Fauna e industria sobre materia dura de origen animal del lugar sagrado de la Cultura de las Motillas: Castillejo del Bonete (Terrinches, Ciudad Real).

En los últimos años revistas científicas han publicado diversos estudios (cerámica, metal, material lítico, etc.) sobre Castillejo del Bonete. Este trabajo presenta datos inéditos sobre la industria ósea, micro y macromamíferos encontrados en este yacimiento. La industria elaborada sobre materia dura de origen animal está constituida principalmente por piezas elaboradas con hueso, asta o dientes, que fueron utilizados como medios de producción o complementos para vestir y adornar a los difuntos, o tallar ídolos. El estudio de los micromamíferos aporta información sobre el final del uso de estos túmulos, así como sobre aspectos ambientales. Los perfiles de mortalidad de los grandes mamíferos sugieren una explotación mixta, tanto de productos primarios (carne) y secundarios (leche, lana y posibles animales de carga o tracción) en el caso de los ovicaprinos, bovinos y cerdos. Las piezas arqueológicas depositadas aquí fueron puestas al servicio de un ritual creado en torno a los ancestros y a un culto solar desde el Calcolítico hasta la Edad del Bronce. Se aportan dos nuevas dataciones radiocarbónicas del yacimiento. La primera está obtenida de una vértebra de ovicaprino, que marca el momento de monumentalización de la cueva utilizada como cámara funeraria, mediante la construcción del Gran Túmulo 1. La segunda permite datar el momento de uso del Túmulo 2. In recent years, scientific journals have published several studies (ceramics, metal, lithic material, etc.) on Castillejo del Bonete. This work presents unpublished data on the bone industry, small and large mammals found in this site. Bone artifacts are mainly made up of from bone, antler or teeth, which were used as tools for production or accessories to dress and adorn the deceased, or to make idols. The study of small mammals provides information on the end of the use of these burial mounds, as well as on environmental aspects. The mortality profiles of big domestic mammals (ovicaprines, bovines and pigs) suggest a mixed exploitation, such primary (meat) as secondary (milk, wool and probably traction use) products The archaeological pieces depos‑ ited here were put at the service of a ritual created around the ancestors and a solar cult from the Chalcolithic until the Bronze Age. Two new radiocarbon dates of the site are provided, one of them obtained from an ovi‑ caprine vertebra, which marks the moment of monumentalization of the cave used as a burial chamber, through the construction of the Great Mound 1. The second one allows to date the time of use of the Tumulus 2

Experience in the Management of Patients Diagnosed with Esophageal Atresia and its Postsurgical Complications in the Neonatal Intensive Care Unit

Introducción: la atresia esofágica (AE) tiene una incidencia estimada de 1 en 3000-4500 nacidos vivos, con mayor frecuencia en recién nacidos prematuros. La etiología es multifactorial y genética. El diagnóstico prenatal es crucial, y su confirmación postnatal se realiza clínicamente y mediante estudios de imagen. El tratamiento es quirúrgico, con tasas de supervivencia del 90%. Se asocia con síndromes como VACTERL o CHARGE. Materiales y Métodos: estudio descriptivo, observacional, transversal y retrospectivo, realizado en pacientes con AE admitidos en una unidad neonatal de enero de 2016 a enero de 2021. Se emplearon métodos de estadística descriptiva y el software SPSS para el análisis de los datos. Resultados: se analizaron 40 expedientes. El 95% presentó AE tipo III. El 10% tuvo asociación VACTERL. Las complicaciones postquirúrgicas incluyeron neumonía (57.5%) y traqueomalacia (30%). La mortalidad fue del 5%. Discusión: los resultados concuerdan con la literatura respecto a incidencia, tipos de AE y asociaciones. Las complicaciones postquirúrgicas son similares, destacando la neumonía. Se destaca la importancia del diagnóstico prenatal para mejorar la gestión y reducir la morbimortalidad. La clasificación pronóstica es útil para estratificar riesgos. Conclusión: este estudio contribuye a la comprensión de la AE y destaca la necesidad de una gestión multidisciplinaria para mejorar los resultados a largo plazo.Introduction: Esophageal atresia (EA) has an estimated incidence of 1 in 3000-4500 live births, with a higher frequency in premature newborns. The etiology is multifactorial and genetic. Prenatal diagnosis is crucial, and postnatal confirmation is done clinically and through imaging studies. The treatment is surgical, with survival rates of 90%. It is associated with syndromes such as VACTERL or CHARGE. Materials and Methods: Descriptive, observational, cross-sectional, and retrospective study conducted on patients with EA admitted to a neonatal unit from January 2016 to January 2021. Descriptive statistical methods and the SPSS software were used for data analysis. Results: 40 records were analyzed. 95% had type III EA. 10% had VACTERL association. Post-surgical complications included pneumonia (57.5%) and tracheomalacia (30%). Mortality was 5%. Discussion: Results align with the literature regarding incidence, types of EA, and associations. Post-surgical complications are similar, with pneumonia being noteworthy. The importance of prenatal diagnosis is emphasized to enhance management and reduce morbidity and mortality. Prognostic classification is useful for risk stratification. Conclusion: This study contributes to understanding EA and emphasizes the need for multidisciplinary management to improve long-term outcomes

A Simple Frailty Score Predicts Survival and Early Mortality in Systemic AL Amyloidosis

Systemic AL amyloidosis is a challenging disease for which many patients are considered frail in daily clinical practice. However, no study has so far addressed frailty and its impact on the outcome of these patients. We built a simple score to predict mortality based on three frailty-associated variables: age, ECOG performance status (<2 vs. ≥2) and NT-proBNP (<8500 vs. ≥8500 ng/L). Four-hundred and sixteen consecutive newly diagnosed patients diagnosed at ten sites from the Spanish Myeloma Group were eligible for the study. The score was developed in a derivation cohort from a referral center, and it was externally validated in a multicenter cohort. Multivariate analysis showed that the three variables were independent predictors of survival. The score was able to discriminate four groups of patients in terms of overall survival and early mortality in both cohorts. Comorbidity was also analyzed with the Charlson comorbidity index, but it did not reach statistical significance in the model. A nomogram was created to easily estimate the mortality risk of each patient at each time point. This score is a simple, robust, and efficient approach to dynamically assess frailty-dependent mortality both at diagnosis and throughout follow-up. The optimal treatment for frail AL amyloidosis patients remains to be determined but we suggest that the estimation of frailty-associated risk could complement current staging systems, adding value in clinical decision-making in this complex scenario.Peer reviewe

Çédille, revista de estudios franceses

Presentació

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

La Cuba que quisimos. La nueva constitución cubana de 2019: debates en Cuba posible sobre su formulación, anteproyectos y proyecto final.

La Cuba que quisimos recoge un grupo sustancial de los debates y propuestas promovidos por el Laboratorio de Ideas Cuba Posible, al calor de la reforma constitucional anunciada por el Gobierno cubano el 2 de junio de 2018, y que finalmente se cristalizó en una nueva Constitución en 2019. Cuba Posible fue el espacio nacional que con mayor intensidad y sistematicidad acompañó la reforma. El libro se constituye en una pieza fundamental para todos aquellos interesados en el antes, durante y después del proceso constitucional desde una perspectiva democrática e incluyente

Risk Factors and Mortality of COVID-19 in Patients With Lymphoma: A Multicenter Study

Patients with cancer are poorly represented in coronavirus disease 2019 (COVID-19) series, and heterogeneous series concerning hematology patients have been published. This study aimed to analyze the impact of COVID-19 in patients with lymphoma. We present a multicenter retrospective study from 19 centers in Madrid, Spain, evaluating risk factors for mortality in adult patients with COVID-19 and lymphoma. About 177 patients (55.9% male) were included with a median follow-up of 27 days and a median age of 70 years. At the time of COVID-19 diagnosis, 49.7% of patients were on active treatment. The overall mortality rate was 34.5%. Age >70 years, confusion, urea concentration, respiratory rate, blood pressure, and age >65 score ≥2, heart disease, and chronic kidney disease were associated with higher mortality risk (P < 0.05). Active disease significantly increased the risk of death (hazard ratio, 2.43; 95% confidence interval, 1.23-4.77; P = 0.01). However, active treatment did not modify mortality risk and no differences were found between the different therapeutic regimens. The persistence of severe acute respiratory syndrome coronavirus 2-positive polymerase chain reaction after week 6 was significantly associated with mortality (54.5% versus 1.4%; P < 0.001). We confirm an increased mortality compared with the general population. In view of our results, any interruption or delay in the start of treatment should be questioned given that active treatment has not been demonstrated to increase mortality risk and that achieving disease remission could lead to better outcomes

La importancia de conocer el idioma

Este proyecto consiste en mejorar el uso cotidiano de la lengua castellana, abordándola desde el vocabulario, la ortografía y la compresión lectora en las distintas asignaturas. Para dar mayor globalidad al ejercicio, se trabaja también estos factores en otros idiomas como el inglés y el francés. Los objetivos son desarrollar un vocabulario adecuado a las distintas materias; escribir correctamente; trabajar la comprensión de los textos; aumentar la cohesión y la coordinación entre alumnos y profesores; fomentar la utilización de distintos métodos de enseñanza-aprendizaje; fomentar el interés con actividades motivadoras e innovadoras en la enseñanza curricular; y potenciar el trabajo en grupo e individual. Las actividades llevadas a la práctica son acordes a la edad y a los objetivos propuestos. Se elaboran listados de palabras de ortografía dudosa, se trabajan textos para acceder a su comprensión, se hacen concursos de ortografía, se cuelgan carteles por pasillos y aulas con palabras significativas, se fabrican tarjetas para jugar-aprendiendo en clases y tutorías, y se utilizan programas de ordenador que refuerzan el aprendizaje de vocabulario y ortografía. La metodología pone en activo tanto a profesores como a alumnos. Los primeros se encargan de hacer los listados de palabras y de preparar y dar formato a las pruebas eliminatorias del concurso. Los alumnos se encargan de buscar la información necesaria para definir las palabras, hacer los carteles y exponer las conclusiones. La evaluación consiste principalmente en reuniones de profesores que analizan el desarrollo del proyecto, exponen las dificultades encontradas y establecen modificaciones y correcciones en relación a los ejercicios. Como anexo se presentan dos CD-ROM con las actividades realizadas..Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Mejora de la Calidad de la EnseñanzaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES