Fibrilación auricular: de la detección al tratamiento. Papel del médico de familia, del cardiólogo y de otros especialistas. Nuevos modelos de gestión clínica

ResumenSe estima que la prevalencia en adultos de fibrilación auricular (FA) en España es del 4,4% de la población >40 años, lo que correspondería a una media de 30 a 40 pacientes por cada médico de familia. La importancia de esta frecuente arritmia radica, sobre todo, en su estrecha relación con el ictus u otras embolias sistémicas por delante de otras posibles complicaciones.El diagnóstico de FA es su registro electrocardiográfico, por lo que está al alcance del médico de familia, que debe evaluar al paciente de forma global, incluyendo los factores de riesgo, la comorbilidad, el tipo de FA y la valoración de los riesgos embólico y hemorrágico. La decisión de anticoagular o no se debe tomar pronto, en función del riesgo embólico del paciente y no del tipo de arritmia. Por otra parte se debe decidir, junto con el cardiólogo de referencia, la mejor estrategia terapéutica para cada paciente individual: control de ritmo (intentar recuperar y mantener el ritmo sinusal) o control de frecuencia (mantener la frecuencia cardíaca en límites aceptables). En ambas estrategias debe estar presente el tratamiento antitrombótico de base, ya que la complicación más grave, frecuente y de mayor repercusión en morbilidad y mortalidad es el ictus. Además, los ictus cardioembólicos (hasta 1 de cada 4 ictus) son especialmente devastadores, con mayor letalidad, consumo de recursos hospitalarios y sociales, y discapacidad asociada. El control de la FA y, en particular, la prevención continuada del ictus a través de una adecuada anticoagulación deben realizarse primordialmente en atención primaria. No obstante, el manejo multidisciplinar se impone en una mayoría de pacientes, donde debe establecerse una buena coordinación entre AP y especializada, en especial cardiología, hematología y neurología (en pacientes que ya presentaron un ictus).AbstractThe prevalence of atrial fibrillation (AF) in adults in Spain is estimated to be 4.4% of the population aged 40 years or more, corresponding to a mean of 30 to 40 patients per family physician. The importance of this common arrhythmia lies, above all, in its close association with stroke and other systemic embolisms, among other possible complications.Diagnosis of AF is based on electrocardiographic recording and can consequently be made by the family physician, who should make an overall assessment of the patient's health, including risk factors, comorbidity and type of AF and evaluate embolic and hemorrhagic risk. The decision to prescribe anticoagulation therapy or not should be taken promptly and should be based on the patient's embolic risk and not on the type of arrhythmia. In addition, the family physician, together with the treating cardiologist, should decide on the most appropriate therapeutic strategy for each individual patient: a rhythm control strategy (attempting to recover and maintain sinus rhythm) or a rate control strategy (maintaining heart rate within acceptable limits). Antithrombotic treatment should form part of both strategies, since stroke is the most serious and common complication of AF and also has the greatest effects on morbidity and mortality. Moreover, cardioembolic strokes (accounting for one out of every four strokes) are especially devastating, with the highest fatality, hospital and social resource use, and associated disability. Control of AF and particularly stroke prevention with adequate anticoagulation should be carried out mainly in primary care. Nevertheless, multidisciplinary management is required in most patients, which requires effective coordination between primary and specialized care, especially cardiology, hematology and neurology (in patients who have already had a stroke)

Diabetes mellitus and intermittent claudication: a cross-sectional study of 920 claudicants

INTRODUCTION: Diabetes mellitus (DM) and intermittent claudication (IC) are frequently associated health conditions. Our hypothesis is that the nature, severity and quality of life (QoL) of patients with IC and DM are worse than those of claudicant patients without diabetes. MATERIAL AND METHODS: An observational, cross-sectional and multicentre study of 920 patients with IC, divided into two groups: diabetic (n = 477) and non-diabetic (n = 443). For each group, we examined clinical and biological characteristics (including levels of glucose and lipids), the ankle-brachial index (ABI), responses to the Walking Impairment Questionnaire (WIQ) and the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. RESULTS: Compared with claudicant patients without diabetes, claudicants with diabetes were older (p < 0.001), more likely to be female (p = 0.006), with a higher BMI (p < 0.001), more likely to have a sedentary lifestyle (p < 0.001) and to be a non-smoker (p < 0.001). Claudicant patients with diabetes also had significantly more cardiovascular risk factors (p < 0.001), more frequent ischaemic cardiopathy (p = 0.023) and chronic renal failure (p = 0.002), and fewer prior ictus events (p = 0.003). No significant differences between groups were found with respect to blood pressure, levels of cholesterol or triglycerides. The mean ABI of diabetic-IC patients was slightly lower than IC patients without diabetes (p = 0.016). All WIQ subdomains scores were significantly lower (p < 0.001), indicating poorer walking ability, in claudicant and diabetic patients with compared with those without diabetes. The mean E5-QD global scores and the mean EQ-5D visual analogue scale in the whole series were 0.58 (SD = 0.21) and 55.04 (SD = 21.30), respectively. Both E5-QD scores were significantly lower, indicating poorer QoL, in claudicant patients with diabetes than claudicant patients without diabetes (p < 0.001). CONCLUSION: Patients with IC and DM had more risk cardiovascular factors, cardiovascular conditions, disability and worse haemodynamic status and QoL than claudicant patients without diabetes

Antioxidant capacity of different cheeses: Affecting factors and prediction by near infrared spectroscopy

In this study, we analyzed antioxidant capacity of 224 cheese samples prepared using 16 varied mixtures of milk from cows, ewes, and goats, in 2 manufacturing seasons (winter and summer), and over 6 mo of ripening. Antioxidant capacity was evaluated using the spectrophotometric 2,2-azinobis(3-ethylenebenzothiazoline-6-sulfonic acid) (ABTS) method. Total antioxidant capacity was significantly correlated with season of manufacturing and time of ripening but not with animal species providing the milk. Moreover, statistically significant correlations between the total antioxidant capacity and retinol (r = 0.399), fat percentage (r = 0.308), protein percentage (r = 0.366), K (r = 0.385), Mg (r = 0.312), Na (r = 0.432), and P (0.272) were observed. We evaluated the use of near infrared spectroscopy technology, together with the use of a remote reflectance fiber-optic probe, to predict the antioxidant capacity of cheese samples. The model generated allowed us to predict antioxidant capacity in unknown cheeses of different compositions and ripening times.Junta de Castilla y León SA1390

COVID-19 anxiety, psychological well-being and preventive behaviors during the COVID-19 pandemic in Latin America and the Caribbean: relationships and explanatory model

This study assesses the relationship between COVID-19 anxiety and subjective well-being in terms of the mediating role of COVID-19 preventive behaviors. Additionally, the contribution of sociodemographic factors (sex and age) and risk perception on COVID-19 anxiety and its potential measurement invariance was tested in 5655 participants from 12 countries in Latin America and the Caribbean. A mixture of both latent and observable variables were analyzed using a system of structural equations. The Coronavirus Anxiety Scale (CAS), Preventive COVID-19 Infection Behaviors Scale (PCIBS) and single-item measures were used to assess the perceived probability of death, perceived severity and concern about transmitting COVID-19. The results indicated that there is a significant and relevant direct effect of COVID-19 anxiety on participants' well-being. Furthermore, COVID-19 anxiety significantly predicted both preventive behavior (β = .29, p < .01) and well-being (β = –.32, p < .01). The effects of COVID anxiety and preventive behavior explained 9.8% of the variance in well-being (R-square = .098); whereas, 8.4% of the variance in preventive behavior was associated with COVID anxiety (R-square = .084). Likewise, perceived likelihood of death from COVID, perceived severity of COVID, and concerns about COVID transmission were positively related to anxiety. Age was negatively related to anxiety, with men being less anxious than women. The results are invariant by country, i.e., the broad relationships found in the combined sample are also present in each individual country. The findings indicate that, although the exact relationships between variables may vary between countries, there are enough similarities to provide useful information about the impact of the COVID-19 pandemic in each of the countries included in the study

COVID-19 anxiety, psychological well-being and preventive behaviors during the COVID-19 pandemic in Latin America and the Caribbean: relationships and explanatory model

This study assesses the relationship between COVID-19 anxiety and subjective well-being in terms of the mediating role of COVID-19 preventive behaviors. Additionally, the contribution of sociodemographic factors (sex and age) and risk perception on COVID-19 anxiety and its potential measurement invariance was tested in 5655 participants from 12 countries in Latin America and the Caribbean. A mixture of both latent and observable variables were analyzed using a system of structural equations. The Coronavirus Anxiety Scale (CAS), Preventive COVID-19 Infection Behaviors Scale (PCIBS) and single-item measures were used to assess the perceived probability of death, perceived severity and concern about transmitting COVID-19. The results indicated that there is a significant and relevant direct effect of COVID-19 anxiety on participants' well-being. Furthermore, COVID-19 anxiety significantly predicted both preventive behavior (β =.29, p <.01) and well-being (β = –.32, p <.01). The effects of COVID anxiety and preventive behavior explained 9.8% of the variance in well-being (R-square =.098); whereas, 8.4% of the variance in preventive behavior was associated with COVID anxiety (R-square =.084). Likewise, perceived likelihood of death from COVID, perceived severity of COVID, and concerns about COVID transmission were positively related to anxiety. Age was negatively related to anxiety, with men being less anxious than women. The results are invariant by country, i.e., the broad relationships found in the combined sample are also present in each individual country. The findings indicate that, although the exact relationships between variables may vary between countries, there are enough similarities to provide useful information about the impact of the COVID-19 pandemic in each of the countries included in the study

MAPK Pathway under Chronic Copper Excess in Green Macroalgae (Chlorophyta): Involvement in the Regulation of Detoxification Mechanisms

Following the physiological complementary/parallel Celis-Plá et al., by inhibiting extracellular signal regulated kinases (ERK), c-Jun N-terminal kinases (JNK), and cytokinin specific binding protein (p38), we assessed the role of the mitogen-activated protein kinases (MAPK) pathway in detoxification responses mediated by chronic copper (10 µM) in U. compressa. Parameters were taken at 6, 24, and 48 h, and 6 days (d). H2O2 and lipid peroxidation under copper and inhibition of ERK, JNK, or p38 alone increased but recovered by the sixth day. By blocking two or more MAPKs under copper, H2O2 and lipid peroxidation decayed even below controls. Inhibition of more than one MAPK (at 6 d) caused a decrease in total glutathione (reduced glutathione (GSH) + oxidised glutathione (GSSG)) and ascorbate (reduced ascorbate (ASC) + dehydroascorbate (DHA)), although in the latter it did not occur when the whole MAPK was blocked. Catalase (CAT), superoxide dismutase (SOD), thioredoxin (TRX) ascorbate peroxidase (APX), dehydroascorbate reductase (DHAR), and glutathione synthase (GS), were downregulated when blocking more than one MAPK pathway. When one MAPK pathway was blocked under copper, a recovery and even enhancement of detoxification mechanisms was observed, likely due to crosstalk within the MAPKs and/or other signalling processes. In contrast, when more than one MAPK pathway were blocked under copper, impairment of detoxification defences occurred, demonstrating that MAPKs were key signalling mechanisms for detoxification in macroalgae.</jats:p

SOCIO-DEMOGRAPHIC VARIABLES, FEAR OF COVID-19, ANXIETY, AND DEPRESSION: PREVALENCE, RELATIONSHIPS AND EXPLANATORY MODEL IN THE GENERAL POPULATION OF SEVEN LATIN AMERICAN COUNTRIES

The COVID-19 pandemic has gravely impacted Latin America. A model was tested that evaluated the contribution of socio-demographic factors and fear of COVID-19 on anxiety and depression in samples of residents in seven Latin American countries (Argentina, Ecuador, Mexico, Paraguay, Uruguay, Colombia, and El Salvador). A total of 4,881 individuals, selected by convenience sampling, participated in the study. Moderate and severe levels of depressive symptoms and anxiety were identified, as well as a moderate average level of fear of COVID-19. In addition, it was observed that about a quarter of the participants presented symptoms of generalized anxiety disorder and a major depressive episode. Fear of COVID-19 significantly and positively predicted anxiety and depressive symptoms, whereas the effects of socio-demographic variables are generally low [χ2(287) = 5936.96, p < 0.001; RMSEA = 0.064 [0.062, 0.065]; CFI = 0.947; and SRMR = 0.050]. This suggests the need for the implementation of preventive actions in the general population of these countries, with the aim of reducing the prevalence of depressive, anxious and fearful symptoms related to COVID-19

MAPK Pathway under Chronic Copper Excess in Green Macroalgae (Chlorophyta): Influence on Metal Exclusion/Extrusion Mechanisms and Photosynthesis

There is currently no information regarding the role that whole mitogen activated protein kinase (MAPK) pathways play in counteracting environmental stress in photosynthetic organisms. To address this gap, we exposed Ulva compressa to chronic levels of copper (10 µM) specific inhibitors of Extracellular Signal Regulated Kinases (ERK), c-Jun N-terminal Kinases (JNK), and Cytokinin Specific Binding Protein (p38) MAPKs alone or in combination. Intracellular copper accumulation and photosynthetic activity (in vivo chlorophyll a fluorescence) were measured after 6 h, 24 h, 48 h, and 6 days of exposure. By day 6, when one (except JNK) or more of the MAPK pathways were inhibited under copper stress, there was a decrease in copper accumulation compared with algae exposed to copper alone. When at least two MAPKs were blocked, there was a decrease in photosynthetic activity expressed in lower productivity (ETRmax), efficiency (αETR), and saturation of irradiance (EkETR), accompanied by higher non-photochemical quenching (NPQmax), compared to both the control and copper-only treatments. In terms of accumulation, once the MAPK pathways were partially or completely blocked under copper, there was crosstalk between these and other signaling mechanisms to enhance metal extrusion/exclusion from cells. Crosstalk occurred among MAPK pathways to maintain photosynthesis homeostasis, demonstrating the importance of the signaling pathways for physiological performance. This study is complemented by a parallel/complementary article Rodríguez-Rojas et al. on the role of MAPKs in copper-detoxification.</jats:p

Forty years of applied mathematical modelling: A bibliometric study

The Journal of Applied Mathematical Modelling (AMM) is a leading international journal in the field of mathematics and engineering focused on research related to mathematical modelling of engineering and environmental processes, manufacturing, and industrial systems, whose first issue was published in 1976. Motivated by the 40th anniversary in 2016, this study aims to develop a bibliometric overview of the publications published in the journal from 1976 to 2016. The objective of this work is to identify the leading variables and trends which have influenced the journal most during these years. In doing so, the study uses the Web of Science Core Collection database to analyze the data. This work also develops a graphical mapping of the bibliometric material by using the visualization of similarities (VOS) viewer software. These graphs represent bibliographic coupling, citation and co-citation analysis, co-authorship and co-occurrence of keywords. The results show the diversity of the published documents and significant growth of the journal through time