Abordaje de la insuficiencia cardiaca amiloidótica desde la pluripatología

A 88-year-old patient with personal clinical record of heart failure with left ventricular hypertrophy preserved ejection fraction and paroxysmal atrial flutter, is admitted due to a right heart failure, being diagnosed of natural transthyretin cardial amyloidosis. We approach the diagnostic process and its implications under the view of pluripathology which allows us to maintain the balance between nihilism and obstinacy upon the advances of the disease.  Paciente de 88 años con antecedentes de insuficiencia cardíaca, hipertrofia ventricular izquierda con fracción de eyección preservada y flutter auricular paroxístico. Ingresó por insuficiencia cardíaca de predominio derecho, siendo diagnosticada finalmente de amiloidosis cardíaca por transtiretina natural. Abordamos el proceso diagnóstico y las implicaciones del mismo desde una visión global e integradora que nos permite mantener el equilibrio entre el nihilismo y la obstinación ante los avances que se están produciendo en esta enfermedad

Evaluación y selección de recursos web: una propuesta de calidad para la sección de referencia de la Biblioteca Universitaria de León

Se propone un método de evaluación para medir la calidad de los recursos web de referencia (diccionarios y enciclopedias) que la Biblioteca Universitaria de León ofrece en su apartado “Recursos en Internet”, dentro de la Biblioteca digital. El proyecto planteado por el Grupo de Trabajo de Recursos Electrónicos de la biblioteca, consiste en evaluar todos los recursos web incluidos en cada una de las categorías, siguiendo unos parámetros concretos, para determinar su grado de adecuación. Los resultados obtenidos tras la evaluación, nos ayudarán a seleccionar, entre la lista propuesta en un principio, aquellos materiales de referencia en formato electrónico, que sean más útiles para la comunidad universitaria, desechar aquellos que no alcancen la nota mínima exigida y recomendar otros que cumplan al cien por cien los parámetros expuesto

Evaluación y selección de recursos web: Una propuesta de calidad para la sección de referencia de la Biblioteca Universitaria de León

The purpose of this paper is to propose an evaluation method for measuring the quality of World Wide web reference resources (dictionaries and encyclopaedias) that Library of University of León make available through its Digital Library under the heading of “Resources on the internet”. The project, undertaken by the Library Working Group on Electronic Resources, consists on evaluating all web resources included in each of the mentioned categories in order to determine their suitability. The results obtained after the quality assessment, will help us to select, among the list of proposals submitted at the beginning, those electronic reference resources that are more useful for the university community members, discarding those which fail to achieve the scoring proposed and recommending other that fulfill the parameters outlined.Se propone un método de evaluación para medir la calidad de los recursos web de referencia (diccionarios y enciclopedias) que la Biblioteca Universitaria de León ofrece en su apartado “Recursos en Internet”, dentro de la Biblioteca digital. El proyecto planteado por el Grupo de Trabajo de Recursos Electrónicos de la biblioteca, consiste en evaluar todos los recursos web incluidos en cada una de las categorías, siguiendo unos parámetros concretos, para determinar su grado de adecuación. Los resultados obtenidos tras la evaluación, nos ayudarán a seleccionar, entre la lista propuesta en un principio, aquellos materiales de referencia en formato electrónico, que sean más útiles para la comunidad universitaria, desechar aquellos que no alcancen la nota mínima exigida, y recomendar otros que cumplan al cien por cien los parámetros expuestos

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evaluación y selección de recursos web: una propuesta de calidad para la sección de referencia de la Biblioteca Universitaria de León

The purpose of this paper is to propose an evaluation method for measuring the quality of World Wide Web reference resources (dictionaries and encyclopaedias) that the Library of the University of León makes available through its Digital Library under the heading “Resources on the internet”. The project undertaken by the Library Working Group on Electronic Resources, consists on evaluating all web resources included in each of the mentioned categories in order to determine their suitability. The results obtained after the quality assessment, will help us to select, among the list of proposals submitted at the beginning, those electronic reference resources more useful for the university community members, discard those which fail to achieve the scoring proposed and recommend other to meet one hundred percent with the parameters outline

¿Nuestros Grados/Másteres desarrollan competencias relacionadas con la innovación para la crisis?

Póster presentado en: VI Jornadas de Innovación Docente de la UBU, Burgos, 23 y 24 de febrero de 2012, organizadas por el Instituto de Formación e Innovación Educativa-IFIE de la Universidad de Burgo

Three-way PARAFAC decomposition of chromatographic data for the unequivocal identification and quantification of compounds in a regulatory framework

The growing demand for controls of foodstuffs, personal care products, medicines and the environment is unquestionable, as well as a better understanding of the toxicity of chemical products. This causes a growing need to propose methods of analysis for the unequivocal identification and quantification of analytes in complex samples. Several official organizations that regulate these aspects in pesticides, migrants or additives, have increased the requirements regarding the figures of merit, among others, for the unequivocal identification of the target analytes. The general recommendation is the use of the information provided by chromatographic techniques on the test sample, for example, the use of HPLC-DAD or GC-MS data. Therefore, for each sample, a data matrix formed by the response vector (absorbances or abundances) recorded at each retention time is available. A data array is obtained when the matrices corresponding to the calibration standards and the test samples are concatenated. There are several chemometric techniques with the second-order advantage that can handle data arrays, so target analytes can be identified and quantified using them even in the presence of interferents. In this work, PARAFAC has been considered as a good option. If the data array is trilinear, its analysis using PARAFAC/PARAFAC2 enables the unequivocal identification and quantification of the target analyte so that the result is valid according to the criteria imposed by the authorities. In this work, the chemometric methodology is explained through four different case studies related to the determination of analytes in complex matrices (bisphenol A migrated from polycarbonate, dichlobenil in onion, oxybenzone in sunscreen cosmetic creams and melamine migrated from melaware). This multi-way methodology solves the problems of the coelution of interferents that have a similar absorbance spectrum in HPLC-DAD (or share m/z ratios in GC-MS) with the target analyte or with the internal standard causing false-negative results with conventional identification methods. In addition, the PARAFAC decomposition of trilinear arrays enables the joint optimization of several analytical parameters (extraction, clean up, etc.) that control different sample pretreatments prior to the chromatographic determination of complex samples.Spanish MINECO (AEI/FEDER, UE) through project CTQ2017‐88894‐R and by Junta de Castilla y León through project BU012P17 (all co‐financed with European FEDER funds)

Effect of early metoprolol on infarct size in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) trial.

BACKGROUND: The effect of β-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). METHODS AND RESULTS: Patients with Killip class II or less anterior ST-segment-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). Mean ± SD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.6 ± 15.3 versus 32.0 ± 22.2 g; adjusted difference, -6.52; 95% confidence interval, -11.39 to -1.78; P=0.012). In patients with pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was -8.13 (95% confidence interval, -13.10 to -3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09-5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). CONCLUSIONS: In patients with anterior Killip class II or less ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01311700. EUDRACT number: 2010-019939-35