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La afectación económica causada por el cierre de negocios al inicio y durante la pandemia mundial COVID-19 también causó estragos en los micro y pequeños comerciantes de la cabecera municipal de Ahuacatlán. La presente investigación tiene un enfoque cuantitativo con diseño no experimental y de tipo descriptiva, cuyo objetivo es analizar el grado de afectación económica de los pequeños negocios, ya sea el aumento o disminución de sus ingresos. La pregunta de investigación se responde a través de un cuestionario con 14 ítems, de los cuales 13 son de opción múltiple y uno abierto, aplicado a 78 micro o pequeños negocios de la cabecera municipal de Ahuacatlán, Nayarit. Las respuestas muestran que la tercera parte de los comerciantes sufrieron una notoria disminución de sus ingresos, debido al cierre de sus negocios al inicio de la pandemia.

The microorganism Staphylococcus aureus is a notorious causative agent of bacterial infection. The widespread presence of this pathogen has caused significant morbidity and mortality rates in clinical healthcare settings and communities. Due to its increasingly frequent recalcitrant nature towards clinically available antimicrobial agents, the bacterium poses a considerable public health crisis. A significant bacterial mechanism of antimicrobial agent resistance includes multidrug efflux pump systems. These antimicrobial efflux determinants translate into several large superfamilies of transporters that share related amino acid sequences, similarities in three-dimensional structures, modes of energization, and solute transport catalysis across the membrane. Because of their ubiquitous nature and functional role in virulence, these multidrug transporters make good targets for inhibition. This review briefly summarizes recent key findings regarding multidrug efflux activity and modulation in the MATE, SMR, and MFS transporters.

Resumen Objetivo Evaluar el uso de la terapia con beneficio cardiovascular en pacientes con DM tipo 2 previo al ingreso en servicios de medicina interna. Metodos Estudio transversal en un dia de los pacientes con DM tipo 2 hospitalizados en servicios de medicina interna. Se recogieron variables demograficas y antropometricas, datos de laboratorio y utilizacion de farmacos antihiperglucemiantes. La variable desenlace fue la proporcion y los determinantes de uso de inhibidores del cotransportador sodio-glucosa 2 (iSGLT2) y de agonistas del receptor del peptido similar al glucagon tipo 1 (AR-GLP1). Resultados Se incluyeron 928 pacientes pertenecientes a 74 hospitales. La edad media fue 78,9 anos (DE: 10,86), un 50% varones. Un total de 557 (60%) presentaba cardiopatia isquemica, 189 (20,4%) enfermedad cerebrovascular, 293 (31,6%) insuficiencia cardiaca, 274 (29,5%) enfermedad renal cronica y 129 (13,9%) enfermedad arterial periferica. Los antihiperglucemiantes utilizados previo al ingreso fueron: sulfonilureas (5.7%), biguanidas (49.1%), inhibidores de la alfa-glucosidasa (0,2%), pioglitazona (0%), iDPP4 (39%), iSGLT2 (5,8%), AR-GLP1 (2,6%) y analogos de insulina basal (24%). La edad mayor de 75 anos fue el factor determinante principal para no utilizar iSGLT2 (OR ajustada 0,28; intervalo de confianza al 95%: 0,10-0,74; p = 0,039) o AR-GLP1 (OR ajustada 0,09; intervalo de confianza al 95%: 0,02-0,46; p = 0,006). Discusion Una gran proporcion de pacientes ancianos con DM tipo 2 de muy alto riesgo cardiovascular no recibe terapia antihiperglucemiante con farmacos de probado beneficio cardiovascular. El tratamiento mas frecuentemente utilizado fue metformina e iDPP4. Existe un margen de mejora en el tratamiento en esta poblacion de muy alto riesgo.

Resumen Introduccion La monitorizacion ambulatoria de la presion arterial (MAPA) ha demostrado la utilidad en la evaluacion pronostica de los pacientes hipertensos con insuficiencia cardiaca (IC) con o sin otras enfermedades cardiovasculares. El objetivo de este estudio consistio en determinar si la MAPA puede identificar a pacientes con IC con un peor pronostico. Metodos y resultados Estudio multicentrico prospectivo en el que se incluyeron pacientes ambulatorios y clinicamente estables con IC. Todos los pacientes se sometieron a una MAPA. Se incluyo un total de 154 pacientes de 17 centros. La edad media fue de 76,8 anos (± 8,3) y el 55,2% eran mujeres. En total, el 23,7% presentaba IC con fraccion de eyeccion reducida (IC-FEr), el 68,2% se encontraba en la clase funcional II de la NYHA y el 19,5%, en la clase funcional III de la NYHA. Al cabo de un ano de seguimiento se produjeron 13 (8,4%) muertes, 10 de ellas atribuidas a la IC. En 19 de los 29 pacientes que precisaron hospitalizacion, esta se debio a la IC. La presencia de un patron no dipper de PA se asocio a un mayor riesgo de reingreso o muerte al ano de seguimiento (25% frente al 5%; p = 0,024). Segun un analisis de regresion de Cox, una clase funcional mas avanzada de la NYHA (razon de riesgos instantaneos, 3,51; IC del 95%, 1,70-7,26; p = 0,001; comparacion entre las clases III y II de la NYHA) y una mayor reduccion nocturna proporcional de la PA diastolica (razon de riesgos instantaneos, 0,961; IC del 95%, 0,926-0,997; p = 0,032 por cada reduccion del 1% de la PA diastolica) se asociaron a muerte o reingreso al cabo de un ano de manera independiente. Conclusiones En los pacientes de edad avanzada con IC cronica, un patron no dipper de PA determinado mediante MAPA se asocio a un mayor riesgo de hospitalizacion y muerte por IC.

Introduction Ambulatory blood pressure monitoring (ABPM) has demonstrated value in the prognostic assessment of hypertensive patients with heart failure (HF) with or without other cardiovascular diseases. The objective of this study was to evaluate whether ABPM can identify subjects with HF with a worse prognosis. Methods and results Prospective multicenter study that included clinically stable outpatients with HF. All patients underwent ABPM. A total of 154 patients from 17 centers were included. Their mean age was 76.8 years (± 8.3) and 55.2% were female. In total, 23.7% had HF with a reduced ejection fraction (HFrEF), 68.2% were in NYHA functional class II, and 19.5% were in NYHA functional class III. At one year of follow up, there were 13 (8.4%) deaths, of which 10 were attributed to HF. Twenty-nine patients required hospitalization, of which 19 were due to HF. The presence of a non-dipper BP pattern was associated with an increased risk for readmission or death at one year of follow-up (25% vs. 5%; p = .024). According to a Cox regression analysis, more advanced NYHA functional class (hazard ratio 3.51; 95% CI 1.70–7.26; p = .001; for NYHA class III vs. II) and a higher proportional nocturnal reduction in diastolic BP (hazard ratio 0.961; 95%CI 0.926−0.997; p = .032 per 1% diastolic BP reduction) were independently associated with death or readmission at one year. Conclusion In older patients with chronic HF, a non-dipper BP pattern measured by ABPM was associated with a higher risk of hospitalization and death due to HF.

Background Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines.

Resumen Objetivo Conocer las caracteristicas clinicas y epidemiologicas de los pacientes con enfermedad pulmonar obstructiva cronica (EPOC) y aislamiento de especies de Aspergillus en muestra respiratoria e identificar factores que nos ayuden a diferenciar entre colonizacion e infeccion. Metodos Estudio de cohortes retrospectivo en el que se incluyeron todos los pacientes con EPOC y aislamiento de Aspergillus spp. en muestra respiratoria durante un periodo de 12 anos. Se asignaron los pacientes a 2 categorias: colonizacion y aspergilosis pulmonar (AP), que incluye las diferentes formas de presentacion clinica. Se aplico un modelo de regresion logistica binaria para identificar los factores predictores de desarrollo de AP. Resultados Un total de 123 pacientes fueron incluidos en el estudio: 48 (39%) colonizados y 75 (61%) con AP: 68 con AP invasiva probable y 7 con AP cronica. No hubo correlacion entre el riesgo de AP y los estadios espirometricos de la clasificacion GOLD. Se identificaron como factores predictores independientes de AP en pacientes con EPOC la oxigenoterapia domiciliaria (OR: 4,39; IC 95%: 1,60-12,01; p = 0,004), las bronquiectasias (OR: 3,61; IC 95%: 1,40-9,30; p = 0,008), la hospitalizacion en los 3 meses previos al ingreso (OR: 3,12; IC 95%: 1,24-7,87; p = 0,016) y la terapia antifungica frente a Candida spp. en el mes previo (OR: 3,18; IC 95%: 1,16-8,73; p = 0,024). Conclusiones La oxigenoterapia continua domiciliaria, las bronquiectasias, la hospitalizacion en los 3 meses previos al ingreso y la utilizacion de terapia antifungica frente a Candida spp. en el mes previo se asocian a mayor riesgo de AP en pacientes con EPOC.

Suicide after psychiatric hospitalization is a major concern. Poor treatment engagement may contribute to risk. The World Health Organization Brief Intervention and Contact (BIC) Program is an evidence-based practice shown to prevent suicide after psychiatric discharge in international trials. There have been no efforts to implement BIC into routine practice in US populations.The authors conducted a 12-month quality improvement (QI) collaborative at six US Department of Veterans Affairs (VA) medical centers serving a large rural population. Sites had low to moderate performance on a VA quality measure of mental health postdischarge care; a measure assessing the proportion of discharged patients who achieve the required number of visits ≤ 30 days. Sites received programmatic support to implement BIC locally. Implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.Overall, teams had high participation in programmatic activities and enrolled 85% of eligible patients that they approached. Among 70 enrolled patients, 81.4% achieved the VA quality measure of mental health postdischarge care, suggesting good treatment engagement. On average, patients rated BIC as excellent. Team members agreed that BIC was easy to use, implementable, possible, and doable. Factors facilitating implementation included standardized operating procedures to standardize processes. Barriers included insufficient staffing and loss to follow-up. Most sites plan to continue to enroll patients and to expand BIC to other areas.A QI collaborative can facilitate implementation of BIC in six VA facilities that provide inpatient psychiatric treatment. BIC may appeal to patients and providers and may improve treatment engagement.

Purpose To analyse whether an intergenerational programme in which students interacted with institutionalised older persons had any impact on the older persons’ functional status. Methods Each academic year, a group of older adults living in nursing homes were divided into two arms. For the next four months, the first group received daily visits from a group of students during which they followed a pre-established activity plan, whilst the other arm proceeded with their normal activity. After 4 months, the groups crossed over, and the second arm received the student visits, whilst the first group returned to their normal activity. A battery of tests was performed at inception, crossover and the end of the second period. The tests explored mobility (Timed Up-and-Go), cognition (Mini-Mental Examination), executive function (Frontal Assessment Battery) and mood (Geriatric Depression Scale). A dichotomous aggregate “significant impairment” variable was deemed to be present when there was at least a 20% loss of function (compared to the value at the beginning of the period) in any of the aforementioned tests. Results The study included 289 older adults who visited with 91 students. Subjects in the active phase had a lower incidence of significant impairment than those in the control phase (O.R. 0.90, p Conclusion An intergenerational project with students visiting older adults in nursing homes had a protective effect, delaying functional decay in older adults.

BackgroundLow-dose dexamethasone demonstrated clinical improvement in patients with coronavirus disease 2019 (COVID-19) needing oxygen therapy; however, evidence on the efficacy of high-dose dexamethasone is limited.MethodsWe performed a randomised, open-label, controlled trial involving hospitalised patients with confirmed COVID-19 pneumonia needing oxygen therapy. Patients were randomly assigned in a 1:1 ratio to receive low-dose dexamethasone (6 mg once daily for 10 days) or high-dose dexamethasone (20 mg once daily for 5 days, followed by 10 mg once daily for an additional 5 days). The primary outcome was clinical worsening within 11 days since randomisation. Secondary outcomes included 28-day mortality, time to recovery and clinical status at day 5, 11, 14 and 28 on an ordinal scale ranging from 1 (discharged) to 7 (death).ResultsA total of 200 patients (mean±sd age 64±14 years; 62% male) were enrolled. 32 (31.4%) out of 102 patients enrolled in the low-dose group and 16 (16.3%) out of 98 in the high-dose group showed clinical worsening within 11 days since randomisation (rate ratio 0.427, 95% CI 0.216–0.842; p=0.014). The 28-day mortality was 5.9% in the low-dose group and 6.1% in the high-dose group (p=0.844). There was no significant difference in time to recovery, and in the seven-point ordinal scale at days 5, 11, 14 and 28.ConclusionsAmong hospitalised COVID-19 patients needing oxygen therapy, high dose of dexamethasone reduced clinical worsening within 11 days after randomisation, compared with low dose.

Aim: To analyze changes on UACR in T2DM patients according to treatment schedule groups (GLP-1RA or SGLT2i). Methods: Observational, prospective, multicenter study. Patients were stratified according to predetermined treatment schedule groups (successively vs.simultaneously). Results: 178 patients (58.6% males, age 61.9+/-10.0 years). Table 1 shows baseline findings by groups. Initial UACR was 19.6+/-52.5 mg/g and initial UACR >30 mg/g (n=68) was 95.1+/-222 mg/g. At 26 weeks significant % change in UACR and UACR>30mg/g was found (4.35+/-30** and 48.8+/105.5**), greater when SGLT2i is added (90.5+/-276.5 *) (Table 2). Discussion: Our results shows that the combination GLP-1ra-SGLT2i reduces UACR, especially if macroalbuminuria is present and is correlated to improvement in either HbA1c, weight and SBP. Disclosure J. Carretero Gomez: None. J. Ena: None. J. Segui-Ripoll: None. F. Carrasco-Sánchez: None. J. Arevalo Lorido: None. M. Suarez Tembra: None. J. Varela: None. R. Gomez-Huelgas: None.

AIMS We aimed to determine the efficacy and safety of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists to prevent worsening urinary albumin-to-creatinine ratio as an early biomarker of diabetes kidney disease. METHODS A total of 178 patients with type 2 diabetes and obesity received combination treatment with SGLT2i added to GLP1ra (n = 76), GLP1ra added to SGLT2i (n = 50) or GLP1ra plus SGLT2i from start (n = 52), according to investigators´ best clinical judgement. Major outcomes assessed at 26 weeks were changes in urine albumintocreatinine-ratio (UACR), estimated glomerular filtration rate (eGFR), glycated haemoglobin, body weight and systolic blood pressure. RESULTS All patients (58.6% men, mean age 61.9 ± 10.0 years) completed the study. Baseline HbA1c, weight and eGFR levels were 8.2 ± 0.9%, 109.9 ± 19 kg and 83.3 ± 19.6 mL/min/m2 , respectively. At 26 weeks, we found significant reductions in HbA1c (1.16%), weight (5.17 kg) and systolic blood pressure (8.13 mmHg). The reduction in UACR was 15.14 mg/g (95% CI 8.50-22.4) (-24.6 ± 64.7%), which was greatest in the group of patients with SGLT2i added on to GLP1ra therapy (116.7 mg/g; 95% CI: 54-296.5 mg/g; P

[EN] Background The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an attractive alternative to bariatric surgery for obese diabetic patients. This article aims to study dynamical aspects of the glycaemic profile that may influence DJBL effects. Methods Thirty patients underwent DJBL implantation and were followed for 10 months. Continuous glucose monitoring (CGM) was performed before implantation and at month 10. Dynamical variables from CGM were measured: coefficient of variation of glycaemia, mean amplitude of glycaemic excursions (MAGE), detrended fluctuation analysis (DFA), % of time with glycaemia under 6.1 mmol/L (TU6.1), area over 7.8 mmol/L (AO7.8) and time in range. We analysed the correlation between changes in both anthropometric (body mass index, BMI and waist circumference) and metabolic (fasting blood glucose, FBG and HbA1c) variables and dynamical CGM-derived metrics and searched for variables in the basal CGM that could predict successful outcomes. Results There was a poor correlation between anthropometric and metabolic outcomes. There was a strong correlation between anthropometric changes and changes in glycaemic tonic control ( increment BMI- increment TU6.1: rho = - 0.67, P < .01) and between metabolic outcomes and glycaemic phasic control ( increment FBG- increment AO7.8: r = .60, P < .01). Basal AO7.8 was a powerful predictor of successful metabolic outcome (0.85 in patients with AO7.8 above the median vs 0.31 in patients with AO7.8 below the median: Chi-squared = 5.67, P = .02). Conclusions In our population, anthropometric outcomes of DJBL correlate with improvement in tonic control of glycaemia, while metabolic outcomes correlate preferentially with improvement in phasic control. Assessment of basal phasic control may help in candidate profiling for DJBL implantation., Research Center for Informatics, Grant/Award Number: CZ.02.1.01/0.0/0.0/16_019/0000765; Biomedical data acquisition, processing and visualization, Grant/Award Number: SGS19/171/OHK3/3T/13; MH CZ - DRO ("IKEM, IN 00023001"); RVO VFN64165

O presente relatório propõe-se como objetivo principal a descrição do estágio desenvolvido no âmbito do mestrado em Direção e Gestão Hoteleira, realizado entre dezembro de 2018 e julho de 2019, no hotel Vila Galé Collection Braga, sendo esta a primeira, e até à data, única unidade hoteleira do grupo Vila Galé no Minho. Assim, para além da descrição, fará parte deste relatório, uma análise reflexiva da execução das diversas tarefas nas secções da referida unidade hoteleira, tendo por referência o respetivo enquadramento teórico. Deste modo, através da observação e participação no dia-a-dia de cada sector, foi possível descrever as principais tarefas desempenhadas e correspondente análise crítica, apresentando os pontos positivos e os passiveis de serem alterados. O estágio consistiu pela passagem por todos os departamentos do hotel, nomeadamente: Restaurante e Bar; Cozinha; Housekeeping; Economato; Manutenção, Receção e Direção. Baseado nas vivências ao longo do decorrer do estágio, bem como na experiência de mais de 20 anos de trabalho na área do Turismo e Hotelaria, identificou-se que o maior problema persiste na falta de recursos humanos, constituindo a falta de formação profissional, bem como uma maior autonomia nos procedimentos acabam por tornar a unidade num sistema de trabalho mais rígido e perdendo-se assim a essência da hospitalidade portuguesa. Não houve possibilidade de criar ou ainda desenvolver um plano prático e viável, de modo a minimizar alguns constrangimentos que serão identificadas e refletidas ao longo deste relatório. No entanto, a experiência deste estágio veio, possibilitou uma melhor compreensão e aperfeiçoamento das capacidades profissionais em algumas áreas onde o conhecimento era apenas académico, pelo que nesse sentido, a vivência adquirida foi gratificante e positiva, pois para gerir e dirigir uma unidade hoteleira, nada melhor que dominar o saber fazer. The main objective of this report is to describe the internship developed under the master’s degree in Hotel Management and Management, which took place between December 2018 and July 2019, at the Vila Galé Collection Braga hotel, which is the first and to date, the only hotel unit of the Vila Galé group in Minho. Thus, beyond the description, will be part of this report, a reflective analysis of the execution of the various tasks in the sections of said hotel, with reference to the respective theoretical framework. Thus, through the observation and daily participation of each sector, it was possible to describe the main tasks performed and the corresponding critical analysis, presenting the positive points and those that could be changed. The internship consisted of passing through all departments of the hotel, namely: Restaurant and Bar; Kitchen; Housekeeping; Storage and Purchase; Maintenance, Reception and Direction. Based on the experiences throughout the internship, as well as the experience of more than 20 years of work in the field of Tourism and Hospitality, it was identified that the biggest problem persists in the lack of human resources, constituting the lack of professional training, as well as a greater autonomy in the procedures end up turning the unit into a more rigid work system and thus losing the essence of Portuguese hospitality. There was no possibility to create or develop a practical and workable plan to minimize some constraints that will be identified and reflected throughout this report. However, the experience of this internship came, enabled a better understanding and improvement of professional skills in some areas where knowledge was only academic, so the experience gained was rewarding and positive, because to manage and run a hotel unit, nothing better than mastering the know-how.

[Background] Chronic obstructive pulmonary disease (COPD) is one of the diseases that leads to a higher number of hospitalizations in internal medicine departments. These patients are usually older and have greater multimorbidity than COPD patients hospitalized in other departments, which hinders the implementation of clinical guidelines necessarily focused on the management of a single disease., [Aims] To ascertain the opinion of Spanish internists on the management of COPD in scenarios in which the available evidence is sparse and to produce a consensus document designed to assist in decision-making in COPD patients with comorbidities treated in internal medicine services., [Methods] After identifying the clinical areas of greatest uncertainty by consensus, a survey was designed with 89 questions on the epidemiology and diagnosis of COPD, its management both in stable phase and during decompensation, and the treatment of the associated comorbidities in outpatients and inpatients. The consensus process was carried out using the Delphi method in an anonymized two-round process., [Results] The survey was completed by 67 internists experienced in the clinical management of COPD. Of all the questions posed, a consensus was reached for 51 (57.3%) in the first round and for 67 (75.3%) in the second round. The result of the process is a series of 67 suggestions that may assist in the care of these patients., [Conclusions] Our study allows us to ascertain the views of a large number of internists experienced in the management of COPD and to learn how the recommendations for guidelines are applied in clinical practice., This study was supported in part by Pharmaceutical Laboratories Rovi, Spain.

Background: The prognosis of a patient with Covid-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. Methods: A retrospective study was performed of patients admitted with Covid-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, analytical, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. Findings: During the study period 1,152 patients presented with Covid-19 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 hours of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤5%, 6-25%, and >25% exhibited disease progression, respectively. Interpretation: A simple risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis. Funding Statement: This project was funded by the Carlos III Health Institute, Spain, Grant/Award Number: COV20/00404; Ministry of Economy and Competitiveness (SPAIN) and the European Regional Development Fund (FEDER). Declaration of Interests: The authors declare no conflicts of interest associated with this publication. Ethics Approval Statement: The study was conducted in accordance with the guidelines of the Declaration of Helsinki and the principles of good clinical practice and was approved by the Institutional Review Board (IRB) of the Galician Health Service on April 3, 2020 (#2020/194). Informed consent forms were waived by the IRB.

The prognosis of a patient with Covid-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. A retrospective study was performed of patients admitted with Covid-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, analytical, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. During the study period 1,152 patients presented with Covid-19 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 hours of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤5%, 6-25%, and >25% exhibited disease progression, respectively. A simple risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis. Carlos III Health Institute, Spain, Ministry of Economy and Competitiveness (SPAIN) and the European Regional Development Fund (FEDER) Instituto de Salud Carlos III

O Castro de Guifoes (Matosinhos, Noroeste de Portugal), estrategicamente implantado junto ao Rio Leca, tem sido alvo de estudo por varios arqueologos, desde os finais do seculo XIX. Em 2016, tiveram inicio novas escavacoes arqueologicas que levaram a recolha de amostras sedimentares para analises arqueobotânicas. Neste trabalho serao divulgados os resultados do estudo carpologico (frutos e sementes), de amostras provenientes de quatro campanhas. Este estudo cobre uma ampla diacronia, que se estende entre a Idade do Ferro e a Antiguidade Tardia, bem como um conjunto diverso de contextos arqueologicos. Os resultados revelaram um predominio de cereais, principalmente de milho-miudo e de trigo de grao nu. O centeio e, sobretudo, o milho- -painco e a cevada, surgiram em numero mais reduzido.

Background and objective To determine the effectiveness of a simple educational intervention to improve the management of cardiovascular comorbidities in patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Material and methods Multicenter study participated in by 26 hospital centers. A panel of experts elaborated a set of recommendations about diagnostic and therapeutic management of acute exacerbation of COPD and cardiovascular comorbidities (coronary artery disease, atrial fibrillation, heart failure and diabetes). The recommendations were graduated as indispensable, advisable and outstanding. Compliance with recommendations were assessed in the discharge letter for COPD patients hospitalized with acute exacerbation in Internal Medicine departments. The protocols to treat the comorbidities in COPD were explained in a clinical session. After 6 months’ compliance with recommendations they were reassessed. Results A total of 390 cases before and after the intervention were assessed. There was significant progress in 53% of cases. The improvement was greater in cases referred to general management and COPD management (66.7 and 76.9%, respectively), and lower in cases referred to ischemic heart disease (11.1%) and none in those referred to coronary artery disease. After the intervention, the adherence to overall and indispensable recommendations was higher ( p = 0.020 and p = 0.017, respectively) and a trend to improve was observed in advisable ( p = 0.058) and outstanding recommendations ( p = 0.063). Conclusions A simple intervention can improve the management of lung disease in COPD patients with an acute exacerbation, but has less effect on the management of comorbidities.