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The COVID-19 pandemic has affected the care of patients with other diseases. Difficulty in access to healthcare during these months has been especially relevant for persons with HIV infection (PWH). This study therefore sought to ascertain the clinical outcomes and effectiveness of the measures implemented among PWH in a region with one of the highest incidence rates in Europe.Retrospective, observational, pre-post intervention study to compare the outcomes of PWH attended at a high-complexity healthcare hospital from March to October 2020 and during the same months across the period 2016-2019. The intervention consisted of home drug deliveries and preferential use of non face-to-face consultations. The effectiveness of the measures implemented was determined by reference to the number of emergency visits, hospitalisations, mortality rate, and percentage of PWH with viral load50 copies, before and after the two pandemic waves.A total of 2,760 PWH were attended from January 2016 to October 2020. During the pandemic, there was a monthly mean of 106.87 telephone consultations and 2,075 home deliveries of medical drugs dispensed to ambulatory patients. No statistically significant differences were found between the rate of admission of patients with COVID-HIV co-infection and that of the remaining patients (1,172.76 admissions/100,000 population vs. 1,424.29,Our results show that the strategies implemented during the first 8 months of the pandemic prevented any deterioration in the control and follow-up parameters routinely used on PWH. Furthermore, they contribute to the debate about how telemedicine and telepharmacy can fit into future healthcare models.Introducción: La pandemia causada por el SARS-CoV-2 ha afectado a la atención de pacientes con otras enfermedades. La dificultad en el acceso a la asistencia sanitaria durante estos meses es especialmente relevante en las personas con infección por VIH (PWH). El objetivo del estudio fue conocer los resultados clínicos y la efectividad de las medidas implementadas en PWH en una de las regiones con mayor incidencia de Europa.Métodos: Estudio observacional retrospectivo, pre-post intervención, comparando los resultados de PWH atendidos en un hospital de alta complejidad entre marzo-octubre de 2020 y el mismo periodo de 2016 a 2019. La intervención consistió en el envío a domicilio de medicamentos y la realización preferente de consultas no presenciales. La efectividad de las medidas implementadas se determinó por el número de visitas a Urgencias, hospitalizaciones, mortalidad y porcentaje de PWH con carga viral50 copias antes y después de dos olas pandémicas.Resultados: Se atendieron 2.760 PWH entre enero de 2016 y octubre de 2020. Durante la pandemia se realizaron una media mensual de 106,87 consultas telefónicas y 2.075 envíos a domicilio de medicamentos de dispensación ambulatoria. No se encontraron diferencias estadísticamente significativas en la frecuentación de pacientes con co-infección COVID-VIH respecto al resto (1.172,76 ingresos/100.000 habitantes vs. 1.424,29, p = 0,401), ni en su mortalidad (11,54% vs. 12,96%, p = 0,939). El porcentaje de PWH con carga viral50 copias fue similar antes y después de la pandemia (1,20% pre-pandemia vs. 0,51% en 2020, p = 0,078).Conclusión: Nuestros resultados revelan que las estrategias implementadas durante los 8 primeros meses de pandemia han evitado el deterioro en parámetros de control y seguimiento empleados habitualmente en PWH. Además, contribuyen a la reflexión sobre el encaje de la telemedicina y telefarmacia en modelos asistenciales futuros.

Introduction Traumatic injury elicits an inflammatory response such as the one occurring during systemic infection. Monocyte distribution width (MDW) has been found to distinguish sepsis in a pool of patients with suspected infection. We hypothesized that an elevated MDW in trauma patients would be associated with the development of multiple organ dysfunction syndrome (MODS) and an increased mortality. Materials and Methods Observational study in a dedicated trauma Intensive Care Unit (ICU) in Madrid during 2019-2020. Patients were classified according to their first MDW value on admission, as greater or lesser than 21 U. Clinical data was obtained and univariate and multivariate analysis were realized, as well as a test performance analysis. Results 354 patients were studied, with a median age of 46 years, 78% male. Half presented with severe trauma ISS > 15, mostly with a blunt mechanism of injury. A MDW ≥ 21 U on admission was found in 17% of cases. These patients were more likely to present with hemodynamic instability and MODS. They had a higher length of stay (3.8 vs 2 days) and higher mortality (21 vs 5%) compared to the low MDW group. These findings remained statistically significant in the multivariate analysis, with an OR 4.6 (IC 95% 1.7-12) for MODS and 3.1 (IC 95% 1.2-8.3) for mortality. Conclusions In trauma patients, a MDW ≥ 21 U on admission was independently associated with a greater risk of MODS, a higher mortality and a higher length of stay. This biomarker could be useful in predicting severity in the initial evaluation of trauma patients.

Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values? Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.

El presente trabajo se basa en una propuesta de generación de un modelo de programación lineal de asignación de horarios para una entidad bancaria con la metodología simplex, cuyo objetivo es generar la optimización de recursos, minimizando el número de empleados contratados y de esta forma reducir el costo de la nómina. El modelo matemático proporciona el número mínimo requerido de personal para la sucursal con la función de minimización para el personal de caja de tiempo completo cuyo modelo puede ser emulado para situaciones similares pertinentes a la gestión de servicio en supermercados, cooperativas, mutualistas, servicios de comida rápida y atención a clientes de entidades públicas. El principal resultado de este trabajo es la asignación óptima del recurso en 16 empleados. EL modelo puede ser sensibilizado en función de las necesidades de personal en la semana, crecimiento de las entidades donde el papel de la tecnología juega un rol importante en la automatización de los servicios

This is a multicenter prospective observational study which included a large cohort (n = 397) of allogeneic (allo-HSCT) (n = 311) and autologous (ASCT) hematopoietic stem cell transplant (n = 86) recipients who were monitored for antibody detection within 3 to 6 weeks after complete SARS-CoV-2 vaccination from February 1st 2021 to July 20th 2021. Most patients (n = 387, 97.4%) received mRNA-based vaccines. Most of recipients (93%) were vaccinated more than 1 year after transplant. Detectable SARS-CoV-2-reactive antibodies were observed in 242 (78%) of allo-HSCT and in 73 (85%) of ASCT recipients. Multivariate analysis in allo-HSCT recipients identified lymphopenia

BACKGROUND Despite the existence of numerous published models predicting the risk of caesarean delivery in women undergoing induction of labour (IOL), validated models are scarce. OBJECTIVES To systematically review and externally assess the predictive capacity of caesarean delivery risk models in women undergoing IOL. SEARCH STRATEGY Studies published up to 15 January 2021 were identified through PubMed, CINAHL, Scopus and ClinicalTrials.gov, without temporal or language restrictions. SELECTION CRITERIA Studies describing the derivation of new models for predicting the risk of caesarean delivery in labour induction. DATA COLLECTION AND ANALYSIS Three authors independently screened the articles and assessed the risk of bias (ROB) according to the prediction model risk of bias assessment tool (PROBAST). External validation was performed in a prospective cohort of 468 pregnancies undergoing IOL from February 2019 to August 2020. The predictive capacity of the models was assessed by creating areas under the receiver operating characteristic curve (AUCs), calibration plots and decision curve analysis (DCA). MAIN RESULTS Fifteen studies met the eligibility criteria; 12 predictive models were validated. The quality of most of the included studies was not adequate. The AUC of the models varied from 0.520 to 0.773. The three models with the best discriminative capacity were those of Levine et al. (AUC 0.773, 95% CI 0.720-0.827), Hernandez et al. (AUC 0.762, 95% CI 0.715-0.809) and Rossi et al. (AUC 0.752, 95% CI 0.707-0.797). CONCLUSIONS Predictive capacity and methodological quality were limited; therefore, we cannot currently recommend the use of any of the models for decision making in clinical practice. TWEETABLE ABSTRACT Predictive models that predict the risk of cesarean section in labor inductions are currently not applicable.

Water distribution networks have high values of energy consumption from the source to the distribution. The use of pumps working as turbines is an innovative technology for leverage the energy exce...

Introduction Some local protocols suggest using intermediate or therapeutic doses of anticoagulants for thromboprophylaxis in hospitalized patients with coronavirus disease 2019 (COVID‐19). However, the incidence of bleeding, predictors of major bleeding, or the association between bleeding and mortality remain largely unknown. Methods We performed a cohort study of patients hospitalized for COVID‐19 that received intermediate or therapeutic doses of anticoagulants from March 25 to July 22, 2020, to identify those at increased risk for major bleeding. We used bivariate and multivariable logistic regression to explore the risk factors associated with major bleeding. Results During the study period, 1965 patients were enrolled. Of them, 1347 (69%) received intermediate‐ and 618 (31%) therapeutic‐dose anticoagulation, with a median duration of 12 days in both groups. During the hospital stay, 112 patients (5.7%) developed major bleeding and 132 (6.7%) had non‐major bleeding. The 30‐day all‐cause mortality rate for major bleeding was 45% (95% confidence interval [CI]: 36%‐54%) and for non‐major bleeding 32% (95% CI: 24%‐40%). Multivariable analysis showed increased risk for in‐hospital major bleeding associated with D‐dimer levels >10 times the upper normal range (hazard ratio [HR], 2.23; 95% CI, 1.38–3.59), ferritin levels >500 ng/ml (HR, 2.01; 95% CI, 1.02–3.95), critical illness (HR, 1.91; 95% CI, 1.14–3.18), and therapeutic‐intensity anticoagulation (HR, 1.43; 95% CI, 1.01–1.97). Conclusions Among patients hospitalized with COVID‐19 receiving intermediate‐ or therapeutic‐intensity anticoagulation, a major bleeding event occurred in 5.7%. Use of therapeutic‐intensity anticoagulation, critical illness, and elevated D‐dimer or ferritin levels at admission were associated with increased risk for major bleeding.

Summary Autoimmune disease is a risk factor for first incident venous thromboembolism (VTE). However, data on the risk of recurrent VTE in people with autoimmune disease is sparse. We explored the risk of recurrent VTE using the RIETE registry, comparing people with autoimmune disease (n = 1305) to those without (n = 50608). Overall rates were 6.5 and 5.1 recurrent VTE/100 years for patients with autoimmune disease vs controls, respectively. After adjustment for sex and unprovoked/provoked VTE yielded an adjusted hazard ratio of 1.29 (95%CI 1.03‐1.62). The analysis was limited by short median follow up time (161 days overall), precluding definitive conclusions on recurrent VTE risks.

Introduction: There is sufficient evidence on the usefulness of surgery as a therapeutic alternative for patients with drug-resistant epilepsy; however this treatment is underutilised, especially in developing countries. Methods: We describe the outcomes of epilepsy surgery in 27 paediatric patients at Hospital Baca Ortiz in Quito, Ecuador. Our analysis considered the following variables: reduction in seizure frequency, surgery outcome according to the Engel classification, improvement in quality of life, and serious complications due to surgery. Results: Twenty-one Corpus callosotomies and 6 resective surgeries were performed. The mean seizure frequency decreased from 465 per month before surgery to 37.2 per month thereafter (P

BackgroundSecondary haemophagocytic lymphohistiocytosis (sHLH) is characterised by a hyper activation of immune system that leads to multiorgan failure. It is suggested that excessive immune response in patients with COVID-19 could mimic this syndrome. Some COVID-19 autopsy studies have revealed the presence of haemophagocytosis images in bone marrow, raising the possibility, along with HScore parameters, of sHLH.AimOur objective is to ascertain the existence of sHLH in some patients with severe COVID-19.MethodsWe report the autopsy histological findings of 16 patients with COVID-19, focusing on the presence of haemophagocytosis in bone marrow, obtained from rib squeeze and integrating these findings with HScore parameters. CD68 immunohistochemical stains were used to highlight histiocytes and haemophagocytic cells. Clinical evolution and laboratory parameters of patients were collected from electronic clinical records.ResultsEleven patients (68.7%) displayed moderate histiocytic hyperplasia with haemophagocytosis (HHH) in bone marrow, three patients (18.7%) displayed severe HHH and the remainder were mild. All HScore parameters were collected in 10 patients (62.5%). Among the patients in which all parameters were evaluable, eight patients (80%) had an HScore >169. sHLH was not clinically suspected in any case.ConclusionsOur results support the recommendation of some authors to use the HScore in patients with severe COVID-19 in order to identify those who could benefit from immunosuppressive therapies. The presence of haemophagocytosis in bone marrow tissue, despite not being a specific finding, has proved to be a very useful tool in our study to identify these patients.

Ministerio de Ciencia e Innovación de España, Instituto de Salud Carlos III (convocatoria de investigación COVID-19 COV20 / 00181) cofinanciado por el Fondo Regional Europeo de Desarrollo “Una forma de lograr Europa”. Ministerio de Asuntos Económicos y Transformación Digital de España y Fondos Feder (beca PI18 / 00139). 8.490 JCR (2021) Q1, 3/29 Medical Laboratory Technology 1.295 SJR (2021) Q1, 292/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Introduction Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. Objectives To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. Patients and methods The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. Results Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. Conclusions Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes.

BACKGROUND: During the COVID-19 outbreak, most hospitals deferred elective surgical procedures to allow space for the overwhelming number of COVID-19 patient admissions, expecting a decrease in routine blood component requirements. However, because transfusion support needs of COVID-19 patients are not well known, its impact on hospital blood supply is uncertain. The objective of this study was to assess the effect of the COVID-19 pandemic on transfusion demand. STUDY DESIGN AND METHODS: Transfusion records during the peak of the COVID-19 pandemic (March 1-April 30, 2020) were reviewed in our center to assess changes in blood requirements. RESULTS: During this period 636 patients received a total of 2934 blood components, which reflects a 17.6% reduction in transfusion requirements with regard to the same period of 2019, and blood donations in Madrid dropped by 45%. The surgical blood demand decreased significantly during the outbreak (50.2%). Blood usage in the hematology and oncology departments remained unchanged, while the day ward demand halved, and intensive care unit transfusion needs increased by 116%. A total of 6.2% of all COVID inpatients required transfusion support. COVID-19 inpatients consumed 19% of all blood components, which counterbalanced the savings owed to the reduction in elective procedures. CONCLUSION: Although only a minority of COVID-19 inpatients required transfusion, the expected reduction in transfusion needs caused by the lack of elective surgical procedures is partially offset by the large number of admitted patients during the peak of the pandemic. This fact must be taken into account when planning hospital blood supply.

Low-scale aquaculture can be a successful model in rural settings because it can reduce demand for products and job creation, but one of the limiting factors to establish these aquaculture systems is the weakness of the manage-ment of technological processes in fish production by farmers. It is therefore necessary to promote training and technology transfer to the productive sector in order to promote conditions of self-employment, food security and to include beneficiaries throughout the process. Technological transfer is a mechanism that can increase aquaculture productivity and boost its profits. This scenario sought to design and build an aquaculture system for tropical gar (Atractosteus tropicus) and Mayan cichlid (Mayaheros urophthalmus) culture, with the participa-tion of local skilled people through the technological transfer of aquaculture. This system was developed in a locality in the Centla Swamps in southeastern México from 2017 to 2019 in five phases: diagnosis, presentation, design and construction, implementation and monitoring. The transfer of technology for the culture of species was made possible by the advice of the working teams and the support of the inhabitants. It was identified that the participants had a change in their perception of aquaculture and acquired skills in this activity. Community participation is an essential part of technology transfer. Keywords: Tropical gar, Mayan cichlid, fisheries, capacity, adaptation.

[EN] Thousands of deaths associated with air pollution each year could be prevented by forecasting the behavior of factors that pose risks to people's health and their geographical distribution. Proximity to pollution sources, degree of urbanization, and population density are some of the factors whose spatial distribution enables the identification of possible influence on the presence of respiratory diseases (RD). Currently, Bogota is among the cities with the poorest air quality in Latin America. Specifically, the locality of Kennedy is one of the zones in the city with the highest recorded concentration levels of local pollutants over the last 10 years. From 2009 to 2016, there were 8619 deaths associated with respiratory and cardiovascular diseases in the locality. Given these characteristics, this study set out to identify and analyze the areas in which the primary socioeconomic and environmental conditions contribute to the presence of symptoms associated with RD. To this end, information collected in field by performing georeferenced surveys was analyzed through geostatistical and machine learning tools which carried out cluster and pattern analyses. Random forests and AdaBoost were applied to establish hot spots where RD could occur, given the conjugation of predictor variables in the micro-territory. It was found that random forests outperformed AdaBoost with 0.63 AUC. In particular, this study's approach applies to densely populated municipalities with high levels of air pollution. In using these tools, municipalities can anticipate environmental health situations and reduce the cost of respiratory disease treatments., Many thanks to the members of the Intelligence and Territorial Analysis Group of the Universidad Santo Tomás for their collaboration in conducting the fieldwork.

El objetivo de este artículo es identificar el nivel de cumplimiento de la política de cambio climático en los estados de México mediante la revisión y análisis de los avances y los rezagos de la política estatal. A partir de ello se proponen estrategias para impulsar la implementación de la política climática nacional y, por consiguiente, la reducción de los impactos del cambio climático. El proceso metodológico consistió en una revisión de los instrumentos de la política de cambio climático estatal: 1) consulta de páginas web gubernamentales, 2) envío de solicitudes a través de la Plataforma Nacional de Transparencia, y 3) utilización de motores de búsqueda en internet. Se organizaron y se asignó un puntaje de acuerdo con el número de instrumentos. La suma equivalió al 100 % de cumplimiento y se dividió en cinco rangos (muy bajo, bajo, medio, alto y muy alto). La mayoría de los estados se encuentran en un nivel bajo y muy bajo de cumplimiento (63 %), once estados con un cumplimiento medio y uno con un cumplimiento muy alto. Se observó que hay un avance en ciertas entidades, pero hace falta desarrollar e impulsar la política de cambio climático a nivel estatal. El aporte principal de este análisis fue la determinación del nivel de cumplimiento para cada estado, reconociendo sus particularidades de cumplimiento.

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Informàtica de la salut; Qualitat en l'atenció sanitària; Infeccions respiratòries Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Informática de la salud; Calidad en el cuidado de la salud; Infecciones respiratorias Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Health informatics; Quality in health care; Respiratory infections Background Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19. Methods A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes. Results Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p

Trasplantament de cèl·lules mare; Micafungina; Profilaxi Trasplante de células madre; Micafungina; Profilaxis Stem cell transplantation; Micafungin; Prophylaxis Introduction. The fungal infections remain an important problem in the allogeneic stem cell trasnsplantation (allo-SCT) setting and thus, anti-fungal prophylaxis is commonly used. The antifungal drug should offer activity, at least against Candida and Aspergillus spp., a good safety profile and low probability interactions. Micafungin could theoretically fulfill these requisites. The aim of the study was to describe the experience with micafungin as primary prophylaxis in patients undergoing allo-SCT in a cohort of Spanish centres, and to evaluate its ef-ficacy and tolerability in this population. Material and methods. Retrospective multicentre observational study including all consecutive adult patients admitted for allo-SCT in participating centres of the Grupo Español de Trasplante Hematopoyético (GETH), from January 2010 to December 2013, who received micafungin as primary prophylaxis during the neutropenic period. Results. A total of 240 patients from 13 centres were identified and 159 patients were included for the analysis. Most patients (95.6%) received 50 mg/day of micafungin. During the follow-up, 7 (4.4%) patients developed breakthrough invasive fungal disease, 1 proven and 6 probable; one patient discontinued the drug because of serious drug interactions. Prophylaxis with micafungin was considered effective in 151 (94.9%) patients. Conclusions. According to our experience, micafungin is an appropriate alternative for antifungal prophylaxis in patients undergoing an allo-HSCT, because its efficacy, its low profile of drug interactions and side-effects. Introducción. Las infecciones fúngicas siguen representando un problema en el trasplante alogénico de progenitores hematopoyéticos (alo-TPH) por lo que es habitual el uso de profilaxis antifúngica en estos pacientes. El tratamiento antifúngico debe presentar al menos actividad frente a Candida y Aspergillus spp, un buen perfil de seguridad y baja probabilidad de infecciones, siendo micafungina una de las opciones que podría cumplir todos estos requisitos. El objetivo del estudio fue describir la experiencia con micafungina como profilaxis primaria en pacientes sometidos a alo-TPH en una cohorte de hospitales españoles, y evaluar su eficacia y seguridad en esta población. Material y métodos. Estudio retrospectivo multicéntrico observacional consecutivo de todos los pacientes adultos ingresados para alo-TPH en los centros del Grupo Español de Trasplante Hematopoyético (GETH) desde enero de 2010 a diciembre de 2013 y que recibieron micafungina como profilaxis primaria durante el periodo de neutropenia. Resultados. Se identificaron 240 pacientes de 13 hospitales y 159 fueron incluidos para el análisis. La mayoría (95.6%) de ellos recibieron dosis de 50mg/día de micafungina. Durante el seguimiento, 7 (4.4%) pacientes desarrollaron infecciones de brecha, 1 probada y 6 probables; en un paciente se suspendió el tratamiento por interacciones medicamentosas graves. La profilaxis con micafungina se consideró efectiva en el 94,9% de los pacientes (151 de 159). Conclusiones. En base a nuestros resultados, consideramos que Micafungina es una buena alternativa como profilaxis antifúngica en pacientes sometidos a alo-TPH, por su eficacia, el bajo riesgo de interacciones y de efectos adversos. This study has been partially funded by Astellas.

A 4-year-old female neutered Welsh Springer Spaniel was presented with pneumothorax secondary to a migrating foreign body in the right caudal lung lobe. Within 24 hours following thoracic exploration and hilar lung lobectomy, the patient deteriorated. CT was consistent with lobar torsion. A second median sternotomy identified concurrent right cranial and middle lung lobe torsion. Hilar lobectomy of the affected lobes was performed. To prevent lobar torsion of the remaining lobe, a preventative accessory lobe pneumopexy was performed, potentially averting an additional surgical procedure and reducing total lung capacity to less than the reported minimum critical mass compatible with survival. No complications following accessory lung lobe pneumopexy were encountered in this single case. Although post-lobectomy lung lobe torsion appears to be rare in dogs, clinicians should be aware of this potentially life-threatening complication. This case report documents the first description of pneumopexy as a preventative procedure in a dog.

Background: Vaginal dinoprostone (PGE2) is currently used as the prostaglandin of choice in many obstetric units. However, few studies have evaluated its safety, especially in women who previously had a cesarean section. Objective: To evaluate the efficacy and safety of PGE2 in pregnant women who are undergoing induction of labor (IOL), and who have had a previous cesarean section. Materials and Methods: A prospective observational study was conducted in La Mancha Centro Hospital in Alcázar de San Juan, Spain, from 1 February 2019 to 30 August 2020. Obstetric and neonatal outcomes, following IOL with PGE2, in 47 pregnant women who wanted a trial of labor after cesarean (TOLAC), and 377 pregnant women without a history of cesarean section, were analyzed. The outcomes were analyzed by bivariate and multivariate analyses using binary and multiple linear regression. Results: A total of 424 women were included in this study. The percentage of cesarean sections in the TOLAC group was 44.7% (21), compared with 31.6% (119) in the group without a history of cesarean section (adjusted odds ratio: 1.4, 95% CI: 0.68–2.86). In the multivariate analysis, no statistically significant differences were observed between both groups for obstetric and neonatal outcomes (p &gt, 0.05). However, two uterine ruptures (4.3%) occurred in the group of patients with a history of cesarean section who underwent IOL with PGE2. Conclusions: The induction of labor with vaginal dinoprostone (PGE2), in patients with a previous history of cesarean section, was not associated with worse obstetric or neonatal outcomes compared with the group of patients without a history of cesarean section in our study sample. However, further research is needed regarding this IOL method, and it should be used with caution in this population group.

[EN] The pandemic situation due to SARS-Cov-2 obligates to adapt the learning processes in different academic levels. Universitat Politècnica de València (Spain) had to deal with this challenge, where the learning process changed from a face-to-face way to a non-face learning model when the confinement began in March 2020. This caused the need to adapt the teaching process, methods and materials from in-person classes to virtual ones. This contribution shows the adaptation process to face the problems caused by the pandemic and related to the non-face-to-face education through an example in a case study, particularly in the subject called Fluid-Mechanics Engineering. This subject is taught in the third year of the mechanical engineering degree at the Universitat Politècnica de Valencia (Campus of Alcoy). The students enrolled in this subject followed two different teaching procedures and the present research shows how the planning of the subject was adapted when the pandemic situation arose, the different activities developed to adjust to this new context as well as the perception of the students about such an adaptation through the development of an online survey., This work was supported by the project SISIFO (Development of analytical toolS to characterIze the Sustainability of hydraulic systems Indicators that deFine sustainable development Objectives) PID2020-114781RA-I00 from Spanish State Research Plan Scientific and Technical and Innovation 2017-2020. This article has been supported by Universitat Politècnica de València, particularly by the Vice-rectorate for Digital Resources and Documentation (Vicerrectorado de Recursos Digitales y Documentación) and Vice-Rectorate for Studies, Quality and Accreditation (Vicerrectorado de Estudios, Calidad y Acreditación) under the Call for Learning + Teaching (Convocatoria A+D2019: Aprendizaje + Docencia. Proyectos de Innovación y Mejora Educativa) and Project Code: A157. The authors would like to acknowledge the support of the Institute of Educational Sciences (Instituto de Ciencias de la Educación), the Evaluation and Monitoring Commission for Educational Innovation and Improvement Projects (Comisión de Evaluación y Seguimiento de Proyectos de Innovación y Mejora Educativa (CESPIME) and Escuela Politécnica Superior de Alcoy

[EN] Hydropower is a well-known technology, applied worldwide for electricity generation from renewable sources. Within the current framework, some studies have started to consider its application to existing urban water systems, to harness an excess of energy that otherwise would be wasted. This research sought to determine a methodology to assess the potential of hydropower application to wastewater treatment plants (WWTPs), regarding different aspects of sustainability. Firstly, previously developed methodologies for potential assessment in this sector at a country level were analyzed. Secondly, data from existing real case studies were gathered from publicly available documents and a theoretical analysis of their actual performance was conducted to validate assumptions made in the previous methodologies. As a result, the proposed new approach suggests adapting methodologies for potential assessment at a lower level, considering possible driving factors, other than economic feasibility. To define the study area, the management model scope should be considered. The power to determine the cut-off point for a WWTP to be considered as a potential site, is proposed to be lowered according to technical feasibility. Additionally, bearing in mind the sustainability concept, social or environmental factors should also be introduced in the methodology, tailored to the region being assessed. This novel perspective could provide a closer approach to the most likely decision-making level for these kinds of strategies in the wastewater industry., Grant PID2020-114781RA-I00 funded by MCIN/AEI/10.13039/501100011033.

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90‐day and 1‐year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90‐day all‐cause (odds ratio [OR], 2.81; 95% CI, 2.33–3.38) and PE‐related mortality (OR, 2.38; 95% CI, 1.37–4.14) and increased 1‐year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10–9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all‐cause mortality (OR, 1.91; 95% CI, 1.57–2.32) but not PE‐related mortality (OR, 1.50; 95% CI, 0.85–2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90‐day all‐cause (OR, 2.28; 95% CI, 1.75–2.97) and PE‐related (OR, 3.64; 95% CI, 2.01–6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.

Reality shows that the recent and disruptive advances that occur in new technologies –which are evolving at an ever-increasing rate– are having a notable impact on the way in which we communicate, work or carry out actions typical of the consumption. We are witnessing, in these settings and in many others, unprecedented social change. Society - and with it, the public and private sectors - is more influenced by information and communication technologies (ICT). In this order of issues, we can conclude that the digitization that society is leading is called to consolidate a new order in which we are immersed. We refer to the suggestive structure that begins with the blockchain. The Blockchain, in effect, stands as a technology susceptible to impact, in a relevant way, on consumers, or users, and entrepreneurs.

Gerbode defect is defined as an abnormal left ventricle–right atrium shunting which may have congenital or acquired origin, first described by Thurman in 1838, representing 0.08% of intracardiac shunts and

BACKGROUND The significance of discrepant findings between histology (BMB) and flow cytometry (FC) in bone marrow (BM) examination at diffuse large B-cell lymphoma (DLBCL) diagnosis is uncertain. METHODS We performed a 5-year retrospective single-center study of patients diagnosed by DLBCL not otherwise specified (n = 82), divided into three groups according to BM infiltration at diagnosis: BMB-/FC- (75.6%), BMB+/FC+ (13.4%), and BMB-/FC+ (11%). RESULTS Median infiltration by FC analysis of the BMB-/FC+ group was 0.8% and if we considered BM infiltration as positive in all cases, 4/9 would be upstaged. Median follow was 33 months. Event-free survival (EFS) after 18 months was 82, 23, and 27% for BMB-/FC-, BMB-/FC+, and BMB+/FC+, respectively (p

Social workers are constantly called on to respond to social demands arising from new social realities. Innovation competencies are critical for social workers, and various training programmes adop...

Aim To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step‐down units. Background Acuity refers to the categorization of patients based on their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue. Method Cross‐sectional, multi‐centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated. Results The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81–0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p

Tehuacan-Cuicatlan Valley is a semi-arid zone in the south of Mexico. It was inscribed in the World Heritage List by the UNESCO in 2018. This unique area has wide biodiversity including several endemic plants. Unfortunately, human activity is constantly affecting the area. A way to preserve a protected area is to carry out autonomous surveillance of the area. A first step to reach this autonomy is to automatically detect and recognize elements in the area. In this work, we present a deep learning based approach for columnar cactus recognition, specifically, the Neobuxbaumia tetetzo species, endemic of the Valley. An image dataset was generated for this study by our research team, containing more than 10,000 image examples. The proposed approach uses this dataset to train a modified LeNet-5 Convolutional Neural Network. Experimental results have shown a high recognition accuracy, 0.95 for the validation set, validating the use of the approach for columnar cactus recognition.

For decades the economy was based on production and physical assets were the main source of resources. This situation has now changed, with intangible assets now being the main source of value creation and sustainability of competitive advantages in the company. The current definition of intangibles has focused on the strategic area within the Resource-Based Approach, emerging as a complementary structure to the Competitive Advantage approach. Goals: The analysis of intangibles as a scenario of competitiveness in the hotel industry, in particular, such as management, control and identification of unspecified intangibles. Metodology: Starting from the general objective, this research will have a mixed, quantitative and qualitative methodological approach. And through a quantitative research approach of analytical type, it is intended to know the influence of intangible resources on the factors that allow obtaining and sustaining a competitive advantage in the company. The above is based on the “Intellectus Model” (IADE-CIC, 2003) and the “Five Capital Model” (IADE-Caja Madrid, 2004). Contributios: Based on 106 variables analyzed, the multifactorial analysis by reduction of factors allows to determine 11 cross factors that contribute to generate the space of the intangible assets that in the case of the hotel which allows to be more competitive.

The value of minimal residual disease (MRD) status by bone marrow and imaging analysis as independent prognostic factors has been well established in multiple myeloma (MM). Nevertheless data about their potential complementarity for a more accurate assessment are limited. With this aim, we retrospectively analyzed the prediction of outcome with the combination of PET-CT and MRD, assessed by multiparameter flow cytometry (MFC) in 103 patients with newly diagnosed MM. We confirmed the benefit in terms of progression-free survival (PFS), linked to the achievement of negativity by MFC (hazard ratio [HR] 0.53; 95% confidence interval [CI]: 0.28-0.98), and PET-CT (HR 0.18; 95% CI: 0.09-0.36) individually. By combining both techniques, patients who became MRD-/PET-, with a median of PFS 92 months, had significant prolonged median PFS (P < .001). This is compared with MRD+/PET- and PET+ patients (median PFS of 45 and 28 months, respectively). We observed a significant difference (P = .003) in overall survival (OS) outcomes between MRD-/PET- and MRD+/PET- patients (4-year OS 94.2% and 100%, respectively), vs PET+ patients (4-year OS 73.8%). All survival results were confirmed in a conditional landmark analysis. These findings support the potential complementarity between PET-CT and MFC, and highlight their better predictive capability when improving sensitivity.

Objectives: The principal aim of this study was to identify whether the Newcastle Satisfaction with Nursing Scales (NSNS) could be used on cancer patients. Methods: This was a descriptive, cross-sectional study carried out on cancer patients (n = 298). Results: We found that a majority of cancer patients were around 50 years old (hospitalized patients [HP]: 49.5 ± 14.9; chemotherapy outpatients [COP]: 49.4 ± 12.7), were female (HP: 74%; COP: 63.5%), and had received education at least up to elementary level (HP: 70%; COP: 80%). Breast cancer was the principal type of cancer (>34%) in both groups (HP and COP). The groups were comparable in age, sex distribution, place of origin, educational qualification, and type of cancer. Among HP, the experience and satisfaction scales of the NSNS showed good internal consistency (n = 235, α >0.9, r > 0.7), while among COP, only the satisfaction scale showed good internal consistency (n = 62, α = 1.00). Most patients’ perceptions (level of satisfaction) of hospitalization and chemotherapy services were positive (98% and 97%, respectively). Conclusion: An NSNS instrument specifically designed for ambulatory care cancer patients is necessary for it to be useful in assessing cancer patients' perception of nursing care. This will help improve the quality of care in Mexico. The presence of cancer by itself could modify the patients’ satisfaction level. Further large-scale studies are required to inves- tigate the patients’ perceptions of nursing care using the NSNS on different cancer patient groups. Keywords: Spanish satisfaction tool; hospital; patient satisfaction; oncology nursing; health care evaluation mechanisms.

Background: The relationship between the quality of the diet and the adherence to the Mediterranean diet with the presence of persistent or recurrent depressive symptoms have been described. The objective of this study is to analyze the relationship between adherence to the Mediterranean diet and the intake of specific foods in primary care patients aged 45 to 75, having subclinical or major depression. The study also specifically analyzes this relationship in individuals suffering from chronic diseases. Methods: A cross-sectional descriptive study was conducted. 3062 subjects met the inclusion criteria from the EIRA study. Sociodemographic variables, clinical morbidity, depression symptomatology (PHQ-9) and adherence to Mediterranean diet (MEDAS) were collected. Results: Being female, younger, with a higher BMI, consuming more than 1 serving of red meat a day and drinking more than one carbonated or sugary drink daily, not consuming 3 servings of nuts a week and not eating 2 vegetables cooked in olive oil a week are predictors of having higher depressive symptomatology. Conclusions: Assessing the type of diet of patients presenting depressive symptoms and promoting adherence to a healthy diet is important, especially in patients with chronic diseases. However, depression is a very complex issue and the relationship between nutrition and depression must be further examined.