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This research study computationally examined the thermal decomposition of three molecules, 3,6-dihydro-2H-pyran, 4-methyl-3,6-dihydro-2H-pyran, and 2,6-dimethyl-3,6-dihydro-2H-pyran, using the PBE0/6-311+G(d,p) level of theory and a concerted mechanism with a 6-member cyclic transition state. For this analysis, kinetic and thermodynamic parameters were calculated for reactions within a temperature range of 584 to 633 K and compared with experimental data. Our results revealed that methyl substituents at 2, 4, and 6 positions decrease the activation free energy of the molecules. Even though the evaluated reactions exhibited high absolute synchronicity, significant differences were observed regarding the extent of their bond evolution.

Abstract Background Assessing self-efficacy in evidence-based practice (EBP) is crucial for identifying training needs, evaluating the effectiveness of educational programs, and assessing the overall application confidence of EBP in healthcare professions, including occupational therapy (OT). Thus, the objectives of this study were to cross-culturally adapt the Evidence-Based Practice Confidence Scale (EPIC) for Spanish-speaking OT students and professionals and to evaluate its internal consistency, test–retest reliability, and construct validity. Methods A professional translation and cross-cultural adaptation of the EPIC was developed, including a pilot study that resulted in the EPIC Spanish version. A total of 260 OT students and 202 professionals completed the Spanish EPIC at baseline, with 177 (68.1%) students and 129 (63.9%) professionals participating in the test–retest reliability assessment two weeks later. The EPIC’s internal consistency was evaluated using Cronbach’s alpha. Test–retest reliability was assessed using Spearman’s correlations and intra-class correlations (ICC). Known-groups validity hypothesis based on participants' roles (students, diploma/bachelor’s, master’s, and doctorate) was explored using ANOVA. Finally, an exploratory factor analysis with oblique Promax rotation was conducted to examine the EPIC factor structure. Results Cronbach’s alpha for the total EPIC score was excellent in both OT professionals (α = 0.91) and students (α = 0.90). For OT students, Spearman’s correlation was 0.67 (p

Abstract Background Occupational balance (OB) has been associated with health indicators in informal caregivers (CGs) such as well-being and subjective health. Consequently, maintaining an adequate OB could be crucial to providing adequate care without becoming overwhelmed, converting the condition of caregivers into an important aspect of public health as the ageing population increases. However, little is known about the factors influencing OB in CGs. Thus, this study aimed to explore the associated factors with the OB in CGs of persons with dementia. Methods We cross-sectionally analysed data from 134 CGs and the individuals with dementia. We assessed CGs’ OB using the Occupational Balance Questionnaire (OBQ). Simultaneously, several sociodemographic, clinical, and caregiving-related variables including CGs’ burden and psychological distress were assessed. The association between the CGs’ OB and those factors was explored through robust multiple linear regression. Results Firstly, CGs that presented secondary education exhibited a decrement of 5.41 (CI95% = -10.62, -0.41; p-value = 0.03) OB points. Moreover, CGs with higher education experienced a more pronounced OB reduction (β = -7.74; 95%CI = -12.19, -3.29; p-value =

Summary: Background: Infections and sepsis are leading causes of morbidity and mortality in women during pregnancy and the post-pregnancy period. Using data from the 2017 WHO Global Maternal Sepsis Study, we explored the use of early warning systems (EWS) in women at risk of sepsis-related severe maternal outcomes. Methods: On April 27, 2023, we searched the literature for EWS in clinical use or research in obstetric populations. We calculated the proportion of women for whom each existing EWS identified them as at risk for developing severe maternal outcomes by infection severity (complications and severe maternal outcomes). Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios, and J statistics were calculated to assess EWS performance. Machine learning was used to test the diagnostic potential of routine maternal sepsis markers. Findings: 21 EWS were assessed in 2560 women from 46 countries with suspected or confirmed infections. The NICE Risk Stratification tool, Modified Shock Index, maternity Systemic Inflammatory Response Syndrome, and Early Maternal Infection Prompts scores had high sensitivity (88.1–97.5%) for identifying sepsis-related severe maternal outcomes. The quick Sequential Organ Failure Assessment (SOFA) in Pregnancy score and Obstetrically modified SOFA had high specificity (90.4–100%) for identifying women with sepsis-related severe maternal outcomes. Furthermore, combinations of sepsis markers had very low sensitivity and high specificity using machine learning. Interpretation: No score demonstrated enough diagnostic accuracy to be used alone to identify sepsis. However, obstetric—and sepsis-specific EWS performed better for early identification of maternal sepsis than non-obstetric and non-sepsis-specific scoring systems. There are limitations to applying EWS to real-world data, mainly due to the incompleteness of medical data that hinders EWS effectiveness. There is a need to continue developing and testing criteria for early identification of maternal sepsis. Funding: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Merck for Mothers, U.S. Agency for International Development, Wellcome Trust, and National Institute for Health and Care Research.

El deporte desempeña un papel crucial en la creación de redes sociales y en el fortalecimiento personal, especialmente en mujeres. La práctica regular de actividades físicas mejora la confianza, las habilidades físicas y la capacidad de superar desafíos, promoviendo una identidad empoderada en distintos ámbitos de la vida social. Además, estas actividades contribuyen a alcanzar objetivos globales como la equidad de género, la calidad de vida y el desarrollo personal, fomentando la autogestión, la toma de decisiones y la autonomía femenina. El presente estudio analiza la relación entre la práctica físico-deportiva y el nivel de empoderamiento en mujeres adultas españolas. Se utilizó un cuestionario para comparar a mujeres activas y sedentarias en dimensiones clave como la satisfacción social, la seguridad y la igualdad. Los resultados destacan que la actividad física tiene un impacto positivo en el empoderamiento, proporcionando herramientas concretas para que las estas mujeres. Se resalta el potencial transformador de las actividades deportivas no solo en la salud física, sino también en la construcción de una sociedad más igualitaria y en el fortalecimiento del papel de la mujer en diversos contextos. En ello, el papel de las entidades públicas y privadas es crucial, huyendo de prácticas como el genderwashing.

Background Research utilization and evidence-based practice (EBP) in occupational therapy rely on essential scientific skills. Despite prior research exploring factors influencing EBP, a gap remains in understanding the specific scientific competencies crucial for effective EBP application.Objectives To (1) describe the level of scientific skills for EBP and research application, and (2) investigate the factors influencing higher scientific competence among 1159 Spanish-speaking occupational therapists.Material and Methods We assessed the scientific skills using the HACTO-Screen online survey. Recruitment was conducted through a non-probability convenience sampling method between April to June 2020, using social networks and email dissemination to education and professional organizations in Spain and Spanish-speaking Latin American countries.Results Out of a total score of 115 points, participants showed a moderate level of scientific skills (mean: 62.7, SD: 21.6), with literature searching skills ranking the highest and scientific writing skills ranking the lowest. Associations were found between greater scientific competence and advanced degrees, ongoing research training, and on-the-job research.Conclusions Continuous research training, higher academic degrees, and active research engagement are essential for enhancing scientific competence among occupational therapists.Significance Targeted training to enhance scientific skills and promote research utilization are crucial in advancing EBP in occupational therapy.

Intraoperative hypotension (IOH) poses significant risks during surgeries, necessitating effective management to ensure patient safety and successful outcomes. The Hypotension Prediction Index (HPI) software was developed as a decision support model to assist anesthesiologists in monitoring and addressing hypotensive episodes during non-cardiac surgeries. We have utilized the predictive capabilities of HPI and the physiological variables provided by the Hemosphere monitor to create a Decision Support System (HPI-DSS) for hemodynamic management. This article presents a comprehensive overview of the HPI-DSS, detailing its model for hemodynamic decision support. The system's performance and its ability to enhance intraoperative management are discussed. The article explores the methodology, results, and limitations of the HPI-DSS. It also covers potential applications of the system and offers suggestions for further research to improve and refine its capabilities.

Abstract Background Artisanal cheeses usually contain a highly diverse microbial community which can significantly impact their quality and safety. Here, we describe a detailed longitudinal study assessing the impact of ripening in three natural caves on the microbiome and resistome succession across three different producers of Cabrales blue-veined cheese. Results Both the producer and cave in which cheeses were ripened significantly influenced the cheese microbiome. Lactococcus and the former Lactobacillus genus, among other taxa, showed high abundance in cheeses at initial stages of ripening, either coming from the raw material, starter culture used, and/or the environment of processing plants. Along cheese ripening in caves, these taxa were displaced by other bacteria, such as Tetragenococcus, Corynebacterium, Brevibacterium, Yaniella, and Staphylococcus, predominantly originating from cave environments (mainly food contact surfaces), as demonstrated by source-tracking analysis, strain analysis at read level, and the characterization of 613 metagenome-assembled genomes. The high abundance of Tetragenococcus koreensis and Tetragenococcus halophilus detected in cheese has not been found previously in cheese metagenomes. Furthermore, Tetragenococcus showed a high level of horizontal gene transfer with other members of the cheese microbiome, mainly with Lactococcus and Staphylococcus, involving genes related to carbohydrate metabolism functions. The resistome analysis revealed that raw milk and the associated processing environments are a rich reservoir of antimicrobial resistance determinants, mainly associated with resistance to aminoglycosides, tetracyclines, and β-lactam antibiotics and harbored by aerobic gram-negative bacteria of high relevance from a safety point of view, such as Escherichia coli, Salmonella enterica, Acinetobacter, and Klebsiella pneumoniae, and that the displacement of most raw milk-associated taxa by cave-associated taxa during ripening gave rise to a significant decrease in the load of ARGs and, therefore, to a safer end product. Conclusion Overall, the cave environments represented an important source of non-starter microorganisms which may play a relevant role in the quality and safety of the end products. Among them, we have identified novel taxa and taxa not previously regarded as being dominant components of the cheese microbiome (Tetragenococcus spp.), providing very valuable information for the authentication of this protected designation of origin artisanal cheese. Video Abstract

BackgroundIntraoperative hypotension (IOH) has been associated with increased postoperative morbidity and mortality, emphasizing the importance of maintaining hemodynamic stability during general anesthesia. The Hypotension Prediction Index (HPI) is a recently developed tool obtained from the arterial pressure waveform for predicting the likelihood of hypotension and reflecting the level of hemodynamic instability (HI).MethodsIn this retrospective observational cohort study, we analyzed anonymized data that were prospectively collected in patients having major abdominal surgery in six Spanish centers during 2022. We analyzed data from patients who underwent general anesthesia and required intraoperative monitoring with the Hemosphere monitoring system and HPI software. We defined five patterns of HI using a decision-making algorithm based on cardiovascular pathophysiology: absolute and relative hypovolemia, vasoplegia, and myocardial depression with and without vasoplegia.ResultsAfter analyzing 2,038 hours of hemodynamic monitoring from 393 patients, 1,946 episodes of HI were identified. Vasoplegia was the most common type of HI, accounting for 50.1% HI episodes. Absolute and relative hypovolemia were the next most frequent types, contributing 30.7% and 15.5% of the HI episodes.ConclusionsWe identified five distinct patterns of hemodynamic instability based on the evaluation of hemodynamic parameters underlying arterial hypotension during general anesthesia for patients undergoing major abdominal surgery. Vasoplegia was found to be the most frequent type. These novel classifications can help guide targeted treatment strategies for managing hemodynamic instability and reducing the risk of intraoperative hypotension.

La adaptación fisiológica de los distintos sistemas orgánicos y las modificaciones hormonales en cada trimestre, con la insulinorresistencia típica del tercero, favorecen la aparición de diabetes mellitus gestacional (DMG) y otras patologías durante la gesta. Aproximadamente un 10% de las gestantes en nuestro país desarrolla DMG. El embarazo es un estado de hiperinsulinemia con insulinorresistencia, que puede generar aumento de marcadores inflamatorios. Se observa aterosclerosis subclínica en el curso de embarazos con DMG, sobre todo en pacientes con un índice de masa corporal (IMC) >25, siendo esto un factor de riesgo para eventos cardiovasculares a futuro. Probablemente el aumento de la íntima media carotidea existe desde antes del embarazo. Luego del parto se describe una mayor probabilidad de desarrollar DM, hipertensión y enfermedad cardiovascular, independiente del desarrollo de DM2. Debemos considerar, además, que hay un grupo de mujeres que inicia DM1 o DM2 u otro tipo de diabetes durante el embarazo. También existen otras con DM pregestacional que desconocían su condición y que se diagnostica durante el embarazo. Para la madre el diagnóstico de DMG aumenta el riesgo de hipertensión inducida por el embarazo, preeclamsia y eclampsia, así como hipertrigliceridemia. Presenta, también, mayor riesgo de cesárea y parto pretérmino. El incremento de la prevalencia de obesidad en mujeres en edad fértil, así como el aumento de la edad de las gestantes, son factores que se asocian fuertemente con el incremento de las patologías descriptas. Los procesos inflamatorios involucrados incluyen el aumento de la proteína C reactiva, y otras citoquinas. La lactancia materna se asocia con disminución del riesgo de desarrollar DM2 e hipertensión. Por lo mencionado anteriormente, la reclasificación a las 6 semanas posparto permitirá evaluar no solo el metabolismo hidrocarbonado y lipídico, sino el riesgo de desarrollar DM2 y complicaciones cardiovasculares, lo cual constituye una gran oportunidad para intervenir precozmente.

Reseña de Ana Abello Verano: Poéticas de lo fantástico en la cuentística española actual. Madrid: Iberoamericana, 2023.

Abstract Background Dyspareunia is defined as the occurrence of pain during or after sexual intercourse, which directly affects physical, sexual, and mental health. This condition can lead to depression, anxiety, and low self-esteem in women who experience it. Objectives The aim of this research was to evaluate the effectiveness of physical therapy interventions for the treatment of female dyspareunia. Design A systematic review and meta-analysis was conducted. Method Search of publications was conducted in Scopus, Medline, Pubmed, Cinahl and Web of Science. Treatment effects were defined as standardized mean difference and their 95% confidence intervals. Statistical heterogeneity was assessed using Crohan's Q test and quantified using the I2 index. Results Of the 19 articles selected, six applied multimodal physiotherapy treatments; five, electrotherapy; three, Thiele's massage; two, interdisciplinary interventions or pelvic floor muscle training; and one, extracorporeal shockwave therapy. The meta-analysis showed significant results for the variables pain and quality of life with the interventions based on electrotherapy and electrotherapy combined with pelvic floor muscle training. These interventions did not show significant results for the improvement of sexual function. Conclusions Physiotherapy techniques are effective and procedures have been identified with reliable results in improving pain and quality of life in patients with dyspareunia. One of the most important aspects is the strengthening of the perineal musculature and the application of Transcutaneous Electrical Nerve Stimulation. Furthermore, manual trigger point release therapy and Thiele massage, optimize and guarantee the reduction of pain intensity. Prospero registration CRD42021236155.

Prolyl endopeptidase-like (PREPL) deficiency (MIM#616224) is a rare congenital disorder characterised by neonatal hypotonia and feeding difficulties, growth hormone (GH) deficiency and hypergonadotropic hypogonadism. This syndrome is an autosomal recessive disease resulting from mutations in the PREPL gene (MIM#609557). Herein we report a 7-year-old female patient with biallelic mutations in PREPL (c.1528C>T in one allele and whole gene deletion in the other) with early growth impairment in infancy. GH deficiency was confirmed at 20 months of life. Recombinant GH treatment was introduced with a good response. Her clinical features were similar to those of previously reported cases. The description of new patients with PREPL deficiency syndrome is essential to better delineate the phenotypic and genotypic spectrum of the disease.

Over the last decade, Europe has experienced a sharp increase in infrastructure expenditure due to the severe and frequent natural phenomena related to climate change. Local consequences, such as habitat destruction, finite freshwater availability and food scarcity exert significant pressure on the available ecological space. Therefore, there is a growing interest in assessing risks and vulnerabilities to climate change, which has already led to a wide range of impacts on environmental systems and society, including destabilising security. Increased environmental, social, and financial damage costs are expected in the future. Many of these imminent or ongoing challenges are related to the overexploitation of resources and the energy transition, requiring a more holistic approach to encouraging new technologies, that involves a whole-of-society approach and stakeholder participation. State-of-the-art CCUS and hydrogen energy technologies, offer sustainable solutions to mitigate the current situation, allowing a reduction in carbon emissions, a transition towards a low-carbon economy, and an increased overall resilience of the international community to climate change.

ObjectiveThe aim is to examine whether the addition of Virtual Reality (VR) meditation training to a standard 8-week Mindfulness-Based Health Care Program (MBHC-VR) results in a significantly increased improvement in occupational, mental health, and psychological functioning versus MBHC-only in university students.Materials and methodsA randomized controlled clinical trial with three arms (MBHC, MBHC-VR, Control Group), four assessment time points (pre-intervention, inter-session, post-intervention, and 3-month follow-up), and mixed methodology will be proposed. University students (undergraduate, master, or doctoral) interested in participating and who meet the inclusion/exclusion criteria will be included over two years. Data will be collected from different ad hoc questionnaires, several standardized tests, and an Ecological Momentary Assessment. We will use R software to carry out descriptive analyses (univariate and bivariate), multilevel modeling, and structural equation models to respond to the proposed objective. The qualitative analysis will be carried out using the MAXQDA program and the technique of focus groups.DiscussionIt is expected that with the proposed intervention university students will learn to relate in a healthier way with their mental processes, so as to improve their occupational balance (OB) and their psychological well-being.Trial registrationClinicalTrials.gov Identifier NCT05929430.

Hepatocellular carcinoma (HCC) is one of the most common and deadly cancers worldwide and is characterized by complex molecular carcinogenesis. Neuropilins (NRPs) NRP1 and NRP2 are the receptors of multiple proteins involved in key signaling pathways associated with tumor progression. We aimed to systematically review all the available findings on their role in HCC. We searched the Scopus, Web of Science (WOS), PubMed, Cochrane and Embase databases for articles evaluating NRPs in preclinical or clinical HCC models. This study was registered in PROSPERO (CRD42022349774) and include 49 studies. Multiple cellular and molecular processes have been associated with one or both NRPs, indicating that they are potential diagnostic and prognostic biomarkers in HCC patients. Mainly NRP1 has been shown to promote tumor cell survival and progression by modulating several signaling pathways. NRPs mainly regulate angiogenesis, invasion and migration and have shown to induce invasion and metastasis. They also regulate the immune response and tumor microenvironment, showing a crucial interplay with the hypoxia response and microRNAs in HCC. Altogether, NRP1 and NRP2 are potential biomarkers and therapeutic targets, providing novel insight into the clinical landscape of HCC patients.

Abstract Background Spain as multiple other countries has been experiencing an increasing and sustained trend in the use of psychotropic medications since the mid 90s. Recent studies show public health measures implemented to control SARS-Cov2, such as mobility restrictions and the shutdown of nonessential activities increased mental suffering, even contributing to a higher number of anxiety, depression and insomnia disorders that could lead to an increase in the consumption of psychotropics. The aims were: 1) Evaluate the temporal trend in psychotropic consumption by pharmacological subgroup, sex, and age group 2) Estimate the effect of the COVID-19 pandemic in the use of psychotropic drugs. Methods We conducted a retrospective observational study, retrieving all prescriptions of anxiolytics, hypnotics and sedatives, and antidepressants dispensed in pharmacies of Asturias (Northern Spain) for Primary Care patients for the period 2018–2021. We presented the data expressed in Daily Defined Doses (DDDs) for 1000 persons/day (DHD). To estimate changes in DHDs by year and age group we conducted two multiple linear regressions (one for males and one for females) for every pharmacological subgroup studied. Changes were considered statistically significant when the regression coefficient was p

El presente trabajo recorre la historia de los corredores intérpretes de buques, agentes mediadores del comercio marítimo que desarrollaron su actividad en los puertos españoles durante la segunda mitad del siglo XIX y la primera mitad del siglo XX. Aborda los aspectos relativos a los requisitos exigidos para ejercer la profesión, su organización en colegios profesionales y los motivos que propiciaron su desaparición. También se han rescatado algunas identidades de quienes en su momento se dedicaron a esta actividad, todo ello con el fin de contribuir a la historiografía de la profesión de intérprete.

The new and unique possibilities that nanomaterials offer have greatly impacted biomedicine, from the treatment and diagnosis of diseases, to the specific and optimized delivery of therapeutic agents. Technological advances in the synthesis, characterization, standardization, and therapeutic performance of nanoparticles have enabled the approval of several nanomedicines and novel applications. Discoveries continue to rise exponentially in all disease areas, from cancer to neurodegenerative diseases. In Spain, there is a substantial net of researchers involved in the development of nanodiagnostics and nanomedicines. In this review, we summarize the state of the art of nanotechnology, focusing on nanoparticles, for the treatment of diseases in Spain (2017–2022), and give a perspective on the future trends and direction that nanomedicine research is taking.

El presente artículo analiza el bienestar socioemocional de las personas mayores en el contexto de la pandemia por COVID-19, indagando en su salud mental y bienestar psicosocial. Los resultados muestran que las personas mayores son uno de los principales grupos de riesgo de contagio en el contexto de emergencia sanitaria, viendo afectada su salud mental y bienestar psicosocial a causa de las transformaciones de los estilos de vida y las medidas de restricción social; impactando significativamente su satisfacción vital. Lo anterior, pone en evidencia la necesidad de nuevas políticas públicas intersectoriales para la intervención del SARS-CoV-2 y otras posibles emergencias socio sanitarias en la vejez.

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.

Neural differentiation, synaptic transmission, and action potential propagation depend on membrane sphingolipids, whose metabolism is tightly regulated. Mutations in the ceramide transporter CERT (CERT1), which is involved in sphingolipid biosynthesis, are associated with intellectual disability, but the pathogenic mechanism remains obscure. Here, we characterize 31 individuals with de novo missense variants in CERT1. Several variants fall into a previously uncharacterized dimeric helical domain that enables CERT homeostatic inactivation, without which sphingolipid production goes unchecked. The clinical severity reflects the degree to which CERT autoregulation is disrupted, and inhibiting CERT pharmacologically corrects morphological and motor abnormalities in a Drosophila model of the disease, which we call ceramide transporter (CerTra) syndrome. These findings uncover a central role for CERT autoregulation in the control of sphingolipid biosynthetic flux, provide unexpected insight into the structural organization of CERT, and suggest a possible therapeutic approach for patients with CerTra syndrome.

Abstract To date, trends are still a generally unknown tool on the part of companies and agents that propose consumer goods. Although in recent years its role has been changing, attracting attention, generating numerous jobs and specialized agencies in the study of foresight, continue to generate mistrust and are appreciated as a superficial element beyond a tool that can propose a clear competitive advantage within a market. This article presents a reflection that explains the process of adoption of the trends, trying to decipher its operation with the aim of improving its implementation, explaining this phenomenon from a social point of view. Resumen Hasta la fecha, las tendencias siguen siendo una herramienta generalmente desconocida por parte de las empresas y agentes que proponen bienes de consumo. Aunque en los últimos años su papel ha ido cambiando, llamando la atención, generando numerosos puestos de trabajo y agencias especializadas en el estudio de la prospectiva, siguen generando desconfianza y son apreciadas como un elemento superficial más allá de una herramienta que puede proponer una clara ventaja competitiva dentro de un mercado. Este artículo presenta una reflexión que explica el proceso de adopción de las tendencias, tratando de descifrar su funcionamiento con el objetivo de mejorar su implementación, explicando este fenómeno desde un punto de vista social.

Resumen: Objetivo: Evaluar el efecto del confinamiento por COVID-19 sobre la prescripción de benzodiacepinas según edad, sexo y zona básica de salud. Diseño: Estudio observacional longitudinal. Emplazamiento: Atención primaria. Área V de Salud del Principado de Asturias. Participantes: Mayores de 15 años a los que se prescribieron benzodiacepinas entre 2017 y 2020. Mediciones principales: Diferencia de las medias de dosis diaria definida por 1.000 habitantes (DHD) mensual de benzodiacepinas entre el periodo definido como preconfinamiento y el confinamiento. Además, se ajusta la diferencia por edad, sexo y zona básica de salud, así como por la interacción entre ellas. Resultados: La DHD media preconfinamiento fue 131,3 y 139,5 durante el confinamiento; en el análisis crudo, esta diferencia fue estadísticamente significativa (IC 95% 4,1 a 12,1). Se objetivó un aumento de DHD media en el grupo de 60-74 años (IC 95% 2,28 a 21,42) y en el de 90 años o más (IC 95% 21,31 a 40,63), así como en las mujeres (IC 95% 3,51 a 14,59). Finalmente, se observó una disminución de DHD media en las zonas básicas V11 (IC 95% -29 a -0,66) y V14 (IC 95% -54,28 a -25,04). Conclusiones: Determinados subgrupos muestran un cambio en la tendencia de dispensación de benzodiacepinas sin poder atribuirse completamente al confinamiento. Creemos que pueda existir una inercia terapéutica en la prescripción de psicofármacos, según las características biopsicosociales del paciente, que es importante detectar para evitar la medicalización de cuadros psicológicos. Abstract: Objective: To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. Design: Longitudinal observational study. Location: Primary care. Asturias (Spain) health district V. Participants: People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. Main measurements: Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. Results: DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1–12.1). There was an increase in the DHD mean in the 60–74 age group (95% CI: 2.28–21.42), in the group over 90 years old (95% CI: 21.31–40.63) and in women (95% CI: 3.51–14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. Conclusions: Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.

Introduction Previous studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury (AKI), might reduce rate and severity of AKI after surgery. However, the effects of the care bundle in broader population of patients undergoing surgery require confirmation.Methods and analysis The BigpAK-2 trial is an international, randomised, controlled, multicentre trial. The trial aims to enrol 1302 patients undergoing major surgery who are subsequently admitted to the intensive care or high dependency unit and are at high-risk for postoperative AKI as identified by urinary biomarkers (tissue inhibitor of metalloproteinases 2*insulin like growth factor binding protein 7 (TIMP-2)*IGFBP7)). Eligible patients will be randomised to receive either standard of care (control) or a KDIGO-based AKI care bundle (intervention). The primary endpoint is the incidence of moderate or severe AKI (stage 2 or 3) within 72 hours after surgery, according to the KDIGO 2012 criteria. Secondary endpoints include adherence to the KDIGO care bundle, occurrence and severity of any stage of AKI, change in biomarker values during 12 hours after initial measurement of (TIMP-2)*(IGFBP7), number of free days of mechanical ventilation and vasopressors, need for renal replacement therapy (RRT), duration of RRT, renal recovery, 30-day and 60-day mortality, intensive care unit length-of-stay and hospital length-of-stay and major adverse kidney events. An add-on study will investigate blood and urine samples from recruited patients for immunological functions and kidney damage.Ethics and dissemination The BigpAK-2 trial was approved by the Ethics Committee of the Medical Faculty of the University of Münster and subsequently by the corresponding Ethics Committee of the participating sites. A study amendment was approved subsequently. In the UK, the trial was adopted as an NIHR portfolio study. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research.Trial registration number NCT04647396.

Introduction: The COVID-19 has repercussion in the public health system of the country and in health personnel. Objective: To describe some clinical and epidemiologic characteristics of the health personnel diagnosed with COVID- 19 in a health area of Santiago de Cuba. Methods: A descriptive and retrospective study of 19 health workers of Ramón López Peña Teaching Polyclinic in Santiago de Cuba was carried out. They were diagnosed with the COVID-19 during February-April, 2021. The described variables were: age, sex, occupational category, comorbidities, infection source, symptoms and clinical course. Results: There was a prevalence of the females between 40 and 59 years (36.8 %), community source of infection (52.6 %), doctors as the most affected health staff (47.3 %) and respiratory signs (47.3 %); also, 94.7 % of the affected patients were alive when discharged from the hospital and there was only one dead patient. Conclusions: In spite of the low prevalence of the COVID-19 in the health staff, the biosecurity measures implemented in each institution to avoid new infections should be maximized.

Antecedentes: La cirugía urgente disminuyó durante la primera ola de la pandemia de COVID-19. Objetivo: Estudiar la evolución de la cirugía urgente y su relación con la gravedad de la pandemia. Método: Estudio de cohortes retrospectivo que compara los pacientes intervenidos de forma urgente durante la pandemia con un grupo control. Resultados: Se incluyeron 660 pacientes (253 en el grupo control, 67 en primera ola de la pandemia, 193 en el periodo valle y 147 en la segunda ola). La mediana del número de cirugías urgentes fue de 2 (intervalo intercuartílico: 1-3) durante el periodo control, disminuyó durante la primera ola (1/día), aumentó durante el valle (2/día) y no se modificó en la segunda ola (2/día). Las complicaciones mayores fueron más comunes durante la primera ola (22.4%). Se encontró una correlación lineal negativa entre el número de procedimientos quirúrgicos urgentes diarios y el número de ingresos hospitalarios y fallecimientos diarios por COVID-19. Conclusiones: La cirugía urgente se redujo durante la primera ola, aumentó durante el periodo valle y volvió a niveles prepandémicos durante la segunda ola. Además, la cirugía urgente se relaciona con la gravedad de la pandemia, ya que se realizaron menos cirugías urgentes durante el periodo de mayor gravedad de la pandemia.

Abstract Background The microorganisms that inhabit food processing environments (FPE) can strongly influence the associated food quality and safety. In particular, the possibility that FPE may act as a reservoir of antibiotic-resistant microorganisms, and a hotspot for the transmission of antibiotic resistance genes (ARGs) is a concern in meat processing plants. Here, we monitor microbial succession and resistome dynamics relating to FPE through a detailed analysis of a newly opened pork cutting plant over 1.5 years of activity. Results We identified a relatively restricted principal microbiota dominated by Pseudomonas during the first 2 months, while a higher taxonomic diversity, an increased representation of other taxa (e.g., Acinetobacter, Psychrobacter), and a certain degree of microbiome specialization on different surfaces was recorded later on. An increase in total abundance, alpha diversity, and β-dispersion of ARGs, which were predominantly assigned to Acinetobacter and associated with resistance to certain antimicrobials frequently used on pig farms of the region, was detected over time. Moreover, a sharp increase in the occurrence of extended-spectrum β-lactamase-producing Enterobacteriaceae and vancomycin-resistant Enterococcaceae was observed when cutting activities started. ARGs associated with resistance to β-lactams, tetracyclines, aminoglycosides, and sulphonamides frequently co-occurred, and mobile genetic elements (i.e., plasmids, integrons) and lateral gene transfer events were mainly detected at the later sampling times in drains. Conclusions The observations made suggest that pig carcasses were a source of resistant bacteria that then colonized FPE and that drains, together with some food-contact surfaces, such as equipment and table surfaces, represented a reservoir for the spread of ARGs in the meat processing facility. Video Abstract

The Hippo signaling pathway controls cell proliferation and tissue regeneration via its transcriptional effectors yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ). The canonical pathway topology is characterized by sequential phosphorylation of kinases in the cytoplasm that defines the subcellular localization of YAP and TAZ. However, the molecular mechanisms controlling the nuclear/cytoplasmic shuttling dynamics of both factors under physiological and tissue-damaging conditions are poorly understood. By implementing experimental in vitro data, partial differential equation modeling, as well as automated image analysis, we demonstrate that nuclear phosphorylation contributes to differences between YAP and TAZ localization in the nucleus and cytoplasm. Treatment of hepatocyte-derived cells with hepatotoxic acetaminophen (APAP) induces a biphasic protein phosphorylation eventually leading to nuclear protein enrichment of YAP but not TAZ. APAP-dependent regulation of nuclear/cytoplasmic YAP shuttling is not an unspecific cellular response but relies on the sequential induction of reactive oxygen species (ROS), RAC-alpha serine/threonine-protein kinase (AKT, synonym: protein kinase B), as well as elevated nuclear interaction between YAP and AKT. Mouse experiments confirm this sequence of events illustrated by the expression of ROS-, AKT-, and YAP-specific gene signatures upon APAP administration. In summary, our data illustrate the importance of nuclear processes in the regulation of Hippo pathway activity. YAP and TAZ exhibit different shuttling dynamics, which explains distinct cellular responses of both factors under physiological and tissue-damaging conditions.

Qué realidades se activan cuando abstraemos nuestra mirada y gestos de las luces de nuestra época es una cuestión que convoca las ideas que encontraremos a continuación. Dicha ignición parece poder ensayarse desde múltiples posturas: la que aquí se plantea es una navegación por las posibilidades, o vías, que le restan a un Diseño ahogado por las disposiciones del Progreso Moderno. Despojándose de determinaciones orientativas, ¿cuáles habrían de ser las materias y ocupaciones del diseño en el mundo? Nuestras actuales formas de hacer mundo, cómo entendemos y abordamos lo real, parecen imposibles de transformación. Variados son los caminos que parecen abrirse al disolver la densidad del proyecto: la tentación nostálgica, lo absoluto de la objetividad del dato, el diseño reaccionario. Sin embargo, con un escenario como el actual donde la certeza o los pronósticos quedan opacados por cuestiones tan de actualidad como la crisis política, medioambiental, o nuestra sumisión en la era de la hiperinformación, un desplazamiento de la mirada a otros territorios diferentes de los asumidos puede desvelar otras potencias. Incluso desde los lugares más insospechados -un delta colapsado, un cuento- podemos empezar a prestar atención a las sombras que se escapan por el rabillo del ojo y encontrar nuevas formas de entender cómo diseñamos. También otras espacialidades desde las que reconsiderar una nueva cultura del diseño. Ser capaces de trabajar con atención nuestro entorno dado y reconsiderar nuestro proyecto de futuro —construyendo nuevas formas de narrarnos a nosotros mismos— puede resultar en una desorientación total, una ausencia con respecto a nuestro tiempo que disuelva los límites de lo que entendemos por mundo real.

Abstract The availability of a simple, robust and non-invasive in vitro airway model would be useful to study the functionality of the cystic fibrosis transmembrane regulator (CFTR) protein and to personalize modulator therapy for cystic fibrosis (CF) patients. Our aim was to validate a CFTR functional study using nasospheroids, a patient-derived nasal cell 3D-culture. We performed live-cell experiments in nasospheroids obtained from wild-type individuals and CF patients with different genotypes and phenotypes. We extended the existing method and expanded the analysis to upgrade measurements of CFTR activity using forskolin-induced shrinking. We also tested modulator drugs in CF samples. Immobilizing suspended-nasospheroids provided a high number of samples for live-cell imaging. The diversity observed in basal sizes of nasospheroids did not affect the functional analysis of CFTR. Statistical analysis with our method was simple, making this protocol easy to reproduce. Moreover, we implemented the measurement of inner fluid reservoir areas to further differentiate CFTR functionality. In summary, this rapid methodology is helpful to analyse response to modulators in CF samples to allow individualized treatment for CF patients.

Pediatric neurological tumors are a heterogeneous group of cancers, many of which carry a poor prognosis and lack a “standard of care” therapy. While they have similar anatomic locations, pediatric neurological tumors harbor specific molecular signatures that distinguish them from adult brain and other neurological cancers. Recent advances through the application of genetics and imaging tools have reshaped the molecular classification and treatment of pediatric neurological tumors, specifically considering the molecular alterations involved. A multidisciplinary effort is ongoing to develop new therapeutic strategies for these tumors, employing innovative and established approaches. Strikingly, there is increasing evidence that lipid metabolism is altered during the development of these types of tumors. Thus, in addition to targeted therapies focusing on classical oncogenes, new treatments are being developed based on a broad spectrum of strategies, ranging from vaccines to viral vectors, and melitherapy. This work reviews the current therapeutic landscape for pediatric brain tumors, considering new emerging treatments and ongoing clinical trials. In addition, the role of lipid metabolism in these neoplasms and its relevance for the development of novel therapies are discussed.

Objectives: The course of progressive liver damage after achieving sustained virological response (SVR) with direct-acting antivirals (DAAs) remains undetermined. We aimed to determine risk factors associated with the development of liver-related events (LREs) after SVR, focusing on the utility of non-invasive markers. Methods: An observational, retrospective study that included patients with advanced chronic liver disease (ACLD) caused by hepatitis C virus (HCV), who achieved SVR with DAAs between 2014 and 2017. Patients were followed-up until December 2020. LREs were defined as the development of portal hypertension decompensation and the occurrence of hepatocellular carcinoma (HCC). Serological markers of fibrosis were calculated before treatment and one and two years after SVR. Results: The study included 321 patients, with a median follow-up of 48 months. LREs occurred in 13.7% of patients (10% portal hypertension decompensation and 3.7% HCC). Child–Pugh [HR 4.13 (CI 95% 1.74; 9.81)], baseline FIB-4 [HR 1.12 (CI 95% 1.03; 1.21)], FIB-4 one year post-SVR [HR 1.31 (CI 95% 1.15; 1.48)] and FIB-4 two years post-SVR [HR 1.42 (CI 95% 1.23; 1.64)] were associated with portal hypertension decompensation. Older age, genotype 3, diabetes mellitus and FIB-4 before and after SVR were associated with the development of HCC. FIB-4 cut-off values one and two years post-SVR to predict portal hypertension decompensation were 2.03 and 2.21, respectively, and to predict HCC were 2.42 and 2.70, respectively. Conclusions: HCV patients with ACLD remain at risk of developing liver complications after having achieved SVR. FIB-4 evaluation before and after SVR may help to predict this risk, selecting patients who will benefit from surveillance.

MAMLD1 (X chromosome) is one of the recognized genes related to different sex development. It is expressed in testis and ovaries and seems to be involved in fetal sex development and in adult reproductive function, including testosterone biosynthesis. However, its exact role remains unclear. Over 40 genetic variants have been described, mainly in male individuals and mostly associated with hypospadias. Although MAMLD1 has been shown to regulate the expression of the steroidogenic pathway, patients with MAMLD1 variants mostly show normal gonadal function and normal testosterone levels. Here we describe a patient (46,XY) with hypospadias and microphallus, with low testosterone and dihydrotestosterone (DHT) levels, and with inappropriately low values of luteinizing hormone (LH) during minipuberty. This hormonal pattern was suggestive of partial hypogonadotropic hypogonadism. A stimulation test with hCG (4 months) showed no significant increase in both testosterone and dihydrotestosterone concentrations. At 5 months of age, he was treated with intramuscular testosterone, and the penis length increased to 3.5 cm. The treatment was stopped at 6 months of age. Our gonadal function massive-sequencing panel detected a previously unreported nonsense variant in the MAMLD1 gene (c.1738C>T:p.Gln580Ter), which was classified as pathogenic. This MAMLD1 variant, predicting a truncated protein, could explain his genital phenotype. His hormonal profile (low testosterone, dihydrotestosterone, and LH concentrations) together with no significant increase of testosterone and DHT plasma concentrations (hCG test) highlight the potential role of this gene in the biosynthesis of testosterone during the fetal stage and minipuberty of the infant. Besides this, the LH values may suggest an involvement of MAMLD1 in the LH axis or a possible oligogenesis. It is the first time that a decrease in DHT has been described in a patient with an abnormal MAMLD1.

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Introducción: La lepra es una enfermedad infectocontagiosa crónica, producida por el Mycobacterium leprae, y constituye uno de los males más antiguos de la humanidad. Objetivo: Describir algunas características clínicas y epidemiológicas de los pacientes con lepra pertenecientes al Policlínico Docente Ramón López Peña de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo de los 11 pacientes diagnosticados con la enfermedad de Hansen en la mencionada área de salud en el período 2005-2019. Para el procesamiento de la información se creó una base de datos mediante el sistema SPSS, versión 11.5 para Windows, donde se tabularon los datos de las encuestas. El análisis de los resultados se expresó en números absolutos y porcentajes para su mejor interpretación. Resultados: Predominaron el grupo etario de 35-44 años (54,5 %), el sexo masculino (54,6 %) y la lepra dimorfa, en su forma clínica multibacilar. La mayoría de los pacientes fueron diagnosticados precozmente y solo se observó algún grado de discapacidad en los diagnósticos tardíos; asimismo, las condiciones higiénicas desfavorables y el hacinamiento fueron los factores de riesgo de mayor relevancia. Conclusiones: A pesar de la existencia de pacientes con lepra en dicha área de salud, se observó un período de silencio epidemiológico, que unido a los factores de riesgo presentes, aumenta la posibilidad de contagio y pone en peligro los objetivos establecidos para su erradicación.

En este artículo coral, las autoras analizan el rol de la diáspora, territorio y raza en la colonialidad canaria desde la mirada de un feminismo descolonial interseccional canario. Con su análisis y reflexión, las autoras contribuyen a la construcción de una genealogía de experiencias como mujeres canarias, alimentando su propio proceso emancipador de auto- descolonización y facilitando la descolonización del territorio y cuerpos canarios, tanto en las Islas como en la diáspora canaria. Asimismo, el texto aporta una meta-reflexión sobre el feminismo descolonial canario e interroga sobre materialidades como el cuerpo y la tierra. Además de contribuir a la descolonización canaria, este texto enriquece el corpus de estudios descoloniales, al ser la compleja colonialidad canaria una realidad aún poco estudiada.

Abstract Background and Aims During the first peak of the COVID‐19 pandemic, the Preventive Medicine Department and the Occupational Health Department at Hospital Clinic de Barcelona (HCB), a large Spanish referral hospital, developed an innovative comprehensive SARS‐CoV2 Surveillance and Control System (CoSy‐19) in order to preserve patients' and health care workers' (HCWs) safety. We aim to describe the CoSy‐19 and to assess the impact in the number of contacts that new cases generated along this time. Methods Observational descriptive study of the findings of the activity of contact tracing of all cases received at the HCB during the first peak of COVID‐19 in Spain (February 25th‐May 3rd, 2020). Results A team of 204 professionals and volunteers performed 384 in‐hospital contact‐tracing studies which generated contacts, detecting 298 transmission chains which suggested preventive measures, generated around 22 000 follow‐ups and more than 30 000 days of work leave. The number of contacts that new cases generated decreased during the study period. Conclusion Coordination between Preventive Medicine and Occupational Health departments and agile information systems were necessary to preserve non‐COVID activity and workers safety.

The poor prognosis of most cases of advanced cholangiocarcinoma (CCA) constitutes a severe problem in modern oncology, which is aggravated by the fact that the incidence of this liver cancer is increasing worldwide and is often diagnosed late, when surgical removal is not feasible. The difficulty of dealing with this deadly tumor is augmented by the heterogeneity of CCA subtypes and the complexity of mechanisms involved in enhanced proliferation, apoptosis avoidance, chemoresistance, invasiveness, and metastasis that characterize CCA. Among the regulatory processes implicated in developing these malignant traits, the Wnt/β-catenin pathway plays a pivotal role. Alteration of β-catenin expression and subcellular localization has been associated with worse outcomes in some CCA subtypes. This heterogeneity, which also affects cellular and in vivo models commonly used to study CCA biology and anticancer drug development, must be taken into account for CCA investigation to more accurately extrapolate basic laboratory research to the clinical situation. A better understanding of the altered Wnt/β-catenin pathway in relationship with the heterogeneous forms of CCA is mandatory for developing novel diagnostic tools and therapeutic strategies for patients suffering from this lethal disease.

Cell proliferation in pancreatic cancer is determined by a complex network of signaling pathways. Despite the extensive understanding of these protein-mediated signaling processes, there are no significant drug discoveries that could considerably improve a patient’s survival. However, the recent understanding of lipid-mediated signaling gives a new perspective on the control of the physiological state of pancreatic cells. Lipid signaling plays a major role in the induction of cytocidal autophagy and can be exploited using synthetic lipids to induce cell death in pancreatic cancer cells. In this work, we studied the activity of a synthetic lipid, tri-2-hydroxyarachidonein (TGM4), which is a triacylglycerol mimetic that contains three acyl moieties with four double bonds each, on cellular and in vivo models of pancreatic cancer. We demonstrated that TGM4 inhibited proliferation of Mia-PaCa-2 (human pancreatic carcinoma) and PANC-1 (human pancreatic carcinoma of ductal cells) in in vitro models and in an in vivo xenograft model of Mia-PaCa-2 cells. In vitro studies demonstrated that TGM4 induced cell growth inhibition paralleled with an increased expression of PARP and CHOP proteins together with the presence of sub-G0 cell cycle events, indicating cell death. This cytocidal effect was associated with elevated ER stress or autophagy markers such as BIP, LC3B, and DHFR. In addition, TGM4 activated peroxisome proliferator-activated receptor gamma (PPAR-γ), which induced elevated levels of p-AKT and downregulation of p-c-Jun. We conclude that TGM4 induced pancreatic cell death by activation of cytocidal autophagy. This work highlights the importance of lipid signaling in cancer and the use of synthetic lipid structures as novel and potential approaches to treat pancreatic cancer and other neoplasias.

Reseña

Abstract Background Leaf senescence is a complex process, controlled by multiple genetic and environmental variables. In sunflower, leaf senescence is triggered abruptly following anthesis thereby limiting the capacity of plants to keep their green leaf area during grain filling, which subsequently has a strong impact on crop yield. Recently, we performed a selection of contrasting sunflower inbred lines for the progress of leaf senescence through a physiological, cytological and molecular approach. Here we present a large scale transcriptomic analysis using RNA-seq and its integration with metabolic profiles for two contrasting sunflower inbred lines, R453 and B481–6 (early and delayed senescence respectively), with the aim of identifying metabolic pathways associated to leaf senescence. Results Gene expression profiles revealed a higher number of differentially expressed genes, as well as, higher expression levels in R453, providing evidence for early activation of the senescence program in this line. Metabolic pathways associated with sugars and nutrient recycling were differentially regulated between the lines. Additionally, we identified transcription factors acting as hubs in the co-expression networks; some previously reported as senescence-associated genes in model species but many are novel candidate genes. Conclusions Understanding the onset and the progress of the senescence process in crops and the identification of these new candidate genes will likely prove highly useful for different management strategies to mitigate the impact of senescence on crop yield. Functional characterization of candidate genes will help to develop molecular tools for biotechnological applications in breeding crop yield.

Introducción: Las enfermedades transmitidas por Aedes aegypti, causan grandes impactos en la salud pública, considerándose que la sexta parte de la humanidad se ve afectada por una o más enfermedades de transmisión vectorial. Objetivo: Evaluar la efectividad de una estrategia de intervención durante la fase intensiva contra el Aedes aegypti. Método: Se realizó un estudio de intervención en el Policlínico Ramón López Peña, del municipio y provincia de Santiago de Cuba, durante el período de agosto a septiembre de 2019. El universo de trabajo fueron los 3 consejos populares del área de salud. Inicialmente se estudió el comportamiento de los indicadores entomológicos y de vigilancia clínica. Se diseñaron e implementaron las acciones contenidas en la estrategia y posteriormente para la evaluación final, se evaluaron los mismos indicadores. Resultados: El índice casa disminuyó a 0,5%. El índice de Breteaux se mantiene por encima del índice casa, pero con muy poca diferencia. El porciento de manzanas positivas y reiterativas disminuyó a 36,9% y 25%, respectivamente. Hubo un aumento considerable de febriles, ingresos y monosueros realizados; y una disminución de la reactividad y el número de casos confirmados. Conclusiones: Se logró una disminución de los niveles de infestación por el Aedes aegypti y un comportamiento positivo de los principales indicadores del programa, a punto de partida de la aplicación de acciones integradas, intersectoriales y con la participación de la comunidad. Palabras clave: dengue, Aedes aegypti, estrategia, intervención

Background: The relationship between children's sleep and health has been widely examined; however, research focused on the link between sleep and sensory reactivity in children without medical conditions is relatively new and based on studies with small samples. Hence, we aimed at exploring the association between sleep duration and quality and prevalence of sensory reactivity in a population-based sample of children aged 3–7.Methods: We examined data on 579 school-age children from the InProS project, a cross-sectional population-based study. Children's sleep duration was classified as

Introduction: the mechanisms that are suggested as determinant in the vulnerability of patients with heart failure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and which cause the respiratory syndrome labeled COVID-19 (Coronavirus Infectious Disease-19), has revealed controversial. Objective: to gather information on the pathophysiological features of acute heart failure in the context of COVID-19. Method: concerning this topic, from September to November 2020 at the Policlínico Comunitario “Ramón López Peña” in Santiago de Cuba, a narrative review was carried out. The search was conducted checking the databases Pubmed, Infomed and SciELO, without date restriction, and in Spanish and English language. Development: the mechanisms involved on the pathophysiological features of heart failure in patients with this infectious disease revealed uncertainty. Myocardial damage is achievement of two aspects, the direct effect of viral respiratory infection on the myocyte, which is expressed as a local inflammatory response, and the heart participation as a target organ to the systemic and inappropriate inflammatory response, generated by a marked cytokines release. The last aspect referred also causes endothelial damage that triggers thromboembolic and ischemic complications, systolic and diastolic dysfunction of the heart, and ultimately leads to multiorgan system failure. Conclusions: despite the advances in understanding the etiopathogenesis of this disease, the pathophysiological mechanisms that determine on the heart failure still require to be precisely clarified, although the influence of the inappropriate inflammatory response, induced by cytokines, it is recognized in the onset myocardial damage.