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Los indicadores del estado de pandemia se han basado en el número total de casos diagnosticados de la COVID-19, el número de personas hospitalizadas o en unidades de cuidados intensivos y los fallecimientos por la infección. El objetivo de este estudio es describir los datos disponibles sobre pruebas diagnósticas, servicio sanitario utilizado para el diagnóstico de COVID-19 y seguimiento/detección de casos.

In the field of the intralogistics industry, we present DMZoomNet, a novel architecture that combines deep learning-based detectors with distance information to enhance object detection performance. Evaluation of our approach is conducted using the LOCO dataset, one of the few open source datasets available specifically designed for intralogistics scenarios. By comparing DMZoomNet with existing detectors and object detection methods, we demonstrate its superiority in several object detection metrics within complex intralogistics environments, such as warehouses densely packed with objects. This work contributes to the advancement of object detection techniques in the intralogistics industry and paves the way for future research and applications in this domain.

β-cyclodextrin (βCyD) derivatives equipped with aromatic appendages at the secondary face exhibit tailorable self-assembling capabilities. The aromatic modules can participate in inclusion phenomena and/or aromatic–aromatic interactions. Supramolecular species can thus form that, at their turn, can engage in further co-assembling with third components in a highly regulated manner; the design of nonviral gene delivery systems is an illustrative example. Endowing such systems with stimuli responsiveness while keeping diastereomeric purity and a low synthetic effort is a highly wanted advancement. Here, we show that an azobenzene moiety can be “clicked” to a single secondary O-2 position of βCyD affording 1,2,3-triazole-linked βCyD-azobenzene derivatives that undergo reversible light-controlled self-organization into dimers where the monomer components face their secondary rims. Their photoswitching and supramolecular properties have been thoroughly characterized by UV–vis absorption, induced circular dichroism, nuclear magnetic resonance, and computational techniques. As model processes, the formation of inclusion complexes between a water-soluble triazolylazobenzene derivative and βCyD as well as the assembly of native βCyD/βCyD-azobenzene derivative heterodimers have been investigated in parallel. The stability of the host–guest supramolecules has been challenged against the competitor guest adamantylamine and the decrease of the medium polarity using methanol–water mixtures. The collective data support that the E-configured βCyD-azobenzene derivatives, in aqueous solution, form dimers stabilized by the interplay of aromatic–aromatic and aromatic-βCyD cavity interactions after partial reciprocal inclusion. Photoswitching to the Z-isomer disrupts the dimers into monomeric species, offering opportunity for the spatiotemporal control of the organizational status by light.

Las redes neurales que integran el funcionamiento del sistema nervioso central poseen tres posibles estados naturales: vigilia, sueño REM y sueño no-REM. El 16 de octubre de 1846 fue inducido, de forma artificial, un nuevo estado cerebral que posteriormente recibiría el nombre de anestesia. La monitorización de este nuevo estado se basó principalmente en signos clínicos hasta el último lustro del siglo pasado, a pesar de que ya en 1937, Gibbs y Lennox recomendaron el uso rutinario del electroencefalograma (EEG) para este fin.

The exploitation of PCB integrated magnetic components in the high power field brings new challenges due to the compactness of the design and the poor thermal performance of components using standard PCB technology. In this work, a thermal modeling approach is proposed, which is suitable for optimization based design of planar PCB magnetic components. The targets are high accuracy, low computation time, and easy implementation. The results show an accuracy comparable to finite element simulations, with average absolute error of 1.3 $^{\circ }$C with respect to measurement, while the computation time is 13 times shorter than simplified finite element simulations. The equations are purely analytical, i.e., no measurements or simulations are needed to obtain the involved parameters. The structure of the model enables easy and fast generation of PCB geometries, with the possibility to make a parametric sweep of any variable. The model has been verified with finite element simulations and experimental measurements for a wide range of operating conditions, including dc and ac excitation.

The Covid-19 pandemic has been responsible for millions of deaths worldwide. Patients with comorbidities– such as those on peritoneal dialysis (PD)– present higher morbidity and mortality than the general population. We prospectively evaluated all Chilean patients on PD (48 centres) and followed those who had Covid-19 from the beginning of the Covid-19 pandemic in Chile (March 2020) to January 2021 (start of vaccination campaign). We described demographic history, comorbidities, factors related to infection, need for hospitalisation and death due to Covid-19. During the study period, 106 adults on PD were infected by SARS-CoV-2, with a mean age of 53.1 (±16.3) and of which 53.9% were female. From that group, 54.8% required hospitalisation and 24.5% (n= 26) died due to Covid-19. Most of the patients (63.4%) were infected at home and 22.8% during hospitalisation for other reasons. There was a significant association for Covid-19 mortality with: being ≥60 years old, diabetes, time on PD ≥5 years, need for hospitalisation and hospital-acquired infection. At 90 days of follow-up, all deaths associated to Covid-19 occurred before 40 days. We conclude that patients on PD without Covid-19 vaccination have a high mortality and need for hospitalisation associated to Covid-19. To avoid this negative outcome, it is necessary to intensify strategies to avoid contagion, especially in those ≥60 years old, with diabetes and/or ≥5 years spent on PD.

Three-dimensional InGaN/GaN nano- and microstructures with high aspect ratios and large active sidewall areas are still of great interest in the field of optoelectronics. However, when grown by metalorganic chemical vapor deposition (MOCVD), their optical performance can be negatively affected by gradients in thickness and peak emission wavelength along their sidewalls, which is still a key obstacle for using such structures in commercial products. In this work, we present a detailed study on the different mechanisms causing this gradient, as well as means to alleviate it. Gas-phase mass transport and surface diffusion are found to be the two main processes governing the shell growth, and the predominance of one process over the other is varying with the geometry of the 3D structures as well as the spacing between them. Consequently, variations in temperature, which mainly affect surface diffusion, will have a stronger impact on structures with small separation between them rather than larger ones. On the other hand, variations in pressure modify gas-phase diffusion, and thus, structures with a large spacing will be more strongly affected. A proper design of the dimensions of 3D architectures as well as the separation between them may improve the gradient along the sidewalls, but a tradeoff with the active area per wafer footprint is inevitable.

Intestinal helminth parasites can alter immune responses to vaccines, other infections, allergens and autoantigens, implying effects on host immune responses in distal barrier tissues. We herein show that the skin of C57BL/6 mice infected with the strictly intestinal nematode Heligmosomoides polygyruscontain higher numbers of CD4+T cells compared to the skin of uninfected controls. Accumulated CD4+T cells were H. polygyrus-specific TH2 cells that skewed the skin CD4+T cell composition towards a higher TH2/TH1 ratio which persisted after worm expulsion. Accumulation of TH2 cells in the skin was associated with increased expression of the skin-homing chemokine receptors CCR4 and CCR10 on CD4+T cells in the blood and mesenteric lymph nodes draining the infected intestine and was abolished by FTY720 treatment during infection, indicating gut-to-skin trafficking of cells. Remarkably, skin TH2 accumulation was associated with impaired capacity to initiate IFN-γrecall responses and develop skin-resident memory cells to mycobacterial antigens, both during infection and months after deworming therapy. In conclusion, we show that infection by a strictly intestinal helminth has long-term effects on immune cell composition and local immune responses to unrelated antigens in the skin, revealing a novel process for T cell colonisation and worm-mediated immunosuppression in this organ.

The Coronavirus Disease 2019 (COVID-19) pandemic has transformed health systems worldwide. There is conflicting data regarding the degree of cardiovascular involvement following infection. A registry was designed to evaluate the prevalence of echocardiographic abnormalities in adults recovered from COVID-19. We prospectively evaluated 595 participants (mean age 45.5 ± 14.9 years; 50.8% female) from 10 institutions in Argentina and Brazil. Median time between infection and evaluation was two months, and 82.5% of participants were not hospitalized for their infection. Echocardiographic studies were conducted with General Electric equipment; 2DE imaging and global longitudinal strain (GLS) of both ventricles were performed. A total of 61.7% of the participants denied relevant cardiovascular history and 41.8% had prolonged symptoms after resolution of COVID-19 infection. Mean left ventricular ejection fraction (LVEF) was 61.0 ± 5.5% overall. In patients without prior comorbidities, 8.2% had some echocardiographic abnormality: 5.7% had reduced GLS, 3.0% had a LVEF below normal range, and 1.1% had wall motion abnormalities. The right ventricle (RV) was dilated in 1.6% of participants, 3.1% had a reduced GLS, and 0.27% had reduced RV function. Mild pericardial effusion was observed in 0.82% of participants. Male patients were more likely to have new echocardiographic abnormalities (OR 2.82, p = 0.002). Time elapsed since infection resolution (p = 0.245), presence of symptoms (p = 0.927), or history of hospitalization during infection (p = 0.671) did not have any correlation with echocardiographic abnormalities. Cardiovascular abnormalities after COVID-19 infection are rare and usually mild, especially following mild infection, being a low GLS of left and right ventricle, the most common ones in our registry. Post COVID cardiac abnormalities may be more frequent among males.

: El adenocarcinoma es actualmente el tipo más común de cáncer de pulmón. Las mutaciones en EGFR son predictivas de respuesta a TKI y son mutuamente excluyentes con mutaciones en KRAS. El análisis molecular del DNA libre circulante (cfDNA) ha prometido ser una herramienta útil para realizar estas determinaciones. Este estudio compara tres diferentes técnicas para determinar mutaciones en KRAS y EGFR en muestras de biopsia y sangre de pacientes con adenocarcinoma de pulmón.

Ante la pandemia por la COVID-19 son necesarias nuevas herramientas de trabajo a nivel sanitario para la evaluación precoz de las personas sospechosas de haber sido infectadas. La tecnología de la información y comunicación (TIC) puede dar solución a este nuevo escenario. El objetivo de este estudio es conocer qué TIC hay en España.

El uso de la ecografía ha demostrado mejorar los resultados de la canalización venosa central. Sin embargo, sus beneficios en la canalización arterial en niños no han sido claramente establecidos. El objetivo de este estudio fue evaluar el uso de la ecografía en la canalización arterial en la unidad de cuidados intensivos pediátricos (UCIP).

This article offers guidance on managing the infodemic in digital media, based on the experiences of news agencies at a time when an increase in journalistic production is coinciding with the response to the COVID- 19 pandemic. A documentary review of the literature (scientific articles and documents from international agencies) on infodemics, infodemiology, and management of journalistic information during disasters and emergencies was carried out, as well as an analysis of the health and fact-checking sections on the websites and social networks of the Reuters, AFP and EFE news agencies. The accumulated experience reveals that it is not only useful but necessary for the media to make use of data analysis, service journalism, anticipation and prevention of false information, collaboration, narratives across different media, and media literacy both in consumers and producers of information. This article proposes a plan consisting of 10 actions (grouped into three stages: information collection, selection of journalistic information, and presentation of information) that can help digital media combat misinformation about health issues. [ABSTRACT FROM AUTHOR]

Genomics and metabolomics are widely used to explore specialized metabolite diversity. The Paired Omics Data Platform is a community initiative to systematically document links between metabolome and (meta)genome data, aiding identification of natural product biosynthetic origins and metabolite structures.

Describir las características clínicas y respiratorias de una cohorte de 43 pacientes con COVID-19 tras 28 días de evolución.

Two etiopathogenic types of vulvar squamous cell carcinoma (VSCC) have been described: human papillomavirus (HPV)-associated and HPV-independent. Precursor lesions, frequently identified in the adjacent skin, are also distinct in the 2 types of VSCC: high-grade squamous intraepithelial lesions (HSILs) in HPV-associated VSCC and differentiated vulvar intraepithelial neoplasia (dVIN) or vulvar acanthosis with altered differentiation in HPV-independent VSCC. Although HPV-independent precursors mimicking HSIL have been described in the vulva, their frequency and morphologic spectrum have not been completely characterized. We explored, in a large series of HPV-independent VSSC, the frequency and the histologic features of precursors mimicking HSIL. We included 779 DNA HPV-negative/p16-negative VSCC with at least 1 cm of adjacent skin. We evaluated the histologic and immunohistochemical (p16 and p53) characteristics of the intraepithelial lesions, focusing on precursors mimicking HPV-associated vulvar HSIL. A total of 254 tumors (33%) had adjacent premalignant lesions. Of them, 186 (73%) had dVIN, 22 (9%) had vulvar acanthosis with altered differentiation, and 46 (18%) had lesions that mimicked HSIL. The mean age of the patients with these HSIL-like lesions was 72±15 years. Twenty-six of these HSIL-like lesions had basaloid morphology, 13 warty, and 7 mixed basaloid/warty features. All the HSIL-like precursors were DNA HPV-negative/p16-negative; 74% of them showed p53 abnormal staining and 35% of them had areas of conventional dVIN. In conclusion, about one fifth of the HPV-independent precursors mimic HSIL, showing either basaloid or warty features. Older age and the presence of areas of typical HPV-independent intraepithelial lesions, together with p16 negativity, should raise suspicion of an HPV-independent etiology.

Studies addressing critical care nurses' practices regarding physical restraints have focused on individual nurses' knowledge and attitudes but lack the understanding of other social influences that could affect nurses’ intentions to use them.

Se estima que un 3% del total de parejas en edad reproductiva serán estériles debido a un factor masculino severo. En estos casos, se ha sugerido la existencia de un daño en el ADN espermático debido al efecto deletéreo que ejerce el estrés oxidativo sobre los espermatozoides a su paso por el tracto genital postesticular masculino. Esto ha llevado a proponer el uso generalizado de espermatozoides procedentes de biopsia testicular a pesar del riesgo quirúrgico que ello supone.

Objectives: The Roma population in Spain makes up about two percent of the population and has worse health indicators than the general population. We analyzed both populations in 2006 and 2014 to discover whether there are differences in terms of gynecological visits and preventive services for breast and cervical cancer in Spain. Methods: Cross-sectional study is based on the Spanish National Health Survey (SNHS) of 2006 and 2012 and the National Health Survey of the Roma Population (NHSRP) of 2006 and 2014. Results: Roma women used gynecological visits less than the general population in 2006 (ORa 0.5 [0.4; 0.6] and in 2014 (ORa 0.2 [0.2; 0.3)]. In addition, use of the mammogram was lower in Roma women (ORa 0.7 [0.6; 0.8]), especially in the ages of the screening tests, and they had lower probability of receiving cervical examinations in 2006 (ORa 0.5 [0.4; 0.6]) and in 2014 (ORa 0.7 [0.6; 0.9]). Conclusions: This study shows that the inequality gap in gynecological visits and preventive services for breast and cervical cancer in Roma women has persisted during the years studied (2006 and 2014), despite Spanish prevention policies.

Basaloid squamous cell carcinoma (BSCC) is a subtype of squamous cell carcinoma that characteristically occurs in the head and neck, may be related to HPV infection and is usually considered to be aggressive. We present the first description of BSCC of the breast. The tumor exhibited characteristic histologic features of BSCC, including nests of basaloid squamous cells with comedonecrosis, abrupt keratinization, and abundant hyaline basement membrane-like material deposition. The tumor showed immunohistochemical features of triple negativity, diffuse p63 positivity, p16 positivity, and Rb negativity. HPV immunogenotyping was negative.

Objetivo principal:Conocer qué unidades de cuidados intensivos (UCI) españolas valoran y registran, de forma normalizada, niveles de dolor, sedación/agitación, delirio y uso de contenciones mecánicas (CM). Objetivos secundarios:Determinar la utilización de herramientas validadas de valoración y explorar los niveles de dolor y sedación/agitación de los pacientes, la prevalencia de deliro y el uso de CM.

Nematode samplings in various areas and crops of Greece were carried out and the recovered nematode species were characterized using morphological and molecular data. Seven species of plant-parasitic nematodes were recovered, three of which are reported for the first time in Greece, including Hemicycliophora poranga, Helicotylenchus dihysteraand Tylenchorhynchus zeae. Four other recovered species had already been reported in Greece, including Bitylenchus hispaniensis, Helicotylenchus microlobus, Nanidorus minorand Scutellonema brachyurus. D2–D3 segments of 28S rRNA gene for all of these nematode species are provided.

A new species from the family Tylenchidae was recovered in the grasslands of Isfahan province, Iran, and is herein described based on morphological and molecular data. Ottolenchus isfahanicusn. sp. is mainly characterized by having a faintly annulated cuticle; elongated, slightly sigmoid amphidial apertures developed metacorpus with distinct valve under LM; vulva located at 69.472.3% of body length; large spermatheca about 2.75 times of corresponding body width; and elongated conoid tail with broadly rounded tip. SEM observations showed that the lip region is smooth; the amphidial apertures are elongated, slightly sigmoid slits; and the lateral field is a simple band. It is further characterized by 477-to-515-μm-long females with delicate 5.7-to-6.9-μm-long stylets with small, slightly posteriorly sloping knobs, as well as functional males, in the population. The new species closely resembles O. facultativus, but is separated from it based on morphological and molecular data. It was further morphologically compared with O. discrepans, O. fungivorus, and O. sinipersici. The phylogenetic relationships of the new species with other relevant genera and species were reconstructed using near-full-length sequences of small subunit and D2-D3 expansion segments of large subunit (SSU and LSU D2-D3). In the inferred SSU phylogeny, the newly generated sequence of Ottolenchus isfahanicusn. sp. formed a clade with two sequences of O. sinipersiciand sequences assigned to O. facultativusand O. fungivorus. In the inferred LSU phylogeny, the three newly generated sequences of the new species and LSU sequences of O. sinipersiciand O. discrepansformed a clade.

La literatura médica acerca de los cuidados anestesiológicos perioperatorios de la rotura carotídea en cirugía endoscópica endonasal de la base del cráneo es, prácticamente, inexistente. En este tipo de lesión neurovascular se combinan una incidencia relativamente escasa, con una morbi-mortalidad no desdeñable. Asimismo, precisa un tratamiento multidisciplinar coordinado, para minimizar la lesión encefálica inducida por un manejo terapéutico inadecuado.

La monitorización electrofisiológica del dolor aporta medidas objetivas que permiten controlar el dolor y ajustar la analgesia en pacientes no comunicativos.

El uso de contenciones mecánicas es una práctica frecuente en las Unidades de Cuidados Intensivos. Sin embargo, y a pesar de su elevada prevalencia, es una práctica que posee múltiples efectos adversos, además de una dudosa eficacia para prevenir la autorretirada de dispositivos y plantea numerosos conflictos éticos. Las recomendaciones actuales proponen que las contenciones sean una medida de último recurso, que no se prolonguen más allá de lo estrictamente necesario y solo se usen si, en la valoración interprofesional (enfermeras, médicos, psicólogos) de beneficios-riesgos para el paciente, los beneficios superan ampliamente los perjuicios. El presente manuscrito pretende servir de guía para la toma de decisiones desde una perspectiva ética sobre el empleo o no uso de contenciones mecánicas en pacientes críticos. Asimismo, se plantea un repaso por el marco legal y deontológico que rige el uso de contenciones en nuestro país. Por último, se ofrecen una serie de recomendaciones, tanto para profesionales asistenciales para como gestores sanitarios, para la construcción de Unidades de Cuidados Intensivos libres de contenciones y la aplicación de buenas prácticas en los casos en los que éstas sean necesarias.

Un tercio de los pacientes críticos que reciben analgosedación de forma prolongada puede presentar sedación difícil, cuestión que puede influir negativamente en su evolución y pronóstico. La sedación difícil incluye situaciones de fracaso terapéutico, tolerancia o privación de fármacos analgésicos y sedantes. Su origen es multifactorial y depende de las características del paciente, los antecedentes de consumo de sustancias tóxicas, la propia condición crítica y la administración de agentes que alteran la farmacocinética de los sedantes utilizados. La dificultad para lograr un nivel adecuado de sedación, aumentando la dosis de sedantes o agregando nuevos agentes, representa un desafío en la práctica diaria en las unidades de críticos ya que puede aumentar los riesgos de toxicidad y complicaciones relacionadas. La prevención e identificación temprana de situaciones de sedación difícil son estrategias esenciales para minimizar su impacto, por lo que la autonomía de las enfermeras en el manejo de la analgosedación representa una intervención primordial.

El uso de contenciones mecánicas en las unidades de pacientes críticos es una práctica frecuente, de bajo valor e influida por numerosos factores que configuran una cultura local. La traslación a la práctica clínica de las recomendaciones basadas en la evidencia es escasa por lo que es necesario analizar las intervenciones que pueden ayudar a revertirla. El objetivo de la presente puesta al día es describir e identificar las intervenciones no farmacológicas que contribuyen a la reducción del uso de contenciones mecánicas en pacientes críticos adultos. Las intervenciones se clasifican en 2 grupos: las que incluyen formación aislada y las que combinan la formación con uno o más componentes (intervenciones multicomponente). Estos componentes incluyen: alternativas de contención menos restrictivas, uso de la estimulación física y cognitiva, herramientas de ayuda en la toma de decisiones, comités institucionales multidisciplinares y la implicación del equipo. La heterogeneidad en el diseño de los programas y la baja calidad de la evidencia de las intervenciones no permite establecer recomendaciones en cuanto a su efectividad. Sin embargo, las intervenciones multicomponente basadas en la formación, la estimulación física y cognitiva del paciente, y un cambio de cultura de los profesionales y la organización hacia la visibilización de las contenciones podrían ser las más efectivas. La implementación de estos programas debería fundamentarse en un análisis previo de cada contexto local para diseñar la combinación de intervenciones a medida más efectiva que ayude a reducir o eliminar su aplicación de la práctica clínica.

En mujeres con una respuesta pobre a la estimulación de la ovulación (1-3 ovocitos) o subóptima (4-9 ovocitos), no es infrecuente obtener ovocitos inmaduros. Cuando este porcentaje es superior al 50% se le denomina asincronía folicular. Nuestro objetivo fue analizar, en mujeres de edad materna avanzada y una respuesta subóptima a la estimulación ovárica, la influencia de presentar asincronía folicular en los resultados del ciclo de ICSI.

Determinar el grado de conocimientos de las enfermeras sobre el uso de contenciones mecánicas en las unidades de críticos y los factores relacionados.