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Abstract Background The PI*S variant is one of the most prevalent mutations within alpha-1 antitrypsin deficiency (AATD). The risk of developing AATD-related lung disease in individuals with the PI*SS genotype is poorly defined despite its substantial prevalence. Our study aimed to characterize this genotype and its risk for lung disease and compare it with the PI*ZZ and PI*SZ genotypes using data from the European Alpha-1 antitrypsin Deficiency Research Collaboration international registry. Method Demographic, clinical, functional, and quality of life (QoL) parameters were assessed to compare the PI*SS characteristics with the PI*SZ and PI*ZZ controls. A propensity score with 1:3 nearest-neighbour matching was performed for the most important confounding variables. Results The study included 1007 individuals, with PI*SS (n = 56; 5.6%), PI*ZZ (n = 578; 57.4%) and PI*SZ (n = 373; 37.0%). The PI*SS population consisted of 58.9% men, with a mean age of 59.2 years and a mean FEV1(% predicted) of 83.4%. Compared to PI*ZZ individuals they had less frequent lung disease (71.4% vs. 82.2%, p = 0.037), COPD (41.4% vs. 60%, p = 0.002), and emphysema (23.2% vs. 51.9%, p

AbstractBackground Psoriasis significantly impacts patients’ quality of life (QoL). Dissatisfaction and non-adherence are major barriers associated with topical treatments. A cream based on the polyaphron dispersion (PAD) Technology containing a fixed-dose of calcipotriol (CAL) and betamethasone dipropionate (BDP) was designed for a patient-friendly psoriasis management. The CAL/BDP PAD-cream demonstrated efficacy, convenience, and safety/tolerability in clinical trials.Objectives This research assesses the real-world use, perception, satisfaction, and adherence of CAL/BDP PAD-cream among plaque psoriasis patients.Methods Between September–November 2023, psoriasis patients from Spain and Germany using or having used CAL/BDP PAD-cream for >2 weeks were recruited via Wefight network to complete a 30-questions online survey. Anonymized results were pooled for descriptive statistical analysis.Results The survey was completed by 129 patients (mean age: 43 years; 66% females; mean psoriasis duration: 12 years). Most patients (93%) were satisfied with CAL/BDP PAD-cream. The 66% reported high adherence (visual analogue scale 80-100) and 91% preferred CAL/BDP PAD-cream to their previous topical(s). Patients highlighted its ease/convenience of application, tolerability, and lack of itching/burning.Conclusions Psoriasis patients treated with CAL/BDP PAD-cream in a real-world setting show high satisfaction, good adherence, and a positive perception of the product, suggesting that favorable outcomes observed in clinical trials translate to real clinical practice.

In the paper, the authors simply review recent results of inequalities, monotonicity, signs of determinants, determinantal formulas, closed-form expressions, and identities of the Bernoulli numbers and polynomials, establish an identity involving the differences between the Bernoulli polynomials and the Bernoulli numbers, present two identities among the differences between the Bernoulli polynomials and the Bernoulli numbers in terms of a determinant and a partial Bell polynomial, and derive a determinantal formula of the differences between the Bernoulli polynomials and the Bernoulli numbers.

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of global mortality. Despite clinical predictors (age, severity, comorbidities, etc.) being established, proteomics offers comprehensive biological profiling to obtain deeper insights into COPD pathophysiology and survival prognoses. This pilot study aimed to identify proteomic footprints that could be potentially useful in predicting mortality in stable COPD patients. Plasma samples from 40 patients were subjected to both blind (liquid chromatography–mass spectrometry) and hypothesis-driven (multiplex immunoassays) proteomic analyses supported by artificial intelligence (AI) before a 4-year clinical follow-up. Among the 34 patients whose survival status was confirmed (mean age 69 ± 9 years, 29.5% women, FEV1 42 ± 15.3% ref.), 32% were dead in the fourth year. The analysis identified 363 proteins/peptides, with 31 showing significant differences between the survivors and non-survivors. These proteins predominantly belonged to different aspects of the immune response (12 proteins), hemostasis (9), and proinflammatory cytokines (5). The predictive modeling achieved excellent accuracy for mortality (90%) but a weaker performance for days of survival (Q2 0.18), improving mildly with AI-mediated blind selection of proteins (accuracy of 95%, Q2 of 0.52). Further stratification by protein groups highlighted the predictive value for mortality of either hemostasis or pro-inflammatory markers alone (accuracies of 95 and 89%, respectively). Therefore, stable COPD patients’ proteomic footprints can effectively forecast 4-year mortality, emphasizing the role of inflammatory, immune, and cardiovascular events. Future applications may enhance the prognostic precision and guide preventive interventions.

The placement of endotracheal prostheses is a procedure used to treat tracheal lesions when no other surgical options are available. Unfortunately, this technique remains controversial. Both silicon and metallic stents are used with unpredictable success rates, as they have advantages but also disadvantages. Typical side effects include restenosis due to epithelial hyperplasia, obstruction and granuloma formation. Repeat interventions are often required. Biodegradable stents are promising in the field of cardiovascular biomechanics but are not yet approved for use in the respiratory system. The aim of the present study is to summarize important information and to evaluate the role of different geometrical features for the fabrication of a new tracheo-bronchial prosthesis prototype, which should be biodegradable, adaptable to the patient’s lesion and producible by 3D printing. A parametric design and subsequent computational analysis using the finite element method is carried out. Two different stent designs are parameterized and analyzed. The biodegradable material chosen for simulations is polylactic acid. Experimental tests are conducted for assessing its mechanical properties. The role of the key design parameters on the radial force of the biodegradable prosthesis is investigated. The computational results allow us to elucidate the role of the pitch angle, the wire thickness and the number of cells or units, among other parameters, on the radial force. This work may be useful for the design of ad hoc airway stents according to the patient and type of lesion.

El virus Covid-19 (Neumonía Atípica), desde su origen hace más de tres años, continúa cobrando vidas y causando aglomeraciones en los sistemas de salud de países como Ecuador, por lo que se hace necesario el uso de tecnologías de la información para asistir al personal médico en el diagnóstico temprano. El objetivo de la investigación fue analizar el deep learning como estrategia de servicio al cliente para el diagnóstico precoz de Covid-19. La metodología utilizada se sistematizó mediante selección de imágenes de tipo no probabilístico, la elección del investigador fue clave en el uso de imágenes de rayos X de tórax obtenidas en casas de salud privadas y públicas en las ciudades de Riobamba y Quito-Ecuador, además se utilizó la base de datos “Chest X-ray”, en la plataforma Kaggle. La evidencia científica muestra que las radiografías de tórax son una prueba eficaz para una primera fase diagnóstica de presunción de Covid-19, por lo que el uso de deep learning como estrategia de atención al cliente a través del análisis de radiografías de tórax, cuenta con las propiedades necesarias para extraer características y lograr un buen nivel de precisión en su clasificación y ayudar con el cribado de pacientes infectados.

Ser director de comunicación es muchas veces una profesión de riesgo, de alto riesgo, sobre todo si se desempeña en zonas de conflicto. Nuestra mente se hace cargo del peligro que corren reporteros afanados en mostrarnos la zona cero de un área donde no cesan las hostilidades entre bandos enemigos. Lo que nuestra retina no percibe es la persona, el cargo, que ha hecho posible rodar dicha escena o facilitar una entrevista controvertida. Casi siempre es el director de comunicación, jefe de prensa o dircom de una institución, de un líder, o de una formación política la que lo favorece poniendo también, en esos ambientes, en riesgo su vida. En la España de los últimos cincuenta años el terrorismo de la banda ETA sacudió a representantes de numerosas instituciones y estamentos del país. La necesaria labor informativa para cubrir sus atrocidades consecuencias no se detuvo gracias a la estrecha colaboración entre informadores y directores de comunicación. Sobre estos últimos, grandes olvidados, se pone la lupa en este ensayo pues durante esos años de plomo tuvieron vigilada su libertad de expresión, el espacio público reducido y menguado el ejercicio periodístico. Fueron además fuente reconocida para contrastar informaciones y contribuir a un periodismo alejado de las fake news y por tanto de la desafección que hoy padece la profesión respecto al conjunto de la población.

Background Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design. Methods A systematic review was performed identifying studies that reported in-hospital mortality, post-discharge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement. Results Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisations

This study proposes simulating the cooking of eggs by modeling fluid egg products as phase-change materials (PCMs) within a computational fluid dynamics (CFD) model. A simplified physical prototype was built to conduct experiments to tune a simpler version of the mathematical model. The information was later used to build a complete mathematical model of a real egg that was compared with experimental data. Phase transition temperature ranges, and the energy required to initialize the transition were specified. Heat transfer coefficients were estimated for both models. Experiments for thermal processing and phase change were conducted at temperatures between 90 and 100 °C. The real egg model was validated with experimental data reported elsewhere. The simulations assess the time required to cook an egg (800–1200 s), demonstrating a homogeneous increase in temperature and phase transition. However, potential overestimation in simulations was observed, likely due to differences in quantifying techniques and non-uniform cooking processes.

Una de las manifestaciones más agresivas del aumento de las velocidades y del cambio social, característico de las sociedades aceleradas, se da en la creación de tendencias laborales basadas en la hibridación entre trabajo y tiempo libre. Proyectadas sobre una idea positiva de la flexibilidad y del autocontrol, mantienen una estrecha relación con niveles altos de autointensificación. Este artículo reconstruye los rasgos básicos de prácticas formalizadas como el bleisure o el workation para caracterizar un fenómeno de la aceleración más específico dentro de esta tendencia, al que denomino "turistificación del trabajo". Este concepto resalta la atribución específica de rasgos atractivos de la práctica turística al trabajo con fines productivos. Frente a los discursos positivos sobre la movilidad y el turismo asociados a este fenómeno, se sugieren las bases de un modelo de crítica para reconocer sus implicaciones alienantes negativas en relación con la vida buena.

La actual digitalización de las empresas en el sector industrial genera un nuevo entorno digital que tiene efectos diversos sobre las condiciones de trabajo, representando un nuevo modelo de consumo y organización del factor humano en las fábricas y talleres. En este artículo se presentan una parte de los resultados obtenidos en una investigación de cinco años para medir y evaluar el impacto ocupacional de la industria 4.0. En concreto, se exponen los resultados relativos a la existencia de una serie de factores que, como resultado de la digitalización de las empresas, tienen capacidad para alterar las condiciones de trabajo en los diferentes empleos y ocupaciones.

Abstract Background Alpha-1 antitrypsin deficiency (AATD) is an underrecognized genetic disorder associated mainly with pulmonary emphysema and Chronic Obstructive Pulmonary Disease (COPD). All individuals with COPD regardless of age or ethnicity should be tested for AATD, but in Colombia its prevalence in unknown. Main objective To determine the prevalence of the genetic mutations, present in AATD in adult patients with COPD in Colombia, using a genotyping test on cells from the oral mucosa. Methods This was a multicentre, observational, cross-sectional study which included adult patients attending seven COPD care centres in Colombia. Demographic data, medical history, including history of exposure to smoking and biomass smoke, most recent spirometry, pharmacological and non-pharmacological treatment received, serum AAT levels, and mutations detected by the genotyping test were recorded for all the recruited patients. For the comparison of variables between the groups with and without mutation, we used the X2 test for the qualitative variables and the Student’s t-test or Mann-Whitney U test according to their distribution. Main findings We collected a sample of 1,107 patients, the median age was 73.8 years (87.6–79.9). Mutations were documented in 144 patients (13.01%), the majority had the M/S mutation (78.50%), followed by M/Z (9.72%). One patient had a ZZ mutation and two patients had null alleles. In total, 23 patients had mutations associated with serum AAT deficiency (levels below 60 mg/dl). Conclusions Genetic mutations were documented in 13.01% of patients with COPD in Colombia and 2.07% were AATD-related, showing that there is a significant number of underdiagnosed patients.

The hawksbill sea turtle Eretmochelys imbricata is categorized as Critically Endangered on the IUCN Red List and its population has declined by over 80% in the last century. The Eastern Pacific population is one of the most threatened hawksbill populations globally. Western Mexico is the northern distribution limit for hawksbill sea turtles in the Eastern Pacific and recent research indicates that the Mexican Pacific portion of the population is a separate management unit because of the restricted movements of these turtles. Here we use the most complete database of sighting records in the north-west Pacific of Mexico to identify sites where hawksbill turtles are present. We also develop a conservation index to determine the conservation status of hawksbill turtle sites. Our results demonstrate the importance of this region for juveniles and the relevance of rocky reefs and mangrove estuaries as habitats for hawksbill turtles. We identified 52 sites with records of hawksbill turtles. Most of these sites (71%) are not protected; however, sites with high conservation value included islands and coastal sites along the Baja California peninsula that are established as marine protected areas. Reefs and mangrove estuaries relevant for hawksbill turtles are probably also significant fish nursery areas that are important for local fishing communities, creating opportunities for conservation strategies that combine science, local engagement and policy to benefit both local fishing communities and hawksbill sea turtle conservation.

Abstract Background Patients with alpha-1 antitrypsin deficiency (AATD), commonly categorized as a rare disease, have been affected by the changes in healthcare management brought about by COVID-19. This study’s aim was to identify the changes that have taken place in AATD patient care as a result of the COVID-19 pandemic in Spain and to propose experts’ recommendations aimed at ensuring humanized and quality care for people with AATD in the post-pandemic situation. Methods A qualitative descriptive case study with a holistic single-case design was conducted, using focus groups with experts in AATD clinical management, including 15 health professionals with ties to the Spanish health system (12 pneumologists and 2 hospital pharmacists from 11 different hospitals in Spain) and 1 patient representative. Results COVID-19 has had a major impact on numerous aspects of AATD clinical patient management in Spain, including diagnostic, treatment, and follow-up phases. The experts concluded that there is a need to strengthen coordination between Primary Care and Hospital Care and improve the coordination processes across all the organizations and actors involved in the healthcare system. Regarding telemedicine and telecare, experts have concluded that it is necessary to promote this methodology and to develop protocols and training programs. Experts have recommended developing personalized and precision medicine, and patient participation in decision-making, promoting self-care and patient autonomy to optimize their healthcare and improve their quality of life. The possibility of monitoring and treating AATD patients from home has also been proposed by experts. Another result of the study was the recommendation of the need to ensure that plasma donations are made on a regular basis by a sufficient number of healthy individuals. Conclusion The study advances knowledge by highlighting the challenges faced by health professionals and changes in AATD patient management in the context of the COVID-19 pandemic. It also proposes experts’ recommendations aimed at ensuring humanized and quality care for people with AATD in the post-pandemic situation. This work could serve as a reference study for physicians on their daily clinical practice with AATD patients and may also provide guidance on the changes to be put in place for the post-pandemic situation.

Abstract Background Alpha-1 antitrypsin deficiency (AATD) is a rare disease that is associated with an increased risk of pulmonary emphysema. The European AATD Research Collaboration (EARCO) international registry was founded with the objective of characterising the individuals with AATD and investigating their natural history. Methods The EARCO registry is an international, observational and prospective study of individuals with AATD, defined as AAT serum levels 1000 individuals with AATD from 15 countries in its first 2 years. Baseline cross sectional data provide relevant information about the clinical phenotypes of the disease, the patterns of functional impairment and factors associated with poor lung function. Trial registration www.clinicaltrials.gov (ID: NCT04180319)

This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors.Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees. Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles.

RESUMEN Introducción y objetivos: Se debate la necesidad de realizar revascularización coronaria completa tras un síndrome coronario agudo en pacientes diabéticos con enfermedad coronaria multivaso, y más aún si estos son reflejo de los pacientes de la práctica clínica habitual (mundo real). Por ello, el objetivo de este trabajo es analizar las complicaciones cardiovasculares en pacientes diabéticos con y sin revascularización completa incluibles en ensayos clínicos como de la práctica clínica habitual. Métodos: Estudio unicéntrico retrospectivo de pacientes diabéticos con enfermedad coronaria multivaso. Se analizaron 733 pacientes diabéticos: 299 (40,8%) con criterios compatibles de inclusión de ensayos clínicos y 434 (59,2%) del mundo real. Resultados: Los pacientes del mundo real constituyen el 59,2% de la muestra. Se caracterizan por presentar mayor porcentaje de factores de riesgo, mayor edad media y comorbilidad. Los diabéticos con enfermedad coronaria multivaso incluibles en ensayos tienen menor riesgo de mortalidad total (HR = 0,30; IC95%, 0,16-0,57; p < 0,001), de mortalidad de causa cardiaca (HR = 0,33; IC95%, 0,15-0,71; p = 0,03) y de sufrir eventos cardiovasculares adversos mayores (HR = 0,58; IC95%, 0,38-0,86; p = 0,008). Por otro lado, recibir revascularización completa desciende el riesgo de mortalidad de causa cardiaca (HR = 0,32; IC95%, 0,13-0,83; p = 0,019) y de eventos cardiacos adversos mayores (HR = 0,50; IC95%, 0,29-0,89; p = 0,017) en los pacientes diabéticos del mundo real. Conclusiones: Se sugiere que revascularizar completamente a los pacientes del mundo real mejoraría el pronóstico en cuanto a supervivencia. Asimismo, los diabéticos incluibles en ensayos clínicos presentan menos complicaciones que los diabéticos no incluibles.

ABSTRACT Introduction and objectives: The need for complete coronary artery revascularization after acute coronary syndrome in diabetic patients with multivessel coronary artery disease was discussed, even more so if they reflect the routine clinical practice (“real world”). Therefore, the objective of this study is to analyze cardiovascular complications in diabetics with and without complete revascularization included in clinical trials and in the routine clinical practice. Methods: This was a single-center retrospective study of diabetic patients with multivessel coronary artery disease. We analyzed 733 diabetic patients: 299 (40.8%) with compatible criteria to be included in clinical trials, and 434 real-world patients (59.2%). Results: Real-world patients make up 59.2% of the sample. They are characterized by a higher percentage of risk factors, older mean age, and more comorbidities. Diabetics with multivessel coronary artery disease included in the trials have a lower risk of overall mortality (HR, 0.30; 95%CI, 0.16-0.57; P < .001), cardiac death (HR, 0.33; 95%CI, 0.15-0.71; P = .03), and major adverse cardiovascular events (HR, 0.58; 95%CI, 0.38-0.86; P = .008). On the other hand, receiving complete revascularization reduces the risk of cardiac death (HR, 0.32; 95%CI, 0.13-0.83; P = .019), and major adverse cardiovascular events (HR, 0.50; 95%CI, 0.29-0.89; P = .017) in real-world diabetic patients. Conclusions: It is suggested that fully revascularizing real-world patients would improve survival prognosis. In addition, diabetics included in clinical trials present fewer complications compared to those not included.

Abstract Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.

Multidrug-resistant Enterobacteriaceae (MRE) represent a major threat for patients’ health. Here, the authors describe how cooperation between gut commensal bacteria (Lactobacillus spp. And Clostridiales) restrict MRE colonization in mice and patients

Fasting has been reported to protect from chemotherapy-associated toxicity. Here, the authors show that fatty acid profiles in erythrocyte membranes and gene expression from peripheral blood mononuclear cells are associated to the fasting-mediated benefits during cancer treatment in mice and patients.

IntroductionDevelopment of Robust and Innovative Vaccine Effectiveness (DRIVE) was a European public–private partnership (PPP) that aimed to provide annual, brand-specific estimates of influenza vaccine effectiveness (IVE) for regulatory and public health purposes. DRIVE was launched in 2017 under the umbrella of the Innovative Medicines Initiative (IMI) and conducted IVE studies from its pilot season in 2017–2018 to its final season in 2021–2022.MethodsIn 2021–2022, DRIVE conducted four primary care-based test-negative design (TND) studies (Austria, Italy, Iceland, and England; involving >1,000 general practitioners), nine hospital-based TND studies (France, Iceland, Italy, Romania, and Spain, for a total of 21 hospitals), and one population-based cohort study in Finland. In the TND studies, patients with influenza-like illness (primary care) or severe acute respiratory infection (hospital) were enrolled, and laboratory tested for influenza using RT-PCR. Study contributor-specific IVE was calculated using logistic regression, adjusting for age, sex, and calendar time, and pooled by meta-analysis.ResultsIn 2021–2022, pooled confounder-adjusted influenza vaccine effectiveness (IVE) estimates against laboratory-confirmed influenza (LCI) overall and per type and subtype/lineage was produced, albeit with wide confidence intervals (CI). The limited circulation of influenza in Europe did not allow the network to reach the optimal sample size to produce precise IVE estimates for all the brands included. The most significant IVE estimates were 76% (95% CI 23%−93%) for any vaccine and 81% (22%−95%) for Vaxigrip Tetra in adults ≥65 years old and 64% (25%−83%) for Fluenz Tetra in children (TND primary care setting), 85% (12%−97%) for any vaccine in adults 18–64 years (TND hospital setting), and 38% (1%−62%) in children 6 months−6 years (population-based cohort, mixed setting).DiscussionOver five seasons, DRIVE collected data on >35,000 patients, more than 60 variables, and 13 influenza vaccines. DRIVE demonstrated that estimating brand-specific IVE across Europe is possible, but achieving sufficient sample size to obtain precise estimates for all relevant stratifications remains a challenge. Finally, DRIVE's network of study contributors and lessons learned have greatly contributed to the development of the COVID-19 vaccine effectiveness platform COVIDRIVE.

Resumen: Objetivos: Actualmente, la identificación de nuevos casos de déficit de alfa-1 antitripsina (DAAT) continúa siendo uno de los grandes retos a los que se enfrenta la enfermedad. El presente estudio tiene por objetivo realizar un análisis de los resultados de la implementación de un programa de detección de casos sistemático de DAAT para los pacientes con enfermedad pulmonar obstructiva crónica. Material y métodos: Estudio observacional transversal en el que se analizaron los resultados de la detección del DAAT hasta diciembre de 2022. Los casos estudiados se dividieron en tres periodos: 1) sin detección de casos sistemático hasta 2013; 2) detección de casos sistemático de alelos S y Z para casos con AAT

El presente trabajo tiene la finalidad de dar a conocer el desarrollo de un prototipo de sensor para la medición de mercurio (Hg2+) en solución acuosa sobre una plataforma electroquímica basada en electrodos serigrafiados de nanotubos de carbonos (CNT-SPE) en conjunto con nanopartículas de oro (NPs-Au) realizadas a través de síntesis verde, utilizando extracto acuoso de Sargassum spp. Para esto, se realizó la caracterización de las NPs-Au por espectroscopía ultravioleta-visible (UV-Vis), infrarrojo (TF-IR), difracción de rayos X (DRX) y microscopía electrónica de barrido (SEM); obteniendo nanopartículas entre 80-100 nm las cuales poseen un recubrimiento orgánico que les confiere una sinergia al momento de ser conjugadas con CNT-SPE oxidadas/activadas. Posteriormente, las NPs-Au se utilizaron para modificar el CNT-SPE a través del método drop-casting y así ensamblar un novedoso sensor electroquímico para la medición de Hg2+, cuya validación y habilidad para medir fue demostrada utilizando voltametría diferencial de pulso (DPV). Se obtuvieron límites de detección de 2.38 uM y cuantificación de 3 uM. Los resultados demuestran que la plataforma desarrollada es una alternativa rápida, eficiente y portátil para la medición de Hg2+.

BackgroundDonor-specific antibodies (DSAs) are IgG allo-antibodies against mismatched donor HLA molecules and can cause graft failure (GF) in the setting of haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Our aim was to report the experience of the Spanish Group of Hematopoietic Transplant (GETH-TC) in DSA-positive patients who had undergone haplo-HSCT.MethodsWe conducted a survey of patients who underwent haplo-HSCT in GETH-TC centers between 2012 and 2021. Data were collected on the DSA assay used, monitoring strategy, complement fixation, criteria for desensitization, desensitization strategies and transplant outcomes.ResultsFifteen centers from the GETH-TC responded to the survey. During the study period, 1,454 patients underwent haplo-HSCT. Seventy of the transplants were performed in 69 DSA-positive patients, all of whom lacked a suitable alternative donor; 61 (88%) patients were female (90% with prior pregnancies). All patients received post-transplant cyclophosphamide-based graft-versus-host disease prophylaxis. Regarding baseline DSA intensity, 46 (67%) patients presented mean fluorescence intensity (MFI) >5,000, including 21 (30%) with MFI >10,000 and three (4%) with MFI >20,000. Six patients did not receive desensitization treatment, four of them with MFI 20,000 as an independent risk factor for survival and an increase in titers after infusion as an independent risk factor for GF.ConclusionsHaplo-HSCT is feasible in DSA-positive patients, with high rates of engraftment after desensitization guided by DSA intensity. Baseline MFI >20,000 and increased intensity after infusion are risk factors for survival and GF.

OBJECTIVES In Spain, there has been a recent increase in the mortality rate for chronic obstructive pulmonary disease (COPD) in younger women. This study aimed to analyze trends in the COPD mortality rate in Spain from 1980 to 2020, evaluating any differences between genders and age groups. METHODS Death certificates and mid-year population data were obtained from the Spanish National Institute of Statistics. For both genders, age group-specific and standardized (overall and truncated) rates were calculated by the direct method using the world standard population. The data were analyzed using the joinpoint regression method. RESULTS In both men and women, the number of COPD deaths increased from 1980 to 1999 (average annual increase of 7% in men and 4% in women), while from 1999 onwards, deaths decreased by -1.0% per year in both genders. In women, there was a significant final period of increase in the 55-59 to 70-74 age groups and a slowing of the decline in the over 75 age group. Additionally, an increase in mortality for the truncated rates was observed for women between 2006 and 2020. In men under 70 years of age, there was an initial period in which death rates remained stable or significantly increased, followed by a period in which they decreased significantly. CONCLUSIONS Our study shows age and gender differences in COPD mortality trends in Spain. Although the data show a downward trend, we have identified a worrying increase in the truncated rates in women for the last few years.

Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles. Abstract: This guide for living donor renal transplantation (LDRT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current RT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDRT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This guide does not forget that LDRT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able to take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDRT programmes when evaluating potential donors.Finally, this guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

Lung cancer (LC) is the leading cause of cancer deaths, and chronic obstructive pulmonary disease (COPD) can increase LC risk. Metallomics may provide insights into both of these tobacco-related diseases and their shared etiology. We conducted an observational study of 191 human serum samples, including those of healthy controls, LC patients, COPD patients, and patients with both COPD and LC. We found 18 elements (V, Al, As, Mn, Co, Cu, Zn, Cd, Se, W, Mo, Sb, Pb, Tl, Cr, Mg, Ni, and U) in these samples. In addition, we evaluated the elemental profiles of COPD cases of varying severity. The ratios and associations between the elements were also studied as possible signatures of the diseases. COPD severity and LC have a significant impact on the elemental composition of human serum. The severity of COPD was found to reduce the serum concentrations of As, Cd, and Tl and increased the serum concentrations of Mn and Sb compared with healthy control samples, while LC was found to increase Al, As, Mn, and Pb concentrations. This study provides new insights into the effects of LC and COPD on the human serum elemental profile that will pave the way for the potential use of elements as biomarkers for diagnosis and prognosis. It also sheds light on the potential link between the two diseases, i.e., the evolution of COPD to LC.

Abstract Is terrorism just another form of criminal activity, as many nations’ justice systems assume? We offer an initial answer using face-to-face interviews and structured surveys in thirty-five Spanish prisons. Recent theories of extreme sacrifice inform this direct observational and comparative study. Islamist terrorists display levels of self-sacrifice for their primary reference group similar to that of Latino gangs, but greater willingness to sacrifice for primary values than other inmates (non-radical Muslims, Latino gangs, and delinquent bands). This disposition is motivated by stronger perceived injustice, discrimination, and a visceral commitment to such values (risk/radicalization factors). Nevertheless, state authorities, prison staff, and families are (protective/de-radicalization) factors apt to reduce willingness to sacrifice and keep foreign fighters, now being released in large numbers, from returning to terrorism.

Los sistemas de gestión de la calidad en la educación superior basados en la norma ISO 9001:2015, integrados a los requerimientos del Control Interno y de la Junta de Acreditación Nacional constituye una Estrategia adoptada por la Escuela Superior de Cuadros del Estado y del Gobierno (ESCEG) para el cumplimiento de su misión. El artículo tiene como objetivo exponer el diseño del Manual de Procedimientos del Sistema de Gestión de la Calidad de la ESCEG, basado en cuatro etapas, referidas al marco teórico referencial, el diagnóstico integral con enfoque a procesos y a riesgos, el diseño del Manual, alineado a los objetivos estratégicos, el cumplimiento de las normativas y requerimientos, así como el control y la mejora de los procedimientos para el cumplimiento de las metas de los indicadores trazados en la proyección estratégica de la universidad.

En la posguerra inmediata, con unas políticas cinematográficas ya definidas en torno al “Nuevo Estado” franquista, y con una tendencia a la consolidación de una industria española del cine, será cuando la política de géneros se despliegue en un cine policiaco crecientemente sólido y definido. Este género y sus diversas corrientes internas reflejarán la sociedad española herida por la contienda bélica. Este artículo pretende aportar una primera perspectiva histórica global del cine policiaco español de posguerra desde 1939, y en la etapa histórica inmediatamente previa a la eclosión de la llamada “edad dorada” del género en la década de los 50. Para ello, se caracterizarán sus corrientes estético-narrativas principales con ejemplos ilustrativos, y análisis y comentarios de cómo plasmaban la sociedad de su tiempo y la ideología predominante de este contexto histórico.

Introduction The phase IIIb open-label ODYSSEY APPRISE study prospectively assessed the safety and efficacy of alirocumab (a proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitor) in a real-life setting in high cardiovascular risk patients with heterozygous familial hypercholesterolemia or low-density lipoprotein cholesterol (LDL-C) not at goal despite maximally tolerated dose statins ± other lipid-lowering therapies (NCT02476006). This post-hoc analysis assessed patient adherence to statins and alirocumab, plus alirocumab efficacy and safety, according to concomitant statin intensity and prior ezetimibe usage. Material and methods Patients received alirocumab 75 or 150 mg (dose adjustment based on physician’s judgment) every 2 weeks (for ≥3 to ≤30 months). Results Of 994 enrolled and treated patients, 58.4% received concomitant high-intensity statins, 18.2% moderate/low-intensity statins, and 23.4% no statin; 55.9% received prior ezetimibe. Mean alirocumab adherence (percent adherence defined as injections received ÷ theoretical injections x 100) was 96.6% over 72.4 weeks’ mean treatment duration. Mean LDL-C reduction from baseline at Week 12 was similar between statin intensity subgroups (53.6–55.7%). More patients achieved LDL-C

Background The Spanish registry of α1-antitrypsin deficiency (AATD) integrated in the European Alpha-1 Research Collaboration (EARCO) provides information about the characteristics of patients, in particular those with the PI*SZ genotype, which is frequent in Spain. Method Individuals with severe AATD defined as proteinase inhibitor (PI) genotypes PI*ZZ, PI*SZ and other rare deficient variants were included from February 1, 2020, to February 1, 2022. The analysis focused on a comparison of the characteristics of PI*ZZ and PI*SZ patients. Results 409 patients were included (53.8% men) with a mean±sd age of 53.5±15.9 years. Genotypes were PI*ZZ in 181 (44.7%), PI*SZ in 163 (40.2%), PI*SS in 29 (7.2%) and other in 32 (7.9%). 271 (67.4%) had lung disease: 175 chronic obstructive pulmonary disease (43.5%), 163 emphysema (40.5%) and 83 bronchiectasis (20.6%). Patients with the PI*SZ genotype were younger, more frequently non-index cases and had a lower frequency of respiratory diseases except asthma compared with PI*ZZ patients. Among patients with respiratory diseases, PI*SZ individuals were significantly older both at onset of symptoms and at diagnosis; only asthma was more frequent in PI*SZ than in PI*ZZ individuals. Twelve PI*SZ patients (15.4%) received augmentation therapy compared with 94 PI*ZZ patients (66.2%; p

Guaranteeing inclusive, high-quality education for all requires comprehensive changes to the curriculum so that, instead of creating or perpetuating barriers, these barriers are eliminated. Universal Design for Learning (UDL) and Universal Design for Instruction (UDI) emerge as teaching strategies that encourage inclusion in education. This study presents the implementation of both models within the higher education framework, applying them to the Spanish Sign Language and Deaf Communities degree that is studied by a large number of deaf students. For this purpose, a descriptive study is presented with a quantitative methodological approach using a survey as an instrument. Four dimensions were established for designing the curriculum: course materials, teaching strategies, synchronous course management, and asynchronous. After student assessment, the results revealed their high level of satisfaction and the importance these teaching strategies had for their motivation, comprehension, and learning of the relevant competencies. There was also recognition of the importance of blended teaching methods for active learning as a vehicle for increasing student involvement and participation. This study concludes that it is necessary to continue progressing in the practical implementation of teaching models based on Universal Design, which also supports course management.

Transmission is a driver of tuberculosis (TB) epidemics in high-burden regions, with assumed negligible impact in low-burden areas. However, we still lack a full characterization of transmission dynamics in settings with similar and different burdens. Genomic epidemiology can greatly help to quantify transmission, but the lack of whole genome sequencing population-based studies has hampered its application. Here, we generate a population-based dataset from Valencia region and compare it with available datasets from different TB-burden settings to reveal transmission dynamics heterogeneity and its public health implications. We sequenced the whole genome of 785 Mycobacterium tuberculosis strains and linked genomes to patient epidemiological data. We use a pairwise distance clustering approach and phylodynamic methods to characterize transmission events over the last 150 years, in different TB-burden regions. Our results underscore significant differences in transmission between low-burden TB settings, i.e., clustering in Valencia region is higher (47.4%) than in Oxfordshire (27%), and similar to a high-burden area as Malawi (49.8%). By modeling times of the transmission links, we observed that settings with high transmission rate are associated with decades of uninterrupted transmission, irrespective of burden. Together, our results reveal that burden and transmission are not necessarily linked due to the role of past epidemics in the ongoing TB incidence, and highlight the need for in-depth characterization of transmission dynamics and specifically tailored TB control strategies.

Abstract Incidence of pneumococcal disease has increased worldwide in recent years. Response to pneumococcal vaccine is usually measured using the multiserotype enzyme-linked immunosorbent assay (ELISA) pneumococcal test. However, this approach presents several limitations. Therefore, the introduction of new and more robust analytical approaches able to provide information on the efficacy of the pneumococcal vaccine would be very beneficial for the clinical management of patients. Surface plasmon resonance (SPR) has been shown to offer a valuable understanding of vaccines’ properties over the last years. The aim of this study is to evaluate the reliability of SPR for the anti-pneumococcal capsular polysaccharides (anti-PnPs) IgGs quantification in vaccinated. Fast protein liquid chromatography (FPLC) was used for the isolation of total IgGs from serum samples of vaccinated patients. Binding-SPR assays were performed to study the interaction between anti-PnPs IgGs and PCV13. A robust correlation was found between serum levels of anti-PnPs IgGs, measured by ELISA, and the SPR signal. Moreover, it was possible to correctly classify patients into “non-responder”, “responder” and “high-responder” groups according to their specific SPR PCV13 response profiles. SPR technology provides a valuable tool for reliably characterize the interaction between anti-PnPs IgGs and PCV13 in a very short experimental time.

Este artículo examina los argumentos de Jacques Derrida contra la fenomenología de Husserl y a favor de la tesis principal del giro lingüístico: la tesis de que no hay pensamiento sin lenguaje. A continuación se defiende que la disolución derridiana de la subjetividad en el lenguaje no es la consecuencia de afirmar el giro lingüístico como tal, sino del modelo de lenguaje que adopta y radicaliza Derrida: el modelo estructuralista de Ferdinand de Saussure. Finalmente, partiendo de las objeciones de Ricoeur se argumenta que la omisión de la dimensión pragmática del lenguaje (el habla) es la raíz de las principales paradojas de la filosofía postestructuralista de Derrida en la teoría del significado, la referencia y la subjetividad.

Abstract Field cancerization (FC) is a chronic disease involving multiple clinical and subclinical actinic keratoses (AK) on large photo-exposed surfaces with multifocal areas of dysplasia and precancerous changes. Patients and treatment must be properly monitored and managed to avoid aggravation and progression of the disease. Management of actinic keratoses includes lesion-directed treatments, such as cryotherapy and field-directed therapies. Field-directed therapies may have the potential to address subclinical damage, reduce AK recurrence rates and potentially reduce the risk of squamous cell carcinoma development. Multiple studies have demonstrated the efficacy of field-directed treatments, including 5-fluorouracil, photodynamic therapy, imiquimod, chemical exfoliation with trichloroacetic acid and diclofenac gel, for multiple AK and FC. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs and cosmetic results. Management of AK includes not only treatment but also prevention. Medical devices, such as sunscreens containing liposome-encapsulated DNA repair enzymes, can repair DNA damage associated with chronic UV radiation and reduce the number of new AK lesions. Here we provide therapeutic pearls and expert opinions on the treatment of AK and FC (as monotherapy or in combination) with the overall aim to achieve better, faster, and well-tolerated clinical responses.

ABSTRACT Introduction and objectives: The Lotus Valve device (Boston Scientific) is a second-generation fully-retrievable and repositionable transcatheter aortic valve. We report the initial multicenter experience with the Lotus valve in the management of patients with severe aortic stenosis. Methods: Observational study that described the short and long-term results of implanting the Lotus valve in 8 Spanish and Portuguese centers from March 2014 through April 2016. Results: The study included 102 patients (mean age 80.4 ± 6.1 years; STS score 5.2% ± 3.3%) with severe symptomatic aortic stenosis (mean aortic valve area 0.66 ± 0.17 cm2, aortic gradients 74.3 / 45.6 mmHg). The valve was successfully implanted in 100 patients (98%), with significant improvement in both the peak and mean aortic valve gradients and with only one patient showing moderate paravalvular regurgitation. Upon hospital discharge, mortality rate was 3.9% while the stroke rate was 2.9%. No cases of valve embolization, ectopic valve deployment or additional valve implantation (valve-in-valve) were seen. Thirty-three patients (32.3%) received a permanent pacemaker. Conclusions: The Lotus Valve System is effective and safe for the management of patients with severe symptomatic aortic stenosis. In particular, considering the low rate of periprosthetic regurgitation and lack of complications like embolization or ectopic valve deployment; however at the expense of a high pacemaker implantation rate.

RESUMEN Introducción y objetivos: El dispositivo Lotus (Boston Scientific, Estados Unidos) es una prótesis valvular aórtica transcatéter de segunda generación, completamente recuperable y reposicionable. Se presenta la experiencia inicial con la prótesis Lotus en un registro multicéntrico. Métodos: Estudio observacional que reporta los resultados a corto y largo plazo del implante transfemoral de prótesis Lotus entre marzo de 2014 y abril de 2016 en 8 centros de España y Portugal. Resultados: Se incluyeron 102 pacientes (edad media 80,4 ± 6,1 años, índice STS medio 5,2% ± 3,3%) con estenosis aórtica grave sintomática (área valvular media 0,66 ± 0,17 cm2, gradientes 74,3/45,6 mmHg). Se implantó con éxito el dispositivo en 100 pacientes (98%), con mejoría significativa de los gradientes máximo y medio valvular, y un solo caso de regurgitación periprotésica moderada. No hubo ninguna embolización ni necesidad de implante de una nueva prótesis intravalvular. Hasta el alta hospitalaria, la mortalidad fue del 3,9% y la tasa de ictus fue del 2,9%. En 33 pacientes (32,3%) fue necesario el implante de marcapasos definitivo. Conclusiones: La válvula Lotus es eficaz y segura para el tratamiento de pacientes con estenosis aórtica grave sintomática. Destacan la escasa tasa de insuficiencia periprotésica y la ausencia de complicaciones derivadas del mal posicionamiento o la embolización de la prótesis, a costa de un alta incidencia de implante de marcapasos.

Abstract Background Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients. Methods An eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed. Results A total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013–2017). The incidence of CL and MCL increased from 3.6/100,000 (2006–2012) to 13.58/100,000 (2013–2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported. Conclusions Some interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.

Este artículo parte de la premisa de que en las democracias liberales actuales se extiende un nuevo estilo discursivo propiamente cínico. El artículo traza una genealogía de este cinismo político partiendo del liberalismo político de John Rawls y recalando en la teoría agonística de la democracia de Chantal Mouffe, e intenta mostrar que la superación del liberalismo político que la teoría agonística lleva años proponiendo parece realizarse finalmente a través del cinismo, aunque con resultados diferentes de los esperados: la expansión del cinismo en la esfera pública debe entenderse como una degradación del debate público con consecuencias políticas inquietantes.

Sustainable Development Goals and the targets described in each of them can only be fully achieved with the commitment and involvement of universities. These institutions are the perfect environment to promote and enhance sustainable human development, in such a way that from their own structure and operation they favor the transition towards the building of peaceful, fair, and inclusive societies. To achieve the goals described in SDG4, universities must address three areas in a combined and parallel way: “Institutional Management and Governance”, “Education”, and “Leadership”. Following the development of four quantitative and qualitative studies that address these areas individually, the main common conclusions are presented, aimed at showing the path that the university system must follow to achieve these goals within 10 years. The results reveal the need to the focus on the development of an inclusive university culture based on the foundations of each institution (mission, vision, and values), as well as the need to strengthen the link with the NGO sector. Similarly, this inclusive culture must be transversal in university strategic plans to ensure that all actions developed in this context are aligned with the precepts of the 2030 Agenda.

The recent periodic influx of massive quantities of pelagic Sargassum spp. (sargasso) into the Caribbean has posed ecological, social, and economic challenges to the region. Sustainable use of the biomass is crucial to mitigate negative impacts of beached algae. The current uses of sargasso in Mexico are reviewed, and a biorefinery approach is proposed to optimize its commercialization. The commercialization potential of sargasso in the Mexican Caribbean is analyzed using the strengths, weaknesses, opportunities, and threats (SWOT) analysis. The unpredictability of the influx to the Mexican shores is considerable, both in time and space, also, some areas receive consistently more sargasso than others. The lack of available technology, local infrastructure and regulations concerning sargasso are relevant, as is the urgent need to establish proper regulatory measures. In the context of the Mexican legal system, the category “special waste” can best be applied to sargasso that is collected from the beach or nearshore waters for the purpose of regulation. Lessons learnt from in Mexico may be applied elsewhere, with adaptations for each specific location. More importantly, mutual understanding of the constraints and possibilities of sargasso management in other countries, or territories, may facilitate the coordinated management of this transboundary macroalgae bloom.