Monitorización de la presión arterial en las primeras 24 horas del ictus, estudio diferencial según el tipo de ictus y de su valor pronóstico precoz

Introducción. La evaluación y manejo de la presión arterial (PA) es importante en la fase aguda del ictus. La monitorización ambulatoria de la PA (MAPA) se utiliza en el estudio y evaluación de la hipertensión arterial (HTA), pero apenas se ha estudiado en la fase aguda del ictus. Este estudio pretende investigar la PA obtenida por Monitorización de la PA durante 24 horas (MPA24h) el primer día del ictus, utilizando los equipos de la MAPA, analizando sus posibles diferencias según el tipo de ictus y su valor pronóstico precoz. Material y Métodos. Estudio observacional, longitudinal, de cohortes prospectivo sobre ictus de menos de 24 horas de evolución ingresados en el Hospital General La Mancha Centro de Alcázar de San Juan durante 4 años a los que se realizó MPA24h el primer día de ingreso y se determinó la escala de Rankin modificada (mRS) al séptimo día. Se ha realizado regresión lineal y logística binaria multivariante utilizando como variable de control del sesgo de confusión el índice de propensión (IP) obtenido como las probabilidades de respuesta positiva en un modelo de regresión multinominal con la variable dependiente politómica tipo de ictus y la variables independientes predictoras, sexo, HTA, diabetes mellitus (DM), dislipemia, insuficiencia cardiaca (IC), puntuación National Institute of Health Stroke Scale (NIHSS) al ingreso, enfermedad intercurrente, edad, ictus previo y tratamiento antiagregante. Resultados. Se han reclutado 499 ictus, con una mediana de edad de 74 años (amplitud intercuartil –AIC– de 67 a 79 años), 282 (56,5%) son varones, 297 (59,5%) hipertensos y 183 (36,7%) diabéticos. El 20,0% (100 pacientes) habían tenido un ictus previo, 25 (5%) un IAM previo y 68 (13,6%) tenían fibrilación auricular (FA). La mediana de puntuación de la NIHSS al ingreso es de 6 (AIC 3 a 13) puntos. La distribución por tipos de ictus es de 197 (37,5%) ictus lacunares, 99 (19,8%) cardioembólicos, 155 (31,1%) aterotrombóticos y 58 (11,6%) hemorrágicos. Se han encontrado 392 (78,9%) casos de buen pronóstico a los 7 días con mRS 0-3 y 105 (21,1%) casos de mal pronóstico con mRS 4-7. Las medianas de PA sistólica (PAS) son 134 (AIC 119 a 147) mmHg para ictus lacunar, 138 (AIC 124 a 156) mmHg para cardioembólico, 145 (AIC 127 a 160) mmHg para aterotrombótico y 144 (AIC 129 a 161) mmHg para ictus hemorrágico. Las medianas de PA diastólica (PAD) son 71 (AIC 64 a 78,5) mmHg en ictus lacunar, 70 (AIC 62 a 78) mmHg en cardioembólico, 74 (AIC 67 a 84) mmHg en aterotrombótico y 80 (AIC 70 a 93) en hemorrágico. En el análisis multivariante ajustado por el IP, no se observan diferencias significativas en los valores de PAS (p>0,200). Las diferencias significativas se observan en los valores de PAD (p=0,006), con diferencias significativas en las comparaciones múltiples de PAD entre hemorrágico-lacunar (diferencia de medias –DMed– 4,5 mmHg; intervalo de confianza –IC– 95% 0,5 a 8,4 mmHg; p=0,028), hemorrágico-cardioembólico (DMed 7,5 mmHg; IC 95% 3,3 a 11,6 mmHg; p0,200) ni de PAD (p>0,200) ni en los patrones circadianos de PAS (p>0,200), siendo diferentes los patrones circadianos de PAD (p=0,001). Las medianas de PAS y de PAD en el grupo de mal pronóstico son 148 (AIC 132 a 168) mmHg y 74 (AIC 65 a 83,5) mmHg, respectivamente, y en el grupo de buen pronóstico son 136 (AIC 21 a 150) mmHg y 73 (AIC 65 a 81) mmHg, respectivamente. En el análisis con regresión logística binaria multivariante ajustado por el IP, no se asocian a mal pronóstico los valores de PAS (razón de odds –RO– 1,01; IC 95% 1,00 a 1,02; p=0,111) ni de PAD (RO 1,00; IC 95% 0,98 a 1,02; p>0,200) del día 1. Se encuentra relación con el pronóstico en los cocientes nocturno/diurno de PAS (multiplicado por 100: RO 1,05; IC 95% 1,01 a 1,09; p=0,022) y de PAD (multiplicado por 100: RO 1,04; IC 95% 1,00 a 1,07; p=0,045). También tiene relación con el pronóstico la caída el día 7 respecto al día 1 tanto de la PAS (RO 0,97; IC 95% 0,95 a 0,99; p=0,002) como de la PAD (RO 0,93; IC 95% 0,90 a 0,97; p<0,001). Conclusiones. En la PA obtenida mediante MPA24h el día 1 de ingreso hospitalario por ictus, no hay diferencias en la PAS entre los cuatro tipos de ictus (lacunares, cardioembólicos, aterotrombóticos y hemorrágicos) pero sí la hay en la PAD siendo los ictus hemorrágicos los que mayor PAD presentan no existiendo diferencias en la PAD de los ictus lacunares, cardioembólicos y aterotrombóticos entre sí. No hay diferencias entre los cuatro tipos de ictus en los cocientes nocturno/diurno de PAS, ni de PAD, ni en los patrones circadianos de PAS, siendo diferentes los patrones circadianos de PAD. Los valores de PAS y de PAD el día 1 de ingreso por ictus no tienen relación con el pronóstico precoz a los 7 días. La disminución de la PAS y de la PAD del día 1 al día 7 de ingreso por ictus se relaciona con buen pronóstico precoz. Respecto a los patrones circadianos, el aumento de los cocientes nocturno/diurno de PAS y de PAD el día 1 de ingreso por ictus se relacionan con mal pronóstico precoz

Plasmodium ovale malaria acquired in central Spain

3 p.We describe a case of locally acquired Plasmodium ovale malaria in Spain. The patient was a Spanish woman who had never traveled out of Spain and had no other risk factors for malaria. Because patients with malaria may never have visited endemic areas, occasional transmission of malaria to European hosts is a diagnostic and clinical challenge

Plasmodium ovale malaria acquired in central Spain

3 p.We describe a case of locally acquired Plasmodium ovale malaria in Spain. The patient was a Spanish woman who had never traveled out of Spain and had no other risk factors for malaria. Because patients with malaria may never have visited endemic areas, occasional transmission of malaria to European hosts is a diagnostic and clinical challenge

Impact of a Serious Game (#RedPingüiNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention

Background: After the COVID-19 pandemic, society has become more aware of the importance of some basic hygienic habits to avoid exposure to pathogens transmitted via hands. Given that a high frequency of touching mucous membranes can lead to a high risk of infection, it is essential to establish strategies to reduce this behavior as a preventive measure against contagion. This risk can be extrapolated to a multitude of health scenarios and transmission of many infectious diseases. #RedPingüiNO was designed as an intervention to prevent the transmission of SARS-CoV-2 and other pathogens through the reduction of facial self-touches by thoughtfully engaging participants in a serious game. Objective: Facial self-touches should be understood as behaviors of limited control and awareness, used to regulate situations of cognitive and emotional demands, or as part of nonverbal communication. The objective of this study was to ensure that participants become aware of and reduce these behaviors through a game of self-perception. Methods: The quasi-experimental intervention was applied to 103 healthy university students selected by convenience sampling and put into practice for 2 weeks, with 1 control group (n=24, 23.3%) and 2 experimental groups (experimental group with no additional social reinforcement interventions: n=36, 35%; experimental group with additional social reinforcement interventions: n=43, 41.7%). The objective was to improve knowledge and perception and reduce facial self-touches to prevent exposure to pathogens transmitted via hands not only in health multihazard scenarios but also in ordinary circumstances. The ad hoc instrument used to analyze the experience consisted of 43 items and was valid and reliable for the purpose of this study. The items were divided into 5 blocks extracted from the theoretical framework: sociological issues (1-5); hygiene habits (6-13); risk awareness (14-19); strategies for not touching the face (20-26); and questions after the intervention (27-42), designed as a postintervention tool assessing the game experience. Validation of the content was achieved through assessment by 12 expert referees. External validation was performed using a test-retest procedure, and reliability was verified using the Spearman correlation. Results: The results of the ad hoc questionnaire, which were analyzed using the Wilcoxon signed-rank test and McNemar index to identify significant differences between test and retest for a 95% CI, showed that facial self-touches were reduced (item 20, P<.001; item 26, P=.04), and awareness of this spontaneous behavior and its triggers increased (item 15; P=.007). The results were reinforced by qualitative findings from the daily logs. Conclusions: The intervention exhibited a greater effect from sharing the game, with interactions between people; however, in both cases, it was helpful in reducing facial self-touches. In summary, this game is suitable for reducing facial self-touches, and owing to its free availability and design, it can be adapted to various contexts.Este proyecto obtuvo un diploma de reconocimiento de la Universidad de Alcalá, una distinción por su contribución a paliar la situación provocada por la pandemia de COVID-19

Facing climate change and improving emergency responses in Southern America by analysing urban cyclonic wind events

Funding Information: Funding for open access charge: Universidad de Granada / CBUA. Publisher Copyright: © 2023 The AuthorsPeer reviewedPublisher PD

Methodological proposal for the inclusion of citizen participation in the management and planning of urban public spaces

The appropriate planning of Areas of Public Space and Meeting (APSM) plays a pivotal role in enhancing the quality of life for citizens, particularly in developing countries where socio-economic disparities impact social and territorial cohesion. Engaging the local population in decision-making processes through public participation is crucial. This research endeavours to design and implement two geoinformatics tools aimed at streamlining data collection processes, thereby contributing to the democratization of urban planning and management. These tools, known as Field Geoform (FG) and Crowdsourcing Geoform (CG), have been successfully deployed in Comunne #9 of Monteria, Colombia. The collected data is presented systematically and in real-time through a web-based data visualization platform. FG offers a practical and efficient means of characterizing and assessing the physical and conservation status of APSM. On the other hand, CG empowers users of these areas to actively contribute valuable data. The trial to evaluate the functionality of CG confirms that the use of digital crowdsourcing tools, accessible to the community, gathers pertinent data regarding APSM. This mechanism greatly facilitates the efforts of those responsible for the restoration and maintenance of these infrastructures, as well as decision-makers within the realm of urban management

Manejo no tecnificado de cerdos (Sus scrofa) en las regiones Andina, Amazónica y Orinoquía de Colombia

The swine industry in Colombia has grown in recent years. A percentage of this industry occurs under technified conditions. However, in several regions of the country, there are small artisanal pig production systems where management exhibits a gradient in animal husbandry from confinement to complete freedom with different health implications. The aim of this study was to identify the most common non-technified forms of pig farming in several regions of Colombia and to explore their implications. Data collection was carried out in the flooded savannas of the Colombian Orinoquia region and through the Classical Swine Fever (CSF) eradication zone, as well as in the Guaviare department. The information was gathered from semi-structured interviews with public officials and local settlers involved in pig farming. The work was carried out in August 2017 and from June to October 2019. In total, the work included a distance of 8,486.4 km along 151 municipalities of the country, and 262 semi-structured interviews were conducted. The following four types of pig farming management were identified: confined, outdoor enclosure, free breeding, and feral or unmanaged breeding. Each management type reflects differences in the need for care, economic investment, escape risk, or pig release frequency, facilitating feral behavior. Furthermore, information on health aspects, food, reproduction, and institutional presence in each municipality as well as on current problems faced by producers for slaughtering and commercialization of pigs was obtained.La industria porcina en Colombia ha crecido en los últimos años. Aunque parte de esta actividad se realiza en instalaciones tecnificadas, en varias regiones del país aún existen pequeños sistemas de producción artesanales, cuyas condiciones de manejo de los animales varían desde tenerlos confinados hasta completamente libres, con diferentes implicaciones sanitarias. Este estudio buscó identificar las formas no tecnificadas más comunes para la cría de cerdos en varias regiones de Colombia y explorar sus implicaciones. Se recolectaron datos de las sabanas inundables de la Orinoquía colombiana, la zona en erradicación de la peste porcina clásica y el departamento del Guaviare. La información fue recopilada mediante entrevistas semiestructuradas a funcionarios públicos y pobladores locales involucrados en la cría de cerdos. El trabajo se realizó en agosto de 2017 y entre junio y octubre de 2019. En total, se recorrieron 8.486,4&nbsp;km en 151 municipios del país, y se realizaron 262 entrevistas semiestructuradas. Se identificaron cuatro tipos de manejo para la cría de cerdos: en cochera, en encierro, cría libre y asilvestrada (sin manejo). Cada tipo de manejo refleja diferentes necesidades de cuidado, inversión económica, riesgo de escape o frecuencia de liberación de los cerdos, lo que facilita el asilvestramiento. Además, se obtuvo información sobre las condiciones sanitarias, la alimentación, la reproducción, la presencia institucional en cada municipio y la dificultad de los pequeños productores para el sacrificio y la comercialización

Situación actual del sindicalismo en Colombia

El sindicalismo en Colombia ha confluido a través de su historia con una serie de fenómenos históricos tanto nacionales como internacionales. Este estudio que consultó las más importantes y calificadas instituciones en el país que tienen como marco de referencia el sindicalismo, busca un análisis que acerque a los lectores a la verdadera situación del movimiento obrero en Colombia. Hoy en día fenómenos como la globalización, la apertura económica, la violencia de los grupos armados y la crisis económica han cambiado radicalmente las relaciones laborales afectando al derecho individual y colectivo del trabajo

Role of Innate and Adaptive Cytokines in the Survival of COVID-19 Patients

SARS-CoV-2 is a new coronavirus characterized by a high infection and transmission capacity. A significant number of patients develop inadequate immune responses that produce massive releases of cytokines that compromise their survival. Soluble factors are clinically and pathologically relevant in COVID-19 survival but remain only partially characterized. The objective of this work was to simultaneously study 62 circulating soluble factors, including innate and adaptive cytokines and their soluble receptors, chemokines and growth and wound-healing/repair factors, in severe COVID-19 patients who survived compared to those with fatal outcomes. Serum samples were obtained from 286 COVID-19 patients and 40 healthy controls. The 62 circulating soluble factors were quantified using a Luminex Milliplex assay. Results. The patients who survived had decreased levels of the following 30 soluble factors of the 62 studied compared to those with fatal outcomes, therefore, these decreases were observed for cytokines and receptors predominantly produced by the innate immune system-IL-1 alpha, IL-1 alpha, IL-18, IL-15, IL-12p40, IL-6, IL-27, IL-1Ra, IL-1RI, IL-1RII, TNF alpha, TGF alpha, IL-10, sRAGE, sTNF-RI and sTNF-RII-for the chemokines IL-8, IP-10, MCP-1, MCP-3, MIG and fractalkine; for the growth factors M-CSF and the soluble receptor sIL2Ra; for the cytokines involved in the adaptive immune system IFN gamma, IL-17 and sIL-4R; and for the wound-repair factor FGF2. On the other hand, the patients who survived had elevated levels of the soluble factors TNF beta, sCD40L, MDC, RANTES, G-CSF, GM-CSF, EGF, PDGFAA and PDGFABBB compared to those who died. Conclusions. Increases in the circulating levels of the sCD40L cytokine; MDC and RANTES chemokines; the G-CSF and GM-CSF growth factors, EGF, PDGFAA and PDGFABBB; and tissue-repair factors are strongly associated with survival. By contrast, large increases in IL-15, IL-6, IL-18, IL-27 and IL-10; the sIL-1RI, sIL1RII and sTNF-RII receptors; the MCP3, IL-8, MIG and IP-10 chemokines; the M-CSF and sIL-2Ra growth factors; and the wound-healing factor FGF2 favor fatal outcomes of the disease

Biomarker candidates for progression and clinical management of COVID-19 associated pneumonia at time of admission

COVID-19 pathophysiology is currently not fully understood, reliable prognostic factors remain elusive, and few specific therapeutic strategies have been proposed. In this scenario, availability of biomarkers is a priority. MS-based Proteomics techniques were used to profile the proteome of 81 plasma samples extracted in four consecutive days from 23 hospitalized COVID-19 associated pneumonia patients. Samples from 10 subjects that reached a critical condition during their hospital stay and 10 matched non-severe controls were drawn before the administration of any COVID-19 specific treatment and used to identify potential biomarkers of COVID-19 prognosis. Additionally, we compared the proteome of five patients before and after glucocorticoids and tocilizumab treatment, to assess the changes induced by the therapy on our selected candidates. Forty-two proteins were differentially expressed between patients' evolution groups at 10% FDR. Twelve proteins showed lower levels in critical patients (fold-changes 1.20-3.58), of which OAS3 and COG5 found their expression increased after COVID-19 specific therapy. Most of the 30 proteins over-expressed in critical patients (fold-changes 1.17-4.43) were linked to inflammation, coagulation, lipids metabolism, complement or immunoglobulins, and a third of them decreased their expression after treatment. We propose a set of candidate proteins for biomarkers of COVID-19 prognosis at the time of hospital admission. The study design employed is distinctive from previous works and aimed to optimize the chances of the candidates to be validated in confirmatory studies and, eventually, to play a useful role in the clinical practice