Revisión sistemática: Clipaje/embolización de aneurismas cerebrales rotos

Un aneurisma es una dilatación localizada en un vaso sanguíneo ocasionada por una degeneración o debilitamiento de la pared vascular. La ruptura de un aneurisma intracraneal produce una hemorragia subaracnoidea. Se estima que el 5% de la población tenga al menos un aneurisma cerebral. El objetivo de este estudio es revisar y comparar el resultado de la embolizacion frente al clipaje quirúrgicos de los aneurismas cerebrales rotos. Métodos: se realizó una búsqueda bibliográfica en Medline y Cochrane, seleccionando los estudios mediante unos criterios de inclusión y de exclusión. Se realizó un análisis de calidad de los estudios y se realizó un metaanálisis, un análisis de heterogeneidad y de los sesgos de publicación. Resultados: se encontraron seis artículos que cumplían los criterios de inclusión y exclusión y sobre ellos se realizaron los análisis. Al analizar la supervivencia libre de discapacidad a un año se obtiene un OR global 1,3747 a favor del tratamiento endovascular. El resultado de la prueba de heterogeneidad no fue significativo. Si se analiza la supervivencia libre de discapacidad a seis años se obtiene un OR global 1,2293; en comparación con los datos obtenidos a un año se aprecia una disminución de la efectividad del tratamiento endovascular con valores al límite de la significación. Si se analiza la supervivencia libre de discapacidad en pacientes con mal grado funcional antes de recibir tratamiento se obtiene un OR global 1,2240 (IC 95=0.7683-1.9500) por lo que no se obtuvo diferencias estadísticamente significativas entre los dos grupos de tratamiento. Conclusiones: tras el análisis de los estudios escogidos y considerando sus características metodológicas, consideramos que la decisión sobre cuál es el mejor tratamiento para un aneurisma en el contexto de la HSA debe ser individualizada teniendo en cuenta factores relacionados con el aneurisma y las características del paciente, y debe ser tomada por un equipo capaz de ofrecer ambas solucionesGrado en Medicin

What is the Current and Future Status of Digital Mental Health Interventions?

The prevalence of mental disorders continues to increase, especially with the advent of the COVID-19 pandemic. Although we have evidence-based psychological treatments to address these conditions, most people encounter some barriers to receiving this help (e.g., stigma, geographical or time limitations). Digital mental health interventions (e.g., Internet-based interventions, smartphone apps, mixed realities -virtual and augmented reality) provide an opportunity to improve accessibility to these treatments. This article summarizes the main contributions of the different types of digital mental health solutions. It analyzes their limitations (e.g., drop-out rates, lack of engagement, lack of personalization, lack of cultural adaptations) and showcases the latest sophisticated and innovative technological advances under the umbrella of precision medicine (e.g., digital phenotyping, chatbots, or conversational agents). Finally, future challenges related to the need for real world implementation of these interventions, the use of predictive methodology, and hybrid models of care in clinical practice, among others, are discussed

Theoretical adequacy, methodological quality and efficacy of online interventions targeting resilience: a systematic review and meta-analysis

Background There is a growing interest in the promotion of mental health, and concepts as resilience are re-emerging and taking relevance. In addition, Information and Communication Technologies can provide potential benefits in the field of mental health, and the treatment of mental disorders in particular. This study aims to synthesize the evidence of internet-based resilience interventions, analyzing the theoretical adequacy, methodological quality and efficacy. Methods A systematic search was performed. The eligibility criteria stated for this article were: randomized controlled trials targeted at adults or adolescents and including any psychological intervention focussing on resilience in its rationale or design. Studies with direct (e.g. resilience scales) and proximal resilience measures (e.g. scales on well-being) were included. Risk of bias was assessed for each trial using Cochrane’s Collaboration Tool. Two reviewers worked independently in order to identify potential articles. A total of 11 articles were selected. A random-effects pooling model using the Hartung–Knapp–Sidik–Jonkman method based on direct and proximal resilience measures at post-test was used. Results The overall effects of online resilience training compared to control groups at post-test were not significant; the effect size concerning the improvement of resilience was g=0.12 (95% CI: −0.14 to 0.38). In addition, a potential association between the type of outcome and the effect size could be revealed. Conclusions The results of the present meta-analysis showed that the overall effect of online resilience trainings was not significant. Nonetheless, a tendency for a higher benefit for resilience was found in the studies with a clear assessment theory, indicating some promising effects

Trojan Microparticles Potential for Ophthalmic Drug Delivery

The administration of drugs to treat ocular disorders still remains a technological challenge in this XXI century. Although there is an important arsenal of active molecules useful to treat ocular diseases, ranging from classical compounds to biotechnological products, currenty, no ideal delivery system is able to profit all their therapeutic potential. Among the intraocular drug delivery systems (IODDS) proposed to overcome some of the most important limitations, microsystems and nanosystems have raised high attention. While microsystems are able to offer long-term release after intravitreal injection, nanosystems can protect the active compound from external environment (reducing their clearance) and direct it to its target tissues. In recent years, some researchers have explored the possibility of combining micro and nanosystems in “nanoparticle-in-microparticle (NiMs)” systems or “trojan systems”. This excellent idea is not exempt of technological problems, remains partially unsolved, especially in the case of IODDS. The objective of the present review is to show the state of art concerning the design, preparation and characterization of trojan microparticles for drug delivery and to remark their potential and limitations as IODDS, one of the most important challenges faced by pharmaceutical technology at the moment

Electroencefalografía clínica para el anestesiólogo

The use of electroencephalography (EEG) monitors to assess the level of hypnosis is standard practice in anesthesiology. The monitors are based on an electroencephalographic record obtained by a sensor that it’s place on the patient's forehead. These signals are recorded by a machine and reflects by an index the degree of unconsciousness. Anaesthetists generally pay attention only to the Patient State Index (PSI) calculated by EEG monitors. Sometimes the PSI index does not correspond to the clinical context of the patient. For this reason, we consider that it is necessary to know some basic aspects of electroencephalography.La monitorización electroencefalográfica intraoperatoria de la profundidad anestésica es una práctica habitual en anestesiología. Los sistemas de monitorización no invasivos se fundamentan en un registro electroencefalográfico obtenido por un sensor que se coloca en la frente del paciente. El monitor procesa la señal eléctrica cerebral y refleja mediante un número el grado de inconsciencia. En muchas ocasiones el número que refleja no corresponde con el contexto clínico del paciente. Por este motivo, consideramos que es necesario conocer unos aspectos básicos sobre electroencefalografía.    

Guías sobre el manejo perioperatorio de pacientes sospechosos o susceptibles de padecer Hipertermia Maligna del Grupo Europeo de Hipertermia Maligna.

Malignant hyperthermia (MH) is a life-threatening condition in which genetically predisposed individuals develop a hypermetabolic reaction to inhalational anesthetics or succinylcholine. Due to the rarity of the disease and ethical limitations, there are no intervention trials to inform the optimal perioperative management of patients susceptible to MH.  These guidelines aim to group the available knowledge on the perioperative management of patients susceptible to MH and the preparation of anesthesia machines. The guidelines were developed by members of the European Malignant Hyperthermia Group and are based on evaluation of the available literature and a formal consensus process. The most important recommendation is that susceptible patients should receive trigger-free anesthesia, prophylactic administration of dantrolene should be avoided, intraoperative and postoperative follow-up should not be affected by susceptibility to the condition, and patients may be anesthetized in an outpatient setting.La hipertermia maligna (HM) es una afección potencialmente fatal, en la que los individuos genéticamente predispuestos desarrollan una reacción hipermetabólica a los anestésicos inhalatorios o a la succinilcolina. No existen ensayos de intervención para informar del manejo óptimo de los pacientes susceptibles de padecer HM. Estas guías pretenden agrupar el conocimiento disponible sobre el manejo perioperatorio de pacientes susceptibles a HM y la preparación de las máquinas de anestesia. Las pautas fueron desarrolladas por el Grupo Europeo de HM y se basan en la evaluación de la literatura disponible y en un proceso de consenso formal. La recomendación más importante es que los pacientes susceptibles deben recibir una anestesia libre de agentes desencadenantes, se debe evitar el dantroleno profiláctico, el seguimiento intraoperatorio y el postoperatorio no deben verse alterados por la susceptibilidad al cuadro y los pacientes pueden ser anestesiados en un entorno ambulatorio

Actualización en analgesia epidural para el trabajo de parto.

The pain of labor produces not only emotional suffering but also physiological alterations that affect the mother and the fetus such as: hyperventilation, severe respiratory alkalosis, increased catecholamines and stress hormones, fetal-placental hypoxia and fetal acidosis and psychological alterations and stress post-traumatic. Currently, neuraxial anesthesia and more specifically epidural analgesia is the main recommendation as a pharmacological method of analgesia in labor. We have mainly focused on two methods of infusion. On the one hand, the traditional, continuous epidural infusion (CEI) plus patient-controlled epidural analgesia (PCEA) and on the other; programmed intermittent epidural bolus (PIEB) which is a method of infusing drugs into the epidural space that consists of the administration of fixed boluses at determined intervals.El dolor del trabajo de parto produce no sólo sufrimiento emocional sino alteraciones fisiológicas que afectan a la madre y al feto tales como: hiperventilación, alcalosis respiratoria severa aumento de catecolaminas y hormonas de estrés, hipoxia feto-placentaria y acidosis fetal y alteraciones psicológicas y estrés postraumático. Actualmente,  la anestesia neuroaxial y más concretamente la analgesia epidural es la principal recomendación como método farmacológico de analgesia en el trabajo de parto. Nos hemos centrado principalmente en dos métodos de infusión. Por un lado, el tradicional, de infusión continua de anestésico local por el catéter epidural (CEI) más bolos de analgesia epidural controlada por el paciente (PCEA) y por otro; epidural con bolos intermitentes programados: (PIEB) que es un método de infusión de fármacos en el espacio epidural que consiste en la administración de bolos fijos en intervalos determinados

Block copolypeptide nanoparticles for the delivery of ocular therapeutics

Self-assembling block copolypeptides were prepared by sequential ring-opening polymerization of N-carboxyanhydride (NCA) derivatives of γ-benzyl-L-glutamic acid and ε-carbobenzyloxy-L-lysine, followed by selective deprotection of the benzyl glutamate block. The synthesized polymers had number average molecular weights close to theoretical values, and had low dispersities (ĐM = 1.15–1.28). Self-assembly of the amphiphilic block copolymers into nanoparticles was achieved using the “solvent-switch” method, whereby the polymer was dissolved in THF and water and the organic solvent removed by rotary evaporation. The type of nanostructures formed varied from spherical micelles to a mixture of spherical and worm-like micelles, depending on copolymer composition. The spherical micelles had an average diameter of 43 nm by dynamic light scattering, while the apparent diameter of the mixed phase system was around 200nm. Reproducibility of nanoparticle preparation was demonstrated to be excellent; almost identical DLS traces were obtained over three repeats. Following qualitative dye-solubilization experiments, the nanoparticles were loaded with the ocular anti-inflammatory drug dexamethasone. Loading efficiency of the nanoparticles was 90% and the cumulative drug release was 94% over 16 d, with a 20% burst release in the first 24 h.mabi201400471-gra-000

Un análisis observacional del descubrimiento guiado en categoría pre-benjamín de fútbol

El presente trabajo pretende analizar la efectividad de un programa basado en el estilo de resolución de problemas (Delgado, 1991) destinado a la enseñanza de táctica ofensiva en fútbol, en un grupo de jugadores de categoría Pre-Benjamín. Se ha utilizado la metodología observacional, siendo necesaria la construcción ad hoc del instrumento de observación, “formato de campo”. El análisis de datos realizado ha buscado la emergencia de patrones de conducta que pudieran dar cuenta de la efectividad del programa de intervención. Se ha llevado a cabo también un análisis descriptivo de las frecuencias de las conductas y de las acciones de los jugadores. Gracias a la utilización de esta metodología pudimos comprobar que ha habido una transferencia de lo aprendido en las sesiones de entrenamiento a los partidos

Co-option of endogenous retroviruses through genetic escape from TRIM28 repression

Endogenous retroviruses (ERVs) have rewired host gene networks. To explore the origins of co-option, we employed an active murine ERV, IAPEz, and an embryonic stem cell (ESC) to neural progenitor cell (NPC) differentiation model. Transcriptional silencing via TRIM28 maps to a 190 bp sequence encoding the intracisternal A-type particle (IAP) signal peptide, which confers retrotransposition activity. A subset of "escapee" IAPs (∼15%) exhibits significant genetic divergence from this sequence. Canonical repressed IAPs succumb to a previously undocumented demarcation by H3K9me3 and H3K27me3 in NPCs. Escapee IAPs, in contrast, evade repression in both cell types, resulting in their transcriptional derepression, particularly in NPCs. We validate the enhancer function of a 47 bp sequence within the U3 region of the long terminal repeat (LTR) and show that escapee IAPs convey an activating effect on nearby neural genes. In sum, co-opted ERVs stem from genetic escapees that have lost vital sequences required for both TRIM28 restriction and autonomous retrotransposition