Substitute therapy of the sclera. Identification of the patologies and methodologies in the University Hospital of Granada (2014-2019)

Introducción: La esclera es un tejido avascular compuesto por tejido conectivo denso cuya función principal es proteger las estructuras intraoculares. Existen diversas patologías que ponen en riesgo la integridad de dicho tejido y, en consecuencia, pueden provocar terribles secuelas con un pronóstico nefasto. El tratamiento sustitutivo forma parte de la terapia de dicha patología, siendo el injerto de esclerótica cadáver una opción biocompatible y biomimética a valorar. El injerto de esclerótica de cadáver es un tejido de fácil acceso y con buenos resultados post-quirúrgicos por lo que no solo es usado en el ámbito de la patología escleral, sino que también es utilizado para cirugía de oculoplástica, glaucoma o de retina. No obstante, el peligro de transmisión de priones o el déficit de suministro en algunos países hacen que este tejido sea suplantado por otros tejidos o técnicas quirúrgicas. Métodos: Los objetivos de este estudio son identificar la patología esclerótica susceptible de terapia sustitutiva en los últimos 5 años en el complejo hospitalario universitario de Granada, identificar los métodos empleados como terapéutica sustitutiva en dicha patología y evaluar la práctica de dicha terapia en el contexto de la bibliografía existente al respecto. Para ello, se aplicó un diseño retrospectivo en el que se realizó una búsqueda en los archivos de la unidad de documentación clínica del Hospital Clínico San Cecilio y Hospital Virgen de las Nieves, de los cuales se obtuvieron 9 casos clínicos. Resultados: Entre los 9 casos clínicos, solo 4 fueron sometidos a tratamiento quirúrgico, y de estos, 3 de ellos a terapia sustitutiva por membrana amniótica o injerto escleral. En los 5 casos restantes no se llevó a cabo ninguna técnica quirúrgica, no obstante, podría ser de gran valor el uso del refuerzo con injerto de esclerótica en los casos con escleromalacia para evitar complicaciones futuras. La esclerótica procedente de cadáver se postula como una opción con unos resultados prometedores; sin embargo, las líneas de investigación actuales apuestan por el desarrollo de un sustituto basado en las ventajas de la fibrina agarosa que supla los puntos negativos del tejido donante.Introduction: The sclera is an avascular tissue composed of dense connective tissue whose main function is to protect intraocular structures. There are several pathologies that jeopardize the integrity of this tissue and, consequently, can cause terrible consequences with a dire prognosis. Substitute treatment is part of the therapy of this pathology, with the donor sclera graft being a biocompatible and biomimetic option to be evaluated. The donor sclera graft is an easily accessible tissue with good post-surgical results, so it is not only used in the field of scleral pathology, but also used for oculoplastic, glaucoma or retinal surgery. However, the danger of prion transmission or the supply deficit in some countries causes that, other tissues or surgical techniques supplant this tissue. Methods: The objectives of this study are to identify the sclerotic pathology susceptible of replacement therapy in the last 5 years in the university hospital of Granada, identify the methods used as a replacement therapy in this pathology and evaluate the practice of such therapy. A retrospective design was applied and a search was made in the archives of the clinical documentation unit of the San Cecilio Clinical Hospital and Virgen de las Nieves Hospital. There were 9 clinical cases found. Results: Among the nine clinical cases, only 4 were subjected to surgical treatment, and of these, three of them for replacement therapy of donor sclera or amniotic membrane. In the remaining 5 cases did not carry out any surgical technique, however, it could be of great value using reinforcement sclera graft in cases with scleromalacia to avoid further complications. Sclera from cadaver is postulated as an option with promising results; however, current research committed to the development of a substitute based on the advantages of fibrin agarose that mitigates the negative points of the donor tissue

A horizon scan exercise for aquatic invasive alien species in Iberian inland waters

As the number of introduced species keeps increasing unabatedly, identifying and prioritising current and potential Invasive Alien Species (IAS) has become essential to manage them. Horizon Scanning (HS), defined as an exploration of potential threats, is considered a fundamental component of IAS management. By combining scientific knowledge on taxa with expert opinion, we identified the most relevant aquatic IAS in the Iberian Peninsula, i.e., those with the greatest geographic extent (or probability of introduction), severe ecological, economic and human health impacts, greatest difficulty and acceptability of management. We highlighted the 126 most relevant IAS already present in Iberian inland waters (i.e., Concern list) and 89 with a high probability of being introduced in the near future (i.e., Alert list), of which 24 and 10 IAS, respectively, were considered as a management priority after receiving the highest scores in the expert assessment (i.e., top-ranked IAS). In both lists, aquatic IAS belonging to the four thematic groups (plants, freshwater invertebrates, estuarine invertebrates, and vertebrates) were identified as having been introduced through various pathways from different regions of the world and classified according to their main functional feeding groups. Also, the latest update of the list of IAS of Union concern pursuant to Regulation (EU) No 1143/2014 includes only 12 top-ranked IAS identified for the Iberian Peninsula, while the national lists incorporate the vast majority of them. This fact underlines the great importance of taxa prioritisation exercises at biogeographical scales as a step prior to risk analyses and their inclusion in national lists. This HS provides a robust assessment and a cost-effective strategy for decision-makers and stakeholders to prioritise the use of limited resources for IAS prevention and management. Although applied at a transnational level in a European biodiversity hotspot, this approach is designed for potential application at any geographical or administrative scale, including the continental one

Black list and Alert list of the Aquatic Invasive Alien Species in the Iberian Peninsula: an action of the LIFE INVASAQUA

Resumen del trabajo presentado en VI Congreso Nacional sobre Especies Exóticas Invasoras y I Congreso Ibérico sobre EEI (EEI 2022) celebrado en Navarra del 20 al 23 de abril de 2022.One of the objectives of LIFE INVASQUA project is to develop tools that will be more efficient the Early Warning and Rapid Response (EWRR) framework for Invasive Alien Species in the Iberian Peninsula. Horizon scanning for high-risk IAS is basic in implementing measures to reduce new invasions, developing Alert lists, and to focus effort in the species already established, for instance making a Black list. We developed a trans national horizon scanning exercise focused on inland waters of Spain and Portugal in order to provide a prioritized lists (Black list and Alert list) of aquatic IAS that may pose a threat to aquatic ecosystems and socio economic sectors in the future. We followed a step approach of existing information about IAS (Plants, Freshwater Invertebrates, Estuarine Invertebrates and Vertebrates; 127 established taxa in Black list; 90 non established taxa in Alert list) combining with an expert scoring of prioritized taxa. IAS established in the Iberian aquatic system consistently highlighted as the worst included vertebrates (e.g. Cyprinus carpio, Gambusia holbrooki, Silurus glanis), freshwater and estuarine invertebrates (e.g. Procambarus clarkii, Dreissena polymorpha, Pacifastacus leniusculus, Ficopomatus enigmaticus, Callinectes sapidus, Corbicula fluminea) and plants (e.g. Eichhornia crassipes, Azolla filiculoides, Ludwigia grandiflora). Amongst taxa not yet established (Alert list), expert pointed to Perna viridis, Hydroides dirampha, Dreissena bugensis, Procambarus fallax f. virginallis, Perccottus glenii with higher risk of invasion, ecological and socioeconomic impacts. Over 20.6% of the taxa in the preliminary black list received no votes (no prioritization) by experts, 17.8% in the innitial alert list. Our horizon scanning approach is inclusive of all-taxa, prioritizes both established and emerging biological threats across trans-national scales, and considers not only the ecological impact, but also potential direct economic consequences as well as the manageability of invasive species.This work received funds from the LIFE Programme (LIFE17 GIE/ES/000515)

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. Results: The median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO < 80% and 24% having DLCO < 60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO < 60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. Conclusion: Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities

LISTA NEGRA Y LISTA DE ALERTA DE ESPECIES EXÓTICAS INVASORAS ACUÁTICAS DE LA PENÍNSULA IBÉRICA - Ejercicio de exploración del horizonte transnacional centrado en las especies exóticas invasoras acuáticas de alto riesgo para las aguas interiores ibéricas.

Un objetivo importante de LIFE INVASAQUA es desarrollar herramientas que mejoren la gestión y sean más eficientes en el marco de Alerta Temprana y Respuesta Rápida (EWRR) para las Especies Exóticas Invasoras (EEI) en la Península Ibérica. La exploración del horizonte para las EEI de alto riesgo es básica para aplicar medidas que reduzcan las nuevas invasiones y para centrar los esfuerzos en las especies ya registradas. Desarrollamos un ejercicio transnacional de exploración del horizonte centrado en las aguas interiores de España y Portugal con el fin de proporcionar una lista negra de las EEI acuáticas actualmente establecidas y una lista de alerta de las EEI acuáticas potenciales que pueden suponer una amenaza para los ecosistemas acuáticos y los sectores socioeconómicos en el futuro. Para la exploración del horizonte seguimos un enfoque estructurado de 5 pasos que combinaba las pruebas existentes sobre las EEI con una puntuación de expertos de los taxones priorizados. En la lista negra final se priorizaron 126 EEI, que representan el 41,2% de los taxones exóticos registrados en las aguas continentales ibéricas. Las 24 primeras especies tenían un riesgo de impacto muy alto porque obtuvieron los valores máximos en el proceso de puntuación de la evaluación de riesgos. Además, la lista de alerta incluía 89 EEI con un riesgo significativo de invasión en la Península Ibérica en el futuro, estando 11 taxones en cabeza con un riesgo muy alto de invasión

Measuring efficiency and productivity in professional football teams: Evidence from the English Premier League

Professional football clubs are unusual businesses, their performance judged on and off the field of play. This study is concerned with measuring the efficiency of clubs in the English Premier League. Information from clubs’ financial statements is used as a measure of corporate performance. To measure changes in efficiency and productivity the Malmquist non-parametric technique has been used. This is derived from the Data Envelopment Analysis (DEA) linear programming approach, with Canonical Correlation Analysis (CCA) being used to ensure the cohesion of the input-output variables. The study concludes that while clubs operate close to efficient levels for the assessed models, there is limited technological advance in their performance in terms of the displacement of the technological frontier

COVID-19 outbreaks in a transmission control scenario: challenges posed by social and leisure activities, and for workers in vulnerable conditions, Spain, early summer 2020

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends’ gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis