Arqueología de la Batalla del Jarama

En este artículo se describen varias intervenciones arqueológicas en municipios del sureste de Madrid que resultaron afectados por el desarrollo de la Batalla del Jarama (1937). Las intervenciones incluyeron prospecciones, documentación planimétrica y fotográfica de estructuras militares, excavaciones y la organización de itinerarios histórico-arqueológicos de la guerra.In this article, we describe several archaeological interventions in municipalities south of Madrid that were affected by the Battle of Jarama (1937). These interventions involved survey, mapping of military structures, excavations, and the organization of historical-archaeological routes of the Spanish Civil War

Comportamiento del centro de presión en sujetos sanos y sujetos secuelados de accidente cerebrovascular

Tesis (Kinesiólogo)En patologías del sistema nervioso central (SNC) como lo es el Accidente Cerebro Vascular (ACV), los componentes del control motor se encuentras alterados, reflejándose en diferentes grados, en el control de la postura. La regulación que ejerce el SNC sobre el resto de los sistemas tiene una relevancia tal que, ha generado la postulación de diversas hipótesis que a través de la evidencia han tratado de explicar el comportamiento del control postura1 entre sujetos secuelados de ACV y sujetos sanos. Es por esto que es necesario cuantificar las diferencias entre las variables del CoP, las cuales son: área de centro de presión, desplazamiento del CoP y bandas frecuenciales de CoP entre ambos sujetos.In pathologies of the center nervous system (CNS) as the stroke, the components of the motor control are altered, reflecting in different degrees, in the posture control. The regulation of the CNS over the rest of the systems has such a relevance, that it has generated the postulation through evidence of hypothesis that postulate discrepancy in the behavior between subjects with stroke and healthy subjects

Maxillary sinus floor augmentation comparing bovine versus porcine bone xenografts mixed with autogenous bone graft. A split-mouth randomized controlled trial

This investigation was conducted under an Investigator--Initiated Study partially funded by Dentsply Sirona Implants (Molndal, Sweden) through a research transfer agreement with the Technology Transfer Office of the University of Granada (number I--BI--17--026) and the Research Cathedra "Dentsply Sirona-UGR" agreed between Dentsply Sirona Iberia S.A.U. and the University of Granada. The authors are also supported by funding from Research Groups #CTS-138 and #CTS--1028 (Junta de Andalucia, Spain) The authors are grateful to Justin G. Davis for assistance with the English translation and to Emilio Couso-Queiruga for assistance with the volumetric radiographic analyses.Aim: To compare the effectiveness of two xenografts for maxillary sinus floor augmentation in terms of clinical, radiographical, histologic, and molecular outcomes. Materials and methods: A split-mouth randomized clinical trial was conducted at the University of Granada. Ten consecutive patients in need of bilateral two-staged maxillary sinus floor augmentation were included. Each patient received both biomaterials (porcine bone mineral and anorganic bovine bone), which were randomly assigned for bilateral sinus augmentation. The maxillary autogenous bone scraped from the sinus access window was mixed with each xenograft at a 20:80 ratio. After a healing period of 6 months, bone biopsies were collected with a trephine during the implant placement in the regenerated area. Histologic, histomorphometrical, immunohistochemical, and molecular outcomes were analyzed. Clinical and radiographical data throughout the treatment phases were also evaluated. Results: The resulting anatomic features were similar between both groups. After six months of graft consolidation, the graft resorption rates were similar between both biomaterials. The histologic, histomorphometrical, and immunohistochemical results showed no statistical differences between groups. Conclusion: Anorganic bovine bone and porcine bone mineral combined with maxillary autogenous cortical bone show similar biologic and radiologic features in terms of biomaterial resorption, osteoconduction, and osteogenesis when used for maxillary sinus floor augmentation.Dentsply Sirona Implants (Molndal, Sweden)Technology Transfer Office of the University of Granada I-BI-17-026Dentsply Sirona Iberia S.A.U.University of GranadaJunta de AndaluciaEuropean Commission CTS-138 CTS-102

Análisis genético preliminar para el estudio de las interacciones intraespecíficas de oso pardo de la Cordillera Cantábrica

XIV Congreso de la Sociedad Española para la Conservación y Estudio de los Mamíferos (SECEM), Jaca, 5-8 diciembre de 2019.El rascado en los árboles juega un papel fundamental en la comunicación intraespecífica de los osos pardos (Ursus arctos), cuyas áreas de campeo a menudo se encuentran solapadas. A través de estos mensajes, los osos son capaces de reconocer a todos los individuos de su zona sin necesidad de interacciones directas. Se ha demostrado que los osos pardos invierten una parte de su tiempo en la búsqueda activa de las señales químicas dejadas por los conspecíficos como parte esencial de su red de comunicación. El presente trabajo busca descubrir: (a) la red social existente en torno a los árboles de rascado (o árboles de marcaje) del occidente de la Cordillera Cantábrica (n= 18 árboles de rascado); (b) los patrones de marcaje a lo largo de todo el año (n= 32 árboles de rascado); así como(c) entender dinámicas de envejecimiento en la población sujeta a estudio, mediante la toma de muestras de pelo depositado en trampas no lesivas, situadas en Asturias y León, tras el rascado. La recogida de los pelos se ha realizado mensualmente durante un período de un año, por lo que disponemos de un volumen total de 216 muestras, cada una de ellas con material de distintos ejemplares de oso. Se ha realizado la extracción genética de cada pelo con un total de ocho folículos pilosos por muestra, de forma que la posibilidad de error disminuya al 5% y se obtenga una concentración de ADN nuclear suficiente para su identificación. Para la determinación del individuo, sexo y rango de edad se han escogido siete marcadores microsatélites, descritos como los más informativos para este fin. La población occidental es la que cuenta con el mayor número de individuos de la población pero, en base a los resultados preliminares y debido a la limitada variabilidad genética es necesario determinar si es suficiente para realizar una correcta identificación individual. Datos preliminares muestran que los patrones anuales en el rascado se han estudiado como una variable en torno a la época del año, siendo los meses de abril a septiembre de los que mayor cantidad de pelo se obtiene, así como en los meses en torno a la hibernación cuando se denota una reducción en el comportamiento de rascado coincidente con su disminución de actividad

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Pandemia desde la academia: experiencias transdisciplinarias de la universidad cuencana en tiempos de COVID-19

Pandemia es una palabra con origen profundo que en el tiempo se ha cargado con la historia de pueblos y naciones, alcanzando su plena expresión en nuestra sociedad globalizada. No solamente por las estadísticas que atraen la atención de todo el mundo y nos obligan a razonar de manera lógico-numérica, cuantitativa, olvidando que muchas veces los números son personas, y no rinden la justa cuenta de todos aquellos seres humanos que representan estas cifras. Una pandemia logra su máxima expresión al alcanzar el mayor número de personas, esto refleja en su etimología proveniente del griego pan (todo) y demos (pueblo) y desde sus orígenes ha significado principalmente una cosa, la “reunión del pueblo”. Dicha noción invita a reflexionar sobre el porqué de las medidas sanitarias, del aislamiento y confinamiento, y, más aún, nos recuerda la importancia de la unión como decisión ancestral al origen de nuestras sociedades, columna portante de la familia, fortaleza de cualquier sistema en desequilibrio. Reconociendo esto, se evidencia la capacidad de transformar juntos las debilidades en fortalezas, de saber demostrar nuestro mejor impulso a la solidaridad y colaboración cuando sentimos que nos necesitan, que permite terminar con alegría un capítulo con la seguridad de que el próximo será mucho mejor. Este espíritu es responsable de la iniciativa de quienes enfrentamos los desafíos del contexto desde la unión, con la aspiración de formar seres humanos en un espacio compartido de generación de conocimiento y conformación de valores humanos y sociales que llamamos Universidad

Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients

BackgroundPrevious studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. MethodsProspective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. ResultsWe included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 +/- 12 vs. 54 +/- 16 years, p < 0.001), had been diagnosed younger (31 +/- 12 vs. 36 +/- 15 years, p < 0.001), and had a shorter disease duration (14 +/- 7 vs. 18 +/- 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92-2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0-1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. ConclusionsCompared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

INNOVA Research Journal

El presente trabajo tiene por objetivo determinar la importancia del Órgano de Solución de Diferencias de la OMC dentro de las negociaciones sobre el acceso a los mercados internacionales. El área que se está investigando es el funcionamiento de la OMC especialmente, cómo esta resuelve las diferencias entre países, especialmente teniendo en cuenta el análisis de costo-beneficio que se incurre. La investigación se lleva a cabo a través de la revisión de fuentes primarias y secundarias con un enfoque cualitativo y comparativo así como perspectiva analítica y descriptiva. El resultado que se obtuvo después de estudiar dos casos específicamente en Ecuador, nos muestra cómo el organismo proporciona buenas oportunidades de desarrollo comercial a nivel mundial con ahorro de recursos. Se recomienda que los países hagan conciencia y permitan que estos organismos les asesoren al momento de tomar decisiones y resolver conflictos en búsqueda de un comercio más eficaz y eficiente

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group