Influencia de la calidad del sueño sobre el grado de severidad de la retinosis pigmentaria

La Retinosis Pigmentaria (RP) comprende un conjunto de trastornos de origen genético responsables de la degeneración y posterior destrucción de las células retinianas implicadas en el proceso de fototransducción. Se trata de la distrofia hereditaria de retina más común, y desafortunadamente, a día de hoy sigue sin existir un tratamiento verdaderamente efectivo que logre detener su evolución o revertir la pérdida de visión que ocasiona, por lo que desde el punto de vista de la investigación, interesa el identificar y controlar los factores relacionados con su progresión para así poder mejorar la calidad de vida de los sujetos afectados a la espera de soluciones más definitivas. El objetivo de este trabajo es establecer el grado de relación existente entre la calidad del sueño y el grado de severidad de la RP. Se realizó un estudio observacional transversal con grupo control en el que se valoraron la severidad de la RP y la calidad del sueño de una muestra de 78 pacientes mediante el estudio de su función visual (AV, CV y OCT) y la cumplimentación de dos cuestionarios de autoadministración validados (PSQI y ESS), respectivamente. Además, se intentó comprobar si el análisis de los niveles de melatonina en saliva de estos sujetos podría constituir un método innovador para evaluar de manera objetiva la calidad de su sueño o el grado de severidad de su enfermedad. La influencia de la edad y el sexo de los participantes sobre la gravedad de la patología también fue determinada. La calidad del sueño no se relacionó de forma estadísticamente significativa con el grado de severidad de la RP, ni los niveles de melatonina analizados en saliva con estas dos variables. Por su parte, la edad resultó un factor de riesgo para la progresión de la enfermedad, mientras que el sexo no demostró asociarse con la severidad de la misma. Pese a los resultados obtenidos, debido a la novedad de la temática abordada se requiere de estudios de validación externa que confirmen o refuten tales conclusiones.Departamento de EnfermeríaMáster en Enfermería Oftalmológic

Revisión bibliográfica sobre la cura local de los principales tipos de heridas crónicas

Las heridas fueron con toda seguridad uno de los primeros problemas de salud a los que el ser humano tuvo que enfrentarse, y a día de hoy, a pesar de los avances realizados en la investigación y en la difusión de conocimientos al respecto, su curación continúa siendo un tema que suscita controversia entre los distintos profesionales, y que adquiere especial relevancia cuando hablamos de lesiones incapacitantes para el paciente y costosas para la sociedad como son las heridas crónicas. El objetivo es determinar los procedimientos curativos más adecuados para los principales tipos de heridas crónicas en función de la evidencia científica actual. Se realizó una revisión bibliográfica de la literatura científica publicada en diversas bases de datos electrónicas (Medline, Biblioteca Cochrane y Portal Regional de la Biblioteca Virtual en Salud) siguiendo una terminología DeCS y MeSH específica, y adicionalmente se consultaron varios documentos elaborados por distintos organismos especializados en el cuidado de las heridas y diferentes servicios autonómicos de salud del territorio español. Independientemente de la etiología asociada a su origen, las heridas crónicas pueden tratarse mediante métodos comunes que aseguren unas condiciones óptimas para la consecución del proceso de cicatrización y el impedimento de sus barreras. La correcta limpieza, desbridamiento y desinfección de la lesión, sumada a la elección del apósito apropiado para el mantenimiento de un ambiente húmedo en su interior, promueve la cicatrización y evita la aparición de contratiempos en su desarrollo tales como la infección.Grado en Enfermerí

EL DERECHO AL ACCESO A LA INFORMACIÓN: ¿CONTINGENCIA O PANDEMIA? SUS EFECTOS JURÍDICOS. CASO COVID-19

El aspecto jurídico de una pandemia (crisis sanitaria mundial del COVID-19) puede ser estudiada desde el ámbito de aplicación sustantiva del acceso al derecho a la información, además del debate sobre la efectividad con la que el gobierno mexicano protege a sus ciudadanos del Estado para no generar caos, desestabilización socialy permear un estado de derecho efectivo-positivo. En este artículo, la interpretación de la ley desde la aplicación en el campo del rigor formal ayudará a los expertos a tomar decisiones inmediatas con el propósito inherente de salvaguardar la vida de los ciudadanos del Estado Mexicano. Para ello, se requiere un verdadero acceso a la información, armando un equipo interdisciplinario para la toma de decisiones, para evitar el miedo, el estrés, el cansancio, la frustración, el pánico, la depresión, la ansiedad entre otros

Stimuli Characteristics and Psychophysical Requirements for Visual Training in Amblyopia: A Narrative Review

Active vision therapy using perceptual learning and/or dichoptic or binocular environments has shown its potential effectiveness in amblyopia, but some doubts remain about the type of stimuli and the mode and sequence of presentation that should be used. A search was performed in PubMed, obtaining 143 articles with information related to the stimuli used in amblyopia rehabilitation, as well as to the neural mechanisms implied in such therapeutic process. Visual deficits in amblyopia and their neural mechanisms associated are revised, including visual acuity loss, contrast sensitivity reduction and stereopsis impairment. Likewise, the most appropriate stimuli according to the literature that should be used for an efficient rehabilitation of the amblyopic eye are described in detail, including optotypes, Gabor’s patches, random-dot stimuli and Vernier’s stimuli. Finally, the properties of these stimuli that can be modified during the visual training are discussed, as well as the psychophysical method of their presentation and the type of environment used (perceptual learning, dichoptic stimulation or virtual reality). Vision therapy using all these revised concepts can be an effective option for treating amblyopia or accelerating the treatment period when combining with patching. It is essential to adapt the stimuli to the patient’s individual features in both monocular and binocular training.The authors C.J.H.-R., D.P.P., A.M.-M., D.d.F., L.L.-V., M.B.C.-M. have been funded by CDTI (Centro para el Desarrollo Tecnológico Industrial, Ministry of Economy and Competitiveness of Spain) and FEDER (Fondos Europeos de Desarrollo Regional) funds by means of the program PID (“Proyectos de Investigación y Desarrollo”) in the context of the Project NEIVATECH (“Neuroplasticity through virtual reality for amblyopia”, application number 111705). The author León Morales-Quezada is supported by funding from the Spaulding Research Catalyst award. The author David P Piñero has been also supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471

Propuesta en Supply Chain Management y Logística en la empresa Gaseosas Glacial.

El planteamiento de este proyecto se realiza con el diseño del Supply Chain Management y logística para la organización Gaseosas Glacial, con el cual se busca la mejor forma de implementar el SCM en la organización para buscar la mejora de sus procesos y su incremento en la productividad y competitividad en el mercado nacional y global, este informe lo conforman doce actividades o fases en donde se referencia la integración de las operaciones en relación a mejoras teniendo en cuenta los flujos de materiales e información desde proveedores, pasando por la producción, la logística, distribuidores y consumidores finales de la organización Gaseosas Glacial.The approach of this project is carried out with the design of the Supply Chain Management and logistics for the organization Gaseosas Glacial, which seeks the best way to implement the SCM in the organization to seek the improvement of its processes and its increase in productivity and competitiveness in the national and global market, this report is made up of twelve activities or phases where the integration of operations in relation to improvements is referenced taking into account the flow of materials and information from suppliers, through production, logistics, distributors and final consumers of the organization Gaseosas Glacial

Randomized controlled trial evaluating the benefit of a novel clinical decision support system for the management of COVID-19 patients in home quarantine: A study protocol

Producción Científica(1) Background: We present the protocol of a randomized controlled trial designed to evaluate the benefit of a novel clinical decision support system for the management of patients with COVID-19. (2) Methods: The study will recruit up to 500 participants (250 cases and 250 controls). Both groups will receive the conventional telephone follow-up protocol by primary care and will also be provided with access to a mobile application, in which they will be able to report their symptoms three times a day. In addition, patients in the active group will receive a wearable smartwatch and a pulse oximeter at home for real-time monitoring. The measured data will be visualized by primary care and emergency health service professionals, allowing them to detect in real time the progression and complications of the disease in order to promote early therapeutic interventions based on their clinical judgement. (3) Results: Ethical approval for this study was obtained from the Drug Research Ethics Committee of the Valladolid East Health Area (CASVE-NM-21-516). The results obtained from this study will form part of the thesis of two PhD students and will be disseminated through publication in a peer-reviewed journal. (4) Conclusions: The implementation of this telemonitoring system can be extrapolated to patients with other similar diseases, such as chronic diseases, with a high prevalence and need for close monitoring.Junta de Castilla y León e Instituto de Salud Carlos III - (grant COV20/00539

Evidence-Based Practice and Trends in Visual Rehabilitation for Patients with Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a common, chronic, and progressive eye disease that is considered the leading cause of visual loss among the elderly in developed countries. Advanced AMD, including choroidal neovascularization (CNV) or geographic atrophy (GA), is associated with substantial and progressive visual impairment that can lead to a significant reduction in functional independence and quality of life (QoL) for affected individuals, whose number is expected to increase in the coming years in line with population growth and ageing. In this context, while an important part of medical care is focused on preventing the progression of the disease, Visual Rehabilitation (VR) aims to address its consequences by providing these patients with a number of strategies to achieve their goals and participate autonomously, actively and productively in society. This chapter aims to provide an update on evidence-based practices in the field and how modern technologies play an important role in the development of new VR approaches

Visual perception alterations in COVID-19: a preliminary study

AIM: To compare the visual perception (color and chromatic-achromatic contrast vision) of a small cohort of COVID-19 patients at the time of infection and after 6mo with that of a healthy population matched for sex and age. METHODS: A total of 25 patients (9 females, 16 males, mean age: 54±10y) with COVID-19 hospitalized in the COVID-19 Unit of the University Clinical Hospital of Valladolid were recruited for this preliminary study. Visual perception, as determined by monocular measurement of contrast sensitivity function (CSF) and color vision was assessed in each patient using the Optopad test. The results obtained were then compared with those of a sample of 16 age- and sex-matched healthy controls (5 females, 11 males, mean age: 50±6y) in which the same measurement procedure was repeated. Statistically significant differences between groups were assessed using the Mann-Whitney U test. Measurements were repeated after a minimum follow-up period of 6mo and statistically significant differences between the two time points in each group were assessed using the Wilcoxon signed rank test. RESULTS: Discrimination thresholds (color and chromatic-achromatic contrast vision) and their corresponding sensitivity, calculated as the inverse of the discrimination threshold, were evaluated. Analysis of the data revealed higher contrast threshold results (i.e., worse contrast sensitivity) in the COVID-19 group than in the control group for all spatial frequencies studied in the Optopad-CSF achromatic test and most of the spatial frequencies studied in the Optopad-CSF chromatic test for the red-green and blue-yellow mechanisms. In addition, color threshold results in the COVID-19 group were also significantly higher (i.e., worse color sensitivity) for almost all color mechanisms studied in the Optopad-Color test. At 6mo, most of the differences found between the groups were maintained despite COVID-19 recovery. CONCLUSION: The present results provide preliminary evidence that visual perception may be impaired in COVID-19, even when the infection has passed. Although further research is needed to determine the precise causes of this finding, analysis of CSF and color vision could provide valuable information on the visual impact of COVID-19

Influence of non-osteoporotic treatments in patients on active anti-osteoporotic therapy: evidence from the OSTEOMED registry

Producción CientíficaPurpose To evaluate the effect of different non-osteoporotic drugs on the increase or decrease in the risk of incident fragility fractures (vertebral, humerus or hip) in a cohort of patients diagnosed with osteoporosis on active anti-osteoporotic therapy. Methods For this retrospective longitudinal study, baseline and follow-up data on prescribed non-osteoporotic treatments and the occurrence of vertebral, humerus or hip fractures in 993 patients from the OSTEOMED registry were analyzed using logistic regression models. The drugs evaluated with a possible beneficial effect were thiazides and statins, while the drugs evaluated with a possible harmful effect were antiandrogens, aromatase inhibitors, proton pump inhibitors, selective serotonin reuptake inhibitors, benzodiazepines, GnRH agonists, thyroid hormones, and oral and inhaled corticosteroids. Results Logistic regression analyses indicated that no treatment significantly improved fracture risk, with the only treatments that significantly worsened fracture risk being letrozole (OR = 0.18, p-value = 0.03) and oral corticosteroids at doses ≤ 5 mg/ day (OR = 0.16, p-value = 0.03) and > 5 mg/day (OR = 0.27, p-value = 0.04). Conclusion The potential beneficial or detrimental effects of the different drugs evaluated on fracture risk are masked by treatment with anabolic or antiresorptive drugs that have a more potent action on bone metabolism, with two exceptions: letrozole and oral corticosteroids. These findings may have important clinical implications, as patients receiving these treat- ments are not fully protected by bisphosphonates, which may imply the need for more potent anti-osteoporotic drugs such as denosumab or teriparatide.Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

Delineating the molecular and phenotypic spectrum of the SETD1B-related syndrome

Purpose Pathogenic variants in SETD1B have been associated with a syndromic neurodevelopmental disorder including intellectual disability, language delay, and seizures. To date, clinical features have been described for 11 patients with (likely) pathogenic SETD1B sequence variants. This study aims to further delineate the spectrum of the SETD1B-related syndrome based on characterizing an expanded patient cohort. Methods We perform an in-depth clinical characterization of a cohort of 36 unpublished individuals with SETD1B sequence variants, describing their molecular and phenotypic spectrum. Selected variants were functionally tested using in vitro and genome-wide methylation assays. Results Our data present evidence for a loss-of-function mechanism of SETD1B variants, resulting in a core clinical phenotype of global developmental delay, language delay including regression, intellectual disability, autism and other behavioral issues, and variable epilepsy phenotypes. Developmental delay appeared to precede seizure onset, suggesting SETD1B dysfunction impacts physiological neurodevelopment even in the absence of epileptic activity. Males are significantly overrepresented and more severely affected, and we speculate that sex-linked traits could affect susceptibility to penetrance and the clinical spectrum of SETD1B variants. Conclusion Insights from this extensive cohort will facilitate the counseling regarding the molecular and phenotypic landscape of newly diagnosed patients with the SETD1B-related syndrome