Plano de Controlo Ambiental das obras Mahou-Calderón (2018-2020) na cidade de Madrid

Construction and renovation works are one of the major sources of environmental pollution in urban areas, particularly during the demolition phase. A significant increase in particles, especially PM10, and exhaust gases from the diesel motors of the vehicles used for carrying material and equipment is observed during this kind of work. It is important to take pollutant emission minimization measures to prevent this pollution. Thus, it was proposed that project developers introduce an Air Quality Self-Control Plan that envisages, first of all, the assessment of those areas that will be most greatly affected and have the highest population sensitivity in order to estimate what the most unfavorable winds will be therein and, secondly, the monitoring of the environmental conditions and determination of the maximum levels of pollutant emission/immission. The Air Quality Self-Monitoring Plan introduced for the demolition works of the Vicente Calderón Stadium —the former home of the Atlético de Madrid soccer club— is presented herein as a strategy model for preventing the effects of this kind of actions on ambient air quality and, consequently, reducing their impact on the health of the exposed population, as well as in terms of the transparency of the actions of public administrations.Una de las principales fuentes de contaminación ambiental en zonas urbanas son las obras de construcción y rehabilitación, en especial, en las fases de demolición. Durante estas actuaciones se observa un importante incremento de material particulado, en especial PM10, así como un aumento de los gases procedentes de la combustión de motores diésel del transporte de materiales y equipamiento. Para evitar esta contaminación es importante la adopción de medidas de minimización de emisión de contaminantes, para lo que se propone la adopción por parte del promotor de la obra, de un Plan de Autocontrol de la Calidad del Aire que considere la valoración de zonas de mayor afectación y sensibilidad poblacional para estimar los vientos que les son más desfavorables, así como la monitorización de condiciones ambientales y los máximos niveles de emisión/inmisión de contaminantes. Se presenta el Plan de Autocontrol de la Calidad del Aire implantado en las obras de demolición del Estadio Vicente Calderón, antigua sede del club de fútbol Atlético de Madrid, como modelo de estrategia para evitar los efectos de estas intervenciones sobre la calidad del aire ambiente y en consecuencia, la disminución de su incidencia sobre la salud de la población expuesta, así como en términos de transparencia de actuaciones de las administraciones públicas.Uma das principais fontes de poluição ambiental em áreas urbanas são as obras de construção e reabilitação, principalmente nas fases de demolição. Durante essas ações, observa-se um aumento significativo de material particulado, principalmente PM10, bem como aumento de gases provenientes da combustão de motores a diesel, utilizados no transporte de materiais e equipamentos. Para evitar esta contaminação, é importante adotar medidas que minimizem a emissão de poluentes, pelo que se propõe que o promotor da obra adote um Plano de Autocontrolo da Qualidade do Ar, que considere, em primeiro lugar, a avaliação das zonas mais afetadas e de maior sensibilidade populacional, de forma a estimar os ventos mais desfavoráveis para estas áreas, bem como a monitorização das condições ambientais e dos níveis máximos de emissão/imissão de poluentes. O Plano de Autocontrolo da Qualidade do Ar implementado nas obras de demolição do Estádio Vicente Calderón, antiga sede do clube de futebol Atlético de Madrid, apresenta-se como um modelo de estratégia para evitar os efeitos destas intervenções na qualidade do ar ambiente e consequentemente na redução da sua incidência na saúde da população exposta, bem como em termos de transparência das ações das administrações públicas

Plan de Control Ambiental de las obras del Mahou-Calderón (2018-2020) en la ciudad de Madrid

Una de las principales fuentes de contaminación ambiental en zonas urbanas son las obras de construcción y rehabilitación, en especial, en las fases de demolición. Durante estas actuaciones se observa un importante incremento de material particulado, en especial PM10, así como un aumento de los gases procedentes de la combustión de motores diésel del transporte de materiales y equipamiento. Para evitar esta contaminación es importante la adopción de medidas de minimización de emisión de contaminantes, para lo que se propone la adopción por parte del promotor de la obra, de un Plan de Autocontrol de la Calidad del Aire que considere la valoración de zonas de mayor afectación y sensibilidad poblacional para estimar los vientos que les son más desfavorables, así como la monitorización de condiciones ambientales y los máximos niveles de emisión/inmisión de contaminantes. Se presenta el Plan de Autocontrol de la Calidad del Aire implantado en las obras de demolición del Estadio Vicente Calderón, antigua sede del club de fútbol Atlético de Madrid, como modelo de estrategia para evitar los efectos de estas intervenciones sobre la calidad del aire ambiente y en consecuencia, la disminución de su incidencia sobre la salud de la población expuesta, así como en términos de transparencia de actuaciones de las administraciones públicas

Molecular characterization of multidrug resistant Enterobacterales strains isolated from liver and kidney transplant recipients in Spain

The objective of this study was to analyse the mechanisms of resistance to carbapenems and other extended-spectrum-?-lactams and to determine the genetic relatedness of multidrug-resistant Enterobacterales (MDR-E) causing colonization or infection in solid-organ transplantation (SOT) recipients. Prospective cohort study in kidney (n= 142), liver (n= 98) or kidney/pancreas (n= 7) transplant recipients between 2014 and 2018 in seven Spanish hospitals. We included 531 MDR-E isolates from rectal swabs obtained before transplantation and weekly for 4?6 weeks after the procedure and 10 MDR-E from clinical samples related to an infection. Overall, 46.2% Escherichia coli, 35.3% Klebsiella pneumoniae, 6.5% Enterobacter cloacae, 6.3% Citrobacter freundii and 5.7% other species were isolated. The number of patients with MDR-E colonization post-transplantation (176; 71.3%) was 2.5-fold the number of patients colonized pre-transplantation (71; 28.7%). Extended spectrum ?-lactamases (ESBLs) and carbapenemases were detected in 78.0% and 21.1% of MDR-E isolates respectively. In nine of the 247 (3.6%) transplant patients, the microorganism causing an infection was the same strain previously cultured from surveillance rectal swabs. In our study we have observed a low rate of MDR-E infection in colonized patients 4?6 weeks post-transplantation. E. coli producing blaCTX-M-G1 and K. pneumoniae harbouring blaOXA-48 alone or with blaCTX-M-G1 were the most prevalent MDR-E colonization strains in SOT recipients.Acknowledgements The authors thank Mª Jesús Lecea and Laura Álvarez for technical assistance. Tis research was supported by ‘Plan Nacional de I+D+i and Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias 13/01191), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, and the Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0007, RD16/0016/0010, RD16/0016/0012, RD16/0016/0011, RD16/0016/0008, RD16/0016/0002). Te study was co-fnanced by the European Development Regional Fund “A way to achieve Europe” and the Operative Program Intelligent Growth 2014‐2020

Sublingual immunotherapy for asthma.

BACKGROUND: Asthma is a common long-term respiratory disease affecting approximately 300 million people worldwide. Approximately half of people with asthma have an important allergic component to their disease, which may provide an opportunity for targeted treatment. Sublingual immunotherapy (SLIT) aims to reduce asthma symptoms by delivering increasing doses of an allergen (e.g. house dust mite, pollen extract) under the tongue to induce immune tolerance. However, it is not clear whether the sublingual delivery route is safe and effective in asthma. OBJECTIVES: To assess the efficacy and safety of sublingual immunotherapy compared with placebo or standard care for adults and children with asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Group Specialised Register (CAGR), ClinicalTrials.gov (www.ClinicalTrials.gov), the World Health Organization (WHO) trials portal (www.who.int/ictrp/en/) and reference lists of all primary studies and review articles. The search is up to date as of 25 March 2015. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs), irrespective of blinding or duration, that evaluated sublingual immunotherapy versus placebo or as an add-on to standard asthma management. We included both adults and children with asthma of any severity and with any allergen-sensitisation pattern. We included studies that recruited participants with asthma, rhinitis, or both, providing at least 80% of trial participants had a diagnosis of asthma. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results for included trials, extracted numerical data and assessed risk of bias, all of which were cross-checked for accuracy. We resolved disagreements by discussion.We analysed dichotomous data as odds ratios (ORs) or risk differences (RDs) using study participants as the unit of analysis; we analysed continuous data as mean differences (MDs) or standardised mean differences (SMDs) using random-effects models. We rated all outcomes using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) and presented results in the 'Summary of findings' table. MAIN RESULTS: Fifty-two studies met our inclusion criteria, randomly assigning 5077 participants to comparisons of interest. Most studies were double-blind and placebo-controlled, but studies varied in duration from one day to three years. Most participants had mild or intermittent asthma, often with co-morbid allergic rhinitis. Eighteen studies recruited only adults, 25 recruited only children and several recruited both or did not specify (n = 9).With the exception of adverse events, reporting of outcomes of interest to this review was infrequent, and selective reporting may have had a serious effect on the completeness of the evidence. Allocation procedures generally were not well described, about a quarter of the studies were at high risk of bias for performance or detection bias or both and participant attrition was high or unknown in around half of the studies.One short study reported exacerbations requiring a hospital visit and observed no adverse events. Five studies reported quality of life, but the data were not suitable for meta-analysis. Serious adverse events were infrequent, and analysis using risk differences suggests that no more than 1 in 100 are likely to suffer a serious adverse event as a result of treatment with SLIT (RD 0.0012, 95% confidence interval (CI) -0.0077 to 0.0102; participants = 2560; studies = 22; moderate-quality evidence).Within secondary outcomes, wide but varied reporting of largely unvalidated asthma symptom and medication scores precluded meaningful meta-analysis; a general trend suggested SLIT benefit over placebo, but variation in scales meant that results were difficult to interpret.Changes in inhaled corticosteroid use in micrograms per day (MD 35.10 mcg/d, 95% CI -50.21 to 120.42; low-quality evidence), exacerbations requiring oral steroids (studies = 2; no events) and bronchial provocation (SMD 0.69, 95% CI -0.04 to 1.43; very low-quality evidence) were not often reported. This led to many imprecise estimates with wide confidence intervals that included the possibility of both benefit and harm from SLIT.More people taking SLIT had adverse events of any kind compared with control (OR 1.70, 95% CI 1.21 to 2.38; low-quality evidence; participants = 1755; studies = 19), but events were usually reported to be transient and mild.Lack of data prevented most of the planned subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS: Lack of data for important outcomes such as exacerbations and quality of life and use of different unvalidated symptom and medication scores have limited our ability to draw a clinically useful conclusion. Further research using validated scales and important outcomes for patients and decision makers is needed so that SLIT can be properly assessed as clinical treatment for asthma. Very few serious adverse events have been reported, but most studies have included patients with intermittent or mild asthma, so we cannot comment on the safety of SLIT for those with moderate or severe asthma. SLIT is associated with increased risk of all adverse events

A New System for Choosing the Form and Size of Complete Denture Anterior Teeth

Introduction: In the absence of pre-extraction records, the choice of the size an form of anterior complete denture teeth can be extremely subjective. Several clinical and statistical parameters are usually used for choosing the correct size and form of the complete denture anterior teeth. Clinical Innovation: The technique consists of a system that allows the dentist to choose and, if necessary, easily change the dental mold during maxillomandibular recording session. The unique feature of the system is that six teeth of each mold are represented by veneers, which are connected to each other on the lingual surface by a fiber that allows each veneer some degree of movement. Discussion: This technique allows the three-dimensional verification of the patient's esthetics and realistic phonetic test during the session of maxillomandibular records; if necessary, the dentist may easily replace the mold with a different one in form or size, without working the wax to move or replace a tooth