From the North-Iberian Margin to the Alboran Basin: A lithosphere geo-transect across the Iberian Plate

A ~ 1000-km-long lithospheric transect running from the North-Iberian Margin to the Alboran Basin (W-Mediterranean) is investigated. The main goal is to image the changes in the crustal and upper mantle structure occurring in: i) the North-Iberian margin, whose deformation in Alpine times gave rise to the uplift of the Cantabrian Mountains related to Iberia-Eurasia incipient subduction; ii) the Spanish Meseta, characterized by the presence of Cenozoic basins on top of a Variscan basement with weak Alpine deformation in the Central System, and localized Neogene-Quaternary deep volcanism; and iii) the Betic-Alboran system related to Africa-Iberia collision and the roll-back of the Ligurian-Tethyan domain. The modeling approach, combines potential fields, elevation, thermal, seismic, and petrological data under a self-consistent scheme. The crustal structure is mainly constrained by seismic data whereas the upper mantle is constrained by tomographic models. The results highlight the lateral variations in the topography of the lithosphere-asthenosphere boundary (LAB), suggesting a strong lithospheric mantle strain below the Cantabrian and Betic mountain belts. The LAB depth ranges from 180 km beneath the Cantabrian Mountains to 135-110. km beneath Iberia Meseta deepening again to values of 160. km beneath the Betic Cordillera. The Central System, with a mean elevation of 1300. m, has a negligible signature on the LAB depth. We have considered four lithospheric mantle compositions: a predominantly average Phanerozoic in the continental mainland, two more fertile compositions in the Alboran Sea and in the Calatrava Volcanic Province, and a hydrated uppermost mantle in the North-Iberian Margin. These compositional differences allowed us to reproduce the main trends of the geophysical observables as well as the inferred P- and S-wave seismic velocities from tomography models and seismic experiments available in the study transect. The high mean topography of Iberia can be partly consistent with a low-velocity/high-temperature/low-density layer in the sublithospheric mantle.The presented work has been supported by Topo-Iberia Consolider-IngenioCSD2006-0004, GASAM/TopoMed (CGL2008-03474-E/BTE/07-TOPO-EUROPE-FP-006), TECLA (CGL2011-26670) funded by the Spanish Government, and PYRTEC-IP2 (SV-PA-10-03, funded by the Government of Asturias/ESF TOPO-EUROPE Programme) projects. AC benefitted from a JAE-PreCP grant from CSIC. JCA acknowledges the support from ARC GrantDP120102372.Peer Reviewe

Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study

IntroductionMajor trauma is one of the major health care problems facing modern society, trauma systems require careful planning to achieve an ideal level of coverage for the population. The Patient Blood Management Program is an integrated and global strategy to provide patient care that aims to assess and address, when possible, the etiology of blood abnormalities rather than transfuse without treating the underlying cause. We aimed to describe the factors that are associated with the clinical decision to transfuse polytraumatized patients admitted to the Intensive Care Unit (ICU).MethodWe performed a cross sectional multicenter study of patients admitted to ICUs for trauma in 14 Spanish hospitals from September 2020 to December 2021.ResultsA total of 69 patients were treated in the emergency room due to polytrauma, 46% of them were considered serious in the initial triage. Thirty were caused by a fall from considerable height (43.47%), followed by 39 patients admitted due to trac accidents (56.52%). The location of the trauma was mainly cranioencephalic, followed by thoracic trauma. Of the 69 patients, 25 received a blood transfusion during their ICU stay (36.23%).DiscussionNo significant differences were observed between transfused and non-transfused patients, except for the severity scales, where transfused patients have a higher score on all the scales assessed in the ICU except for the Revised Trauma Score. As we can see, the incidence of kidney failure was also different between the groups analyzed, reaching 44.00% in transfused patients and 13.64% in the group of patients without blood transfusion, p = 0.005. In this sense, 92.00% of the transfusions performed were inadequate according to the criteria of Hb in blood prior to the decision to transfuse (Hb < 9). Our data support the need to consider clinical practice guidelines regarding blood transfusion and its practices

Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study

IntroductionMajor trauma is one of the major health care problems facing modern society, trauma systems require careful planning to achieve an ideal level of coverage for the population. The Patient Blood Management Program is an integrated and global strategy to provide patient care that aims to assess and address, when possible, the etiology of blood abnormalities rather than transfuse without treating the underlying cause. We aimed to describe the factors that are associated with the clinical decision to transfuse polytraumatized patients admitted to the Intensive Care Unit (ICU).MethodWe performed a cross sectional multicenter study of patients admitted to ICUs for trauma in 14 Spanish hospitals from September 2020 to December 2021.ResultsA total of 69 patients were treated in the emergency room due to polytrauma, 46% of them were considered serious in the initial triage. Thirty were caused by a fall from considerable height (43.47%), followed by 39 patients admitted due to trac accidents (56.52%). The location of the trauma was mainly cranioencephalic, followed by thoracic trauma. Of the 69 patients, 25 received a blood transfusion during their ICU stay (36.23%).DiscussionNo significant differences were observed between transfused and non-transfused patients, except for the severity scales, where transfused patients have a higher score on all the scales assessed in the ICU except for the Revised Trauma Score. As we can see, the incidence of kidney failure was also different between the groups analyzed, reaching 44.00% in transfused patients and 13.64% in the group of patients without blood transfusion, p = 0.005. In this sense, 92.00% of the transfusions performed were inadequate according to the criteria of Hb in blood prior to the decision to transfuse (Hb < 9). Our data support the need to consider clinical practice guidelines regarding blood transfusion and its practices

Cross-cultural validation of the Spanish version of the Kidney AlloTransplant Immunosuppressive Therapy Adherence Questionnaire (KATITA-25)

The KATITA-25 (Kidney AlloTransplant Immunosuppressive Therapy Adherence) Questionnaire is a multidimensional self-administered scale developed in Brazilian Portuguese that measures the predisposition for non-adherence to immunosuppressive medication in candidate patients for kidney transplantation, in the pre-transplant setting. The aim of this study was the cross-cultural validation of the Spanish version of the KATITA-25 scale. The translation/back-translation method was used, followed by cognitive interviews and a pre-test. The Spanish version of KATITA-25 was administered to 163 candidate patients for kidney transplantation from 2 kidney transplant centres and 2 dialysis centres in Catalonia, Spain. The scale was re-administered to the first 79 patients included into the study, after a 2 to 4 weeks interval. Internal consistency was assessed using Cronbach's alpha, test-retest reliability with the intraclass correlation coefficient (ICC); construct validity with goodness of fit indices after confirmatory factor analysis using structural equation modelling. The Cronbach's alpha of the Spanish version was 0.83, the ICC was 0.86. Confirmatory factor analysis showed adequate fit of the structural model. Overall, the analytical results closely resembled those obtained in the validation of the original scale. In conclusion, this cross-cultural validation study showed adequate reliability and construct validity of the Spanish version of the KATITA-25 questionnaire

Changes in quantity plant‑based protein intake on type 2 diabetes remission in coronary heart disease patients: from the CORDIOPREV study

Purpose: Diabetes remission is a phenomenon described in the context of drastic weight loss due to bariatric surgery or low-calorie diets. Evidence suggests that increasing the intake of plant protein could reduce the risk of type 2 diabetes. We sought for association between changes in plant protein intake in the context of 2 healthy diets without weight loss nor glucose-lowering medication, and diabetes remission in coronary heart disease patients from the CORDIOPREV study. Methods: Newly diagnosed type 2 diabetes participants without glucose-lowering treatment were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was assessed with a median follow-up of 60 months according to the ADA recommendation. Information on patient's dietary intake was collected using food-frequency questionnaires. At first year of intervention, 177 patients were classified according to changes in plant protein consumption into those who increased or decreased its intake, in order to perform an observational analysis on the association between protein intake and diabetes remission. Results: Cox regression showed that patients increasing plant protein intake were more likely to remit from diabetes than those who decreased its intake (HR = 1.71(1.05–2.77)). The remission occurred mainly at first and second year of follow-up with diminished number of patients achieving remission in the third year onwards. The increase in plant protein was associated with lower intake of animal protein, cholesterol, saturated fatty acids, and fat, and with higher intake of whole grains, fibre, carbohydrates, legumes, and tree nuts. Conclusión: These results support the need to increase protein intake of vegetal origin as dietary therapy to reverse type 2 diabetes in the context of healthy diets without weight loss

En la costa aún sin mar

Los trabajos que conforman este volumen son una muestra de la presencia y actualidad de la obra de César Vallejo. Su poesía aún da lugar a nuevas y diversas interpretaciones; también a ciertas reconsideraciones. Asimismo, la narrativa del escritor peruano, poco atendida, está presente y exige estudio además de revalorización. La persona y obra de César Vallejo, en fin, son actuales incluso como un fenómeno metapoético.César Vallejo es un escritor esencial en el ámbito de la literatura contemporánea. Su obra literaria, escrita a principios del siglo pasado, sigue vigente. En su poesía, en particular, captó la sensibilidad de toda una época. Asimismo, supo traducir lo que él llamaba “el ritmo interior y el espíritu que se desprende de la realidad actual”. En cuanto a su obra en prosa, los estudios recientes dan muestra de su importancia, valor social y artístico. A casi cien años de la publicación de libros como Trilce y Los heraldos negros, la obra de César Vallejo sigue siendo fuente de goce estético y, por su complejidad, de búsqueda de conocimiento profundo de la realidad social y humana

Epidemiology, use, and practice of the intraosseous route in an out-of-hospital emergency department: a retrospective cross-sectional study

IntroductionThe Spanish Emergency Medical Services, according to the model we know today, were formed during the 80s and 90s of the 20th century. The Health Emergency Service (EMS), 061 La Rioja, began to assist the population of La Rioja in November 1999. An essential part of the mission of the SES is the provision of care and the transfer of critical patients using advanced life support unit (ALSU) techniques. In daily practice, out-of-hospital emergency services are faced with situations in which they must deal with the care of serious or critically ill patients, in which the possibility of being able to channel peripheral vascular access as part of ALSU quickly may be difficult or impossible. In these cases, cannulation of intraosseous (IO) vascular access may be the key to early and adequate care.AimThis study aimed to determine the incidence and epidemiology use of IO vascular access in SES 061 La Rioja during the year 2022.Matherial and methodsWe performed observational retrospective cross-sectional studies conducted in 2022. It included a population of 4.364 possible patients as a total of interventions in the community of La Rioja in that year.ResultsA total of 0.66% of patients showed a clinical situation that required the establishment of IO vascular access to enable out-of-hospital stabilization; this objective was achieved in 41.3%. A total of 26.1% of patients who presented with cardiorespiratory arrest (CA) were stabilized, while 100% presented with shock and severe trauma.DiscussionIO vascular access provides a suitable route for out-of-hospital stabilization of critically ill patients when peripheral vascular access is difficult or impossible

Open questions and misconceptions in the diagnosis and management of anemia in patients with gastrointestinal bleeding

Despite high prevalence of iron deficiency anemia (IDA) in patients with acute or chronic gastrointestinal bleeding (GIB), IDA and iron deficiency (ID) are frequently untreated. Reasons may be misconceptions about the impact and diagnosis of IDA and the efficacy of new treatments. Addressing these misconceptions, this article summarizes current evidence for better understanding and management of GIB-associated IDA. Despite only few controlled studies evaluated the efficacy of iron treatment in patients with GIB, there is consistent evidence suggesting that: (a) IDA should be diligently investigated, (b) effective treatment of ID/IDA improves outcomes such as health-related quality of life and can avoid severe cardiovascular consequences, and (c) intravenous iron should be considered as well-tolerated treatment in this setting. Overall, the misconceptions and practices outlined in this article should be replaced with strategies that are more in line with current guidelines and best practice in GIB and other underlying conditions of ID/IDA.A pesar de la alta prevalencia de anemia por déficit de hierro (ADH) en pacientes con hemorragia digestiva (HD) aguda o crónica, la ADH y el déficit de hierro (DH) son frecuentemente infratratados. Diversos conceptos erróneos sobre el impacto, el diagnóstico y la eficacia de los nuevos tratamientos de la ADH probablemente lo justifican. Para abordar estos errores conceptuales, este artículo resume la evidencia actual para una mejor comprensión y manejo de la ADH. A pesar de que existen pocos estudios controlados que hayan evaluado la eficacia del tratamiento con hierro en pacientes con HD, hay evidencia que sugiere que: (a) la ADH debe ser investigada diligentemente; (b) el tratamiento eficaz del DH/ADH mejora la calidad de vida relacionada con la salud y puede evitar relevantes complicaciones cardiovasculares, y (c) el hierro intravenoso debe ser considerado como un tratamiento bien tolerado en este contexto. En general, los conceptos erróneos y las prácticas inadecuadas descritas en este artículo deben ser reemplazados por estrategias que estén más en línea con las directrices actuales y buenas prácticas clínicas en HD y otras condiciones causantes del DH/ADHinfo:eu-repo/semantics/publishedVersio

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation

BACKGROUND: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients