Cerebral Protection Devices in Transcatheter Aortic-Valve Replacement

Transcatheter aortic valve replacement (TAVR) is a common procedure used in the treatment of severe aortic stenosis and other cardiac valve diseases. Although this procedure has been shown to be effective and safe in improving cardiac function and life expectancy in this population, there is an inherent risk of neurological complications such as stroke and cognitive impairment. In the last years, there has been a breakthrough in the development of brain protection devices that minimize the risk of brain embolism during the procedure. These devices are designed to capture clots and calcium debris that could become dislodged during the valve implant, therefore keeping the embolus from entering the nervous system via the supra-aortic vessels. Some studies indicate that using brain protection devices during an aortic valve replacement could substantially decrease the burden of stroke and other associated neurological complications. However, despite the promising expected results, further studies are required to sustain the benefit of using these devices, besides with the ongoing development in this area it would be fundamental a face-to-face interaction between the devices in the current development. Furthermore, although the experience with these devices is limited and the recent experience indicates they are safe, it would be fundamental to identify and take in consideration possible risks and complications related to these devices

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic

Ruralidad y campesinado

¿Existe aún el campo? ¿Desapareció el campesinado? ¿Triunfó la expansión del modo de vida urbano y de los urbanistas? ¿Subsiste aún un modo de vida rural? ¿Existe aún una cultura campesina? ¿Cuáles son las tensiones y principales amenazas que recorren el mundo rural latinoamericano? ¿Cuáles son las formas de resistencia desde la identidad campesina e indígena a la marea globalizante? ¿Qué experiencias promisorias y/ o exitosas se están desplegando en el mundo rural? ¿Cómo se ha transformado la ruralidad en las últimas décadas? ¿Cómo se enlaza la producción agraria con la emergencia de territorios intermedios? son algunas de las muchas preguntas que abordamos en este número de Polis

Migraciones sur-sur : Paradojas globales y promesas locales

Durante la primera década del siglo XX el 90% de los migrantes provenía de Europa y se dirigía a cinco países: EEUU, Argentina, Canadá, Brasil y Australia. Hoy esa misma proporción de migrantes proviene de tres continentes: Asia, África y Latinoamérica y se dirige a cuatro grandes regiones: Europa, Norteamérica, Asia Pacífico y El Golfo Pérsico. Las migraciones se han mundializado no tanto por la magnitud de los flujos, que sigue estando por debajo del 5% de la población mundial, sino por el reducido número de países que hoy permanece al margen de las redes migratorias. Estas realidades crecientes crean las condiciones para que los potenciales migrantes en países empobrecidos y en proceso de empobrecimiento quieran migrar. A esto precisamente apuntó Joaquín Arango cuando definió nuestra época como el tiempo de la inmovilidad involuntaria

Lo público. Un espacio en disputa

Rastrear los diferentes sentidos de lo público en la historia de la humanidad, es entrar en un terreno marcado por la polémica. Sus raíces y huellas son posibles de encontrar en la polis griega como en la res pública romana. Su fisonomía moderna está marcada, sin duda, por el pensamiento de Inmanuel Kant, quien de alguna manera delimitará el debate, que continuará en las reflexiones seminales de Jurgen Habermas sobre la esfera pública o en la crítica de Hannah Arendt a la distinción entre lo social y lo político. Trabajos que han dado la pauta a un conjunto amplio de reflexiones y que a su vez han generado una serie de respuestas, derivados, revisiones, comentarios y críticas al concepto de lo público, al punto que el debate ha desbordado los márgenes de la teoría política para desplegarse en variadas disciplinas, desde la sociología, el urbanismo, la geografía, la antropología, los estudios culturales y comunicacionales

ATLANTIC ANTS: a data set of ants in Atlantic Forests of South America

International audienc

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease