Esofagitis eosinofílica, eficacia de las alternativas terapéuticas en el adulto: revisión sistemática

Fundamentos: La esofagitis eosinofílica es hoy en día la principal causa de disfagia en el adulto. La elección de la terapia se debe consensuar con el paciente. El objetivo de este trabajo fue revisar la bibliografía científica para conocer la eficacia de las distintas opciones terapéuticas de la esofagitis eosinofílica en el adulto. Métodos: Se realizó una búsqueda de artículos durante el mes de febrero de 2023 en las bases de datos de PubMed, Web of Science, Scopus y Scielo, empleando los términos de búsqueda eosinophilic esophagitis, therapeutics y treatment, seleccionándose los ensayos clínicos y estudios observacionales publicados en los últimos diez años en adultos. Resultados: Se obtuvieron un total de 1.138 artículos, de los cuales 41 fueron seleccionados tras aplicar los criterios de elegibilidad. De las terapias disponibles, el tratamiento más frecuentemente analizado fueron los corticoides deglutidos, seguido de las dietas de eliminación y de los inhibidores de la bomba de protones, predominando los ensayos clínicos. Los estudios arrojan resultados sobre la eficacia de estas terapias en la remisión histológica y clínica, tanto en la inducción como a largo plazo. Conclusiones: Existen fundamentalmente tres terapias en la esofagitis eosinofílica en el adulto, siendo todas superiores frente a placebo en respuesta histológica y clínica

Draft Genome Sequence of Xylella fastidiosa subsp. Fastidiosa Strain IVIA5235, Isolated from Prunus avium in Mallorca Island, Spain

We report the complete annotated genome sequence of the plant-pathogenic bacterium Xylella fastidiosa subsp. fastidiosa strain IVIA5235. This strain was recovered from a cherry tree in Mallorca, Spain

Modular classes of skew algebroid relations

Skew algebroid is a natural generalization of the concept of Lie algebroid. In this paper, for a skew algebroid E, its modular class mod(E) is defined in the classical as well as in the supergeometric formulation. It is proved that there is a homogeneous nowhere-vanishing 1-density on E* which is invariant with respect to all Hamiltonian vector fields if and only if E is modular, i.e. mod(E)=0. Further, relative modular class of a subalgebroid is introduced and studied together with its application to holonomy, as well as modular class of a skew algebroid relation. These notions provide, in particular, a unified approach to the concepts of a modular class of a Lie algebroid morphism and that of a Poisson map.Comment: 20 page

SARS-CoV-2 infection induces a dual response in liver function tests: Association with mortality during hospitalization

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with abnormal liver function tests. We hypothesized that early altered liver biochemistries at admission might have different clinical relevance than subsequent changes during hospitalization. A single-center retrospective study was conducted on 540 consecutive hospitalized patients, PCR-diagnosed with SARS-CoV-2. Liver test abnormalities were defined as the elevation of either gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), or aspartate aminotransferase (AST), above the upper limit of normality set by our laboratory. Linear mixed models (LMM) evaluated longitudinal associations, incorporating all available follow-up laboratory chemistries. By the end of the follow-up period, 502 patients (94.5%) were discharged (109 (20.5%) died). A total of 319 (64.3%) had at least one abnormal liver test result at admission. More prevalent were elevated AST (40.9%) and GGT (47.3%). Abnormalities were not associated with survival but with respiratory complications at admission. Conversely, LMM models adjusted for age and sex showed that longitudinal increases during hospitalization in ferritin, GGT, and alkaline phosphatase (ALP), as well as a decreased albumin levels, were associated with reduced survival. This dual pattern of liver damage might reconcile previous conflicting reports. GGT and ALP trajectories could be useful to determine who might need more surveillance and intensive care

Supercoherent States, Super K\"ahler Geometry and Geometric Quantization

Generalized coherent states provide a means of connecting square integrable representations of a semi-simple Lie group with the symplectic geometry of some of its homogeneous spaces. In the first part of the present work this point of view is extended to the supersymmetric context, through the study of the OSp(2/2) coherent states. These are explicitly constructed starting from the known abstract typical and atypical representations of osp(2/2). Their underlying geometries turn out to be those of supersymplectic OSp(2/2) homogeneous spaces. Moment maps identifying the latter with coadjoint orbits of OSp(2/2) are exhibited via Berezin's symbols. When considered within Rothstein's general paradigm, these results lead to a natural general definition of a super K\"ahler supermanifold, the supergeometry of which is determined in terms of the usual geometry of holomorphic Hermitian vector bundles over K\"ahler manifolds. In particular, the supergeometry of the above orbits is interpreted in terms of the geometry of Einstein-Hermitian vector bundles. In the second part, an extension of the full geometric quantization procedure is applied to the same coadjoint orbits. Thanks to the super K\"ahler character of the latter, this procedure leads to explicit super unitary irreducible representations of OSp(2/2) in super Hilbert spaces of $L^2$ superholomorphic sections of prequantum bundles of the Kostant type. This work lays the foundations of a program aimed at classifying Lie supergroups' coadjoint orbits and their associated irreducible representations, ultimately leading to harmonic superanalysis. For this purpose a set of consistent conventions is exhibited.Comment: 53 pages, AMS-LaTeX (or LaTeX+AMSfonts

Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols

Background: Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016–2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011–2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216 k inhabitants). Methods: The population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability. Discussion: The current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection.publishedVersio

Superization of Homogeneous Spin Manifolds and Geometry of Homogeneous Supermanifolds

Let M_0=G_0/H be a (pseudo)-Riemannian homogeneous spin manifold, with reductive decomposition g_0=h+m and let S(M_0) be the spin bundle defined by the spin representation Ad:H->\GL_R(S) of the stabilizer H. This article studies the superizations of M_0, i.e. its extensions to a homogeneous supermanifold M=G/H whose sheaf of superfunctions is isomorphic to Lambda(S^*(M_0)). Here G is the Lie supergroup associated with a certain extension of the Lie algebra of symmetry g_0 to an algebra of supersymmetry g=g_0+g_1=g_0+S via the Kostant-Koszul construction. Each algebra of supersymmetry naturally determines a flat connection nabla^{S} in the spin bundle S(M_0). Killing vectors together with generalized Killing spinors (i.e. nabla^{S}-parallel spinors) are interpreted as the values of appropriate geometric symmetries of M, namely even and odd Killing fields. An explicit formula for the Killing representation of the algebra of supersymmetry is obtained, generalizing some results of Koszul. The generalized spin connection nabla^{S} defines a superconnection on M, via the super-version of a theorem of Wang.Comment: 50 page

Severe loss of mechanical efficiency in COVID‐19 patients

Background: There is limited information about the impact of coronavirus disease (COVID-19) on the muscular dysfunction, despite the generalized weakness and fatigue that patients report after overcoming the acute phase of the infection. This study aimed to detect impaired muscle efficiency by evaluating delta efficiency (DE) in patients with COVID-19 compared with subjects with chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), and control group (CG). Methods: A total of 60 participants were assigned to four experimental groups: COVID-19, COPD, IHD, and CG (n = 15 each group). Incremental exercise tests in a cycle ergometer were performed to obtain peak oxygen uptake (VO2 peak). DE was obtained from the end of the first workload to the power output where the respiratory exchange ratio was 1. Results: A lower DE was detected in patients with COVID-19 and COPD compared with those in CG (P ≤ 0.033). However, no significant differences were observed among the experimental groups with diseases (P > 0.05). Lower VO2 peak, peak ventilation, peak power output, and total exercise time were observed in the groups with diseases than in the CG (P < 0.05). A higher VO2 , ventilation, and power output were detected in the CG compared with those in the groups with diseases at the first and second ventilatory threshold (P < 0.05). A higher power output was detected in the IHD group compared with those in the COVID-19 and COPD groups (P < 0.05) at the first and second ventilatory thresholds and when the respiratory exchange ratio was 1. A significant correlation (P < 0.001) was found between the VO2 peak and DE and between the peak power output and DE (P < 0.001). Conclusions: Patients with COVID-19 showed marked mechanical inefficiency similar to that observed in COPD and IHD patients. Patients with COVID-19 and COPD showed a significant decrease in power output compared to IHD during pedalling despite having similar response in VO2 at each intensity. Resistance training should be considered during the early phase of rehabilitation

Effectiveness of an mHealth intervention combining a smartphone app and smart band on body composition in an overweight and obese population: Randomized controlled trial (EVIDENT 3 study)

Background: Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear. Objective: This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese. Methods: A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire. Results: The mHealth intervention produced a greater loss of body weight (–1.97 kg, 95% CI –2.39 to –1.54) relative to standard counselling at 3 months (–1.13 kg, 95% CI –1.56 to –0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; –1.84 kg, 95% CI –2.48 to –1.20), percentage of body fat (PBF; –1.22%, 95% CI –1.82% to 0.62%), and BMI (–0.77 kg/m2, 95% CI –0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of –1.18 kg (95% CI –2.30 to –0.06) and BMI of –0.47 kg/m2 (95% CI –0.80 to –0.13), whereas the obese group only experienced a change in BMI of –0.53 kg/m2 (95% CI –0.86 to –0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of –1.03 kg (95% CI –1.74 to –0.33), PBF of –0.76% (95% CI –1.32% to –0.20%), and BMI of –0.5 kg/m2 (95% CI –0.83 to –0.19). Conclusions: The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m2 and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect

A Pilot Randomized Controlled Trial to Explore Cognitive and Emotional Effects of Probiotics in Fibromyalgia

It has recently been found that microbes in the gut may regulate brain processes through the gut microbiota–brain axis, which modulates affection, motivation and higher cognitive functions. According to this finding, the use of probiotics may be a potential treatment to improve physical, psychological and cognitive status in clinical populations with altered microbiota balance such as those with fibromyalgia (FMS). Thus, the aim of the present pilot study with a double-blind, placebo-controlled, randomised design was to test whether a multispecies probiotic may improve cognition, emotional symptoms and functional state in a sample of patients diagnosed with FMS. Pain, impact of FMS, quality of life, anxiety and depressive symptoms were measured during the pre- and post-intervention phases; participants also completed two computerised cognitive tasks to assess impulsive choice and decision-making. Finally, urinary cortisol concentration was determined. To our knowledge, this is the first study that explore the effect of a multispecies probiotic in FMS patients. Our results indicated that probiotics improved impulsivity and decision-making in these patients. However, more research is needed to further explore the potential effects of probiotics on other cognitive functions affected in FMS as well as in other clinical populations