Educación a distancia: una experiencia para el ingreso en la FRBB

La sociedad plantea una variedad de demandas de educación dependiendo de su situación y circunstancias particulares. La educación a distancia representa una realidad mundial en constante crecimiento cuantitativo y cualitativo potenciada últimamente con nuevos medios de comunicación

Diversidad regional de Amphipoda en el mar Caribe

The order Amphipoda is one of the most diverse within Peracarids, and comprises 6 950 described marine species. Amphipod research in the Caribbean Sea began in the late 1 800s, but has increased significantly since 1 980. In this study, we analized the amphipod biodiversity (Caprellidea, Gammaridea, Hyperiidea, and Ingolfiellidea) of the Caribbean Sea. For this, we compiled available data on species diversity of marine amphipods (data bases: WoRMS and OBIS and published species lists) into a comprehensive taxonomic list by country for the ecoregions of the Caribbean. Additionally, we analized the relative contribution of each country to regional diversity and the rate of discovery of new species. The Caribbean amphipod fauna is composed of 535 species within 236 genera and 73 families for the higher taxon. The Western Caribbean ecoregion holds the largest diversity (282 species), while the Eastern Caribbean recorded the lowest one (73). Mexico and Venezuela recorded the largest number of species with 266 and 206, respectively. Twelve countries had less than 50 species. The richest suborder is the Gammaridea with 381 species followed by the suborder Hyperiidea with 116. From the total of 535 amphipod species reported for the Caribbean region, 218 have the Caribbean as the holotype locality, and 132 are endemic (about 25% of the total). Areas of higher diversity seem to be concentrated along the Mexican Caribbean, Cuba and the Northern coast of South America (VenezuelaColombia); however, such pattern is most likely reflecting local collection efforts and taxonomic expertise rather than actual distribution. Knowledge of amphipod species is mostly limited to shallow, near-shore waters, with little information available on the deep sea fauna. Regional research priorities for this group should be focused on completing shallow water coastal inventories of species in Central America and the Greater and Lesser Antilles. In addition, sampling the deep sea ecosystems should follow along with other particular habitats such as anchialine cave systems. It is also neccessary to increase ecological research efforts, mainly in some speciose suborders, including the Caprellidea and Hyperiidea, known to exhibit high diversity in other tropical localities

A methodology to estimate baseline energy use and quantify savings in electrical energy consumption in higher education institution buildings: Case study, Federal University of Itajubá (UNIFEI)

Accurately forecasting energy consumption in a building is an important strategy for achieving the goal of reducing energy demand and improving energy efficiency. University campuses represent specific groups of diverse buildings with significant energy consumption. Therefore, they provide an excellent testbed to characterize and understand the energy consumption of a group of mixed-use buildings. This paper presents a novel methodology that considers the recommendations of ISO 50001: 2011 and ISO 50006: 2014 for establishing energy baselines and energy performance indicators in higher education institution buildings to identify electrical energy consumption reduction potentials in buildings and establish energy management strategies related to electricity use. The study was implemented in three buildings at the Federal University of Itajubá (José Rodrigues Seabra Campus). Several methods and indicators were evaluated to monitor and measure energy performance in buildings. A wide range of factors that influence operating system energy consumption in the buildings were studied and taken into account, such as the types of activities carried out in the building, weather conditions, building materials, air conditioning system and occupancy, since these contribute directly and indirectly to the difficulty of accurately measuring the building’s energy consumption. The results showed that potential annual savings in electric energy consumption for the campus could be around 9.6%, which translates into a R$ 93,647.2 economic value and a 20.3 tCO2eq emissions reduction without economic investment. It was concluded that the methodology proposed for establishing and monitoring an energy efficiency indicator can be applied to any institute of higher education because it is flexible and adaptable since each institute can define the period of analysis for the indicator. This research is expected to provide theoretical guidance and a practical data reference for relevant evaluations of building energy efficiency

Case-Control Analysis of the Impact of Anemia on Quality of Life in Patients with Cancer: A Qca Study Analysis

Anemia is a common condition in cancer patients and is associated with a wide variety of symptoms that impair quality of life (QoL). However, exactly how anemia affects QoL in cancer patients is unclear because of the inconsistencies in its definition in previous reports. We aimed to examine the clinical impact of anemia on the QoL of cancer patients using specific questionnaires. We performed a post-hoc analysis of a multicenter, prospective, case-control study. We included patients with cancer with (cases) or without (controls) anemia. Participants completed the European Organization for Research and Treatment of Cancer Quality of Life questionnaire version 3.0 (EORTC QLQ-C30) and Euro QoL 5-dimension 3-level (EQ–5D–3L) questionnaire. Statistically significant and clinically relevant differences in the global health status were examined. From 2015 to 2018, 365 patients were included (90 cases and 275 controls). We found minimally important differences in global health status according to the EORTC QLQ-C30 questionnaire (case vs. controls: 45.6 vs. 58%, respectively; mean difference: −12.4, p < 0.001). Regarding symptoms, cancer patients with anemia had more pronounced symptoms in six out of nine scales in comparison with those without anemia. In conclusion, cancer patients with anemia had a worse QoL both clinically and statistically

Normocalcemic hyperparathyroidism, what do we know this disease?

La evaluación de pacientes con niveles de PTH persistentemente elevados y concentraciones séricas de calcio dentro de la normalidad es cada vez más frecuente en la práctica clínica habitual. Esta situación se conoce como hiperparatiroidismo normocalcémico, término acuñado por Wills en 1962. Las evidencias existentes sobre su historia natural son escasas y sugieren una amplia heterogeneidad clínica. En esta revisión repasamos los estudios que analizan su etiopatogenia, sus posibles consecuencias clínicas y su evolución. Asimismo destacamos la importancia del diagnóstico diferencial con las causas tanto habituales como poco frecuentes del hiperparatiroidismo secundario. En este sentido, la determinación de los niveles de vitamina D es fundamental. Por último, concluimos que, para definir esta entidad y establecer el seguimiento de estos pacientes, se precisan estudios más amplios y diseñados específicamente con tales fines.The evaluation of patients with persistently elevated PTH levels and normal serum calcium is increasingly common in clinical practice. This situation is known as normocalcemic hyperparathyroidism, a term coined by Wills in 1962. The existing evidence about its natural history is little and suggests a wide clinical heterogeneity. In this paper, we review studies examining its pathogenesis, clinical consequences and evolution. Also, we emphasize the importance of differential diagnosis for the common such as infrequent causes of secondary hyperparathyroidism. So, the determination of vitamin D levels is essential. Finally, we conclude that larger studies are needed to define this entity and setting up monitoring of these patients

Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial

Randomized controlled trial[Abstract] Aims: We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). Methods and results: The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22-0.67; P < 0.001]. The Kaplan-Meier estimates for survival without admission due to HF were 0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard ratio 2.0, 95% CI = 1.0-4.0; log-rank P = 0.044). Changes in 6-min walk test distance, natriuretic peptides, and Doppler-derived systolic pulmonary pressure were similar in both groups. Conclusion: Treatment with sildenafil in patients with persistent PH after successfully corrected VHD is associated to worse clinical outcomes than placebo. Off-label usage of sildenafil for treating this source of left heart disease PH should be avoided.This study was supported by the Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Spain, and the EU –European Regional Development Fund (EC07/90772) as well as by the Red de Investigación Cardiovascular and CIBERCV.Instituto de Salud Carlos III; EC07/9077

Valor pronóstico de un nuevo modelo de evaluación clínica de pacientes ambulatorios con insuficiencia cardiaca

[Resumen] Introducción y objetivos. Estudiar el valor pronóstico de un modelo de 5 ítems clínicos basado en las recomendaciones IC-BERG para la evaluación en consulta de pacientes ambulatorios con insuficiencia cardiaca (IC). Métodos. Estudio observacional basado en la cohorte histórica de pacientes con IC remitidos a una consulta monográfica entre 2010 y 2019. Se evaluó la presencia de 5 ítems clínicos de riesgo: NYHA III-IV, signos de congestión, ingreso por descompensación en el último año, dosis diaria de furosemida ≥ 40 mg o equivalente y NT-proBNP ≥ 1.000 pg/ml. Se estudió la incidencia de desenlaces clínicos adversos mediante el método de Kaplan-Meier y la regresión de Cox. Resultados. Se estudiaron 1.909 pacientes, que presentaban una media de 2,29 ítems de riesgo. El análisis de Kaplan-Meier mostró una tendencia incremental entre un mayor número de ítems de riesgo y el desenlace combinado muerte o ingreso por IC, la mortalidad global y la mortalidad cardiovascular (p < 0,001). Las hazard ratio ajustadas para el desenlace muerte o ingreso por IC, estimadas por regresión multivariante de Cox, fueron de 1,47 (IC95%, 1-2,15), 2,03 (IC95%, 1,41-2,92), 2,98 (IC95%, 2,08-4,28), 5,07 (IC95%, 3,51-7,32) y 7,73 (IC95%, 5,21-11,45) para pacientes con 1, 2, 3, 4 o 5 ítems de riesgo, respectivamente. El peso proporcional de las causas cardiovasculares de muerte, y en especial la IC, fue mayor en los pacientes con mayor número de ítems de riesgo. Conclusiones. Este estudio apoya el valor pronóstico de un modelo de evaluación clínica para pacientes ambulatorios con IC basado en las recomendaciones IC-BERG.[Abstract] Introduction and objectives. To assess the prognostic value of a 5-item clinical model based in the IC-BERG recommendations to evaluate ambulatory patients with heart failure (HF) in the clinic. Methods. Observational study based on the historical cohort of patients with HF referred to a specific facility since 2010 to 2019. The presence of 5 clinical ítems was evaluated: NYHA III-IV class, signs of congestion, admission due to decompensation in the previous year, daily dose ≥ 40 mg furosemide or equivalent, and NT-proBNP ≥ 1,000 pg/ml. The incidence of adverse clinical events was assessed by means of the Kaplan-Meier method and multivariable Cox's regression. Results. We studied 1909 patients, whose mean number of clinical ítems indicating risk was 2.29. Kaplan-Meier survival analysis showed an incremental trend between an increasing number of clinical ítems of risk and the combined event death or admission due to HF, overall mortality, and cardiovascular mortality (P < .001). Adjusted hazard-ratio for the combined end-point death or admission due to HF, as estimated by means of multivariable Cox's regression, were 1.47 (95%CI, 1–2.15), 2.03 (95%CI, 1.41–2.92), 2.98 (95%CI, 2.08–4.28), 5.07 (95%C,: 3.51–7.32), and 7.73 (95%CI, 5.21–11.45) for patients who showed 1, 2, 3, 4, or 5 clinical ítems indicating risk, respectively. The proportional weight of cardiovascular causes of risk, especially refractory HF, was higher in patients with a higher number of clinical ítems of risk. Conclusions. This study supports the prognostic value of a 5-item clinical model based on IC-BERG recommendations in ambulatory patients with HF

Ambient air pollution and thyroid function in Spanish adults. A nationwide population-based study ([email protected] study)

Background Recent reports have suggested that air pollution may impact thyroid function, although the evidence is still scarce and inconclusive. In this study we evaluated the association of exposure to air pollutants to thyroid function parameters in a nationwide sample representative of the adult population of Spain. Methods The [email protected] study is a national, cross-sectional, population-based survey which was conducted in 2008-2010 using a random cluster sampling of the Spanish population. The present analyses included 3859 individuals, without a previous thyroid disease diagnosis, and with negative thyroid peroxidase antibodies (TPO Abs) and thyroid-stimulating hormone (TSH) levels of 0.1-20 mIU/L. Participants were assigned air pollution concentrations for particulate matter <2.5 mu m (PM2.5) and Nitrogen Dioxide (NO2), corresponding to the health examination year, obtained by means of modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). TSH, free thyroxine (FT4), free triiodothyronine (FT3) and TPO Abs concentrations were analyzed using an electrochemiluminescence immunoassay (Modular Analytics E170 Roche). Results In multivariate linear regression models, there was a highly significant negative correlation between PM2.5 concentrations and both FT4 (p<0.001), and FT3 levels (p<0.001). In multivariate logistic regression, there was a significant association between PM2.5 concentrations and the odds of presenting high TSH [OR 1.24 (1.01-1.52) p=0.043], lower FT4 [OR 1.25 (1.02-1.54) p=0.032] and low FT3 levels [1.48 (1.19-1.84) p=<0.001] per each IQR increase in PM2.5 (4.86 mu g/m(3)). There was no association between NO2 concentrations and thyroid hormone levels. No significant heterogeneity was seen in the results between groups of men, pre-menopausal and post-menopausal women. Conclusions Exposures to PM2.5 in the general population were associated with mild alterations in thyroid function.CIBERDEM (Ministerio de Economia, Industria y Competitividad-ISCIII), Ministerio de Sanidad, Servicios Sociales e Igualdad-ISCIII, Instituto de Salud Carlos III (PI17/02136, PI20/01322), Consejeria de Salud y familias (PI-0144-2018), European Regional Development Fund (ERDF) "A way to build Europe". GRM belongs to the regional Nicolas Monardes research program of the Consejeria de Salud (RC-0006-2016; Junta de Andalucia, Spain). CMA is recipient of a "Rio Hortega" research contract (CM19/00186, Instituto de Salud Carlos III). VKDG is recipient of a "Rio Hortega" research contract (CM21/00214, Instituto de Salud Carlos III)

Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long-Term Survival.

Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow-up of 4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in the age-matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance-either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six-month changes in the composite clinical score and in the 6-minute walk test distance were related to survival. Conclusions Persistent valvular heart disease-pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.This study was funded by the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spain, the European Union–European Regional Development Fund (EC07/90772 and PI19/00649), and the Consorcio de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV).S