Mortalidad por lesiones de tránsito en adultos mayores en la República de Ecuador entre los años 1990 y 2018: estudio descriptivo

The present study aimed to estimate the trend in road traffic injury mortality in older adults (60 years of age or older) and comparison with those <60 years of age in Ecuador (1990-2018). Official death records and population projections were used to calculate mortality rates per 100,000 population, rate ratios, years of potential life lost (YPLL), and trends. Those under 60 years of age had mortality rates of 16.7 (per 100,000) compared to 36.2 (per 100,000) for older adults, with an increasing trend in YPLL. Older adults recorded fewer deaths than the younger population. However, it is necessary to develop road safety strategies oriented to the progressive aging of the Ecuadorian population. Keywords: older adults, traffic accidents, mortality, trends, Ecuador. References [1]World Health Organization (2018, May 17). Global Status Report on Road Safety 2018 [Online]. Available: https://www.who.int/violence_injury_prevention/road_safety_status/2018/en/ [2]A. F. Algora-Buenafé, M. Russo-Puga, P. R. Suasnavas-Bermúdez, P. Merino-Salazar and A. R. Gómez-García,"Tendencias de los accidentes de tránsito en Ecuador: 2000-2015", Gerencia y Políticas de Salud, vol. 16, n.º 33, pp. 52–58, noviembre de 2017. [Online]. Available: https://doi.org/10.11144/javeriana.rgps16-33.tate. [Last Access: September 2nd, 2021 ]. [3]Pan American Health Organization (2019, June 22). Status of Road Safety in the Region of the Americas [Online]. Available: http://iris.paho.org/xmlui/handle/123456789/51088. [4]S. J. Eun, "Trends in mortality from road traffic injuries in South Korea, 1983–2017: Joinpoint regression and age-period-cohort analyses", Accident Analysis &Prevention, vol. 134, p. 105325, January 2020. [Online]. Available: https://doi.org/10.1016/j.aap.2019.105325. [Last Access: September 2nd, 2021 ]. [5]S. Azami-Aghdash, M. H. Aghaei, and H. Sadeghi-Bazarghani, "Epidemiology of Road Traffic Injuries among Elderly People; A Systematic Review and Meta-Analysis", Bulletin of Emergency and Trauma, vol. 6, n.º 4, pp. 279–291, October 2018. [Online]. Available: https://doi.org/10.29252/beat-060403. [Last Access: September 7th, 2021 ]. [6]Y. Abolfathi Momtaz, R. Kargar, R. Hosseiny, and R. Sahaf, "Rate and pattern of road traffic accidents among older and younger drivers", Healthy Aging Research, vol. 7, n.º 2, June 2018, art. n.º e18. [Online]. Available: https://doi.org/10.1097/hxr.0000000000000018. [Last Access: October 13th, 2021 ]. [7]P. Martínez, D. Contreras and M. Moreno, "Safe mobility, socioeconomic inequalities, and aging: A 12-year multilevel interrupted time-series analysis of road traffic death rates in a Latin American country", PLOS ONE, vol. 15, n.º 1, enero de 2020, art. n.º e0224545. [Online]. Available: https://doi.org/10.1371/journal.pone.0224545. [Last Access: October 10th, 2021 ]. [8]G. Bergen et al., "How do older adult drivers self-regulate? Characteristics of self-regulation classes defined by latent class analysis", Journal of Safety Research, vol. 61, pp. 205–210, June 2017. [Online]. Available: https://doi.org/10.1016/j.jsr.2017.01.002. [Last Access: October 9th, 2021 ] [9]Instituto Nacional de Estadística y Censos (2018, February 2). Registros Estadísticos de Nacidos Vivos, Defunciones Fetales y Defunciones Generales [Online]. Available: https://www.ecuadorencifras.gob.ec/nacimientos_y_defunciones. [10]Instituto Nacional de Estadística y Censos (2017, August 2). Proyecciones Demográficas, 2010 – 2020. [Online]. Available: https://sni.gob.ec/proyecciones-y-estudios-demograficos. [11]W. Y. Yee, "Road traffic injuries in the elderly", Emergency Medicine Journal, vol. 23, n.º 1, pp. 42–46, January 2006. [Online]. Available: https://doi.org/10.1136/emj.2005.023754. [Last Access: October 21st, 2021] [12]L. McElroy, J. Juern, A. Bertleson, Q. Xiang, A. Szabo and J. Weigelt, "A single urban center experience with adult pedestrians struck by motor vehicles", WMJ:official publication of the State Medical Society of Wisconsin, vol. 112(3), pp. 117-122, 2013. [13]K. Bhalla, M. Naghavi, S. Shahraz, D. Bartels and C. J. L. Murray, "Building national estimates of the burden of road traffic injuries in developing countries from all available data sources: Iran", Injury Prevention, vol. 15, n.º 3, pp. 150–156, June 2009. [Online]. Available: https://doi.org/10.1136/ip.2008.020826. [Last Access: October 1st, 2021]. [14]D. Bartels, K. Bhalla, S. Shahraz, J. Abraham, R. Lozano and C. J. L. Murray, "Incidence of road injuries in Mexico: country report", International Journal of Injury Control and Safety Promotion, vol. 17, n.º 3, pp. 169–176, September 2010. [Online]. Available: https://doi.org/10.1080/17457300903564553. [Last Access: November 16th, 2021]. [15]W. R. Boot, C. Stothart and N. Charness, "Improving the Safety of Aging Road Users: A Mini-Review", Gerontology, vol. 60, n.º 1, pp. 90–96, 2014. [Online]. Available: https://doi.org/10.1159/000354212.  [Last Access: November 6th, 2021] [16]Y. L. Michael, E. P. Whitlock, J. S. Lin, R. Fu, E. A. O'Connor and R. Gold, "Primary Care–Relevant Interventions to Prevent Falling in Older Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force", Annals of Internal Medicine, vol. 153, n.º 12, p. 815, December 2010. [Online]. Available: https://doi.org/10.7326/0003-4819-153-12-201012210-00008.[Last Access: November 29th, 2021] [17]H. Etehad, S. Yousefzadeh-Chabok, A. Davoudi-Kiakalaye, D. A. Moghadam, H. Hemati and Z. Mohtasham-Amiri, "Impact of road traffic accidents on the elderly", Archives of Gerontology and Geriatrics, vol. 61, n.º 3, pp. 489–493, November de 2015. [Online]. Available: https://doi.org/10.1016/j.archger.2015.08.008. [Last Access: November 3th, 2021]. [18]B. H. Ang, W. S. Chen and S. W. H. Lee, "Global burden of road traffic accidents in older adults: A systematic review and meta-regression analysis", Archives of Gerontology and Geriatrics, vol. 72, pp. 32–38, September 2017. [Online]. Available: https://doi.org/10.1016/j.archger.2017.05.004. [Last Access: December 19th, 2021] [19]J. P. Thompson, M. R. J. Baldock and J. K. Dutschke, "Trends in the crash involvement of older drivers in Australia", Accident Analysis & Prevention, vol. 117, pp. 262–269, August 2018. [Online]. Available: https://doi.org/10.1016/j.aap.2018.04.027. [Last Access: December 16th, 2021].El presente estudio tuvo como objetivo estimar la tendencia de mortalidad por lesiones de tránsito en adultos mayores (igual o mayor a 60 años edad) y la comparación con los menores a 60 años edad en el Ecuador (1990-2018). Se emplearon los registros de defunción y proyecciones demográficas oficiales para el cálculo de tasas de mortalidad por 100 mil habitantes, razón de tasas, años de vida potencialmente perdidos (AVPP) y tendencias. Los menores a 60 años edad registraron tasas de mortalidad de 16,7 (por 100 mil) frente a 36,2 (por 100 mil) en los adultos mayores, con tendencia al aumento en los AVPP. Los adultos mayores registraron menor número de casos de fallecimientos con relación a la población más joven. Sin embargo, es necesario elaborar estrategias en seguridad vial orientadas al progresivo envejecimiento de la población ecuatoriana. Palabras Clave: Anciano, accidentes de tránsito, mortalidad, tendencias, Ecuador. Referencias [1]World Health Organization (2018, May 17). Global Status Report on Road Safety 2018 [Online]. Available: https://www.who.int/violence_injury_prevention/road_safety_status/2018/en/ [2]A. F. Algora-Buenafé, M. Russo-Puga, P. R. Suasnavas-Bermúdez, P. Merino-Salazar y A. R. Gómez-García,"Tendencias de los accidentes de tránsito en Ecuador: 2000-2015", Gerencia y Políticas de Salud, vol. 16, n.º 33, pp. 52–58, noviembre de 2017. Accedido el 2 deseptiembre de 2021. [En línea]. Disponible: https://doi.org/10.11144/javeriana.rgps16-33.tate [3]Pan American Health Organization (2019, June 22). Status of Road Safety in the Region of the Americas [Online]. Available: http://iris.paho.org/xmlui/handle/123456789/51088. [4]S. J. Eun, "Trends in mortality from road traffic injuries in South Korea, 1983–2017: Joinpoint regression and age-period-cohort analyses", Accident Analysis &Prevention, vol. 134, p. 105325, enero de 2020. Accedido el 2 de septiembre de 2021. [En línea]. Disponible: https://doi.org/10.1016/j.aap.2019.105325. [5]S. Azami-Aghdash, M. H. Aghaei y H. Sadeghi-Bazarghani, "Epidemiology of Road Traffic Injuries among Elderly People; A Systematic Review and Meta-Analysis", Bulletin of Emergency and Trauma, vol. 6, n.º 4, pp. 279–291, octubre de 2018. Accedido el 7 deseptiembre de 2021. [En línea]. Disponible: https://doi.org/10.29252/beat-060403 [6]Y. Abolfathi Momtaz, R. Kargar, R. Hosseiny y R. Sahaf, "Rate and pattern of road traffic accidents among older and younger drivers", Healthy Aging Research, vol. 7, n.º 2, junio de 2018, art. n.º e18. Accedido el 13 de octubre de 2021. [En línea]. Disponible: https://doi.org/10.1097/hxr.0000000000000018. [7]P. Martínez, D. Contreras y M. Moreno, "Safe mobility, socioeconomic inequalities, and aging: A 12-year multilevel interrupted time-series analysis of road traffic death rates in a Latin American country", PLOS ONE, vol. 15, n.º 1, enero de 2020, art. n.º e0224545. Accedido el 10 de octubre de 2021. [En línea]. Disponible: https://doi.org/10.1371/journal.pone.0224545 [8]G. Bergen et al., "How do older adult drivers self-regulate? Characteristics of self-regulation classes defined by latent class analysis", Journal of Safety Research, vol. 61, pp. 205–210, junio de 2017. Accedido el 9 de octubre de 2021. [En línea]. Disponible: https://doi.org/10.1016/j.jsr.2017.01.002. [9]Instituto Nacional de Estadística y Censos (2018, February 2). Registros Estadísticos de Nacidos Vivos, Defunciones Fetales y Defunciones Generales [Online].Available: https://www.ecuadorencifras.gob.ec/nacimientos_y_defunciones. [10]Instituto Nacional de Estadística y Censos (2017, August 2). Proyecciones Demográficas, 2010 – 2020. [Online]. Available: https://sni.gob.ec/proyecciones-y-estudios-demograficos. [11]W. Y. Yee, "Road traffic injuries in the elderly", Emergency Medicine Journal, vol. 23, n.º 1, pp. 42–46, enero de 2006. Accedido el 21 de octubre de2021. [En línea]. Disponible: https://doi.org/10.1136/emj.2005.023754. [12]L. McElroy, J. Juern, A. Bertleson, Q. Xiang, A. Szabo and J. Weigelt, "A single urban center experience with adult pedestrians struck by motor vehicles", WMJ:official publication of the State Medical Society of Wisconsin, vol. 112(3), pp. 117-122, 2013. [13]K. Bhalla, M. Naghavi, S. Shahraz, D. Bartels y C. J. L. Murray, "Building national estimates of the burden of road traffic injuries in developing countries from all available data sources: Iran", Injury Prevention, vol. 15, n.º 3, pp. 150–156, junio de 2009. Accedido el 1 de octubre de 2021. [En línea]. Disponible: https://doi.org/10.1136/ip.2008.020826. [14]D. Bartels, K. Bhalla, S. Shahraz, J. Abraham, R. Lozano y C. J. L. Murray, "Incidence of road injuries in Mexico: country report", International Journal of Injury Control and Safety Promotion, vol. 17, n.º 3, pp. 169–176, septiembre de 2010. Accedido el 16 de noviembre de 2021. [En línea]. Disponible: https://doi.org/10.1080/17457300903564553. [15]W. R. Boot, C. Stothart y N. Charness, "Improving the Safety of Aging Road Users: A Mini-Review", Gerontology, vol. 60, n.º 1, pp. 90–96, 2014. Accedido el 6 de noviembre de 2021. [En línea]. Disponible: https://doi.org/10.1159/000354212. [16]Y. L. Michael, E. P. Whitlock, J. S. Lin, R. Fu, E. A. O'Connor y R. Gold, "Primary Care–Relevant Interventions to Prevent Falling in Older Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force", Annals of Internal Medicine, vol. 153, n.º 12, p. 815, diciembre de 2010. Accedido el 29 de noviembre de 2021. [En línea]. Disponible: https://doi.org/10.7326/0003-4819-153-12-201012210-00008. [17]H. Etehad, S. Yousefzadeh-Chabok, A. Davoudi-Kiakalaye, D. A. Moghadam, H. Hemati y Z. Mohtasham-Amiri, "Impact of road traffic accidents on the elderly", Archives of Gerontology and Geriatrics, vol. 61, n.º 3, pp. 489–493, noviembre de 2015. Accedido el 3 de noviembre de 2021. [En línea]. Disponible: https://doi.org/10.1016/j.archger.2015.08.008. [18]B. H. Ang, W. S. Chen y S. W. H. Lee, "Global burden of road traffic accidents in older adults: A systematic review and meta-regression analysis", Archives of Gerontology and Geriatrics, vol. 72, pp. 32–38, septiembre de 2017. Accedido el 19 de diciembre de 2021. [En línea]. Disponible: https://doi.org/10.1016/j.archger.2017.05.004. [19]J. P. Thompson, M. R. J. Baldock y J. K. Dutschke, "Trends in the crash involvement of older drivers in Australia", Accident Analysis & Prevention, vol. 117, pp. 262–269, agosto de 2018. Accedido el 16 de diciembre de 2021. [En línea]. Disponible: https://doi.org/10.1016/j.aap.2018.04.027

Incidence and prevalence of multiple sclerosis in Spain: a systematic review

[EN] Introduction: Greater understanding of the prevalence and incidence of multiple sclerosis in Spain and their temporal trends is necessary to improve the allocation of healthcare resources and to study aetiological factors. Methods: We performed a systematic search of the MedLine database and reviewed the reference lists of the articles gathered. We collected studies reporting prevalence or incidence rates of multiple sclerosis in any geographical location in Spain, with no time limits. In 70% of cases, data were extracted by 2 researchers (FGL and EAC); any discrepancies were resolved by consensus. Results: We identified 51 prevalence and 33 incidence studies published between 1968 and 2018. In the adjusted analysis, the number of prevalent cases per 100 000 population increased by 26.6 (95% confidence interval [CI], 21.5-31.8) every 10 years. After adjusting for year and latitude, the number of incident cases per 100 000 population increased by 1.34 (95% CI, 0.98-1.69) every 10 years. We observed a trend toward higher prevalence and incidence rates at higher latitudes. Conclusions: The prevalence of multiple sclerosis in Spain has increased in recent decades, although case ascertainment appears to be incomplete in many studies. Incidence rates have also increased, but this may be due to recent improvements in the detection of new cases. [ES] Introducción: El conocimiento de la prevalencia y de la incidencia de la esclerosis múltiple en España y de sus tendencias temporales es necesario para planificar mejor los servicios clínicos y estudiar factores etiológicos. Método: Se efectuó una revisión sistemática, mediante una búsqueda en Medline y en las referencias de cada artículo, de todos los estudios que describieran cifras de prevalencia o de incidencia de la esclerosis múltiple en algún lugar geográfico de España, sin límites temporales. En el 70% de los casos la extracción de datos la hicieron dos observadores (FGL y EAC), que resolvieron las discrepancias por consenso. Resultados: Se identificaron 51 estudios de prevalencia y 33 de incidencia entre 1968 y 2018. En el análisis ajustado, por cada 10 años la prevalencia por 100 000 habitantes aumentó en 26,6 (intervalo de confianza -IC- del 95%, 21,5 a 31,8). Según los datos del análisis ajustado por el año y la latitud, por cada 10 años la incidencia por 100 000 habitantes aumentó en 1,34 (IC 95%, 0,98 a 1,69). Se observó una tendencia de mayores prevalencias e incidencias en latitudes más altas. Conclusiones: La prevalencia de la esclerosis múltiple aumentó en las últimas décadas en España, aunque en muchos estudios la verificación de casos parece haber sido incompleta. La incidencia también aumentó, pero eso puede deberse a una detección de casos nuevos más exhaustiva en los últimos años.This study has received funding from Biogen Idec, S. L.S

Health inequity in workers of Latin America and the Caribbean

Latin America and the Caribbean (LAC) is the world’s most inequitable region in terms of wealth distribution. The full scale of social inequalities in health has been hidden by the lack of reliable data. This study aimed to measure and compare health inequalities in the working population within and between 15 countries of LAC

Comparison of micrometeorological techinques for estimating ammonia emission from covered slurry storage and land spreading of cattle slurry

The micrometeorological mass-balance integrated horizontal flux (IHF) technique has been commonly employed for measuring ammonia (NH3) emissions inon-field experiments. However, the inverse-dispersion modeling technique, such as the backward Lagrangian stochastic (bLS) modeling approach, is currently highlighted as offering flexibility in plot design and requiring a minimum number of samplers (Ro et al., 2013). The objective of this study was to make a comparison between the bLS technique with the IHF technique for estimating NH3 emission from flexible bag storage and following landspreading of dairy cattle slurry. Moreover, considering that NH3 emission in storage could have been non uniform, the effect on bLS estimates of a single point and multiple downwind concentration measurements was tested, as proposed by Sanz et al. (2010)

Mechanical Stimulation of Cells Through Scaffold Design for Tissue Engineering

Tissue engineering scaffolds attempt to mimic the stem cell environment by creating different biophysical and chemical signals. On the other hand, stem cells are able to sense these characteristics and change their destiny. Scientists try to explain these phenomena through scaffold design and in vitro experiments, but the mechanisms implicated remain unclear. Moreover, environment-cell interactions are a key process to get organs and tissues arrangement. Therefore, this chapter deals with the mechanical signals and mechanism involved in cell behaviour through scaffolds as a strategy in tissue engineering

Occupational safety and health in Ecuador

Background: The occupational safety and health diagnostic (OSH) constitutes a first step for the design of national programs and ongoing reviews of existing regulations.  The OSH diagnostic performed in Ecuador in 2011 is devastating due to the high labor accidents toll, the scarce official information, lack of high-level academic education, and insufficient research. Objective: To diagnose the current state of occupational safety and health in Ecuador from official sources of information. Methods: We examined the geographical situation, sociodemographic and public health data, legal regulations, statistics on occupational accidents and diseases, training and research on OSH in Ecuador between 2010 to 2015. The main sources of data and information were: national laws and regulations on OSH, conventions of the International Labor Organization, resolutions of the Andean Community of Nations, and official web pages of national public bodies. In addition, we analyzed the scientific production on OSH of authors with Ecuadorian affiliation, carried out in Ecuador, and published in journals indexed in the main scientific databases. Results: In Ecuador, the rate of employment is 94,3%, and 40% is recognized as adequate employment. The percentage of the working population covered by the social security has raised during the period of study, but it remains around 42% of this population. The country has ratified the 32 ILO OSH conventions and has adopted regional regulatory instruments. The national OSH legal body starts with the Constitution. A total of 99.156 occupational injuries and 2.733 occupational were notified, showing a significant increase from 2010 to 2015. Regarding fatal occupational accidents, 1.524 cases were notified. Training in OSH is focused on occupational risk prevention. Twelve scientific articles on OSH from authors of Ecuadorian affiliation and developed in a national context were identified. Conclusions: OSH status in Ecuador faces a persistent high toll of informal workers, an aging working population, an increase of work accidents, a scarce scientific evidence and an outdated legislation. The design of a OSH National Plan should become a priority in order to improve working conditions and health in Ecuador

Intervención psicosocial preventiva de estrés laboral y abuso en el consumo de alcohol en una empresa venezolana

  A descriptive, longitudinal, field and correlational investigation was carried out in the working population of a Venezuelan company. In order to prevent, through psychosocial intervention, negative effects generated by work stress and alcohol consumption abuse. The sample consisted of 127 workers from the operational area, who were given the questionnaire from the Universidad Astral de Chile for work stress and the AUDIT test. 29 workers with occupational stress and 43 with alcohol consumption abuse were identified, from which, only 11 exhibited both variables simultaneously, a sine qua non condition to perform the intervention. Therefore, the CoPsoQ 21 questionnaire was applied and the intervention was performed using expository methods as well as group and individual discussion with the relevant monitoring and observation. Once the intervention was completed, the corresponding impact on the workers was evaluated. Data were analyzed by using descriptive statistics. In conclusion, the level of work stress was reduced as the dimensions of emotional exhaustion and depersonalization continued at the low level and the personal achievement dimension was at the middle level. Regarding alcohol abuse, there was a reduction in the consumption of risk and harmful consumption. Likewise, CoPsoQ istas 21 showed that the dimensions of psychosocial requirements and double presence were within the most favorable level for health, the compensation dimension at the intermediate level and the rest of the dimensions social support in the company and quality of leadership and work active and professional development possibilities showed a more unfavorable level for health. The relationship between the variables labor stress and alcohol consumption was determined with the Spearman coefficient, whose results brought up 0.21, showing a direct, weak and positive relationship.Key words:  stress, work stress, alcohol abuse, alcohol dependency.  Con el objetivo de prevenir, mediante intervención psicosocial, efectos negativos generados por el Estrés Laboral y los Trastornos por el Consumo de Alcohol, se realizó investigación descriptiva, longitudinal, de campo y correlacional en una empresa venezolana. La muestra estuvo constituida por 127 trabajadores del área operativa, a quienes se les aplicó el cuestionario de la Universidad Astral de Chile para Estrés Laboral y el test AUDIT para Consumo de Alcohol. Se identificaron 29 trabajadores con Estrés Laboral y 43 con trastornos por Consumo de Alcohol, respectivamente, de los que solo 11 exhibieron simultáneamente ambas variables, condición sine qua non para ejecutar la intervención. Además, a estos 11 trabajadores se les aplico el cuestionario CoPsoQ istas 21 y se realizó la intervención previa validación de expertos en el área, utilizando métodos expositivos y de discusión grupal e individual con la pertinente vigilancia y observación. Posteriormente, se evaluó el impacto correspondiente en los trabajadores. Los datos obtenidos se analizaron mediante la estadística descriptiva. En conclusión, el nivel de Estrés Laboral se redujo por cuanto las dimensiones Agotamiento Emocional y Despersonalización continuaron en el nivel bajo y la dimensión Logros personales se ubicó en el nivel medio. Con respecto a los Trastornos por Consumo de alcohol, se observó reducción en el consumo de riesgo y consumo perjudicial. Asimismo, se evidenció que las dimensiones exigencias psicosociales y doble presencia estuvieron dentro del nivel más favorable para la salud, la dimensión compensación en el nivel intermedio y el resto de las dimensiones apoyo social en la empresa y calidad de liderazgo y trabajo activo y posibilidades de desarrollo profesional evidenció un nivel más desfavorable para la salud. La relación entre las variables Estrés Laboral y Trastornos por el Consumo de Alcohol mostró una relación positiva, directa y débil. Palabras clave: estrés, estrés laboral, trastornos por el consumo de alcohol, dependencia de alcohol

High Irisin levels in nondiabetic HIV-infected males are associated with insulin resistance, nonalcoholic fatty liver disease, and subclinical atherosclerosis

Objective: HIV infection is associated with an increased risk of cardiovascular disease. Irisin is a miokyne secreted by skeletal muscle, which may influence insulin homeostasis, nonalcoholic fatty liver disease (NAFLD) and atherosclerosis. Our objective was to evaluate the relationships between serum irisin, insulin homeostasis, NAFLD and subclinical atherosclerosis in HIV-infected males. Design: Cross-sectional study in a cohort of HIV-infected patients. Patients: Inclusion criteria: men older than 18 years; antiretroviral therapy (ART) -naïve or on effective ART (<50 HIV-1 RNA copies/mL) without changes in the previous 6 months; no diabetes or hepatitis C. Measurements: Irisin was measured by enzymatic immunoassay (Phoenix Pharmaceuticals), insulin sensitivity by homeostasis model assessment of insulin resistance (HOMA-IR), as well as the 2-hour continuous infusion of glucose with model assessment (CIGMA-HOMA). Hepatic steatosis was measured by 1-H magnetic resonance spectroscopy, subclinical atherosclerosis by evaluation of carotid intima-media thickness (C-IMT), measured by Ultrasonography. Results: Eight nine men (age 42.0 ± 8.3 years, duration of HIV infection 7.9 ± 5.6 years, CD4 count 547 ± 279 cells/mL) were included. Circulating irisin was positively related to HOMA-IR and CIGMA-HOMA, hepatic triglyceride content, and to VAT/SAT ratio. Higher irisin concentrations were associated with higher C-IMT, although this association did not persist in multivariate analysis. Lipodystrophy and a higher baseline PAI-1 concentration were independently associated with C-IMT. Conclusions: In male HIV patients without diabetes, higher irisin concentrations are positively associated with insulin resistance, NAFLD and subclinical atherosclerosis. However, waist-hip- ratio is the main determinant of insulin resistance, and PAI-1 and lipodystrophy were the strongest determinants of IMT in this population

A palaeoecological approach to understanding the past and present of Sierra Nevada, a Southwestern European biodiversity hotspot

Mediterranean mountainous environments are biodiversity hotspots and priority areas in conservation agendas. Although they are fragile and threatened by forecasted global change scenarios, their sensitivity to long-term environmental variability is still understudied. The Sierra Nevada range, located in southern Spain on the north-western European flanks of the Mediterranean basin, is a biodiversity hotspot. Consequently, Sierra Nevada provides an excellent model system to apply a palaeoecological approach to detect vegetation changes, explore the drivers triggering those changes, and how vegetation changes link to the present landscape in such a paradigmatic mountain system. A multi-proxy strategy (magnetic susceptibility, grain size, loss-on-ignition, macroremains, charcoal and palynological analyses) is applied to an 8400-year long lacustrine environmental archive from the Laguna de la Mosca (2889 masl). The long-term ecological data show how the Early Holocene pine forests transitioned towards mixed Pinus-Quercus submediterranean forests as a response to a decrease in seasonality at ~7.3 cal. kyr BP. The mixed Pinus-Quercus submediterranean forests collapsed drastically giving way to open evergreen Quercus formations at ~4.2 cal. kyr BP after a well-known aridity crisis. Under the forecasted northward expansion of the Mediterranean area due to global change-related aridity increase, mountain forests inhabiting territories adjacent to the Mediterranean Region could experience analogous responses to those detected in the Sierra Nevada forests to the Mid to Late Holocene aridification, moving from temperate to submediterranean and then Mediterranean formations

Priapismo maligno: un caso manejado de forma conservadora

Priapism is an urological emergency which requires investigation, especially to differentiate between ischemic and non-ischemic priapism. Initial management is carried out through aspiration and gasometry of blood from the corpus cavernosum. We report the case of a 69-year-old patient with urothelium carcinoma of the bladder T2 G3 and metastasis in urethra/corpus cavernosum who requested an emergency consultation because of edema and a penile erection lasting several days. Due to the poor prognosis and the imaging test, a conservative management was carried out