Knowledge and Practice of Health Professionals in the Management of Dysphagia

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale >= 2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 +/- 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. (C) 2016 S. Karger AG, Base

Hemotórax masivo: una rarísima complicación de la trombólisis de la embolia pulmonar

Massive haemothorax secondary to thrombolysis during the treatment of pulmonary embolism (PE) is an exceptional and poorly documented in the literature event. We talk about massive haemothorax when the amount of extravasated fluid in pleura exceeds 1,500 mL, which is a serious haemodynamic compromise. Spontaneous haemothorax is a rare entity whose most common causes are ruptured arteriovenous malformations, tumors, coagulation disorders or secondary to anticoagulant therapy. We present a case of massive spontaneous haemothorax secondary to systemic thrombolytic treatment in a patient with pulmonary embolism.El hemotórax masivo (HM) secundario a trombólisis durante el tratamiento de la embolia pulmonar (EP) es un evento excepcional y escasamente documentado en la literatura. Se habla de HM cuando la cantidad de líquido extravasado en pleura supera los 1.500 mL, lo que supone un grave compromiso hemodinámico. El hemotórax espontáneo es una entidad poco frecuente cuyas causas más comunes son la rotura de malformaciones arteriovenosas, neoplasias, desórdenes de la coagulación o secundario a tratamiento anticoagulante. Se presenta un caso de hemotórax espontáneo masivo secundario al tratamiento trombolítico sistémico en una paciente con embolia pulmonar

Design of Polymeric and Biocompatible Delivery Systems by Dissolving Mesoporous Silica Templates

There are many nanoencapsulation systems available today. Among all these, mesoporous silica particles (MSPs) have received great attention in the last few years. Their large surface-to-volume ratio, biocompatibility, and versatility allow the encapsulation of a wide variety of drugs inside their pores. However, their chemical instability in biological fluids is a handicap to program the precise release of the therapeutic compounds. Taking advantage of the dissolving capacity of silica, in this study, we generate hollow capsules using MSPs as transitory sacrificial templates. We show how, upon MSP coating with different polyelectrolytes or proteins, fully customized hollow shells can be produced. These capsules are biocompatible, flexible, and biodegradable, and can be decorated with nanoparticles or carbon nanotubes to endow the systems with supplementary intrinsic properties. We also fill the capsules with a fluorescent dye to demonstrate intracellular compound release. Finally, we document how fluorescent polymeric capsules are engulfed by cells, releasing their encapsulated agent during the first 96 h. In summary, here, we describe how to assemble a highly versatile encapsulation structure based on silica mesoporous cores that are completely removed from the final polymeric capsule system. These drug encapsulation systems are highly customizable and have great versatility as they can be made using silica cores of different sizes and multiple coatings. This provides capsules with unique programmable attributes that are fully customizable according to the specific needs of each disease or target tissue for the development of nanocarriers in personalized medicine.This research was funded by ISCIII Projects ref. PI19/00349, DTS19/00033, co-funded by ERDF/ESF, “Investing in your future”; and MICINN Projects ref. CTM2017-84050-R, Xunta de Galicia (Centro Singular de Investigación de Galicia-Accreditation 2016-2019 and EM2014/035), European Union FEDER Funds (European Regional Development Fund-ERDF), and IDIVAL for INNVAL19/18 and INNVAL20/13 and the technical support

NLRP3 inflammasome activation and symptom burden in KRAS-mutated CMML patients is reverted by IL-1 blocking therapy

Chronic myelomonocytic leukemia (CMML) is frequently associated with mutations in the rat sarcoma gene (RAS), leading to worse prognosis. RAS mutations result in active RAS-GTP proteins, favoring myeloid cell proliferation and survival and inducing the NLRP3 inflammasome together with the apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), which promote caspase-1 activation and interleukin (IL)-1(3 release. Here, we report, in a cohort of CMML patients with mutations in KRAS, a constitutive activation of the NLRP3 inflammasome in monocytes, evidenced by ASC oligomerization and IL-1(3 release, as well as a specific inflammatory cytokine signature. Treatment of a CMML patient with a KRASG12D mutation using the IL-1 receptor blocker anakinra inhibits NLRP3 inflammasome activation, reduces monocyte count, and improves the patient's clinical status, enabling a stem cell transplant. This reveals a basal inflammasome activation in RAS-mutated CMML patients and suggests potential therapeutic applications of NLRP3 and IL-1 blockers

El derecho del trabajo y la seguridad social en la encrucijada: retos para la disciplina laboral

Ministerio de Economía y Competitividad DER2012-32111Ministerio de Economía y Competitividad DER2015-6936

Identidad Onubense: Opinión y prácticas sociales respecto a urbanismo, patrimonio y entorno

Presentation of the research results on the Huelva [Onubense] Identity, 2020-2021. The results were presented at the Conference on Knowledge Transfer held on November 25, 2021 (University of Huelva, ETSI). It corresponds to the project: Huelva Identity: Opinion and social practices regarding urban planning, heritage, and environment. See more information at: https://eseis.es/investigacion/identidad-onubensePresentation of the research results on the Huelva [Onubense] Identity, 2020-2021. The results were presented at the Conference on Knowledge Transfer held on November 25, 2021 (University of Huelva, ETSI). It corresponds to the project: Huelva Identity: Opinion and social practices regarding urban planning, heritage, and environment. See more information at: https://eseis.es/investigacion/identidad-onubenseCátedra de la Provincia, UHU - Diputación de Huelva. Facultad de Trabajo Social. Autoridad Portuaria de Huelva. Consejo Social, UHU. Grupo de investigación Estudios Sociales E Intervención Social (Grupo ESEIS). Centro de Pensamiento Contemporáneo e Innovación para el Desarrollo Social (COIDESO

Modified Wisconsin Card Sorting Test (M-WCST): Normative data for Spanish-speaking pediatric population

OBJECTIVE: To generate normative data for the Modified Wisconsin Card Sorting Test (M-WCST) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the M-WCST as part of a larger neuropsychological battery. Number of categories, perseverative errors, and total error scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models indicated main effects for age on all scores, such that the number of categories correct increased and total number of perseverative errors and total number of errors decrease linearly as a function of age. Age2 had a significant effect in Chile, Cuba, Ecuador, and Spain for numbers of categories; a significant effect for number of perseverative errors in Chile, Cuba, Mexico, and Spain; and a significant effect for number of total errors in Chile, Cuba, Peru, and Spain. Models showed an effect for MLPE in Cuba (total errors), Ecuador (categories and total errors), Mexico (all scores), Paraguay (perseverative errors and total error), and Spain (categories and total errors). Sex affected number of total errors for Ecuador. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate way to interpret the M-WCST with pediatric populations