Comportamiento del monóxido de carbono y el clima en la ciudad de Toluca, de 1995 a 2001

Uno de los gases contaminantes con mayor distribución y concentración en Toluca y su área metropolitana es el monóxido de carbono que, al igual que el dióxido de azufre y el dióxido de carbono, es generado principalmente por la combustión automotriz y, en segundo lugar por el sector industrial. Sin embargo, debido a la activa dinámica de los vientos en la mayor parte del año, estos gases tienden a dispersarse en todo el valle; solamente durante el invierno la concentración y la distribución del monóxido de carbono se encuentran por encima de las normas establecidas en la legislación vigente. Por eso se considera la calidad del aire como satisfactoria, aunque por su combinación con las bajas temperaturas del periodo invernal y la baja humedad del aire, tiende a representar riesgos para la salud humana

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Calidad de vida en la Ciudad de Toluca, México. Sus beneficios sociales y ambientales

Los problemas observados en el Área Metropolitana de la Ciudad de Toluca, presenta áreas verdes insuficientes para mitigar la contaminación atmosférica y por lo tanto, hay una disminución en el bienestar social; Dado que las áreas presentes contribuyen a la asimilación de contaminantes atmosféricos, facilitan la infiltración de las lluvias, atenúan las corrientes de aire, regulan el régimen térmico, proporcionan refugio en diferentes inclemencias, amortiguan los efectos del ruido, mejoran el paisaje y suavizan el impacto visual de Las construcciones masivas, es decir, influyen en la mejora de la calidad de vida de la población. Además, la presente investigación hace referencia al estudio de la calidad de vida en la ZMCT, área en la que se considera un desarrollo paulatino, pero que a la vez también presenta un gran sector de la población al margen de esos beneficios incluida la calidad de vida; vinculado a ello en el siguiente se describen los principales organismos y programas que atienden aspectos relacionados a la calidad de vida. Una de las propuestas que en los últimos años ha cobrado mayor importancia es la de la sostenibilidad, la cual promueve de manera integral aspectos económicos, sociales y ambientales. (Hernández 2009 en Torres; 2013) señala que en la calidad de vida urbana está implícita la idea de sustentabilidad, lo cual supera profundamente el concepto economicista del bienestar, el cual solo es medible en el crecimiento económico. El inicio de siglo XXI es sin duda un momento histórico relevante para la sociedad, en el cual las expectativas de transformación generada por el entorno político y económico provocaban incertidumbre en su “estado y modo de vida”, razón por la cual las decisiones institucionales de orden internacional en los últimos años han sido evidentes, sobre todo si hacemos hincapié en aquellas que tienen como objetivo el de promover el desarrollo de los países que tradicionalmente se han quedado al margen de ofrecer mejores condiciones de vida al interior, o que en su caso, no se han visto favorecidos por las políticas neoliberales imperantes. De ahí que el tema del desarrollo se encuentre frecuentemente en las mesas de discusión dentro del entorno político y académico, pero más allá de esto, todavía siguen pendientes las fórmulas que reditúen en el bienestar social (posteriormente se hará referencia sobre su conceptualización). En lo que respecta al término “calidad de vida”, inicialmente hizo referencia a los ámbitos del medio ambiente y del deterioro de las condiciones de vida urbana, y es a principio de los años sesenta cuando surge un gran interés por su atención debido a los efectos que sufrió la sociedad a causa de la incesante industrialización, este proceso implicó la necesidad de tener información para medir o estimar parámetros de tal forma que nos aproximara a una realidad más objetiva. El aspecto ambiental, ha surgido innumerables investigaciones que han convergido en el término de “sostenibilidad”, sin embargo, dado que su conceptualización es multidimensional más no limitada, las áreas y disciplinas del conocimiento de diferente índole han abordado planteamientos a través de diversos enfoques teóricos. El deterioro ambiental provocado por el fenómeno de la industrialización hace algunas décadas ha desencadenado lo que los especialistas denominan actualmente la “crisis ecológica”, que para las generaciones actuales y futuras representa un elevado costo económico y social, y esta expansión industrial específicamente en zonas urbanas se manifestó en aspectos de concentración demográfica, demanda de infraestructura, agotamiento de áreas verdes, transformación del uso de suelo entre otros, esto nos lleva a deducir que las grandes ciudades presentan dos facetas opuestas: por un lado, son atractivas (receptoras) para la sociedad por el hecho de que ofrecen elementos como empleo, servicios educativo, de salud, etcétera; y por otro, son vistas como zonas de conflicto ante la insuficiente oferta de aspectos antes mencionados, y que se podrían agregar otros más como es la inseguridad, tráfico, vivienda, por mencionar sólo algunos y que inciden de manera negativa en los ciudadanos (Torres et al; 2013

TEC behavior over the Mexican region

With the advent of the Navigation Satellites the Total Electron Content (TEC) has become one of the main parameters of the ionosphere. This is the result of a continuous TEC monitoring and rather dense network of GPS receivers. For Mexican region having no ionosondes the use of TEC for ionospheric conditions studies and monitoring has a special value. To study the behaviour of TEC and for its applied aspects two types of source-files are used worldwide: IONEX (global maps) and RINEX (local data) depending on the task solved. Magnetometer and satellite data from CHAMP and DMSP were involved in the analysis. First, benefits and limitations of TEC derived from both types of files are discussed in regard to the estimation of the ionosphere state in the Mexican region. Second, using both methods the specific features of diurnal, seasonal and annual patterns in TEC behaviour over Mexico were revealed, among which are the shift of the diurnal maximum to 14 LT, dependence on solar activity, high probability of night-time enhancements, presence of annual and winter anomalies. Third, it was revealed that the positive short-lived TEC enhancements are characteristic for Mexican region. They may occur even under quiet conditions. The answer is given what part of the ionosphere is responsible for TEC change during these positive disturbances. The results for Mexico were compared to the neighboring regions and South-East zone

Assessment of Morelian Meteoroid Impact on Mexican Environment

Possible ionospheric effects of the Morelian meteoroid that passed and exploded over Mexico on 19 February 2020 (18 February 2020 local time) were estimated. The meteoroid trajectory, velocity and time of occurrence were calculated based on outdoor camera records. Modeling was used to estimate the meteoroid initial diameter, density, mass, velocity, energy and their change during its flight in the atmosphere. The ensemble of ionospheric scintillation indices calculated from the high-rate GNSS data and the filtered slant Total Electron Content data were used to reveal the presence of ionospheric disturbances generated by shock waves excited by the meteoroid flight and explosion. The first ionospheric responses to phenomena accompanying the meteoroid were detected (2.5–3.5) min after the explosion. The disturbances were attenuated quickly with distance from their source and were rarely recorded by GNSS receivers located more than 600 km from the meteoroid explosion site. The ionospheric disturbances of intermediate-scale, small-scale, shock-acoustic-wave-scale and sometimes medium-scale were revealed. The detected disturbances corresponded to the range of acoustic-gravity waves. An asymmetry of the disturbance manifestation in different directions was observed. The obtained results are in accordance with results of the observation of other meteoroids. Although the object was smaller and of less energy than other known meteoroids, it is an interesting case because, to the best of our knowledge, it isthe first known to us low-latitude meteoroid with the detected ionospheric effects