Principales especies de Coleópteros necrófagos presentes en carroña de cerdos en la comarca de La Litera (Huesca)

The purpose of the investigation carried out was to find out which are the “Necrophagous Coleoptera” arriving to carrion most frequently. Domestic pig carcasses were exposed in two different sites (sun and shade) during the four seasons of the year in “La Litera region”, Huesca. Eighteen “Coleoptera species” were identified taxonomically belonging to five different families.La finalidad del estudio es averiguar cuáles son los coleópteros necrófagos más frecuentes en un hábitat carroñero, utilizando cadáveres de cerdos, en la comarca de La Litera en Huesca, durante las cuatro estaciones del año y en dos ambientes distintos, al sol y a la sombra. En total se identificaron dieciocho especies pertenecientes a cinco familias de coleópteros

Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure

A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) a-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of “extra-target” RAS suggests the need for RAS screening in all three DAA target regions

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Reflexiones sobre el espacio geográfico

Durante siglos la esencia del conocimiento geográfico no planteó ninguna duda: se trataba de conocer el mundo, descubriendo nuevas tierras, gentes y culturas. El hombre tenia curiosidad por conocer lo que existía a su alrededor. Pero hoy el hombre conoce todo el mundo. Por eso ha cambiado el objeto de los estudios geográficos. En la actualidad, el trabajo de los geógrafos consiste en la investigación de la organización del espacio y sus atributos, teniendo siempre presente que cada unidad espacial forma parte de un sistema territorial más amplio

Trombopenia aislada no siempre es trombopenia inmune primaria

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune crónica, de etiología desconocida, que afecta a múltiples órganos y sistemas. El LES pediátrico es más frecuente en las niñas y presenta un pico de incidencia entre los 12-16 años. Las manifestaciones clínicas más frecuentes son los síntomas constitucionales, la artritis, el eritema malar y las alteraciones hematológicas. La trombopenia aparece en el 50% de los casos y es la manifestación inicial en el 15% de los casos de LES de inicio pediátrico, aunque puede preceder varios años a la aparición del resto de manifestaciones de LES. Entre el 20 y el 30% de los niños con trombopenia inmune primaria y ANA positivos en suero desarrollarán posteriormente LES. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology that affects multiple organs and systems. Pediatric SLE is more frequent in girls and has a peak incidence between 12-16 years. The most frequent clinical manifestations are constitutional symptoms, arthritis, malar erythema and hematological abnormalities. Thrombopenia appears in 50% of cases and is the initial manifestation in 15% of cases of SLE of pediatric onset, although it may take several years before the appearance of other manifestations of SLE. Between 20 and 30% of children with primary immune thrombopenia and serum positive ANA will subsequently develop SLE