A Descriptive Analysis of ATTR Amyloidosis in Spain from the Transthyretin Amyloidosis Outcomes Survey.

Introduction Transthyretin amyloidosis (ATTR amyloidosis) is a clinically heterogeneous disease caused by mutations in the transthyretin (TTR) gene or aggregation of wild-type transthyretin (ATTRwt). In Spain, there are two large endemic foci of ATTR amyloidosis caused by the Val30Met variant, with additional cases across the country; however, these data may be incomplete, as there is no centralized patient registry. The Transthyretin Amyloidosis Outcomes Survey (THAOS) is an ongoing, global, longitudinal, observational survey of patients with ATTR amyloidosis, including both inherited and wild-type disease, and asymptomatic patients with TTR mutations. This analysis aimed to gain a deeper understanding of the clinical profile of patients with ATTR amyloidosis in Spain. Methods This was a descriptive analysis of the demographic and clinical characteristics of symptomatic patients enrolled at six sites geographically dispersed throughout Spain (data cutoff: January 6, 2020). Patient data at enrollment, including genotype, demographics, and clinical presentation for symptomatic patients, were recorded. Patients were grouped by predominant phenotype based on clinical measures at enrollment: predominantly cardiac, predominantly neurologic, or mixed (cardiac and neurologic). Results There were 379 patients (58.0% male; 63.3% symptomatic) enrolled in the six THAOS sites in Spain. Predominant genotypes were the Val30Met mutation (69.1%) or ATTRwt (15.6%). Predominant phenotype distribution was neurologic (50.4%), mixed (35.8%), and cardiac (13.8%) for all symptomatic patients (n = 240); neurologic (67.8%), mixed (21.2%), and cardiac (11.0%) for symptomatic Val30Met (n = 146); and mixed (64.9%), cardiac (22.8%), and neurologic (12.3%) for symptomatic ATTRwt (n = 57). Symptomatic patients reported a range of ATTR amyloidosis signs and symptoms at enrollment, with autonomic neuropathy and sensory neuropathy common in all phenotypes. Conclusions These results from THAOS highlight the phenotypic heterogeneity associated with ATTR amyloidosis in Spain and the importance of comprehensive neurologic and cardiac evaluations in all patients with ATTR amyloidosis.post-print392 K

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Glotopolítica latinoamericana : Tendencias y perspectivas

Glotopolítica latinoamericana: tendencias y perspectivas recoge el resultado de presentaciones y deliberaciones del IV Congreso Latinoamericano de Glotopolítica, realizado en la Universidad de San Pablo (Brasil) en septiembre de 2019, que convocó a numerosos y destacados especialistas en el área. Su inscripción en una serie (los anteriores se realizaron en Chile, Colombia y Alemania) nos permite apreciar los grandes ejes de los que da cuenta el cuidadoso e inteligente armado del libro decidido por los editores, y fundamentado en la Presentación. El tramo que hemos recorrido como especialistas, en el cual los eventos internacionales son hitos significativos, ha ido mostrando la amplitud de un campo que se construye apelando a tradiciones académicas variadas, que insiste en su carácter interdisciplinario y crítico y que no deja de tener una dimensión militante que se expone en las reflexiones teóricas, las investigaciones empíricas y las prácticas institucionales

Remolacha azucarera (Beta vulgaris L.) como cultivo alternativo en el noreste de Tamaulipas, México: factores agrotecnologicos

Sugar beet (Beta vulgaris L.) is the second source of sugar in the world. The adaptation area is located in countries of the northern hemisphere. In Mexico, several crops have been suggested to obtain biofuels, among which sugar beet stands out. The objective of the study was to evaluate the productive potential of sugar beet varieties in northeastern Tamaulipas, where sorghum and maize monocrops are characteristic. The evaluation was performed during the autumn-winter cycle in the years 2010 and 2011 at INIFAP-Rio Bravo Experimental Station. The root maximum length and diameter was measured in nine commercial varieties, as well as production, dry and fresh root biomass distribution, o Brix, estimated yield and sugar production, and disease incidence. The technological practices and production costs were made with adaptations to predominant crops. The presence of diseases was a risk for the crop, induced by the varietal susceptibility, and the amount and distribution of precipitation. Under the conditions of this study, it is possible to produce sugar beet commercially in up to 54 t ha1 and produce 18 oBrix. The cost of the seed represented the largest investment in the technological package (38%).La remolacha azucarera (Beta vulgaris L.) es la segunda fuente de azúcar en el mundo. El área de adaptación se localiza en países del hemisferio norte. En México se han propuesto varios cultivos para obtención de biocombustibles entre los que destaca la remolacha azucarera. El objetivo del trabajo fue evaluar el potencial productivo de la remolacha azucarera bajo condiciones de riego en el noreste de Tamaulipas; el cual se caracteriza por el monocultivo de sorgo y maíz. La evaluación se hizo durante el ciclo O-I en los años 2010 y 2011 en el Campo Experimental Río Bravo del INIFAP. En nueve variedades comerciales se midió el largo y diámetro máximo de la raíz, producción, distribución de biomasa seca y fresca de raíz, oBrix, rendimiento y producción estimada de azúcar e incidencia de enfermedades. El paquete tecnológico y los costos de producción fueron hechos con adecuaciones a los cultivos predominantes. La presencia de enfermedades fue un riesgo para el cultivo, inducido por la susceptibilidad varietal, cantidad y distribución de la precipitación. Bajo las condiciones de este estudio es posible producir remolacha azucarera en forma comercial hasta 54 t ha1 y 18 oBrix. El costo de la semilla representó la mayor inversión en el paquete tecnológico (38%)

Heterosis and combining ability of seed physiological quality traits of single cross vs. three-way sorghum hybrids

The aim of this research was to compare genetic parameters for traits related with seed germination and seedling vigour of single cross (SCH) vs. three-way (TWH) sorghum hybrids. The study was conducted in a sand bed under a greenhouse; 67 genotypes (four pairs of A- and B- lines, four R- lines, 13 SCH and 42 TWH) were allocated in a randomized complete blocks experimental design with three replications. Statistical analysis included ANOVA’s and Student “t” tests, while Tukey test (p £ 0.05) was applied for mean comparisons. The R-lines showed better physiological seed quality attributes than the A- and B- lines. The seed quality and heterosis values of SCH vs. that of TWH did not show significant differences (p > 0.05) for any variable; however, heterobeltiosis of SCH was higher than that of TWY for normal seedlings, dry weight of plumule and seedling emergence rate. The A2- line and R14 restorer line showed the highest GCA values in both types of hybrids. No differences (p ≤ 0.05) were found between maternal and paternal effects of the A- and B- lines involved in the male sterile cross (female parent) of the TWH, except for plumule length in Line 5.

Population pharmacokinetics of colistin: implications for clinical use for Gram-negative pathogens

The objective of this study was to characterize the pharmacokinetics of colistin methanesulphonate (CMS) and colistin in critically ill patients following the administration of a 4.5 MU CMS loading dose follow by 3MU CMS Q8. A population PK model and Monte Carlo simulation were used to calculate the probability of target attainment (PTA) against Acinetobacter baumannii and Pseudomonas aeruginosa by considering a range of MIC values seen in the clinic

Carbapenem Combinations for Infections Caused by Carbapenemase-Producing Pseudomonas aeruginosa: Experimental In Vitro and In Vivo Analysis.

In the context of difficult-to-treat carbapenem-resistant Pseudomonas aeruginosa infections, we evaluated imipenem, meropenem, and doripenem combinations against eleven carbapenemase-producing P. aeruginosa isolates. According to the widespread global distribution of high-risk clones and carbapenemases, four representative isolates were selected: ST175 (OXA-2/VIM-20), ST175 (VIM-2), ST235 (GES-5), and ST111 (IMP-33), for efficacy studies using a sepsis murine model. Minimum inhibitory concentration (mg/L) ranges were 64-256 for imipenem and 16-128 for meropenem and doripenem. In vitro, imipenem plus meropenem was synergistic against 72% of isolates and doripenem plus meropenem or imipenem against 55% and 45%, respectively. All combinations were synergistic against the ST175, ST235, and ST155 clones. In vivo, meropenem diminished the spleen and blood bacterial concentrations of four and three isolates, respectively, with better efficacy than imipenem or doripenem. The combinations did not show efficacy compared with the more active monotherapies, except for imipenem plus meropenem, which reduced the ST235 bacterial spleen concentration. Mortality decreased with imipenem plus meropenem or doripenem for the ST175 isolate. Results suggest that carbapenem combinations are not an alternative for severe infections by carbapenemase-producing P. aeruginosa. Meropenem monotherapy showed in vivo efficacy despite its high MIC, probably because its dosage allowed a sufficient antimicrobial exposure at the infection sites