Hipertensión arterial resistente en paciente obeso y diabético tipo 2

We present a case of a 56-year-old man with central obesity and resistant arterial hypertension refractory to quadruple therapy who, in his study, shows a cyclical alternation between periods of normal adrenal function with periods of hypercortisolism compatible with the diagnosis of cyclic Cushing's syndrome. This case report shows periodical hormone test is recommended in patients where Cushing syndrome is suspected. This practice allows to identify this disease, many times under diagnosed. Presentamos el caso de un varón de 56 años con obesidad central e hipertensión arterial resistente refractaria a cuádruple terapia que, en su estudio, muestra una alternancia cíclica entre períodos de normofunción suprarrenal con períodos de hipercortisolismo, compatible con el diagnóstico de síndrome de Cushing cíclico. Este caso pone de manifiesto que es recomendable realizar determinaciones analíticas hormonales periódicas durante el seguimiento de pacientes con alta sospecha clínica de síndrome de Cushing, para descartar esta entidad muchas veces infradiagnosticada

Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

[Abstract] Aims. The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (admission-discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods. We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentre, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results. The mean age of the study population was 72 ± 12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one year all-cause mortality (Relative risk (RR) = 1.182, confidence interval (CI) 95% 1.024–1.366, p = 0.022) in SR. In AF patients discharge HR was associated with one year all cause mortality (RR = 1.276, CI 95% 1.115–1.459, p ≤ 0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction. Conclusions. In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients

Chronological and biological aging of the human left ventricular myocardium: Analysis of microRNAs contribution

Aging is the main risk factor for cardiovascular diseases. In humans, cardiac aging remains poorly characterized. Most studies are based on chronological age (CA) and disregard biological age (BA), the actual physiological age (result of the aging rate on the organ structure and function), thus yielding potentially imperfect outcomes. Deciphering the molecular basis of ventricular aging, especially by BA, could lead to major progresses in cardiac research. We aim to describe the transcriptome dynamics of the aging left ventricle (LV) in humans according to both CA and BA and characterize the contribution of microRNAs, key transcriptional regulators. BA is measured using two CA-associated transcriptional markers: CDKN2A expression, a cell senescence marker, and apparent age (AppAge), a highly complex transcriptional index. Bioinformatics analysis of 132 LV samples shows that CDKN2A expression and AppAge represent transcriptomic changes better than CA. Both BA markers are biologically validated in relation to an aging phenotype associated with heart dysfunction, the amount of cardiac fibrosis. BA-based analyses uncover depleted cardiac-specific processes, among other relevant functions, that are undetected by CA. Twenty BA-related microRNAs are identified, and two of them highly heart-enriched that are present in plasma. We describe a microRNA-gene regulatory network related to cardiac processes that are partially validated in vitro and in LV samples from living donors. We prove the higher sensitivity of BA over CA to explain transcriptomic changes in the aging myocardium and report novel molecular insights into human LV biological aging. Our results can find application in future therapeutic and biomarker research

Incidence, typology and measures of prevention and treatment of skin lesions associated with the use of personal protective equipment in health care professionals during the COVID-19 pandemic in Spain

Introducción: La reciente pandemia de COVID-19 ha representado la utilización por parte de los profesionales de la salud de diferentes equipos de protección individual (EPI), lo que ha dado lugar a la aparición de lesiones cutáneas asociadas a los mismos (LC-EPI). Conocer la epidemiología, las características y los factores relacionados con el uso de los diferentes tipos de EPI y la prevención y el tratamiento de las LC-EPI puede ser muy útil para comprender el alcance del problema y definir estrategias para su prevención y tratamiento en posibles pandemias futuras. Métodos: Estudio transversal realizado por el Grupo Nacional para el Estudio y Asesoramiento en Úlceras por Presión y Heridas Crónicas (GNEAUPP) en el ámbito geográfico del Estado español, mediante una encuesta autoadministrada utilizando un cuestionario de Google Forms. El universo de estudio fueron profesionales de la salud, de cualquier disciplina y nivel asistencial o tipo de institución que habían estado en contacto con pacientes o sospechosos de COVID-19 y habían utilizado EPI durante la primera ola de la pandemia de COVID-19 en España. Resultados: Se obtuvieron 2078 cuestionarios, el 75,5% de enfermeras, el 10,79% de técnicos en cuidados auxiliares de enfermería (TCAE) y el 6,6% de médicos. De los respondedores, el 84,7% eran mujeres y el 15,3% hombres con una edad media de 43,7 años. En el 18,2% de los casos, la institución del profesional contaba con un protocolo para la prevención de las LC-EPI, en el 10,2% el profesional no sabía si existía y en el 71,3% restante la institución no contaba con dicho protocolo. El 29,9% de los profesionales utilizaba siempre algún producto de prevención de LC-EPI y el 25,3% en ocasiones. El 52,4% de los encuestados informó haber presentado al menos una LC-EPI, de los cuales el 39% había presentado una, el 35,8% dos, el 14,3% tres, el 2,2% cuatro y el 8,6% más de cuatro. En relación con el tipo de lesiones, el 74,3% fueron definidas como lesiones por presión (LPP), el 11% como lesiones por fricción (LF), el 8,5% como lesiones combinadas o multicausales (LCMC) y el 6,1% como lesiones cutáneas asociadas a la humedad (LESCAH). La duración media de las lesiones incidentes fue de 11,6 días (9,7 días para las LPP, 10,2 días para las LF, 19,9 días para las LCMC y 19,4 días para las LESCAH). En el artículo se presenta información más detallada por tipo de dispositivo causante, tipología y gravedad de las lesiones por dispositivo, así como las medidas preventivas utilizadas.Introduction: The recent COVID-19 pandemic has represented the use by health care professionals (HCP) of different personal protective equipment (PPE), resulting in the appearance of skin injuries associated with PPE (PPE-SI). Knowing the epidemiology, characteristics and factors related to the use of different types of PPE and the prevention and treatment of PPE-SI can be very useful to understand the scope of the problem and to define strategies for its prevention and treatment in possible future pandemics. Methods: To this end, the GNEAUPP proposed the performance of a cross-sectional study, in the geographical area of the Spanish state, by means of a self-administered survey using a Google forms questionnaire. The study universe was HCP, from any discipline and from any level of care or type of institution with patients who have been in contact with COVID-19 patients or COVID-19 suspects and have used PPE during the first wave of the COVID-19 pandemic in Spain. Main results: We obtained 2078 questionnaires, 75.5% from nurses, 10.79% from nurse aids, and 6.6% from physicians. Of these, 84.7% were women and 15.3% were men with an average age of 43.7 years. In 18.2% of the cases the institution of the professional had a protocol for the prevention of PPE-SI, in 10.2% the professional did not know if it existed or not and in the remaining 71.3% the institution did not have such a protocol. 29.9% of the professionals always used some prevention product and 25.3% sometimes. 52.4% of respondents reported having submitted at least one PPE-SI, of which 39% had submitted one, 35.8% two, 14.3% three, 2.2% four and 8.6% more than four. In relation to PPE-SI, 74.3% were defined as pressure injuries (PI), 11% were friction injuries (FI), 8.5% were combined or multicausal injuries (CMCI) and 6.1% were skin injuries associated with moisture (MASI). The mean duration of incident injuries was 11.6 days (9.7 days for PI, 10.2 days for FI, 19.9 days for CMCI and 19.4 days for MASI). More detailed Information is presented in the paper by type of device causing, typology and severity of injuries per device as well as preventive measures used

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Campus virtuales : revista científica iberoamericana de tecnología educativa

El concepto de e-Science 3.0 se ha utilizado para describir el uso de nuevas herramientas web inteligentes por parte de investigadores para compartir, colaborar y publicar más facilmente sus resultados. Se presenta el diseño de una plataforma basada en los conceptos y tecnologías de la e-Science 3.0 que pretende apoyar el trabajo de los investigadores de forma colaborativa en las tareas propias del quehacer investigativo. La plataforma cuenta con un repositorio el cual indexa varias fuentes de información con resultados de investigación científica, tales como: Sciencedirect, ACM Digital Libary, etc. Se describe conceptualmente la plataforma e-Science 3.0, el rol del modelo de colaboración en plataforma, su arquitectura y finalmente se presentan las conclusiones y el trabajo futuroES

Determinant Factors of Repeat Sprint Sequences in Young Soccer Players

The aim of this study was to investigate the relationships between repeated explosive effort sequences (20+20¿m shuttle sprint with change of direction, kicking and jumping), metabolic response (lactate and ammonia), and fitness qualities (strength and endurance) in under-19 soccer players. 21 players completed: 1) sprint test: 30¿m (T30) and 40¿m (20+20¿m) shuttle sprints; 2) countermovement jumps (CMJ); 3) maximal kicking; and 4) 9 repeated-explosive effort sequences (RES); 4) a progressive isoinertial loading test in full squat to determine the load which subjects achieved ~1¿m¿·¿s¿1 (V1-load); 6) Yo-Yo Intermittent Recovery Test Level 1 (YYIRT-1). Mean sprint time of the 9 repeated sprints (RSAmean1¿9) showed correlation with V1-load (r=¿¿0.52 [¿¿0.79, ¿¿0.25]) metabolic response (lactate, r=0.67 [0.47, 0.87] and ammonia, r=0.53 [0.27, 0.79]). YYIRT-1 correlated with RSAmean1-9 (rw=¿¿0.78 [¿¿0.92, ¿¿0.64]) when the body weight was controlled. Furthermore, the 3 first sprints (RSAmean1-3) correlated with RSAbest (r=0.93 [0.88, 0.98]), V1-load (r=¿¿0.64 [¿0.86, ¿¿0.42]), and T30 (r=0.63 [0.41, 0.85]). These results suggest that the soccer player¿s lower body strength (V1-load, jumping and sprinting) explains a large part of the performance in the first sequences, whereas the aerobic capacity, estimated through YYIRT-1, becomes more important to performance as the number of sprints is increases.Universidad Pablo de Olavide de Sevilla. Departamento de Deporte e InformáticaPostprin