Tratamiento inhalatorio en la crisis asmática severa

Se realiza una revisión sobre el tratamiento inhalatorio de la crisis asmática. La inhaloterapia está ampliamente difundida en la práctica médica habitual, implicando importantes costos económicos. Sin embargo, se estima a nivel mundial que hay una administración inadecuada en un porcentaje importante, lo que resulta en fracasos terapéuticos y gastos innecesarios. Esto adquiere relevancia cuando se conoce el aumento de la mortalidad por asma en las últimas décadas y se detecta que tanto los pacientes como los médicos y paramédicos carecen mayoritariamente de los conocimientos básicos y habilidades para su adecuado manejo. Se establecen los objetivos de la inhaloterapia y se consideran sus aspectos fundamentales (físicos, generadores de aerosoles, farmacología). Se estudian y comparan los distintos sistemas de generación de aerosoles y también se analizan los diferentes fármacos inhalados. Se exponen con detalle los beta agonistas, anticolinérgicos y corticoides en sus formas inhaladas. También se presentan otros tratamientos inhalatorios no tradicionales como el sulfato de magnesio y una mezcla gaseosa heliox. En los distintos tópicos se recurre en lo posible a revisiones sistemáticas o metaanálisis para establecer preferencias o elegir tratamientos. Los autores proponen algunas estrategias terapéuticas avaladas en su experiencia, documentada en la bibliografía aportada

Exchange-spring behavior in bimagnetic CoFe2O4/CoFe2 nanocomposite

In this work we report a study of the magnetic behavior of ferrimagnetic oxide CoFe2O4 and ferrimagnetic oxide/ferromagnetic metal CoFe2O4/CoFe2 nanocomposites. The latter compound is a good system to study hard ferrimagnet/soft ferromagnet exchange coupling. Two steps were used to synthesize the bimagnetic CoFe2O4/CoFe2 nanocomposites: (i) first preparation of CoFe2O4 nanoparticles using the a simple hydrothermal method and (ii) second reduction reaction of cobalt ferrite nanoparticles using activated charcoal in inert atmosphere and high temperature. The phase structures, particle sizes, morphology, and magnetic properties of CoFe2O4 nanoparticles have been investigated by X-Ray diffraction (XRD), Mossbauer spectroscopy (MS), transmission electron microscopy (TEM), and vibrating sample magnetometer (VSM) with applied field up to 3.0 kOe at room temperature and 50K. The mean diameter of CoFe2O4 particles is about 16 nm. Mossbauer spectra reveal two sites for Fe3+. One site is related to Fe in an octahedral coordination and the other one to the Fe3+ in a tetrahedral coordination, as expected for a spinel crystal structure of CoFe2O4. TEM measurements of nanocomposite show the formation of a thin shell of CoFe2 on the cobalt ferrite and indicate that the nanoparticles increase to about 100 nm. The magnetization of nanocomposite showed hysteresis loop that is characteristic of the exchange spring systems. A maximum energy product (BH)max of 1.22 MGOe was achieved at room temperature for CoFe2O4/CoFe2 nanocomposites, which is about 115% higher than the value obtained for CoFe2O4 precursor. The exchange-spring interaction and the enhancement of product (BH)max in nanocomposite CoFe2O4/CoFe2 have been discussed.Comment: 9 pages, 10 figure

LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD : a systematic review and meta-analysis

Acknowledgments The meta-analysis work was performed by Guruprasad Rao KS and Sharanbasappa Durg of Molecular Connections (P) Ltd, Bangalore, India, under the guidance of the manuscript authors and Novartis Pharma AG (Basel, Switzerland). Medical writing assistance was provided by Colette O’Sullivan, PhD, of Scriva Medical Communications Ltd, a professional medical writer funded by Novartis. Development of the manuscript was supported by Novartis Pharma AG (Basel, Switzerland). The authors received no compensation related to the development of the manuscript.Peer reviewedPublisher PD

Practical Based Learning (PBL) for Academic, Technological and Scientific Education in Engineering Courses - Case Study

The increase in the number of students evaded has alerted different segments of society and the public sector to the need to update the guidelines of engineering courses as well as innovation in teaching engineering. In this sense, the objective is to report on the challenges of engineering education in Brazil and the methodological strategies that have been adopted for the modernization of the curricula of engineering courses and consequent reduction of the indicators of avoidance and withdrawal. In addition, involving the use of the 43 academic academics of the University of Cruz Alta (Unicruz) who studied the discipline of Research Methodology in the second semester of 2017 through the Problem Based Learning (PBL) strategy as an innovative strategy education. Finally, in addition to the production of a technical material produced throughout the course, it was observed that there were only 2 students in 1 failed exam, demonstrating that teaching by PBL has high effectiveness for academic achievement in the discipline of research methodology

Magnetic field decay in black widow pulsars

We study in this work the evolution of the magnetic field in 'redback-black widow' pulsars. Evolutionary calculations of these 'spider' systems suggest that first the accretion operates in the redback stage, and later the companion star ablates matter due to winds from the recycled pulsar. It is generally believed that mass accretion by the pulsar results in a rapid decay of the magnetic field when compared to the rate of an isolated neutron star. We study the evolution of the magnetic field in black widow pulsars by solving numerically the induction equation using the modified Crank-Nicolson method with intermittent episodes of mass accretion on to the neutron star. Our results show that the magnetic field does not fall below a minimum value ('bottom field') in spite of the long evolution time of the black widow systems, extending the previous conclusions for much younger low-mass X-ray binary systems. We find that in this scenario, the magnetic field decay is dominated by the accretion rate, and that the existence of a bottom field is likely related to the fact that the surface temperature of the pulsar does not decay as predicted by the current cooling models. We also observe that the impurity of the pulsar crust is not a dominant factor in the decay of magnetic field for the long evolution time of black widow systems.Instituto de Astrofísica de La Plat

Cuantificación de emisiones de los GSE según operación de aeronaves bajo modalidad LCC y tradicional

El documento se centra en cuantificar la mínima cantidad de vehículos necesarios y su aporte contaminante según las operaciones efectuadas por las aeronaves debido al servicio y a la circulación en plataforma. En este sentido se han planteado tres configuraciones fijando la cantidad de operaciones: con 100% FSC, 100% LCC y 50-50% FSC-LCC

a living systematic review

Background: Hamstrings injuries are common in sports and the reinjury risk is high. Despite the extensive literature on hamstrings injuries, the efectiveness of the diferent conservative (i.e., non-surgical) interventions (i.e., modalities and doses) for the rehabilitation of athletes with acute hamstrings injuries is unclear. Objective: We aimed to compare the efects of diferent conservative interventions in time to return to sport (TRTS) and/or time to return to full training (TRFT) and reinjury-related outcomes after acute hamstrings injuries in athletes. Data Sources: We searched CINAHL, Cochrane Library, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science databases up to 1 January, 2022, complemented with manual searches, prospective citation tracking, and consultation of external experts. Eligibility Criteria: the eligibility criteria were multi-arm studies (randomized and non-randomized) that compared conservative treatments of acute hamstrings injuries in athletes. Data Analysis: We summarized the characteristics of included studies and conservative interventions and analyzed data for main outcomes (TRTS, TRFT, and rate of reinjuries). The risk of bias was judged using the Cochrane tools. Quality and completeness of reporting of therapeutic exercise programs were appraised with the i-CONTENT tool and the certainty of evidence was judged using the GRADE framework. TRTS and TRFT were analyzed using mean diferences and the risk of reinjury with relative risks. Results Fourteen studies (12 randomized and two non-randomized) comprising 730 athletes (mostly men with ages between 14 and 49 years) from diferent sports were included. Nine randomized studies were judged at high risk and three at low risk of bias, and the two non-randomized studies were judged at critical risk of bias. Seven randomized studies compared exercise-based interventions (e.g., L-protocol vs C-protocol), one randomized study compared the use of low-level laser therapy, and three randomized and two non-randomized studies compared injections of platelet-rich plasma to placebo or no injection. These low-level laser therapy and platelet-rich plasma studies complemented their interventions with an exercise program. Only three studies were judged at low overall risk of inefectiveness (i-CONTENT). No single intervention or combination of interventions proved superior in achieving a faster TRTS/TRFT or reducing the risk of reinjury. Only eccentric lengthening exercises showed limited evidence in allowing a shorter TRFT. The platelet-rich plasma treatment did not consistently reduce the TRFT or have any efect on the risk of new hamstrings injuries. The certainty of evidence was very low for all outcomes and comparisons. Conclusions: Available evidence precludes the prioritization of a particular exercise-based intervention for athletes with acute hamstrings injuries, as diferent exercise-based interventions showed comparable efects on TRTS/TRFT and the risk of reinjuries. Available evidence also does not support the use of platelet-rich plasma or low-level laser therapy in clinical practice. The currently available literature is limited because of the risk of bias, risk of inefectiveness of exercise protocols (as assessed with the i-CONTENT), and the lack of comparability across existing studies. Clinical Trial Registration PROSPERO CRD42021268499 and OSF (https://osf.io/3k4u2/).9513-E3E4-C5C9 | Sílvia Fernanda Rocha RodriguesN/

Gemini multi-conjugate adaptive optics system review II: Commissioning, operation and overall performance

The Gemini Multi-conjugate Adaptive Optics System - GeMS, a facility instrument mounted on the Gemini South telescope, delivers a uniform, near diffraction limited images at near infrared wavelengths (0.95 microns- 2.5 microns) over a field of view of 120 arc seconds. GeMS is the first sodium layer based multi laser guide star adaptive optics system used in astronomy. It uses five laser guide stars distributed on a 60 arc seconds square constellation to measure for atmospheric distortions and two deformable mirrors to compensate for it. In this paper, the second devoted to describe the GeMS project, we present the commissioning, overall performance and operational scheme of GeMS. Performance of each sub-system is derived from the commissioning results. The typical image quality, expressed in full with half maximum, Strehl ratios and variations over the field delivered by the system are then described. A discussion of the main contributor to performance limitation is carried-out. Finally, overheads and future system upgrades are described.Comment: 20 pages, 11 figures, accepted for publication in MNRA