Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome

Objectives: A recent update of the definition of acute respiratory distress syndrome (ARDS) proposed an empirical classification based on ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) at ARDS onset. Since the proposal did not mandate PaO2/FiO2 calculation under standardised ventilator settings (SVS), we hypothesised that a stratification based on baseline PaO2/FiO2 would not provide accurate assessment of lung injury severity. Design: A prospective, multicentre, observational study. Setting: A network of teaching hospitals. Participants: 478 patients with eligible criteria for moderate (100300). Primary and secondary outcomes Group severity and hospital mortality. Results: At ARDS onset, 173 patients had a PaO2/FiO2≤100 but only 38.7% met criteria for severe ARDS at 24 h under SVS. When assessed under SVS, 61.3% of patients with severe ARDS were reclassified as moderate, mild and non-ARDS, while lung severity and hospital mortality changed markedly with every PaO2/FiO2 category (p<0.000001). Our model of risk stratification outperformed the stratification using baseline PaO2/FiO2 and non-standardised PaO2/FiO2 at 24 h, when analysed by the predictive receiver operating characteristic (ROC) curve: area under the ROC curve for stratification at baseline was 0.583 (95% CI 0.525 to 0.636), 0.605 (95% CI 0.552 to 0.658) at 24 h without SVS and 0.693 (95% CI 0.645 to 0.742) at 24 h under SVS (p<0.000001). Conclusions: Our findings support the need for patient assessment under SVS at 24 h after ARDS onset to assess disease severity, and have implications for the diagnosis and management of ARDS patients. Trial registration numbers NCT00435110 and NCT00736892

Non-motor symptom burden in patients with Parkinson's disease with impulse control disorders and compulsive behaviours : results from the COPPADIS cohort

The study was aimed at analysing the frequency of impulse control disorders (ICDs) and compulsive behaviours (CBs) in patients with Parkinson's disease (PD) and in control subjects (CS) as well as the relationship between ICDs/CBs and motor, nonmotor features and dopaminergic treatment in PD patients. Data came from COPPADIS-2015, an observational, descriptive, nationwide (Spain) study. We used the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) for ICD/CB screening. The association between demographic data and ICDs/CBs was analyzed in both groups. In PD, this relationship was evaluated using clinical features and treatment-related data. As result, 613 PD patients (mean age 62.47 ± 9.09 years, 59.87% men) and 179 CS (mean age 60.84 ± 8.33 years, 47.48% men) were included. ICDs and CBs were more frequent in PD (ICDs 12.7% vs. 1.6%, p < 0.001; CBs 7.18% vs. 1.67%, p = 0.01). PD patients had more frequent previous ICDs history, premorbid impulsive personality and antidepressant treatment (p < 0.05) compared with CS. In PD, patients with ICDs/CBs presented younger age at disease onset, more frequent history of previous ICDs and premorbid personality (p < 0.05), as well as higher comorbidity with nonmotor symptoms, including depression and poor quality of life. Treatment with dopamine agonists increased the risk of ICDs/CBs, being dose dependent (p < 0.05). As conclusions, ICDs and CBs were more frequent in patients with PD than in CS. More nonmotor symptoms were present in patients with PD who had ICDs/CBs compared with those without. Dopamine agonists have a prominent effect on ICDs/CBs, which could be influenced by dose

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

Innovación pedagógica y nuevas tecnologías en la enseñanza y en la transferencia de la sociolingüística

Las nuevas tecnologías están presentes en la vida cotidiana de la ciudadanía de manera generalizada, ya sea en la esfera pública, laboral o privada. Por ello, la Unión Europea considera importante que esta desarrolle una competencia digital completa y eficaz. Así, uno de los medios para lograrlo puede ser su incorporación a la educación. Este objetivo se alinea con otro didáctico que consiste en favorecer un conocimiento más profundo y duradero de las asignaturas. Paralelamente, este uso por su novedad también puede aumentar la motivación del alumnado y, a la vez, promover la transferencia de conocimiento a la sociedad a través del uso de las redes sociales. Dado todo este contexto, en este trabajo se presenta una propuesta didáctica basada en el diseño, creación y publicación de post en redes sociales, en particular de Instagram, para lograr un aprendizaje más significativo. Además, se pretende transferir el conocimiento técnico a la sociedad. Los resultados de participación en la propuesta didáctica, que era opcional, fueron altos y el grado de satisfacción y de percepción del alumnado sobre la calidad y la cantidad de contenidos aprendidos, así como sobre el desarrollo de su competencia digital, fue igualmente muy positivo

Enseñanza inclusiva de la lingüística general

La UNESCO establece la necesidad de generar desarrollo sostenible, educación en derechos humanos, formación en relaciones pacíficas, prevención de conflictos y consolidación de la paz. A nivel educativo estos preceptos se pueden concretar en el respeto a los derechos humanos y en evitar cualquier tipo de discriminación. Por ello, este proyecto de investigación en docencia universitaria defiende una pedagogía inclusiva que aborde estos temas vinculándolos con la Lingüística. Este se basa en una reflexión crítica de bibliografía, contenidos y actividades propuestas durante la asignatura de Lingüística General I para proponer cambios y mejoras. Para ello profesorado y alumnado eligieron temas de interés sobre los que investigar: diversidad funcional; identidades de género y orientación sexual y diversidad lingüística, étnico y cultural. Entre las mejoras propuestas se destacan las siguientes: actualización de las fuentes bibliográficas para ofrecer referentes diversos; buscar noticias actuales de investigación lingüística protagonizadas por modelos que reflejen la diversidad; tratar temas de interés y de debate social sobre la igualdad y discriminación vinculables a contenidos lingüísticos; hacer recomendaciones de lecturas adicionales sobre dichos temas; proponer de manera explícita la posibilidad de realizar TFG con perspectiva diversa; introducir temas como la lingüística feminista, la raciolingüística, la lingüística Queer, etc