches to the detection layout problem assume that detectors are located at network links. This paper proposes a modified set that formulates the link detection layout problem with side constraints and presents a new metaheuristic tabu search algorithm with high computational efficiency. Emerging information and communication technologies (ICT), especially those based on the detection of the electronic signature of onboard devices (such as Bluetooth devices), allow the location of sensors at intersections. To take into account explicitly how these ICT sensors operate, this paper proposes a new formulation of a node-covering problem with side constraints, which for practical purposes can be efficiently solved with standard professional solvers such as CPLEX.

Cutaneous fungal infections are a major public health problem. The distribution of the dermatophytoses varies between countries and geographical areas. The aim of this study was to determine the incidence, epidemiology, etiology, and clinical course of the dermatophytoses caused by anthropophilic fungi in Cadiz, Spain, over the past 12 years.

Scalp lesions are common in psoriasis and difficult to treat. Scientific evidence on the topic is scant and fragmentary, especially with respect to long-term treatment. This consensus statement is based on a critical assessment of the results of a MEDLINE search for clinical trials of the efficacy and safety of therapies used to treat scalp psoriasis. The recommendations were developed by an expert panel using the Delphi process to reach a consensus and then ratified by the members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. The recommended induction therapy for scalp psoriasis is either a topical corticosteroid or a topical treatment combining calcipotriol and betamethasone. The choice of an appropriate vehicle is crucial in improving effectiveness and patient adherence to treatment. The only formulations that have been studied in the long-term treatment of scalp psoriasis are a combination of calcipotriol and betamethasone in gel and calcipotriol alone in solution.

We present an experimental study supported by molecular simulations of the influence of the shape of alkyl side groups on the interactions and self-organization of supramolecular assemblies, built from bis-urea-substituted toluene molecules deposited on Au(111) surfaces. In particular, we demonstrate the crucial importance of the presence of branched alkyl groups (i.e., ethylhexyl) that allow two adjacent supramolecular polymers to arrange closer to each other, leading to the formation of molecular “zippers”. Thus, steric constraints at the level of individual molecules can generate improved ordering between neighboring supramolecular polymers interacting with a planar substrate.

Significant progress has been made in the field of human immunodeficiency virus (HIV) pharmacotherapy. This is a remarkable achievement given that the virus was first recognized in the United States in 1981 and the first antiretroviral (ARV) agent became available in 1987. There are now 20 medications in 4 different classes approved by the Food and Drug Administration (FDA) for the treatment of HIV and the carefully orchestrated use of these agents has dramatically decreased HIV mortality. However, the currently available agents have concerning limitations. These include potentially life-threatening side effects, drug interactions, loss of effectiveness over time due to resistance and the need for an extremely high level of medication adherence to achieve viral suppression. In the following review, important features of the presently available agents are described, and the characteristics of an ideal ARV agent defined.

A library of cycloimonium salts has been prepared through Westphal reaction in solid-phase. By reaction of solid-support-bound azolium or azinium acetates 2, 1,2-diketones 4, and base, cycloimonium salts 5 were synthesized in good to high yield and purities.

Six different cultural media (corn meal agar, rice extract agar, chlamydospore agar, PCB, Tween 80-oxgall-caffeic acid and diluted milk) were compared for chlamydospore production by 224 yeastlike fungi isolates. Candida albicans formed chlamydospores to a variable degree in all of the media, as did C. stellatoidea to a lesser extent. C. tropicalis, C. parasilopsis, C. guilliermondii and C. krusei did not produce chlamydospores in any of the media tested. Statistically, the most productive media were the milk and TOC media. Milk medium is particularly useful because of its simplicity and economy.

Summary The aim of this paper is to describe the clinical and hematological characteristics of a 32-year-old woman with concomitant heterozygous pyruvate kinase (PK) and glucose-6-phosphate dehydrogenase (G6PD) deficiencies and severe hemolytic anemia during pregnancy. In 1964, Oski et al. [16] described a family in which a clinically healthy woman was heterozygous for both PK and G6PD deficiencies. To our knowledge, the present case is the first described in which the same condition is associated with hemolysis. A heterozygous condition for both enzymopathies was clearly demonstrated by family study criteria, and all other causes of hemolytic anemia were eliminated. No evidence of genetic relationship between the two disorders was demonstrated. Since late onset of hemolysis in heterozygous PK-deficient women has been observed in association with pregnancy and the molecular characteristics of the concomitant deficient G6PD enzyme were kinetically favorable, partial PK deficiency is suggested as the major cause of hemolysis in this patient.

In this paper we investigate the Hankel transform of integrable Boehmians. The inversion theorem and some operational properties are established. Finally, the relations between the integrable Boehmians and the distributions are studied.