Molecular investigation on the etiology of preeclampsia and new strategies for its early diagnosis

Endometrial decidualization is critical for pregnancy establishment and maintenance. This process promotes endometrial remodeling allowing placental cytotrophoblasts (CTBs) invasion up to an appropriate depth to form the maternal-fetal interface. A shallow CTBs invasion compromises healthy pregnancy and it is associated with the development of severe preeclampsia (sPE). Our working hypothesis is that defective decidualization impairs the adaptation of the maternal “soil” ─the decidua─ to be invaded by CTBs and plays a pivotal role in the etiology of sPE. Previously, we have demonstrated the existence of an in vitro defective decidualization of endometrial stromal cells isolated from women who suffered sPE. The present thesis doctoral aims to dilucidated the existence of a in vivo footprint and the molecular mechanisms encoding endometrial defective decidualization that might identify the maternal contribution to sPE. To that purpose global RNA sequencing was applied to obtain the transcriptomic profile of endometrium collected from non-pregnant women who suffered sPE (n=24) in a previous pregnancy versus women who did not develop this condition (n=16). Samples were randomized in two cohorts, the training set to identify the fingerprint encoding defective decidualization in sPE and the test set for its subsequent validation. Transcriptional analysis revealed 593 differentially expressed genes in sPE compared to controls. From those, 120 (≥1.4-fold; FDR<0.05) genes were selected to formulate the footprint encoding defective decidualization. This signature allowed us to effectively segregate samples into sPE and control groups in both cohorts, the training and the test set. Gene Ontology enrichment and an interaction network were performed to deeper in pathways impaired by genetic dysregulation in sPE. Major biological processes affected were associated with decidualization and sPE pathogenesis such as extracellular matrix and immune response. High-level pathways were also identified using the Kyoto Encyclopedia of Genes and Genomes, revealing enriched pathways involved in response to pathogens including coronavirus disease. This result suggests the immune system is dysregulated in sPE patients. Then, since decidualization is tightly regulated by progesterone and estrogen, we assessed the link between this hormonal signaling and the gene expression imbalance encoding defective decidualization. We identified the footprint was composed by 94 genes highly expressed in the endometrium of which 47.9% are modulated by estrogen receptor 1 (ER1) and 45.7% by progesterone receptor (PR). An interactome network confirmed these receptors were strongly interconnected with the proteins codified by the genes encoding defective decidualization. Moreover, gene expression and protein abundance of ER1 and PR was significantly downregulated in sPE. Specifically, the PR isoform B was impaired in sPE, while the isoform A was not affected. Furthermore, STAT3 and PLZF, critical mediators of PR signaling, were upregulated in the group of cases. Our data support the concept that in vivo defective decidualization is responsible, at least in part, for the maternal contribution to sPE. Further, we postulate that impaired ER1 and PR-B are potential drivers of compromised decidualization, including dysregulation of endothelial and immune response observed in sPE. These findings open new horizons in the search for early detection, prevention, and therapy strategies since the origin of sPE could lie in maternal endometrial health

La responsabilidad penal del empresario en materia de seguridad y salud

Treball Final de Grau en Relacions Laborals i Recursos Humans. Codi: RL0947. Curs: 2019-202

El papel del clima social y su relación con otras variables psicosociales en una muestra de personas privadas de libertad

El clima social tiene la base en las interacciones personales, representando la personalidad de un determinado ambiente, con posibilidades de influir en las conductas de los internos y del personal penitenciario. En este estudio se pretende analizar, en una muestra de 150 participantes, el grado y la relación del clima social con la participación social, sentido de comunidad, apoyo social y autoestima. Las personas internas perciben un negativo clima social (CIES), las puntuaciones se sitúan por debajo del 4 en una escala del 1 al 10. Se identifican las diferencias entre hombres y mujeres, entre módulos y entre los que reciben visitas o no.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

El juego infantil con materiales desestructurados

A lo largo de estas líneas se habla sobre un tipo de juego en libertad, uno que se puso en práctica hace años pero se dejó de lado con la revolución industrial.Se habla del juego con material desestructurado, piezas sueltas o materiales naturales haciendo un breve recorrido por la historia para saber de dónde viene esta idea, quién la inventó, sus pros y sus contras.Se habla también del tratamiento del juego a lo largo de las leyes educativas que nos rigen, además de nombrar diferentes metodologías y cómo en mayor o menor medida han utilizado estos materiales para el proceso evolutivo de los alumnos, siempre desde el respeto a la infancia, la escucha activa y la educación bidireccional, donde alumno y profesor trabajan juntos y construyen el conocimiento de forma cooperativa.<br /

Efectos de un programa de judo utilitario adaptado sobre un adulto de 54 años. Estudio de caso

Active and integrated ageing of the population is one of the main challenges to which administrations must respond. Dimensions such as frailty and fear of falling are associated with physical, psychological and social limitations of older adults. The aim is to find out whether the application of the JUA programme increases the quality of life by positively affecting the fear of falling and the perception of health, based on the improvement of their physical condition and the control of falls. A case study is proposed for a 54-year-old male subject. The subject's fear of falling, quality of life, health perception and physical condition were analysed. The results showed an improvement in all the dimensions studied. We conclude that the JUA programme brings benefits on physical and psychological performance in the subject of study.El envejecimiento activo de la población es uno de los principales retos a los que las administraciones deben responder. Dimensiones como la fragilidad y el miedo a caer, se asocian a limitaciones físicas, psicológicas y sociales de los adultos mayores. Se plantea el objetivo de conocer si la aplicación del programa JUA, aumenta la calidad de vida, al incidir positivamente en el miedo a caer y la percepción de salud, en base a la mejora su condición física y el control de las caídas. Se propone un estudio de caso dirigido a un sujeto varón de 54 años. Se analizó el miedo a caer, calidad de vida, percepción de salud y condición física del sujeto. Los resultados mostraron una mejoría en todas las dimensiones estudiadas. Concluimos que el programa JUA, aporta beneficios sobre el desempeño físico y psicológico en el sujeto de estudio

Effects of Advertising on Food Consumption Preferences in Children

Childhood obesity is a public health problem. The purpose of this study was to know if exposure to commercial messages which advertise food products exerts any effect on the short-term consumption preferences of 4- to 6-year-old children. (2) Methods: A double-blind and randomized experimental design. Sample consisted of 421 boys and girls from twelve schools in a city in Spain. (3) Results: In three of the four product pairs shown, the products advertised in the intervention were preferred. In the results of applying the model for the first product pair presented, sugared cereals, the predictive variable which best explains the behavior of the preferences expressed is gender (Odds Ratio 0.285 (0.19–0.42); p < 0.05). For the second pair, chocolate cookies, the family’s nationality has a strong weight in the model. As regards the regression model calculated for the last pair (filled rolls), the predictive variable which showed having more influence was gender. Boys had a 1.39 times higher risk of selecting the advertised product than girls. (4) Conclusions: The persuasive effect of commercials has shown to be influential in a general, immediate, and significant way only in the case of products with wide brand awareness. This study reinforces the importance of advertising and emphasizes the need to initiate measures to control the content of TV commercials

Anxiety and Perceived Risk in Red Cross Volunteer Personnel Facing the Coronavirus Disease 2019 Pandemic

In the current situation of sanitary emergencies, humanitarian organizations and their volunteers are playing an important role in the coronavirus disease 2019 (COVID-19) pandemic. A study is proposed that includes a network of volunteers who perform humanitarian activities during the COVID-19 pandemic to assess anxiety, perceived risk, and response behaviors and to explore their relationship with sociodemographic variables. For data collection, an online questionnaire was developed through the Google Forms® platform, where the perceived risk, anxiety, and behavioral responses of the general population to the Influenza A (H1N1) pandemic were assessed. The survey presented is a modified version of that survey adapted for COVID-19. This adaptation was endorsed by an experts committee made up of the health chief of the Ecuadorian Red Cross, the focus point of operations from the International Federation of the Red Cross in Ecuador, and a member from the Health Unit of the Americas Regional Office of the International Federation of the Red Cross. A significant relationship has been shown between the job situation and perceived risk and anxiety, being the staff who worked full time away from home, which was exposed to greater risk and anxiety. Both perceived risk and perceived anxiety are very high (according to a 5-point Likert scale). Knowing these data from this first-line personnel will allow adopting measures that could be beneficial for stress management and, therefore, contribute to the well-being and support of these humanitarian and volunteer organizations in the worldwide response to COVID-1 9

Conventional Hospitalization versus Sequential Outpatient Parenteral Antibiotic Therapy for Staphylococcus aureus Bacteremia: Post-Hoc Analysis of a Multicenter Observational Cohort

Staphylococcus aureus; Bacteremia; Outpatient parenteral antimicrobial therapyStaphylococcus aureus; Bacterièmia; Teràpia antimicrobiana parenteral ambulatòriaStaphylococcus aureus; Bacteriemia; Terapia antimicrobiana parenteral ambulatoriaIt is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performed in two prospective Spanish cohorts of patients with S. aureus bacteremia. The PROBAC cohort is a national, multicenter, prospective observational cohort of patients diagnosed in 22 Spanish hospitals between October 2016 and March 2017. The DOMUS OPAT cohort is a prospective observational cohort including patients from two university hospitals in Seville, Spain from 2012 to 2021. Multivariate regression was performed, including a propensity score (PS) for receiving OPAT, stratified analysis according to PS quartiles, and matched pair analyses based on PS. Four hundred and thirteen patients were included in the analysis: 150 in sequential OPAT and 263 in the full hospitalization therapy group. In multivariate analysis, including PS and center effect as covariates, 60-day treatment failure was lower in the OPAT group than in the full hospitalization group (p < 0.001; OR 0.275, 95%CI 0.129−0.584). In the PS-based matched analyses, sequential treatment under OPAT was not associated with higher 60-day treatment failure (p = 0.253; adjusted OR 0.660; % CI 0.324−1.345). OPAT is a safe and effective alternative to conventional in-patient therapy for completion of treatment in well-selected patients with SAB, mainly those associated with a low-risk source and without end-stage kidney disease

Confirmation of preeclampsia-like syndrome induced by severe COVID-19 : An Observational Study

Since the outbreak of the COVID-19 pandemic, some studies have reported an increased preeclampsia (PE) incidence in pregnant women with SARS-CoV-2 infection. Several explanations for this association have been proposed, including a preeclampsia-like syndrome induced by severe COVID-19. This syndrome was described in a small case series and has not been confirmed in larger studies and its impact in perinatal outcomes has not been studied. The aim of this study was to confirm the preeclampsia-like syndrome due to COVID-19 and to investigate its implications in pregnancy outcomes and prognosis. This was a prospective, observational study conducted in a tertiary referral hospital. Inclusion criteria were pregnant women admitted to the Intensive Care Unit for severe pneumonia due to COVID-19. They were classified in three groups based on clinical and laboratory findings: PE, PE-like syndrome, and women without PE features. The three cohorts were analyzed and compared at three different times: before, during and after severe pneumonia. The main outcomes were incidence of adverse perinatal outcomes and signs and symptoms of PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes and increased angiogenic factors (soluble fms-like tyrosine kinase-1 to placental growth factor ratio [sFlt-1/PlGF]). A total of 106 women were admitted to Intensive Care Unit due to severe pneumonia and 68 were included in the study. Of those, 53 (50.0%) did not meet the diagnostic criteria for PE and remained pregnant after pneumonia (non-PE), seven (6.6%) met the diagnostic criteria for PE, had abnormal (>38) sFlt-1/PlGF (PE) and delivered during severe pneumonia, and eight (7.5%) met the diagnostic criteria for PE, had normal (≤38) sFlt-1/PlGF (PE-like) and did not deliver during pneumonia. Despite not having delivered, most PE-related features improved after severe pneumonia in women with PE-like syndrome. Women with PE had significantly poorer outcomes than women with PE-like syndrome or without PE. More than 50% of women with severe COVID-19 and diagnostic criteria for PE may not be PE but a PE-like syndrome, which may affect up to 7.5% of women with severe COVID-19. PE-like syndrome might have similar perinatal outcomes to those of normotensive women with severe pneumonia due to COVID-19. For these reasons, PE-like syndrome should be excluded by using sFlt-1/PlGF in future research and before making clinical decisions

Confirmation of preeclampsia-like syndrome induced by severe COVID-19: an observational study

COVID-19; Preeclampsia; PregnancyCOVID-19; Preeclampsia; EmbarazoCOVID-19; Preeclampsia; EmbaràsBACKGROUND Since the outbreak of the COVID-19 pandemic, some studies have reported an increased preeclampsia incidence in pregnant women with SARS-CoV-2 infection. Several explanations for this association have been proposed, including a preeclampsia-like syndrome induced by severe COVID-19. This syndrome was described in a small case series and has not been confirmed in larger studies, and its effect on perinatal outcomes has not been studied. OBJECTIVE This study aimed to confirm the preeclampsia-like syndrome because of COVID-19 and to investigate its implications on pregnancy outcomes and prognosis. STUDY DESIGN This was a prospective, observational study conducted in a tertiary referral hospital. The inclusion criteria were pregnant women admitted to the intensive care unit for severe pneumonia because of COVID-19. They were classified into 3 groups based on clinical and laboratory findings: preeclampsia, preeclampsia-like syndrome, and women without preeclampsia features. The 3 cohorts were analyzed and compared at 3 different times: before, during, and after severe pneumonia. The main outcomes were incidence of adverse perinatal outcomes and signs and symptoms of PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, and increased angiogenic factors (soluble fms-like tyrosine kinase 1–to–placental growth factor ratio). RESULTS A total of 106 women were admitted to the intensive care unit because of severe pneumonia, and 68 women were included in the study. Of those, 53 (50.0%) did not meet the diagnostic criteria for preeclampsia and remained pregnant after pneumonia (non-preeclampsia); 7 (6.6%) met the diagnostic criteria for preeclampsia, had abnormal (>38) soluble fms-like tyrosine kinase 1–to–placental growth factor ratio (preeclampsia), and delivered during severe pneumonia, and 8 (7.5%) met the diagnostic criteria for preeclampsia, had normal (≤38) soluble fms-like tyrosine kinase 1–to–placental growth factor ratio (preeclampsia like), and did not deliver during pneumonia. Despite not having delivered, most preeclampsia-related features improved after severe pneumonia in women with preeclampsia-like syndrome. Women with preeclampsia had significantly poorer outcomes than women with preeclampsia-like syndrome or without preeclampsia. CONCLUSION More than 50% of women with severe COVID-19 and diagnostic criteria for preeclampsia may not be preeclampsia but a preeclampsia-like syndrome, which may affect up to 7.5% of women with severe COVID-19. Preeclampsia-like syndrome might have similar perinatal outcomes to those of normotensive women with severe pneumonia because of COVID-19. For these reasons, preeclampsia-like syndrome should be excluded by using soluble fms-like tyrosine kinase 1–to–placental growth factor ratio in future research and before making clinical decisions