Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry

La insuficiencia cardiaca es un problema de salud pública de primer orden, con una mortalidad a los 5 años superior a la de las neoplasias más frecuentes y con un coste económico que llega a suponer el 10% del gasto en sanidad de una comunidad, principalmente por los ingresos hospitalarios que conlleva. La fisiopatología es compleja, conduciendo a un mismo síndrome a través de varias vías y con mucho camino aún por recorrer desde el punto de vista tanto de su comprensión como de su tratamiento. Debido a su elevada mortalidad han sido múltiples los intentos de establecer sistemas de estratificación con el objeto de conocer la población más vulnerable y los factores de riesgo que puedan precipitar descompensaciones y se asocien una mayor mortalidad. Muchos son sistemas complejos, siendo la mayoría únicamente válidos para insuficiencias cardiacas con fracción de eyección deprimida, acotando realmente la aplicabilidad de estas escalas. Nuestro estudio, ha demostrado capacidad de predicción de mortalidad para una población mayor, únicamente usando dos variables clínicas y distribuyéndolas de manera que se originan 3 grupos de riesgo en los que estratificar a los pacientes. Este sistema permite, por su simplicidad, implementarlo en consultas de Atención Primaria, Cardiología y Medicina Interna pudiendo repercutir en una mejoría asistencial.Heart failure is a first order problem of public health, with a five years mortality higher than most common cancer and with an economic impact that is about ten percent in the health budget mainly by the hospital admissions. The physiopathology is complex and numerous ways drive to a same syndrom, still we have a lot of research about it. Because of the high mortality there are many attempts to find a way to stratificate the patients trying to know which are the causes of their descompensations and find the patients in risk of higher mortality. Many systems are so much complex and restricted only for heart failure with reduced eyection fraction. Our study has demostrated to be able to predict the mortality for an elderly population, only using two clinical variables and arranging them to obtain three groups of risk. Our method allows, throught this simplicity, be applicated to Primary Care, Cardiology and Internal Medicine with an important influence in the attention and the possibility of ameliorate it

Derecho de extranjería / Immigration Law. Experiencia docente interuniversitaria (España, Estados Unidos y Perú)

El presente trabajo da a conocer la experiencia investigadora y docente sobre Derecho de Extranjería/Immigration Law. El marco constitucional es el hilo conductor para desarrollar y reforzar los métodos de aprendizaje aplicados en tres Universidades de tres países distintos (Estados Unidos, España y Perú). El contenido de esta Memoria da cuenta de una primera etapa en esta interacción en Red. Las diferencias y similitudes en la docencia pueden propiciar el avance en la mejora de le enseñanza del derecho constitucional a través del Derecho de Extranjería/ Immigration Law, una rama del derecho público que desvela algunos conflictos en la construcción del derecho

Métodos de aprendizaje en Derecho Constitucional: red docente en Derechos y Libertades y Ciudadanía (Derecho de Etranjería/Inmigration Law) II

El presente trabajo es la continuación de la investigación docente sobre Derecho de Extranjería/Immigration Law iniciado en el Curso 2014-15. El marco constitucional es el hilo conductor en el aprendizaje en materia de extranjería. Se trata de la interacción entre las experiencias docentes de tres Universidades (Estados Unidos, España y Perú Colombia). El contenido de esta Memoria da cuenta de la segunda etapa en esta interacción en Red. Expone la experiencia de análisis de casos desde el derecho comparado y de los Informes jurídicos sobre la problemática actual de la inmigración en España

Constitución y Migraciones Internacionales. Investigación y docencia desde la perspectiva del constitucionalismo crítico

La presente Memoria tiene su precedente en la investigación docente que sobre Derecho de Extranjería se había iniciado en el Curso 2014-15. En el presente Curso 2015-16 esta investigación amplía su horizonte con el objeto de comprender cómo las migraciones internacionales están cambiando el derecho constitucional y si el derecho constitucional está tomando en cuenta los retos que significan las nuevas formas de comprender las categorías constitucionales. A partir de la interacción entre las experiencias docentes de Universidades (españolas y latinoamericanas) en esta Memoria se refleja la experiencia docente en materia de derechos fundamentales confrontadas con la realidad de las migraciones internacionales que viene cambiando definiciones y prácticas de los derechos fundamentales tales como el derecho de sufragio; de reunión; al trabajo y relativas a la discriminación racial

Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry

Objectives: Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients. Methods: Variables associated with all-cause mortality and readmission for HF during 9 months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups. Results: We evaluated 1551 patients, 82 years and 56% women. Using HR strata of < 70 and ≥ 70 bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP ≥ 140, 120–140 and < 120 mm Hg, mortality rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HR < 70 bpm and SBP ≥ 140 mm Hg (n = 176; low-risk), HR < 70 and SBP < 140 + HR ≥ 70 and SBP < 120 (n = 1089; moderate-risk) and HR ≥ 70 and SBP < 120 (n = 286; high-risk) we found mortality rates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93–3.99, p = 0.077) and 4.32 (95% CI: 2.04–9.14, p < 0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors. Conclusions: The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Moción de censura y ayuntamientos del Bajo Segura (1979-1999)

Se expone en éste artículo una reflexión de lo que supone la nueva moción de censura en el ámbito de los entes locales (Ayuntamientos, etc...) como instrumento de control de la acción política de gobierno por la oposición municipal y la derivación de la exigencia de responsabilidad política a través del expresado mecanismo cuyo objetivo último es la remoción del Alcalde. Se está a presencia de una moción de censura constructiva y dotada de un rígido encorsetamiento normativo incapaz de eludirse. Se relacionan algunos Ayuntamientos de la Vega Baja en que han sido presentadas mociones de censura, y se analiza la idoneidad de este instrumento de control jurídico-político.This study looks at a new type of "Moción de Censura" in local governments (town halls etc) which is used by the opposition to control the government’s political action. It aims to remove the mayor from power, due to the demand of the opposition for political responsibility. This is a real constructive "moción de censura" and once started can’t be stopped. The study discusses some town halls in the "Vega Baja" where a "moción de censura" has been used before, and it also analyses the suitability of these methods of political and legal control