Climatología del Índice de Haines y aplicación a los incendios forestales en la Comunidad Valenciana

Los incendios forestales, junto a las precipitaciones torrenciales, constituyen un grave problema en la cuenca del Mediterráneo Occidental, estando catalogados entre los riesgos meteorológicos de mayor importancia en estas regiones (Estrela, 2008). Por ello, resulta esencial analizar los procesos que generan estos riesgos y mejorar su pronóstico. La predicción de riesgo de incendio forestal es fundamental para evaluar la probabilidad de desarrollo, producción de daños y su posible extensión. Durante años, la inestabilidad y el aire seco se han asociado con el desarrollo de grandes incendios forestales en EUA, siendo Haines (Haines, 1988) el primer científico en desarrollar un índice de riesgo meteorológico basado en la estabilidad (término A) y la humedad (término B) de las capas bajas de la atmósfera. Este índice fue originariamente denominado LASI (Lower Atmospheric Severity Index), aunque es más conocido como Índice de Haines (HI). El HI es un indicador de potencial de riesgo de incendios forestales en los que la pluma convectiva es más importante que los vientos horizontales. Este tipo de incendios, denominados incendios dominados por columna o convectivos, habitualmente dispone de un comportamiento errático que podría complicar las tareas de extinción (Quílez, 2007, Peace et al., 2012). El cálculo del HI consta de la suma de los términos A y B. Se asignan valores de 1 a 3 a cada término dependiendo de la magnitud de la diferencia de la temperatura entre dos niveles de presión (A) y de la temperatura y la temperatura de rocío (B) en los niveles de presión predefinidos en función de la altitud del terreno. A mayor valor del término A, mayor inestabilidad en la baja troposfera. Análogamente, los mayores valores del término B indican condiciones más secas, que son favorables para la extensión de los incendios forestales. Con ello, el HI oscilará entre 2 y 6, tomando valores iguales o superiores a 5 cuando las condiciones atmosféricas son críticas para favorecer este tipo de incendios forestales. En esta tesis, en primer lugar, se lleva a cabo un estudio climatológico del HI para la Comunidad Valenciana con el fin de proporcionar una herramienta de utilidad para la interpretación de los valores adquiridos por el HI sobre la región. En segundo lugar, se analiza el uso de datos procedentes de sondeadores atmosféricos a bordo de satélite para el cálculo del HI durante algunos incendios históricos ocurridos en la región, con la finalidad de comprobar su adecuación para la estimación de este índice de riesgo. Para la obtención del HI, son necesarios datos de temperatura y humedad en las capas bajas de la atmósfera, utilizándose normalmente datos de radiosondeo. No obstante, debido a la baja densidad de estaciones de radiosondeo (10 estaciones a nivel estatal, sin localización en la Comunidad Valenciana), el estudio climático se desarrolló utilizando datos de reanálisis de las 00 UTC del NCEP/NCAR desde 1980 a 2008, con una resolución espacial de 2.5ºx2.5º. Con ellos, se analizaron los patrones espaciales y temporales del índice, tanto de los valores promedios como extremos, y sus términos en la Comunidad Valenciana para todo el período de estudio y centrándonos en meses de verano. Además, se realizó un análisis sinóptico de los diferentes valores que puede tomar el índice a partir de los mapas de reanálisis del NCEP a 500 y 850 hPa. Se definieron tres tipos de situaciones: flujos continentales, marítimos y convectivas, observándose una proporcionalidad directa entre el incremento del valor del HI y de situaciones convectivas. Con ello, se obtuvo como resultado una climatología detallada que puede servir como herramienta de referencia para interpretar y evaluar las observaciones del HI y mejorar el sistema de predicción y seguimiento de incendios (Barberà et al., 2015). Tras esto, se evaluó el uso de datos procedentes de teledetección con el ánimo de mejorar la predicción del (HI). En particular, se exploraron los datos procedentes de los sondeadores atmosféricos MODIS, AIRS y AMSU, situados a bordo de los satélites de observación de la Tierra EOS Aqua y Terra, examinando así sus perfiles atmosféricos y extrayendo las variables necesarias para el cálculo del HI en algunos incendios históricos dominados por columna ocurridos en la Comunidad Valenciana. En concreto, los datos empleados fueron los productos Level 2 AIRS V6 (AIRX2RET, combinación de datos AIRS y AMSU, y AIRS2RET, únicamente con datos AIRS; ambos a bordo de EOS Aqua) con una resolución espacial de 50 km (Olsen, 2014) y los productos Level 2 MOD07 (de la plataforma EOS Terra) y MYD07 (de EOS Aqua) V5 de 5km de resolución espacial (Seemann et al., 2006). Los datos obtenidos a partir de sondeadores atmosféricos a bordo de satélite se muestran como una herramienta alternativa o complementaria para el cálculo del HI, porque disponen de mejor resolución espacial, principalmente si utilizamos el producto ofrecido por MODIS, presentan buena concordancia respecto de los datos NCEP, y en combinación con los datos NCEP proporcionan una mayor frecuencia temporal en la generación de mapas del HI

Spatial and temporal patterns of the stability and humidity terms in the Haines index to improve the estimate of forest fire risk in the Valencia region of Spain

Ponencia presentada en: IX Congreso de la Asociación Española de Climatología celebrado en Almería entre el 28 y el 30 de octubre de 2014.[EN]The assessment of risk index in the propagation and evolution of a hypothetical forest fire is commonly based on stability and moisture content at different atmospheric levels. The Haines Index combines these terms to determine the environmental potential for wildfire growth. In this study the environmental stability and humidity associated with the lower atmospheric layers in the Western Mediterranean Basin are investigated by analysing Haines Index calculations over a 29 year period.[ES]La evaluación del índice de riesgo en la propagación y evolución de un hipotético incendio forestal está basada habitualmente en la estabilidad y el contenido de humedad en los diferentes niveles atmosféricos. El Índice de Haines combina estos términos para determinar el potencial ambiental en el desarrollo de un incendio forestal. En este estudio la estabilidad ambiental y la humedad asociada a las capas atmosféricas más bajas de la cuenca del Mediterráneo occidental se investigan mediante el análisis del cálculo del Índice de Haines durante un período de 29 años.We thank NCEP/NCAR for supplying the data necessary for this study. This study was supported by the Spanish Ministry of Innovation and Science (projects CGL2010-16364, CGL2011-30433-C02 and GRACCIE Consolider-Ingeio 2010; and Dr. Niclòs "Ramón y Cajal"Research Contract) and Generalitat Valenciana (Prometeo/2009/006 FEEDBACKS project). The Instituto Universitario CEAM-UMH is partly supported by the Generalitat

Snail1 transcriptional repressor binds to its own promoter and controls its expression

The product of Snail1 gene is a transcriptional repressor of E-cadherin expression and an inductor of the epithelial–mesenchymal transition in several epithelial tumour cell lines. Transcription of Snail1 is induced when epithelial cells are forced to acquire a mesenchymal phenotype. In this work we demonstrate that Snail1 protein limits its own expression: Snail1 binds to an E-box present in its promoter (at −146 with respect to the transcription start) and represses its activity. Therefore, mutation of the E-box increases Snail1 transcription in epithelial and mesenchymal cells. Evidence of binding of ectopic or endogenous Snail1 to its own promoter was obtained by chromatin immunoprecipitation (ChIP) experiments. Studies performed expressing different forms of Snail1 under the control of its own promoter demonstrate that disruption of the regulatory loop increases the cellular levels of Snail protein. These results indicate that expression of Snail1 gene can be regulated by its product and evidence the existence of a fine-tuning feed-back mechanism of regulation of Snail1 transcription

Increasing trend of antimicrobial resistance in Shigella associated with MSM transmission in Barcelona, 2020-21 : outbreak of XRD Shigella sonnei and dissemination of ESBL-producing Shigella flexneri

Several countries have recently reported the detection of ESBL-producing Shigella sonnei associated with transmission among MSM. In a previous study by our group, 2.8% of Shigella spp. obtained from MSM in Barcelona between 2015 and 2019 were ESBL producers. To describe and characterize the emerging ESBL-producing Shigella spp. associated with sexual transmission among MSM detected from 2020 to 2021 in Barcelona, elucidating their connectivity with contemporaneous ESBL-producing Shigella spp. from other countries. From 2020 to 2021, we identified that among MSM, 68% of S. sonnei were XDR harbouring bla and 14% of Shigella flexneri were MDR harbouring bla . WGS analysis showed that the ESBL-producing S. sonnei were part of a monophyletic cluster, which included isolates responsible for the prolonged outbreak occurring in the UK. Our data also reveal the first emergence and clonal dissemination of ESBL-producing and fluoroquinolone-resistant S. flexneri 2a among MSM. We report an increasing trend of antimicrobial resistance in Shigella spp. among MSM in Barcelona since 2021, mainly as a consequence of the dissemination of XDR ESBL-producing S. sonnei, previously reported in the UK. These results highlight the importance of international collaborative surveillance of MDR/XDR S. sonnei and S. flexneri for rapid identification of their emergence and the prevention of the transmission of these pathogens

Increasing trend of antimicrobial resistance in Shigella associated with MSM transmission in Barcelona, 2020–21: outbreak of XRD Shigella sonnei and dissemination of ESBL-producing Shigella flexneri

Antimicrobial resistance; Shigella sonnei; Sexually transmitted infectionResistencia antimicrobiana; Shigella sonnei; Infección de transmisión sexualResistència antimicrobiana; Shigella sonnei; Infecció de transmissió sexualBackground Several countries have recently reported the detection of ESBL-producing Shigella sonnei associated with transmission among MSM. In a previous study by our group, 2.8% of Shigella spp. obtained from MSM in Barcelona between 2015 and 2019 were ESBL producers. Objectives To describe and characterize the emerging ESBL-producing Shigella spp. associated with sexual transmission among MSM detected from 2020 to 2021 in Barcelona, elucidating their connectivity with contemporaneous ESBL-producing Shigella spp. from other countries. Results From 2020 to 2021, we identified that among MSM, 68% of S. sonnei were XDR harbouring blaCTX-M-27 and 14% of Shigella flexneri were MDR harbouring blaCTX-M-27. WGS analysis showed that the ESBL-producing S. sonnei were part of a monophyletic cluster, which included isolates responsible for the prolonged outbreak occurring in the UK. Our data also reveal the first emergence and clonal dissemination of ESBL-producing and fluoroquinolone-resistant S. flexneri 2a among MSM. Conclusions We report an increasing trend of antimicrobial resistance in Shigella spp. among MSM in Barcelona since 2021, mainly as a consequence of the dissemination of XDR ESBL-producing S. sonnei, previously reported in the UK. These results highlight the importance of international collaborative surveillance of MDR/XDR S. sonnei and S. flexneri for rapid identification of their emergence and the prevention of the transmission of these pathogens.This work was partially supported by the ‘Ministerio de Economía y Competitividad’, ‘Instituto de Salud Carlos III’, and co-financed by the European Regional Development Fund (ERDF) ‘A Way to Achieve Europe’ (Spanish Network for Research in Infectious Diseases, grant number RD16/0016/0003) and by the Centro de Investigación Biomédica en Red (CIBER de Enfermedades Infecciosas, grant no. CB21/13/00054). A.M.M. is supported by a grant from the ‘Fondo de Investigación Sanitaria’ (Contratos Predoctorales de Formación en Investigación, grant number FI19/00315)

Genome-wide transcriptional profiling of pulmonary functional sequelae in ARDS- secondary to SARS-CoV-2 infection

Background: Up to 80% of patients surviving acute respiratory distress syndrome (ARDS) secondary to SARS-CoV- 2 infection present persistent anomalies in pulmonary function after hospital discharge. There is a limited un-derstanding of the mechanistic pathways linked to post-acute pulmonary sequelae. Aim: To identify the molecular underpinnings associated with severe lung diffusion involvement in survivors of SARS-CoV-2-induced ARDS. Methods: Survivors attended to a complete pulmonary evaluation 3 months after hospital discharge. RNA sequencing (RNA-seq) was performed using Illumina technology in whole-blood samples from 50 patients with moderate to severe diffusion impairment (DLCO<60%) and age- and sex-matched individuals with mild-normal lung function (DLCO≥60%). A transcriptomic signature for optimal classification was constructed using random forest. Transcriptomic data were analyzed for biological pathway enrichment, cellular deconvolution, cell/tissue-specific gene expression and candidate drugs. Results: RNA-seq identified 1357 differentially expressed transcripts. A model composed of 14 mRNAs allowed the optimal discrimination of survivors with severe diffusion impairment (AUC=0.979). Hallmarks of lung sequelae involved cell death signaling, cytoskeleton reorganization, cell growth and differentiation and the immune response. Resting natural killer (NK) cells were the most important immune cell subtype for the pre-diction of severe diffusion impairment. Components of the signature correlated with neutrophil, lymphocyte and monocyte counts. A variable expression profile of the transcripts was observed in lung cell subtypes and bodily tissues. One upregulated gene, TUBB4A, constitutes a target for FDA-approved drugs. Conclusions: This work defines the transcriptional programme associated with post-acute pulmonary sequelae and provides novel insights for targeted interventions and biomarker development.MCGH is the recipient of a predoctoral fellowship from the University of Lleida. MM is the recipient of a predoctoral fellowship (PFIS: FI21/00187) from Instituto de Salud Carlos III. AC is supported by Instituto de Salud Carlos III (Sara Borrell 2021: CD21/00087). DdGC has received financial support from Instituto de Salud Carlos III (Miguel Servet 2020: CP20/00041), co-funded by the European Social Fund (ESF) “Investing in your future”. IML is supported by a Miguel Servet contract (CPII20/00029) from the Instituto de Salud Carlos III, co-funded by the European Social Fund (ESF) “Investing in your future”. CIBERES is an initiative of the Instituto de Salud Carlos III. This work is supported by the Instituto de Salud Carlos III (COV20/00110), co-funded by the European Regional Development Fund (ERDF) “A way to make Europe”. Supported by: Programa de donaciones "estar preparados"; UNESPA (Madrid, Spain) and Fundación Francisco Soria Melguizo (Madrid, Spain). Funded by: La Fundació La Marató de TV3, project with code 202108–30/ 31. COVIDPONENT is funded by the Institut Català de la Salut and Gestió de Serveis Sanitaris. This research was funded in part by a grant (PI19/01805) from the Instituto de Salud Carlos III, co-funded by the European Regional Development Fund (ERDF) “A way to build Europe” and by the Fundación Rioja Salu

Staging Parkinson's Disease Combining Motor and Nonmotor Symptoms Correlates with Disability and Quality of Life.

Introduction: In a degenerative disorder such as Parkinson's disease (PD), it is important to establish clinical stages that allow to know the course of the disease. Our aim was to analyze whether a scale combining Hoehn and Yahr's motor stage (H&Y) and the nonmotor symptoms burden (NMSB) (assessed by the nonmotor symptoms scale (NMSS)) provides information about the disability and the patient's quality of life (QoL) with regard to a defined clinical stage. Materials and methods: Cross-sectional study in which 603 PD patients from the COPPADIS cohort were classified according to H&Y (1, stage I; 2, stage II; 3, stage III; 4, stage IV/V) and NMSB (A: NMSS = 0-20; B: NMSS = 21-40; C: NMSS = 41-70; D: NMSS ≥ 71) in 16 stages (HY.NMSB, from 1A to 4D). QoL was assessed with the PDQ-39SI, PQ-10, and EUROHIS-QOL8 and disability with the Schwab&England ADL (Activities of Daily Living) scale. Results: A worse QoL and greater disability were observed at a higher stage of H&Y and NMSB (p < 0.0001). Combining both (HY.NMSB), patients in stages 1C and 1D and 2C and 2D had significantly worse QoL and/or less autonomy for ADL than those in stages 2A and 2B and 3A and 3B, respectively (p < 0.005; e.g., PDQ-39SI in 1D [n = 15] vs 2A [n = 101]: 28.6 ± 17.1 vs 7.9 ± 5.8; p < 0.0001). Conclusion: The HY.NMSB scale is simple and reflects the degree of patient involvement more accurately than the HΨ Patients with a lower H&Y stage may be more affected if they have a greater NMS burden

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd

Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic : a matched analysis

The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with COVID-19-associated respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior non-invasive respiratory support on outcomes. This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICU) participating in the CIBERESUCICOVID project. The study period was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within the first 24 h of intensive care unit (ICU) admission. Propensity score (PS) matching was used to achieve balance across baseline variables between the early intubation cohort and those patients who were intubated after the first 24 h of ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We performed sensitivity analyses to consider a different timepoint (48 h from ICU admission) for early and delayed intubation. Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients were included in the analysis (307 for each group). In the unmatched population, there were no differences in mortality between the early and delayed groups. After PS matching, patients with delayed intubation presented higher hospital mortality (27.3% versus 37.1%, p =0.01), ICU mortality (25.7% versus 36.1%, p=0.007) and 90-day mortality (30.9% versus 40.2%, p=0.02) when compared to the early intubation group. Very similar findings were observed when we used a 48-hour timepoint for early or delayed intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and 45% in the first, second, third and fourth wave, respectively; first versus second, third and fourth waves p<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving high-flow nasal cannula (n=294) who were intubated earlier. The subgroup of patients undergoing NIV (n=214) before intubation showed higher mortality when delayed intubation was set as that occurring after 48 h from ICU admission, but not when after 24 h. In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was associated with a higher risk of hospital mortality. The use of early intubation significantly decreased throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients who had received high-flow nasal cannul

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation